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Obstetrics and Pediatrics: Childbirth

Level 3

Childbirth EMT Refresher Course EMSNeeds.com Continuing Education

Overview | Assessment | Treatment | Roles

Objectives

Childbirth EMT Refresher Course

In this Childbirth course you will earn 2 CE hours. This course is accredited for all levels since all EMS personnel are technically First Responders.

At the end of this course you will be able to:

  • State indications of an imminent delivery.
  • Establish the relationship between body substance isolation and childbirth.
  • State the steps to assist in the delivery.
  • Describe care of the baby as the head appears.
  • List the steps in delivery of the placenta.
  • List the steps in the emergency medical care of the mother post-delivery.
  • Identify the steps in caring for a newborn.

References for content used by permission are on the left side under "EMS Resources." A technical :word: when clicked instantly accesses the EMS glossary online.

There are four sections: Overview, Assessment, Treatment, and Roles. Take the section tests in order by clicking the Take Test button. Your results are saved if you are interrupted. Then do the next section—no lost time or effort with mini-test sections!

EMS Course Levels
Overview

Childbirth in an out-of-hospital setting rarely occurs. Because of the infrequency, taking care of an anxious mother and newborn infant is a stressful emergency call for the First Responder. Knowledge and practice in simulated situations can decrease stress and lead to better mother and child care.This course covers female reproductive anatomy, physiology, and terminology.

 

Definitions

  • Birth Canal - vagina and lower part of the uterus.
  • Placenta (afterbirth) - organ through which fetus exchanges nourishment and waste products during pregnancy.
  • Umbilical Cord - cord which is an extension of the placenta through which fetus receives nourishment while in the uterus.
  • Amniotic Sac - bag of water; the sac that surrounds the fetus inside the uterus.
  • Crowning - the bulging-out of the vagina which is opening as the fetus's head or presenting part presses against it.
  • Bloody show - mucus and blood that may come out of the vagina as labor begins.
  • Labor - the time and process (defined in 3 or 4 stages) beginning with the first uterine muscle contraction until delivery of the placenta.
Emergency Stop
Assessment

If there is a miscarriage where there baby is aborted and the delivery is products of conception early in the pregnancy, assess her status and treat her for shock. Retain the products of conception.

The delivery is imminent if there is crowning or the woman is in the process of delivering. Questions to ask if the delivery is imminent:

  • What is your due date?
  • Any chance of multiple births?
  • Any bleeding or discharge?
  • Does the patient feel as if she is having a bowel movement with increasing pressure in the vaginal area?

Examine for crowning if the patient answers yes to the preceding questions.

 
Treatment

If crowning is present, prepare for delivery. If the head is not the presenting part of the infant, this may be a complicated delivery.

If there is any other part than the head during crowning, tell the mother not to push. Update the responding EMS resources. Calm and reassure the mother.

Delivery Procedures

  1. Prepare with proper gloves and gown during delivery.
  2. Ask the mother to lie on her back with knees drawn up and legs spread apart.
  3. Place absorbent, clean materials (sheets, towels, etc.) under the patient's buttocks.
  4. Elevate buttocks with blankets or pillow.
  5. When the infant's head appears, place the palm of your hand on top of the delivering baby's head and exert very gentle pressure to prevent explosive delivery.
  6. If the amniotic sac does not break or has not broken, tear it with your fingers and push it away from the infant's headand mouth.
  7. As the infant's head is being born, determine if the umbilical cord is around the infant's neck.
    1. Attempt to slip the cord over the baby's shoulder.
    2. If unsuccessful, attempt to alleviate pressure on the cord.
  8. After the infant's head is born, support the head.
  9. Suction the mouth and then the nostrils two or three times
    with the bulb syringe.
    1. Use caution to avoid contact with the back of the baby's mouth.
    2. If a bulb syringe is not available, wipe the baby's mouth and then the nose with gauze.
  10. As the torso and full body are born, support the infant with both hands.
  11. Do not pull on the infant.
  12. As the feet are delivered, grasp the feet.
  13. Keep the infant level with the vagina.
  14. Place the infant on the mother's abdomen for warmth.
  15. When the umbilical cord stops pulsating, it should be tied with gauze between the mother and the newborn and the infant may be placed again on the mother's abdomen. There is no need to cut the cord in a normal delivery.
  16. Keep the infant warm and wait for additional EMS resources who will have the proper equipment to clamp and cut the cord.
  17. Wipe blood and mucus from the baby's mouth and nose with sterile gauze; suction mouth, then the nose again.
  18. Dry the infant.
  19. Rub the baby's back or flick the soles of its feet to stimulate breathing.
  20. Wrap the infant in a warm blanket and place the infant on its side, head slightly lower than trunk.
  21. Record the time of delivery.
  22. If there is a chance of multiple births, prepare for second delivery.
  23. Observe for delivery of placenta. This may take up to 30 minutes.
  24. If the placenta is delivered, wrap it in a towel with 3/4 of the umbilical cord and place in a plastic bag, and keep the bag at the level of the infant.
  25. Place sterile pad over vaginal opening, lower mother's legs,and help her hold them together.

Vaginal Bleeding Following Delivery

  • Up to 300 - 500 ml blood loss is well tolerated by the mother following delivery.
  • Be aware of this loss to avoid undue psychological stress on yourself or the new mother.
  • With continued blood loss, massage the uterus.
    • Use hand with your fingers fully extended.
    • Place the palm of your hand on lower abdomen above the pubis.
    • Massage (knead) over area.
    • If bleeding continues, check massage technique.

Initial Care of the Newborn

Assessment of Infant - Normal Findings

  • Pulse status - greater than 100/min.
  • Pulse can be assessed at the umbilical cord or at the brachial artery.
  • Respiratory status - >40 breaths per minute, crying
  • The most important care is to position, dry, keep warm, and stimulate the newborn to breathe.
  • Wrap newborn in blanket and cover its head.
  • Repeat suctioning if necessary.
  • Continue to stimulate newborn if not breathing.
    • Flick soles of feet.
    • Rub infant's back.
  • If newborn does not begin to breathe or continues to have breathing difficulty after one minute, the First Responder must consider the need for additional measures.
  • Ensure open airway.
  • Ventilate at a rate of 40 breaths per minute.
  • Reassess after one minute. If heart rate is less than 80 beats per minute, a second rescuer should perform chest compressions.

Post delivery care of the mother:

  • Keep contact with the mother throughout the process.
  • Monitor respirations and pulse.
  • Keep in mind that delivery is an exhausting procedure.
  • Replace any blood soaked sheets and blankets while awaiting transport.

childbirth

 

 

pregnancy

 

new baby


mother and child

 

 


infant feet

Roles and Responsibilities

There are several precautions during a delivery of a child:

  • Protect yourself during the delivery.
  • Use body substance isolation (BSI).
  • Wear gloves and protective gown.
  • Do not touch vaginal areas except during delivery and when your partner is present.
  • Do not let the mother go to bathroom.
  • Do not hold mother's legs together.


hands and feet


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