EMS chapter 23 - Childbirth and Pregnancy

amniotic fluid

fluid surrounding the baby contained within the amniotic sac.

clear, slightly yellowish liquid that surrounds and protects the fetus during pregnancy. It contains nutrients, hormones, and antibodies, and is crucial for fetal development, providing a cushion against injury

amniotic sac

fluid-filled sac that surrounds the developing fetus. This ruptures during birth = “water has broken”

bloody show

normal discharge of blood-tinged fluid prior to delivery; caused by rupture of capillaries as the baby’s head expands the cervix and birth canal.

birth canal

aka vagina

fontanel

a space between the bones of the skull in an infant or fetus, where ossification is not complete and the sutures not fully formed. The main one is between the frontal and parietal bones.

if fused together, they have craniosynostosis

full term

a fetus baby reaches week 38 inside the womb

gestation

development of the embryo and fetus in the uterus; the period from conception to birth. Lasts normally 38-40 weeks

imminent delivery

delivery that is likely to occur within the next few minutes.

nuchal cord

condition in which the umbilical cord is wrapped around the baby’s neck during delivery.

ovum

an unfertilized egg

placenta

organ of pregnancy that serves as the filter between the mother and developing fetus.

3 stages of labor

1. begins with the onset of regular contractions and ends when the cervix is fully dilated (approximately 10 centimeters), allowing the baby to enter the birth canal.

2. the baby enters the birth canal and ends when the baby exits the mother’s body (birth).

3. begins when baby is born and ends when placenta (AKA afterbirth) is delivered

contraction time

span of time from the beginning of a contraction until it relaxes is called the contraction time.

interval time

This is the span of time from the start of one contraction to the beginning of the next contraction. As labor progresses, the interval time will become shorter.

whats in an OB kit (obstetric)

1. FULL PPE - birth is VERY messy

2. towels, sheets, blankets - draping the mother, drying + wrapping baby

3. gauze pads - wipe mucus of baby’s mouth + nose

4. rubber bulb syringe - suctioning baby’s airway

5. clamps and ties - used on umbilical cord before cutting

6. scissors - cutting cord

7. pads or bulky dressing - vaginal bleeding

8. basin + plastic bags - transporting and collecting placenta

9. biohazard red bags - disposing soiled linens and dressings.

questions to ask the mother

• What is the expected due date?

• Has she been seeing a doctor during her pregnancy?

• Does she have other children?

• If so, how was her last labor? (Note that if this is her first delivery, labor will typically last about 16 hours. Labor time is usually shorter for subsequent deliveries.)

• Were previous children delivered normally or did they require a Cesarean section (C-section)?

• Is she aware of any known complications, particularly a multiple birth (twins or triplets)?

• Has there been any discharge of fluid or bloody mucus?

• How long has she been having labor pains?

• How frequent are the contractions?

• Has her water broken? If so, when, and what color? (Clear is normal. Cloudy or green means a stressed fetus and requires immediate transport.)

• Does she feel the need to move her bowels? If so, can she feel the baby beginning to move into the birth canal?

• Does she have any significant medical history such as seizures, diabetes, or vaginal bleeding during the pregnancy?

what color should “broken water” be

should to be clear — if cloudy or green means stressed fetus and requires immediate transport

what to do if the mother wants to use the restroom during labor

if mother has contractions less than 2 min apart (active labor) DONT LET HER GO TO THE BATHROOM cause she might give birth in a toilet

coaching the birth

• As each contraction begins, have the mother take a deep breath, hold it, and encourage her to gently bear down, or push.

• Encourage her to rest between each contraction and to breathe normally.

• If available, have the father or someone appropriate at the mother’s head to help coach her through each contraction.

preparing to deliver the baby

1. BSI

2. give the mother privacy (get people away)

3. position mother on back with knees bent and feet flat.

4. ask the mother if she feels faint in this position, and if so have her sit up slightly and support back with pillows/blankets

5. when mother says she’s having contractions, explain what you’re doing and place palm of YOUR hand on her abdomen above the navel (feeling contractions, skip if mother feels baby coming)

6. prepare the mother for examination (remove clothes) then check for crowning (second stage of birth)

7. don’t look INSIDE the vagina, and only touch it if necessary

delivering the baby on the field

1. wash hands, use PPE

2. drape the mother, place her on clean sheets/towels. use folded blankets to lift pelvis about 2 inches

3. have someone near her head in case she vomits (also have her turn her head sideways)

4. as baby head emerges, place one hand below head (spread your fingers evenly, don’t press on fontanels). control speed of delivery - if it ‘pops out” it can damage the vaginal opening

5. if the amniotic sac hasn’t rupture, with clamp cord or gloved finger tear the membrane and pull it from the baby’s mouth+nose

6. once head is delivered, tell mother to stop pushing. then check if umbilical cord is wrapped around the baby’s neck. If it is, use 2 fingers to slip it off

7. continue pushing. next contraction point baby downwards to help deliver upper shoulder. Then position baby upwards to help deliver lower shoulder.

8. once baby’s feet are out, lay baby on their side with head slightly lower than the body (drain fluids). wipe their mouth + nose w/ gauze pads

9. note time of birth

10. keep the baby at level of the vag-ina (known won’t let me write actual word) until the umbilical cord is cut.

11. wait 1 min at least after birth before cutting cord. first cord is 6 inches from baby’s abdomen, and 2nd clamp two inches further away than the first. cut between clamps (if no sterile scissors, just clamp and don’t cut)

12. monitor + record the baby’s and mother’s vital signs. support ABC if needed

13. watch for more contractions - signals delivery of placenta. save placenta in biohazard bag labelled with the mother’s name. Transport it to hospital

14. place sanitary pad over vaginal opening. Lower legs and place them together

caring for newborn after delivery

1. clear airway - position baby on side w/ head slightly lower than body. Use gauze pad to clean nose+mouth. Babies breath through nose, so keep them clear

2. don’t suction if baby is breathing normally - only if their not breathing adequately

   • insert suction device only ½ inch into nose, and 1 inch into mouth (repeat process 2-3 times)

3. if baby still isn’t breathing, rub their back vigorously. If that doesn’t work, flick the sole on their foot

4. once sure they are breathing, check circulation (skin color), any deformities, the strength of their cry, whether they move on their own or just lie still. Note any changes

5. clamp or tie umbilical cord if allowed

6. keep baby warm by wrapping in clean+dry towel/sheet/blanket and place on mother’s abdomen. Keep baby’s head covered

7. if the mother wants to nurse the baby, allow it (it helps contract the uterus and control bleeding)

care for baby that is NOT breathing

ventilate at 1 breath per second

if pulse, but inadequate breathing

ventilate at 40 to 60 breaths per minute for 30 seconds and reassess breathing. Once breathing is spontaneous (but HR is also at least 100), stop ventilations and stimulate baby by rubbing the back or legs

if heart rate is less than 100 BPM or 60 BPM, what do you do?

continue assist w/ ventillations as long as HR is above 60. If HR drops below 60, continue assisting w/ ventillations but start CPR.

care for the mother after birth

1. don’t delay transport to deliver placenta

2. save placenta, soiled sheets and all membranes

3. control vaginal bleeding after delivery

4. keep the mother in a position of comfort

braxton hicks contractions

fake contractions - false labor. Has irregular timing, sometimes go away when one changes position

how to control vaginal bleeding AFTER DELIVERY

1. place sanitary pad at vaginal opening (NOT INSIDE)

2. lower the mother’s legs together

3. palpate abdomen until you find grapefruit-sized object (Uterus). Massage from the pubis bone at pelvis front upwards (ONLY UPWARDS) towards the navel - stimulates the uterus to stop bleeding

4. if bleeding continues, give oxygen + warmth. Continue massaging the uterus. If mother wants to nurse, allow it

vital signs of average pregnant women

BP is 10-15 mm HG lower than normal.
HR is usually 15 BPM higher
Her blood volume up to 45% higher than before (can hide signs of shock)