1. Chapter 37 Emergency Childbirth

2. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Anatomy Review  Normal Childbirth  Emergency Childbirth  Special Delivery Scenarios  Post-Delivery Care

3. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Anatomy Review  During pregnancy, the uterus enlarges  The fetus obtains all nutrients from the placenta  The umbilical cord connects the fetus to the placenta; both are enclosed in the amniotic sac  Effacement and cervical dilation begin as the pregnancy comes to an end

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5. 5 Normal Childbirth  Stage 1 of labor –Fetal head moves into pelvis –Cervix thins and dilates –Uterus begins to contract –Can take from a few to up to 30 hours –The amniotic sac ruptures

6. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6 Normal Childbirth  Stage 2 of labor –Forceful uterine contractions –Increasing vaginal pressure –The head becomes visible –Mother begins to push –Fetus exhibits the cardinal movements of labor –The newborn is delivered –Usually 30 to 60 minutes

7. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Normal Childbirth  Stage 3 of labor –Uterus decreases in size –The placenta separates from the uterus and is expelled –Generally within 30 minutes of delivery

8. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Stop and Review  What are the normal anatomical changes that occur during pregnancy?  Describe the three stages of labor.

9. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved The Process of Birth

10. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10 Emergency Childbirth  History –What is the due date? –Have there been any complications with the pregnancy? –Note the color of the amniotic fluid –When did contractions begin and how far apart are they? –Note the number of pregnancies and the number of live children

11. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Emergency Childbirth  Assessment –Initial assessment and vital signs –Look for signs of crowning or abnormalities –Maintain privacy and perform assessment in the presence of another EMT –Only repeat examination if patient’s condition changes

12. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Emergency Childbirth  Preparation for delivery –Don appropriate PPE –Prepare supplies –Contact medical control –Two EMTs should facilitate delivery: one to tend to the mother and one to tend to the newborn

13. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Emergency Childbirth  Normal delivery –Since field delivery is rare, EMTs may want to review these steps frequently –Most deliveries are completed without complications

14. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Special Delivery Scenarios  Prolapsed umbilical cord –A cord lodged between the birth canal and the fetus’ head –Can be life threatening –The cord is visible on examination of the vaginal opening –Place mother on 100% oxygen and place in head down, buttocks raised position –Push the fetus away from cord

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17. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Special Delivery Scenarios  Breech presentation –Fetus may present buttocks first or limbs first –Increases fetus’ risk of injury –Place mother on 100% oxygen and position head down with pelvis elevated –Immediately transport to nearest facility –Call medical control

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19. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Special Delivery Scenarios  Meconium –Aspiration can be harmful to the fetus –Can result in infection and injury to the lung tissue –The thicker it is, the more dangerous to the fetus –Suction the nose and mouth to remove the meconium –Transport immediately and call for ALS backup

20. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Special Delivery Scenarios  Multiple gestation –Delivery of two or more newborns –Usually premature –Second is often in breech presentation –Transport immediately

21. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Special Delivery Scenarios  Premature delivery –Early delivery of the newborn –Underdeveloped pulmonary system –Prone to injury and requires extensive resuscitation –Transport as soon as possible and alert the hospital you are en route

22. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Post-Delivery Care  Mother –Monitor for bleeding –Stimulate contraction of the uterus via massage –If bleeding is excessive, treat for shock  Newborn –Initial assessment and resuscitation if required

23. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Stop and Review  What are the signs of a pending delivery?  Why is the predelivery history important?  Describe the assessment and management of the following: –Prolapsed umbilical cord –Breech presentation –Multiple births –Meconium