1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Care During Pregnancy and Childbirth 22

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: a.Amniotic fluid b.Amniotic sac c.Birth canal d.Bloody show e.Breech birth f.Cervix g.Crowning h.eclampsia i.Ectopic pregnancy j.Fallopian tube k.Fontanel Objectives (continued)

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: l.Full term m.Imminent delivery n.Labor o.Meconium p.Miscarriage q.Newborn r.Nuchal cord s.Ovary t.Ovum Objectives (continued)

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Define the following terms: u.Placenta v.Placenta previa w.Preeclampsia x.Prenatal care y.Prolapsed cord z.Spotting aa.Supine hypotensive syndrome bb.Trimester cc.Umbilical cord dd.Uterus ee.Vagina Objectives (continued)

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 2.Describe the function of the following anatomy related to childbirth: amniotic sac, birth canal, cervix, placenta, umbilical cord, and uterus. 3.Describe the three stages of labor and when each begins and ends. 4.Describe the signs of an imminent delivery. 5.Explain the steps for preparing for a field delivery. Objectives (continued)

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 6.Explain the steps for assisting with a field delivery. 7.Explain the purpose of each of the items in a typical field obstetrics (OB) kit. 8.Explain the priorities of care for the newborn following a field delivery. 9.Explain the priorities of care for the mother following a field delivery. 10.Explain the common causes of vaginal bleeding during the first trimester. Objectives (continued)

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 11.Explain the common causes of vaginal bleeding during the third trimester. 12.Explain the appropriate care for a pregnant patient with vaginal bleeding. 13.Describe the signs and symptoms of supine hypotensive syndrome. 14.Explain the appropriate care for a patient with signs and symptoms of supine hypotensive syndrome. 15.Describe the signs and symptoms of preeclampsia. Objectives (continued)

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 16.Explain the appropriate care for a patient with signs and symptoms of preeclampsia. 17.Explain the common complications related to a field delivery and how to properly care for each. 18.Demonstrate the ability to identify the signs of an imminent delivery. 19.Demonstrate the steps for preparing for and assisting with a field delivery. Objectives (continued)

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 20.Demonstrate the proper care of the infant following a field delivery. 21.Demonstrate the proper care of the mother following a field delivery. 22.Demonstrate the ability to identify a complicated delivery. 23.Demonstrate the proper assessment and care for a complicated field delivery. 24.Value the importance of proper body substance isolation (BSI) precautions when assisting with a field delivery. Objectives

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Media Slide 14Female Reproductive Anatomy Animation Slide 15Female Reproductive Anatomy Labeling Exercise Slide 21First Stage of Labor Video Slide 23Second Stage of Labor Video Slide 24Transition Stage of Labor Video Slide 43Vacuum Extractor Video Slide 45Umbilical Cord and Apgar Scoring Video Slide 52Placenta Delivery Video

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Topics Understanding Childbirth Delivery Complications and Emergencies

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley UNDERSTANDING CHILDBIRTH

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Anatomy of Pregnancy – Fetus: unborn baby – Ovum: unfertilized egg produced by the mother – Uterus: muscular structure that holds baby during pregnancy – Full term: pregnancy achieved complete gestation of between 38 and 40 weeks (continued)

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a three-dimensional animation of the female reproductive system.here BACK TO DIRECTORY

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to participate in an interactive labeling exercise of female reproductive anatomy.here BACK TO DIRECTORY

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Anatomy of Pregnancy – Trimester: three months of pregnancy – Labor: process body goes through to deliver fetus – Cervix: opening of uterus – Bloody show: normal discharge of bloody mucus prior to delivery – Vagina: birth canal (continued)

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Anatomy of pregnancy.

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Anatomy of Pregnancy – Crowning: showing of baby's head at opening of vagina. – Imminent delivery: delivery that is likely to occur within a few minutes. – Amniotic sac: fluid-filled sac that surrounds developing fetus. – Rupture of membranes: sac breaks during labor; the fluid flows out of vagina. (continued)

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Anatomy of Pregnancy – Placenta: organ of pregnancy that serves as filter between mother and developing fetus. – Umbilical cord: structure that connects baby to placenta.

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Stages of Labor – First stage: begins with onset of regular contractions; ends when cervix is fully dilated allowing baby to enter birth canal. – Second stage: begins when baby enters birth canal; ends when born. (continued)

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a video on the first stage of labor and delivery.here BACK TO DIRECTORY

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Stages of Labor – Third stage: begins when baby is born; ends when placenta (afterbirth) delivered. Normal to have vaginal discharges throughout labor. Contractions of uterus cause labor pains.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a video on the second stage of labor and delivery.here BACK TO DIRECTORY

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a video on the transition stage of labor and delivery.here BACK TO DIRECTORY

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Stages of labor.

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Stages of labor.

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Stages of labor.

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Stages of Labor – Contraction time: span of time from beginning of contraction until it relaxes. – Interval time: span of time from start of one contraction to beginning of next contraction. – Braxton Hicks contractions (false labor): not as regular and rhythmic as true labor contractions.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Measure the contraction intervals by counting the beginning of one contraction to the beginning of the next contraction.

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Understanding Childbirth Supplies and Materials – Personal protective equipment – Towels, sheets, blankets; gauze pads – Rubber bulb syringe; clamps and ties – Sterile scissors or single-edged razor – Sanitary pads or bulky dressings – Basin and plastic bags – Red, plastic biohazard bags

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to the home of a young couple expecting their first child. They had planned to deliver at home, but grew nervous when the pain of labor became too strong. What questions will you include in your assessment? How will you proceed?

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley DELIVERY

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Algorithm for assisting a mother in a normal delivery.

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Preparing for Delivery – Wear PPE. – EMS activated. – Encourage patient to remain lying down. – Place clean sheets or towels under buttocks. – Obtain medical history of pregnancy. (continued)

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Preparing for Delivery – If mother is having contractions two minutes apart or less, delivery is imminent. – Find out if she has taken a childbirth preparation class. – Control scene so mother has privacy. – Position mother on back with knees bent, feet flat, legs spread wide apart. (continued)

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Preparing for Delivery – Feel abdomen for contractions. – Prepare mother for examination. – Check for crowning. – Do not attempt any type of internal or vaginal exam.

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Emergency care algorithm for an imminent delivery.

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Normal Delivery – Crowning evident as head emerges from vagina. – Use both hands to support head as it delivers; check neck for umbilical cord. – Guide baby's head downward to facilitate delivery of top shoulder. – Use both hands to support baby following delivery. (continued)

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Crowning is evident as the head emerges from the vagina.

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Use both hands to support the head as it delivers and check the neck for presence of the umbilical (nuchal) cord.

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Guide the baby's head downward to facilitate delivery of the top shoulder.

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Use both hands to support the baby following delivery.

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a video on use of the vacuum extractor during delivery.here BACK TO DIRECTORY

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Normal Delivery – Dry baby and cover to conserve heat. – Clamp cord in preparation for cutting. (continued)

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a video on Apgar scoring and caring the neonate.here BACK TO DIRECTORY

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Carefully dry the baby and cover him to conserve heat.

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Once the cord has stopped pulsating, clamp it in preparation for cutting.

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Normal Delivery – Cut cord between the clamps. – Assess breathing and pulse rate for newborn. – Expect delivery of placenta 20 to 30 minutes following delivery of baby.

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Cut the cord between the clamps.

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Assess breathing and pulse rate for the newborn.

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Expect delivery of the placenta within 20 to 30 minutes following the delivery of the baby.

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a video on the delivery of the placenta.here BACK TO DIRECTORY

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Caring for the Baby – Clear baby's airway. – Make certain baby is breathing. – Perform quick assessment. – Clamp or tie off cord (if protocols allow). – Keep baby warm. – Place paper bracelet loosely around baby's wrist.

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Algorithm for assessment of the newborn.

55. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley It may be necessary to stimulate the newly born baby to breathe.

56. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Caring for the Nonbreathing Newborn – Provide rescue breaths. – Do not use bag-mask device or airway adjuncts designed for older children or adults. – Be careful not to hyperextend head and neck of baby. (continued)

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Care for the Nonbreathing Newborn

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Resuscitate the newly born baby with a bag-mask resuscitator that is an appropriate size.

59. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Caring for the Nonbreathing Newborn – Do not blow a stream of oxygen directly into baby's face. – Blow-by oxygen: holding mask or cup several inches from baby's face. – Withholding oxygen may be more damaging than delivering too much.

60. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Umbilical Cord – Use sterile clamps or umbilical ties. – Apply one tie or clamp to cord about six inches from baby's abdomen. – Place second tie or clamp about two inches farther from baby. – Cut between two ties or clamps.

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Cutting the umbilical cord.

62. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Delivery Caring for the Mother – Deliver afterbirth (placenta and birth tissues). – Control vaginal bleeding by gently but firmly massaging from the pubis bone at the front of the pelvis upward only toward the naval. – Make her as comfortable as possible. – Provide reassurance.

63. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to a home and find a 32- year-old female seated on the side of her bed. Her husband states that she awoke with intense labor pains and “her water broke.” This is her third child and her contractions are two minutes apart. How will you proceed?

64. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley COMPLICATIONS AND EMERGENCIES

65. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Complications – Abnormal bleeding – Miscarriage – Breech delivery – Premature delivery – Multiple births – Stillbirths

66. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Risk of Complications – Younger than 18 years old or older than 35 – First pregnancy or more than five pregnancies – Swollen face, feet, abdomen from water retention – High or low blood pressure – Diabetes (continued)

67. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Risk of Complications – Illicit drug use during pregnancy – History of seizures – Predelivery bleeding – Infections – Alcohol dependency – Injuries from trauma – Premature rupture of membranes

68. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Predelivery Emergencies – Miscarriage: spontaneous natural loss of embryo or fetus before the twenty-eighth week. – Spotting: normal discharge of blood during pregnancy. – Ectopic pregnancy: when fertilized egg implants somewhere other than uterus.

69. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Algorithm for complications of childbirth.

70. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Complications During Delivery – Meconium staining: product of baby's first bowel movement; if baby inhales this fluid on first attempt to breathe, he/she will develop aspiration pneumonia. – Breech birth: buttocks or feet deliver first. (continued)

71. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Create and maintain an airway for the baby during a breech birth.

72. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Complications During Delivery – Limb presentation: presentation of arm or single leg. – Prolapsed cord: delivery of umbilical cord prior to delivery of baby. – Multiple births: not necessarily abnormal; do frequently involve premature delivery. (continued)

73. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Complications During Delivery – Premature births: any baby weighing less than 5.5 pounds at birth or born before the thirty-seventh week. – Stillborn: fetus that is delivered dead.

74. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Other Emergencies – Supine hypotensive syndrome: abnormally low blood pressure that results when mother is supine and fetus puts pressure on vena cava. – Preeclampsia: potentially life-threatening condition that affects mother during third trimester; characterized by high blood pressure and fluid retention. (continued)

75. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Other Emergencies – Eclampsia: life-threatening condition characterized by seizures, coma, eventually death of both mother and baby. – Trauma: vital signs of a pregnant woman are different from woman who is not pregnant. (continued)

76. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Other Emergencies – A pregnant woman can lose almost 40 percent of her blood volume before she shows any signs of shock. – Blunt-force injuries: common in falls, vehicle crashes, abuse, assaults. – Penetrating injuries: result of gunshot wounds and stabbings or punctures from debris of auto wreckage. (continued)

77. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Other Emergencies – Vaginal bleeding caused by:  Blunt force and penetrating trauma  Intercourse  Sexual assault  Reproductive organ problems  Abnormal pregnancy  Placental tears and uterine rupture (continued)

78. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Other Emergencies – Placenta previa: placenta grows and develops over cervix. – Placenta abruptio: can occur in trauma situation when force of trauma abruptly tears placenta partially or completely away from wall of uterus. (continued)

79. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Complications and Emergencies Other Emergencies – Sexual assault or rape is a psychologically and physically traumatic experience. – Fetus is also victim in the assault. – Injuries that the fetus receives may be direct from blows to abdomen, or indirect as result of injuries to mother.

80. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to an apartment to find a 17-year-old female presenting with intense contractions and a prolapsed umbilical cord. You update EMS, but the ambulance is delayed due to a snowstorm. What steps must you take while awaiting transport?

81. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SUMMARY

82. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Normal gestation period for a human fetus is 40 weeks; approximately nine months. Infant considered premature if delivered prior to thirty-seventh week of gestation.

83. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Labor is a normal process the body uses to deliver a baby. Average labor is 16 hours; can be much shorter or much longer. Labor has three stages. First begins with onset of labor and ends with full dilation of cervix.

84. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Second stage begins with dilation of cervix and ends with delivery of baby. Third stage begins after delivery of baby and ends with delivery of placenta.

85. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Signs of Imminent Delivery – Contractions are two to three minutes apart. – Mother has urge to push. – Crowning at vaginal opening. When signs of imminent delivery are obvious, prepare for delivery at the scene.

86. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Upon delivery of head, check for umbilical cord around neck. If present, gently slip it over baby's head. Suction mouth first then nose prior to delivery of baby.

87. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary After delivery, stimulate baby by drying with clean dry cloth. Baby should begin breathing on own. If breathing or pulse is inadequate, provide appropriate care immediately.

88. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Immediately call for ALS back up for any delivery that appears abnormal or complicated (breech presentation or prolapsed cord). Place mother in knee-chest position and provide high-flow oxygen if available. Follow local protocols.

89. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley REVIEW QUESTIONS

90. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Describe the function of the following: a.Amniotic sac b.Birth canal and cervix c.Placenta and uterus d.Umbilical cord 2.What is the purpose of each of the items in a typical field obstetrics (OB) kit? 3.What are the three stages of labor and when do each begin and end? 4.What are the signs of an imminent delivery? Review Questions (continued)

91. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 5.What are the steps for preparing and assisting with a field delivery? 6.What are the priorities of care for the newborn following a field delivery? 7.What are the priorities of care for the mother following a field delivery? 8.What are the common complications related to a field delivery and how would you properly care for each? Review Questions (continued)

92. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 9.What are the common causes of vaginal bleeding during the first trimester? 10.What are the common causes of vaginal bleeding during the third trimester? 11.What is the appropriate care for a pregnant patient with vaginal bleeding? 12.What are the signs and symptoms of supine hypotensive syndrome? Review Questions (continued)

93. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 13.What is the appropriate care for a patient with signs and symptoms of supine hypotensive syndrome? 14.What are the signs and symptoms of preeclampsia? 15.What is the appropriate care for a patient with signs and symptoms of preeclampsia? Review Questions

94. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Please visit www.bradybooks.com and follow the Resource Central links to access content for this text. www.bradybooks.com