Delivery & Labor

• Delivery will occur in a few mins

• Natural disaster, inclement weather, environment factors

When to deliver at the scene

Multigravida women

Who is more likely to experience a precipitous labor?

Tissues don’t have time to stretch causing perineal tears

What are women at risk for if they have a precipitous birth?

Feel the pt’s abdomen from the moment the contraction begins (uterus/abdomen tightens) to when it ends (relaxing)

How should you time the duration of contractions?

Crowning

What is a definitive sign that delivery is imminent?

• Support the bony parts of the head, avoid the fontanelles (top and back of the head)

• Use minimal pressure so the head comes out smoothly

How should you support the head when delivering a baby?

• Head down to help the upper shoulder

• Head up to deliver the lower shoulder

How should you deliver the baby’s shoulders?

True - only if the airway is obstructed by secretions, remove visible secretions from the nose and mouth using a cloth

True or false: after delivery and before cutting the cord, it’s not necessary to suction the mouth and oropharynx to clear amniotic fluid if the infant's airway isn’t obstructed

Suction the mouth and the nose with a bulb syringe

How should you remove secretions obstructing the airway in a newborn

cephalic/vertex presentation

When the fetus is positioned headfirst in the birth canal

Applying gentle pressure across the perineum with a sterile gauze pad

How can you reduce the risk of perineal tearing during labor?

Puncture it with a clamp or tear it by twisting it between your fingers (away from the fetus’s face, only as the head is crowning)

What should you do if the amniotic sac has not ruptured by the time the fetal head is crowning?

Respiratory distress or airway obstruction

What can meconium in the amniotic fluid result in?

nuchal cord

An umbilical cord wrapped around the fetus’s neck

Cut the cord - use two clamps 2 in apart, cut between the clamps. Encourage the woman to push harder to speed up the delivery (fetus doesn’t have O2 until it’s delivered)

What should you do if you can’t slip a nuchal cord away from their neck?

vernix caseosa

A white substance covering the fetus’s body.

Infection is easily transmitted through the cord to the newborn

Why is postdelivery care of the umbilical cord important?

False

True or false: wait to transport the patient until the placenta has been delivered

They need to be examined to make sure the entire placenta has been delivered (placenta still in the uterus could cause continued bleeding or infection)

Why is it important to wrap the entire placenta and cord and bring them to the hospital

A sterile pad over the vagina and straighten her legs

After delivery of the placenta and before transport, you should place…

Massage the patient’s abdomen using a firm, circular, kneading motion with one hand cupped over the top of the fundus and the other above the pubic bone (makes the uterus contract)

How can you slow down bleeding after the placenta has been delivered?

fundus

The dome-shaped top of the uterus

• Hasn’t delivered after 30 mins

• >500 mL of bleeding before the placenta is delivered

• Significant bleeding after the placenta is delivered

What are three emergency situations when delivering the placenta