Overview of Female Reproductive System and Childbirth

Perineum

the soft tissue and muscle found between the vaginal opening and the anus

mons pubis

a layer of soft tissue that covers and protects the pubic symphysis

Vagina

Birth Canal, Made up of smooth muscle, it connects the uterus to the outside world and will stretch to accommodate passage of the fetus during delivery. It is also the passageway for menstrual waste products leaving the uterus at the conclusion of the menstrual cycle.

Ovary

small, round organs that are located on either side of most women's lower abdominal quadrants, responsible for producing ova (eggs) for conception. They also produce many of the hormones necessary for the process of reproduction.

fallopian tube

Connects Ovaries to Uterus

Uterus

a muscular, hollow organ located along the midline in most women's lower abdominal quadrants.

Cervix

Separates the uterus and vagina

Ovulation

In the early phases of the reproductive cycle, the ovaries are stimulated to release an ovum

Embryo

By combining with the sperm, an ovum becomes

embryonic stage

begins roughly from the point of fertilization and lasts eight weeks

Fetus

At eight weeks of development, the fetal stage begins

placenta

Composed of both maternal and fetal tissues, the placenta is attached to the wall of the uterus and serves as an exchange area between maternal and fetal blood

umbilical cord

Through diffusion, the blood picks up nourishment from the mother and offloads waste products, then returns through the umbilical cord to the fetus's body.

amniotic sac

While developing in the uterus, the fetus is enclosed and protected within a thin, membranous "bag of waters"

supine hypotensive syndrome

dizziness and a drop in blood pressure caused when the mother is in a supine position and the weight of the uterus, infant, placenta, and amniotic fluid compress the inferior vena cava, reducing return of blood to the heart and cardiac output.

Labor

the entire process of delivery

First stage of labour

This stage starts with regular contractions and the thinning and gradual dilation of the cervix and ends when the cervix is fully dilated.

Second Stage of labor

This stage begins when the baby enters the birth canal and lasts until the baby is born.

Third Stage of labor

This stage begins after the baby is born and lasts until the afterbirth is delivered

Afterbirth

placenta, umbilical cord, and some tissues from the amniotic sac and the lining of the uterus

Braxton-Hicks contractions

Sometimes, several days or even weeks before the onset of actual labor, the uterine muscles begin mild contractions

Lightening

is a term used to describe the fetus's movement from high in the abdomen down toward the birth canal

Contraction time

the time from the beginning of a contraction to when the uterus relaxes (from start to end)

Contraction interval

the time from the start of one contraction to the start of the next.

meconium staining

Fluid that is greenish- or brownish-yellow in color is due to fetal defecation and may be an indication of maternal or fetal distress.

How to prepare for delivery of child

Control the scene so the mother will have privacy. (Her birthing coach may remain.) In addition to surgical gloves, you and your partner should put on gowns, caps, face masks, and eye protection. Place the mother on a bed, the floor, or the ambulance stretcher. Elevate her buttocks with blankets or a pillow. Have the mother lie with knees drawn up and spread apart. Remove any of the patient's clothing or underclothing that obstructs your view of the vaginal opening. Position your assistant—your partner, the father, or someone the mother agrees to have assist you—at the mother's head. Position the obstetrics kit near the patient. All items must be within easy reach.

Normal Delivery

To assist the mother with a normal delivery, continue to keep someone at the mother's head to provide support, monitor vital signs, and be alert for vomiting.

Vaginal Opening Positioning

Position your gloved hands at the mother's vaginal opening when the baby's head starts to appear.

Baby's Head Delivery

Place your hand gently on the baby's head as it bulges out of the vagina, to prevent a sudden, uncontrolled expulsion of the newborn.

Shoulder Delivery

Help deliver the shoulders; the upper shoulder will deliver next (usually with some delay), followed quickly by the lower shoulder.

Assess Airway

Assess the airway; although most active babies will not require suctioning, for some it will be necessary.

Neonate

A newly born baby and infants less than 1 month old.

Cutting Umbilical Cord

Cut umbilical cord not sooner than 60 seconds after birth, do not cut a pulsating umbilical cord.

Immediate Cord Clamping Circumstances

The following circumstances would clearly necessitate prompt clamping and cutting of the umbilical cord: the cord is wrapped around the baby's neck and cannot be slipped over the head, the delivery is impeded, or the cord tightens around the neck.

Umbilical Cord Care Procedure

Keep the infant warm, use sterile clamps found in the obstetrics kit when cutting the cord, apply one tie or clamp to the cord about 10 inches (25 cm) from the baby, and a second clamp about 7 inches (18 cm) from the baby.

Cutting the Cord

Cut the cord between the clamps using sterile surgical scissors, and protect your eyes when cutting the cord, as a spurt of blood is very common.

Neonate Not Breathing

Dry, warm and stimulate neonate for 30 seconds; physically dry with a towel and rub the back, if no response, gently flick the sole of the foot.

Delivering the Placenta

In most cases, the placenta will be expelled within a few minutes after the baby is born; guide placenta out with umbilical cord and put in a plastic bag labeled with name and date.

Vaginal Bleeding Control

To control vaginal bleeding after delivery of the baby and placenta, place a sanitary napkin over the mother's vaginal opening and have the mother lower her legs and keep them together.

Breech Presentation

The most common abnormal delivery, involves a buttocks-first or both-legs-first delivery.

Risk of Breech Delivery

The risk of birth trauma to the baby is high in breech deliveries; there is also an increased risk of prolapsed cord.

Massaging the Uterus

Massaging the uterus will help it contract after delivery.

Encouraging Breastfeeding

Encourage the mother to start breastfeeding after delivery.

Time of Birth

Note the exact time of birth and write the mother's last name and time of delivery on a piece of tape.

Puncturing Amniotic Sac

If the amniotic sac has not broken by the time the baby's head is delivered, use your finger to puncture the membrane.

Baby's Skull Soft Spots

Remember that the baby's skull contains 'soft spots,' or fontanelles.

Support During Delivery

Support the baby throughout the entire birth process; remember that newborns are very slippery.

Transport Protocols

Protocols require that the cord be cut if attachment to the cord impedes a resuscitation effort or interferes with the urgent need for transport of the mother and/or the baby.

limb presentation

Occurs when a limb of an infant protrudes from the vagina.

prolapsed umbilical cord

The umbilical cord presents first (this is most common in breech births) and the cord is squeezed between the vaginal wall and the baby's head.

multiple birth

When more than one baby is born during a single delivery.

premature infant

One who weighs less than 5½ pounds (2½ kg) at birth or one who is born before the thirty-seventh week of pregnancy.

emergency care steps for limb presentation

Transport the mother immediately to a medical facility, place the mother in a head-down position with the pelvis elevated, do not try to pull on the limb or replace it into the vagina, and administer high-concentration oxygen to the mother.

steps for managing prolapsed umbilical cord

Position the mother with her head down and pelvis raised, provide high-concentration oxygen, check the cord for pulses, wrap the exposed cord in a sterile towel, and gently push up on the baby's head or buttocks to keep pressure off the cord.

care for multiple births

Request additional assistance and ALS, ensure appropriate resources on scene, clamp or tie the cord of the first baby before the second baby is born, and provide care for the babies, umbilical cords, placenta(s), and the mother as in a single-baby delivery.

neonatal resuscitation for premature infant

Anticipate the need for neonatal resuscitation, request assistance and call for ALS, keep the baby warm, keep the airway clear, and provide ventilations and/or chest compressions based on the baby's pulse and respiratory effort.

umbilical cord bleeding in premature infants

Watch for bleeding from the umbilical cord and apply another clamp or tie closer to the baby's body if there is any sign of bleeding.

transporting premature infants

Transport the infant in a warm ambulance with a desired ambient air temperature between 90°F and 100°F.

notification for limb presentation

Notify the receiving facility of the limb presentation so they can prepare the necessary obstetrical and neonatal resources.

supporting a breech delivery

If the body delivers, support it and prevent an explosive delivery of the head; if delivery is slow or delayed, keep the body aligned with the position of the head to prevent injury to the neck.

lifting the baby in breech presentation

Insert your gloved index and middle fingers into the vagina to form a V on either side of the baby's nose to lift it away from the vaginal wall in case the baby begins to breathe spontaneously.

care after delivery

Care for the baby, cord, mother, and placenta as in after a cephalic delivery.

assisting with multiple births

Assume you will need to conduct multiple neonatal resuscitations simultaneously while still treating the mother.

second baby delivery

The second baby may be born either before or after the placenta is delivered.

keeping multiple babies warm

The babies will probably be smaller than in a single birth, so take special care to keep them warm during transport.

cord management in multiple births

Clamp or tie the cord of the first baby before the second baby is born.

high-concentration oxygen for mother

Provide the mother with high-concentration oxygen by way of a nonrebreather mask to increase the concentration carried over to the infant.

positioning for prolapsed cord

Insert several fingers of your gloved hand into the mother's vagina to gently push up on the baby's head or buttocks to keep pressure off the cord.

transport requirements for prolapsed cord

All patients with prolapsed cords require rapid transport.

examining the umbilical cord

Carefully examine the cut end of the cord to avoid contamination.

Desired ambient air temperature

The desired ambient air temperature is between 90°F and 100°F.

Meconium

A result of the fetus defecating (putting out wastes). It is a sign of fetal distress.

Neonatal resuscitation steps with meconium

If meconium is present during the rupture of membranes, anticipate the need for neonatal resuscitation. Request assistance and call for ALS. Warm the neonate and maintain normal temperature. Position the airway and check for obstruction. If suction is necessary to clear an airway obstruction caused by meconium, do not stimulate the neonate prior to suctioning. Maintain the open airway. Provide artificial ventilations and/or chest compression as indicated by the infant's effort of breathing and heart rate. Transport as soon as possible. Advise the receiving facility staff that meconium was identified at the scene.

Placenta previa

The placenta is formed in an abnormal location

Abruptio placentae

The placenta prematurely separates from the uterine wall.

Excessive prebirth bleeding steps

If signs of shock exist, initiate rapid transport. Keep the patient warm. Administer high-concentration oxygen to prevent hypoxia. Place a sanitary napkin over the vaginal opening. Save all tissue that is passed. Rapidly transport to an appropriate medical facility.

Ectopic pregnancy

The egg may implant outside the uterus—for example, in the fallopian tube, in the cervix, or in another area of the pelvic cavity.

Signs and symptoms of ectopic pregnancy

Acute abdominal pain, often beginning on only one side. Vaginal bleeding (often accompanies pain). Rapid and weak pulse (a later sign). Low blood pressure (a very late sign). Absent menstrual period, suggesting a possible pregnancy.

Eclampsia

A severe complication of pregnancy that produces seizures and is very dangerous to the infant and mother.

Preeclampsia

A complication of pregnancy in which the woman retains large amounts of fluid and has hypertension, and which may progress to eclampsia.

Abortion

Spontaneous (miscarriage) or induced termination of pregnancy.

Spontaneous abortion or miscarriage

When an abortion happens on its own.

Induced abortion

Results from deliberate actions taken to stop the pregnancy.

Signs and symptoms of miscarriage

Cramping abdominal pains not unlike those associated with the first stage of labor. Bleeding ranging from moderate to severe. A noticeable discharge of tissue and blood from the vagina.

Steps for patient with miscarriage or abortion

Obtain baseline vital signs. If signs of shock are present, keep the patient warm and prevent hypoxia. Treatment should be based on signs and symptoms. Help absorb vaginal bleeding by placing a sanitary napkin over the vaginal opening. Do not pack the vagina. Transport as soon as possible. Replace and save all blood-soaked pads. Save all tissues that are expelled. Do not attempt to replace or pull out any tissues that are being expelled through the vagina.

Emotional support

Provide emotional support to the mother.

Pregnant patient pulse

The pregnant patient has a pulse that is 10-15 beats per minute faster than the nonpregnant female.

Blood volume in pregnancy

A woman in later pregnancy may have a blood volume that is up to 48 percent higher than her nonpregnant state.

Hemorrhage in pregnant females

30 percent to 35 percent blood loss may occur before otherwise healthy pregnant females exhibit signs or symptoms.

Shock assessment in pregnancy

Although shock is more difficult to assess in the pregnant patient, it is the most likely cause of prehospital fetal death from injury to the uterus.

Assessment of conscious pregnant patient

Question the conscious patient to determine if she has received any blows to the abdomen, pelvis, or back.

Assessment of unconscious pregnant patient

Examine the unconscious patient for abdominal injuries, remembering to consider the MOI and being certain to provide privacy.

Resuscitation for injured mother

Provide resuscitation if necessary.

Hypoxia treatment

Monitor saturation and aggressively treat any signs of hypoxia with high-concentration oxygen.

Risk of aspiration

There is a greater risk the patient will vomit and aspirate due to slowed digestion and delayed gastric emptying.

Control external hemorrhage

Control external hemorrhage.

Transport injured mother

Transport as soon as possible.

Stillborn

Some babies die in the uterus several hours, days, or even weeks before birth.

Emergency care for stillborn baby

Withhold resuscitative efforts from stillborn babies who have obviously been dead for some time before birth.