CERT Emergency Child Birth 1 Emergency Child Birth 1

Emergency Childbirth What you will need for the delivery: Clean, warm towels and a blanket (and plenty of them). Disposable gloves (sterile, if possible). Sanitary napkins. Handkerchief or something to wear as a face mask. Wash cloths. Plastic bag or bowl for the placenta. First aid kit with rescue breathing mask. Instructor Notes Review the details above. These are items you will need to help assist with the delivery. Emergency Child Birth

Reduce the Risk Don't delay medical attention or assistance when it becomes needed. Do not pull on the baby’s head or shoulders during delivery. Do not smack the baby. Do not cut the umbilical cord. Do not throw away the placenta. Do not wash any fluids off the baby. This substance protects the baby and keeps them warm. Instructor Notes Review points. Emergency Child Birth

1. Labour Cervix of the womb begins to open. The mucous plug is expelled and the amniotic sac may break. Contractions begin. They become more frequent, more regular and more intense as this phase continues. Twelve to fourteen hours long on average. Instructor Notes During the first stage, the neck of the cervix of the womb begins to open. The mucous plug is expelled and the amniotic sac may break. Small amounts of blood may be visible, this is referred to as ‘show’. At this point, the mother may feel either a rush of fluid, small trickle or nothing at all. This may take up to twelve to fourteen hours, sometimes longer. As the contractions begin, they become more frequent, more regular and more intense as this phase continues. Emergency Child Birth

2. Delivery Make sure the mother is covered with a loose sheet. Cover the delivery area with blankets. Help the mother into a comfortable position. Once the widest part of the baby’s head is visible, the mother should stop pushing. Once the baby has been delivered, wrap them up immediately in something clean and warm. If the baby is not breathing, rub them vigorously with a towel to stimulate breathing (begin CPR if required). Allow the mother to hold the baby. Encourage breast feeding. Instructor Notes This stage may take up to two hours on average. Once the cervix is fully dilated, the baby descends from the womb towards the entrance of the vagina. The vagina stretches to allow the baby to deliver. During this stage, the first aider should: Make sure the mother is covered with a loose sheet and remove all unnecessary clothing. Cover the delivery area with blankets. Help the mother into a comfortable position, with her back and shoulders supported. Once the widest part of the baby’s head is visible, the mother should stop pushing. This allows the baby to turn naturally allowing the shoulders to rotate and fit through the vagina. This also helps to prevent tearing. The delivery should occur naturally; the first aider should assist only in supporting the baby. Once the baby has been delivered, wrap them up immediately in something clean and warm. If the baby is not breathing, rub them vigorously with a towel to stimulate breathing. If this does not work, begin CPR. See the section on infant CPR for more information. Allow the mother to hold the baby. If the baby is able to breast feed, encourage feeding. This releases hormones that help control the bleeding and speeds up the delivery of the placenta. Do not cut the cord. Emergency Child Birth

3. After Birth Delivery The placenta and umbilical cord naturally deliver. The womb should contract and blood vessels that were once connecting the placenta and the uterine wall have detached and sealed off permanently. Bleeding should stop or be minimal. Reassure the mother when delivering the placenta. The placenta should be placed in a plastic bag or bowl. Massage the mother’s lower abdomen. Encourage breast feeding. Instructor Notes This stage may take up to thirty minutes. The placenta and umbilical cord naturally deliver. Here, the womb should contract, and blood vessels that were once connecting the placenta and the uterine wall have detached and sealed off permanently. Bleeding should stop or be minimal. Reassure the mother when delivering the placenta. This stage varies between mothers, some feel the urge to push and others experience the same painful contractions they did during delivery. The placenta should be placed in a plastic bag or bowl and sent to the hospital with the mother for inspection. Fragments of the placenta that are left in the womb can be dangerous to the mother and cause bleeding. The mother may bleed a little. Give her sanitary napkins and towels if needed. If the bleeding remains severe, massage the mother’s lower abdomen until EMS arrives, which will help the womb contract and harden to stop any bleeding. Have her lay down with her legs elevated and treat for shock. Nipple stimulation and breast feeding cause a release of oxytocin. This causes uterine contractions which will also help with bleeding. Emergency Child Birth

Imminent Birth Some signs that delivery may occur soon are: Strong, overwhelming urge to push. Urge to have bowel movement. Head presentation (crowning). Mother states that 'the baby is coming'. Instructor Notes If a pregnant woman is showing signs of an imminent birth, there may not be enough time to get to the hospital on your own. Call 911/EMS immediately and prepare for imminent delivery of the baby. Some signs that delivery may occur soon are: Strong, overwhelming urge to push. Urge to have bowel movement. Head presentation (crowning). Mother states that 'the baby is coming'. Emergency Child Birth

Umbilical Cord Emergencies If the umbilical cord is visible before the delivery of the baby, call 911 immediately. The baby’s head or body could be pinching off the blood supply from the placenta. Do not encourage pushing. Have the mother in an ‘all fours’ position with her bottom as high up in the air as possible and chest to the floor. Instructor Notes If the mother presents with the umbilical cord visible before the delivery of the baby, call 911 immediately (if you hadn’t already). This is called a prolapsed cord. The baby’s head or body could be pinching off the blood supply from the placenta to the baby and this is life-threatening. Do not encourage pushing. Have the mother in an ‘all fours’ position with her bottom as high up in the air as possible (chest to the floor) until EMS arrives. If the babies head is being delivered and you notice the cord around the neck, simply slide your fingers between the cord and the neck and unloop it. It may be wrapped around more than once. Remember you now have two casualty’s. Emergency Child Birth

Miscarriage Miscarriage occurs before twenty weeks gestation. Most commonly in the first trimester. Signs and Symptoms Menstrual-like cramping Menstrual-like bleeding, sometimes heavier Abdominal pain Passing of tissue and/or clots Instructor Notes Miscarriage is a pregnancy loss that occurs before twenty weeks gestation (twenty weeks from the last menstrual period). Most commonly, they occur in the first trimester, prior to twelve weeks gestation. Although not commonly talked about, 15% of recognized pregnancies result in miscarriage. The reason for the miscarriage is often unknown, but has something to do with the pregnancy not developing normally and there is nothing that could have been done to prevent it. This can be a very distressing time for your casualty. Ensure that she is well supported and surrounded by trusted loved ones. Emergency Child Birth

Treatment Treat for shock. Place casualty on her back or on her left side. Give casualty nothing to eat or drink. Instruct the casualty to limit movement of any kind. Provide emotional support. Keep any evidence in bleeding (i.e. tissue). Instructor Notes ESM Treat for shock. Place casualty on her back or her left side Give casualty nothing to eat or drink. Instruct the casualty to limit movement of any kind. Provide emotional support. Keep any evidence in bleeding (i.e. tissue). Emergency Child Birth