Delivery Process & Complications

What should be done when crowning occurs?

Apply gentle counter pressure to the fetus’ head

Why is counter pressure applied during crowning?

Prevent explosive delivery

What should be observed for after delivery of the head?

Nuchal cord

How should the head be supported after delivery?

Grab the head with hands over the ears

Why is the head supported after delivery?

To support rotation for shoulder presentation

What should be used to grasp and support the newborn after shoulder delivery?

Dry towel

When should the newborn airway be suctioned?

Only if meconium staining is present with respiratory distress or coarse gurgling

What is the suction order for a newborn airway?

Mouth then nose

What should be done after delivery of the newborn?

Dry the newborn and record sex and time of birth

When should the umbilical cord be clamped?

After it has stopped pulsating

How long should clamping be delayed if the baby does not need resuscitation?

30 seconds to 1 minute

How far from the newborn should the cord be clamped?

4–6 inches

How many clamps should be placed on the umbilical cord?

Two

Where should the umbilical cord be cut?

Between the clamps

Should the cord clamps be removed?

No

What is an umbilical cord prolapse?

Cord passes through the cervix at the same time as or before the fetus

Why is umbilical cord prolapse dangerous?

Cord is compressed against the fetus, reducing oxygenation from the placenta

How often does umbilical cord prolapse occur?

1 in 10 deliveries

What should be assessed first with an umbilical cord prolapse?

Cord pulsation

How should a pulsating prolapsed cord be managed?

Wrap with moist sterile dressing, then dry dressing, and continue assessing for pulse

How should a non-pulsating prolapsed cord be managed?

Insert two gloved fingers into the vagina and attempt to move the baby off the cord

What maternal position may help with a non-pulsating prolapsed cord?

Knee-chest position

How long should prolapsed cord interventions continue?

Until the cord begins pulsating

What is a nuchal cord?

Umbilical cord wrapped around the fetus’ neck

How should a nuchal cord be managed initially?

Attempt to remove it from the fetus’ neck

What should be done if the nuchal cord cannot be removed?

Clamp in two places and cut immediately

What is cephalopelvic disproportion (CPD)?

Newborn’s head is too large to pass through the birth canal

Management of cephalopelvic disproportion

Oxygen administration, IV access, rapid transport

What is a breech presentation?

Largest part of the fetus (head) is delivered last

When is breech presentation more common?

Multiple births

What should NOT be done with a breech presentation?

Push

Management of breech presentation

Rapid transport, call for assistance, oxygen administration, consider anti-contraction medication

What is shoulder dystocia?

Fetal shoulders wedged against the symphysis pubis, blocking shoulder delivery

How common is shoulder dystocia?

1 in 300 deliveries

What maneuver is used for shoulder dystocia?

McRobert’s Maneuver

Where should pressure be applied during shoulder dystocia?

Suprapubic area

Management of shoulder dystocia

McRobert’s Maneuver, gentle suprapubic pressure, rapid transport

What complication occurs when the cord is compressed between the fetus and birth canal?

Umbilical cord prolapse

What complication involves the umbilical cord around the neck?

Nuchal cord

What complication involves the fetal head being too large for the birth canal?

Cephalopelvic disproportion

What complication results in the fetal head delivering last?

Breech presentation

What complication involves the shoulders being stuck behind the symphysis pubis?

Shoulder dystocia