1. Childbirth and Related Emergencies
Slide Presentation prepared by
Randall Benner, M.Ed., NREMT-P

2. Learning Objectives Understand basic reproductive anatomy.
Describe recommended first aid kit equipment for childbirth emergencies.
List the signs and symptoms of
Miscarriage
Preeclampsia and eclampsia
Imminent delivery
Explain the situations in which you would not try to take a pregnant woman to the hospital for delivery.
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3. Learning Objectives Describe and demonstrate the care for
Seizure during pregnancy
Vaginal bleeding during pregnancy
Ectopic pregnancy
Ruptured uterus
Vaginal bleeding after delivery
Describe how to transport a women in labor to the hospital.
Describe and demonstrate normal delivery procedures.
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4. Learning Objectives Describe and demonstrate care of the newborn.
Describe and demonstrate resuscitation of the newborn.
Describe and demonstrate how to manage abnormal deliveries.
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5. Introduction Childbirth is a normal and natural process.
Many times, delivery will not occur for hours after labor has started.
Only in a few situations involving complications do victims need to be transported rapidly.
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6. Reproductive Anatomy
Understand the following terms used to describe reproductive anatomy and physiology.
Uterus – Perineum
Birth canal – Crowning
Placenta – Bloody show
Umbilical cord – Presenting part
Amniotic sac – Miscarriage
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7. Anatomy of Pregnancy
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8. Labor Overview
Labor
Begins with uterine contractions and ends with delivery of the baby
Three distinct stages
Dilation
Crowning and infant delivery
Delivery of the placenta
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9. Labor Stages
Labor
Stage 1
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10. Labor Stages
Labor
Stage 2
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11. Labor Stages
Labor
Stage 3
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12. Delivery Equipment First aid supplies for delivery
Surgical scissors – Sterile gloves
Cord clamps – Baby receiving blanket
Umbilical tape – Sanitary napkins
Bulb syringe – Plastic bags
Five towels – Germicidal wipes
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13. Predelivery Emergencies
Miscarriage is the delivery of fetal tissues prior to 20 weeks of pregnancy.
Cramp-like abdominal pain
Moderate to severe vaginal bleeding
Passage of fetal tissue
Inability to feel the uterus
Uterus located below the woman’s naval
Sometimes referred to as spontaneous abortion.
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14. Predelivery Emergencies
Treatment of a miscarriage
Activate EMS, take standard precautions.
Ask about last menstrual cycle.
Conduct an initial assessment, monitor vitals.
Help control bleeding with sanitary pad.
Save any passed tissues or evidence of blood loss.
Place the patient supine with legs and hips slightly elevated.
Provide emotional support.
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15. Predelivery Emergencies
Seizure during pregnancy can be caused by eclampsia, diabetes, heart disease.
Treatment guidelines:
Treat according to normal seizure protocol.
Position the patient on her left side.
Protect the airway and breathing.
Dim lights and avoid loud noises.
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16. Predelivery Emergencies
Vaginal bleeding in late pregnancy
Placenta previa
Abruptio placenta
Management guidelines:
Treat the victim according to normal shock protocol.
Place sanitary napkin over vaginal opening.
Save any evidence of blood loss or passed tissue.
Provide emotional support to the victim and family.
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17. Predelivery Emergencies
Ectopic pregnancy occurs when an egg implants outside the uterus, eventually bursting.
Symptoms include:
Sudden, sharp lower abdominal pain on one side
Vaginal bleeding
Missed menstrual period
Pain under the diaphragm, tender abdomen
Palpable mass in abdomen
Lightheadedness, dizziness, shock symptoms
Activate EMS, place victim on her back, keep victim warm, and treat for shock.
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18. Predelivery Emergencies
Preeclampsia and Eclampsia
Preeclampsia
Characterized by high blood pressure, swelling in the extremities, and visual disturbances
Eclampsia
Life threatening seizures occur
Treatment includes keeping the patient on her left side, ensuring a calm and quiet environment, treating for active seizures if present, and activating EMS
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19. Predelivery Emergencies
Ruptured Uterus
Can occur from previous cesarean section or other surgical operation, multiple pregnancies, or extended labor.
Severe abdominal tearing pain, shock, minimal vaginal bleeding, lack of uterine contractions, palpable fetus
Activate EMS, treat victim for shock, and give nothing by mouth.
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20. Normal Delivery Best if delivery occurs in hospital, when possible
Signs of imminent delivery
Amniotic sac ruptures
Crowning occurs with contractions
Contractions less than 2 minutes apart
Intense contractions from 45–90 seconds
Mother feels need for bowel movement
Abdomen feels hard
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21. Normal Delivery Transporting a woman in labor
If EMS cannot transport, keep victim supine.
Remove any obstructive clothing.
Place clean bedding beneath the buttocks.
Constantly watch for crowning.
Never delay or restrain delivery process.
Watch for vomiting, keep airway clear.
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22. Normal Delivery Assisting with delivery
Use standard precautions when possible.
Do not allow patient to use the bathroom.
Do not do anything to delay delivery process.
Understand normal delivery procedures.
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23. Delivery Overview
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24. Normal Delivery Vaginal bleeding following delivery
2 cups of blood considered normal
If excessive, place your hand (sideways) just above the pubis at a 90 degree angle.
Use your other hand cupped around the uterus, to massage it in a circular motion.
The uterus should start to feel like a hard grapfruit.
Breastfeeding the baby helps to stop maternal bleeding.
Treat for shock as needed.
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25. Newborn Care Care of a newborn
Normal baby should be crying, with a heart rate above 100/min and respirations at least 40/min
Dry the neonate very well.
Use bulb suctioning on airway as needed.
Assess the baby’s color, pulse, and grimace (APGAR scoring).
Stimulate the baby to breathe by flicking soles of feet or rubbing back.
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26. Newborn Care
How to stimulate breathing
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27. Newborn Resuscitation
Resuscitating a newborn
Provide ventilations at 40–60/min if breathing is inadequate.
Provide ventilations at 40–60/min if heart rate is 100 beats per minute.
Provide ventilations and compressions if not responding to artificial ventilations and/or the heart rate is less than 60 beats per minute.
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28. Abnormal Deliveries Prolapsed cord
When the umbilical cord is the presenting part
Can cut off blood flow to the baby
Activate EMS, position the mother supine with hips elevated, place gloved hand into the vagina to relieve pressure off the cord.
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29. Prolapsed Cord Management of a prolapsed cord
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30. Abnormal Deliveries Breech birth
Baby presents buttocks- or feet-first.
Do not pull on the baby.
If no full delivery within 10 minutes, create an airway for the baby.
Place your gloved hand into the vagina.
With the palm facing the baby’s face, create a “V” with your fingers on either side of the nose.
Push away the vaginal wall to create an air passage.
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31. Breech birth Buttocks or both feet are presenting part
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32. Abnormal Deliveries Limb presentation
When an arm or leg protrudes first as presenting part
Instruct mother to NOT push with contractions.
Activate EMS, do not attempt to deliver the baby.
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33. Abnormal Deliveries Multiple births
Suspect when the mother’s abdomen remains large and firm after first delivery
Activate EMS.
Deliver 2nd baby with the same care steps as initial delivery.
Twins tend to have low birth rates.
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34. Abnormal Deliveries Passage of meconium
Baby’s first feces, found in amniotic fluid
Thick, brownish-yellow or green in color
Meconium may result in airway occlusion
Activate EMS immediately.
Suction out nose and mouth before stimulating.
Maintain airway thereafter, suctioning frenquently.
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35. Abnormal Deliveries Premature birth
Less than 5.5 pounds body weight, or born before 36 weeks gestation
Susceptible to respiratory conditions
Keep baby warm.
Suction airway.
Resuscitate as needed.
Prevent bleeding from umbilical cord.
Prevent contamination as best possible.
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36. Summary
While many deliveries proceed with no complications, emergencies occasionally arise.
Be able to identify when to stay and deliver, and when to instead arrange transport to hospital.
After delivery always keep the infant warm, ensure a clear airway, stimulate the baby to breathe, and arrange transport.
Premature babies require special treatment.
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