Childbirth and Obstetrics Notes
Childbirth: Obstetrics
General Principles
Childbirth is a natural phenomenon.
The level of certification does not regulate the type of delivery a provider can assist with.
If a CFR encounters anything other than a normal delivery, they should call medical control for assistance.
Management of a Normal Delivery (CFR and All Provider Levels)
Support the baby’s head over the perineum with gentle pressure.
If membranes cover the head after it emerges:
Tear the sac with fingers or forceps to allow amniotic fluid escape.
Guide the head downward until the shoulder appears.
Deliver the other shoulder by gentle upward traction.
The infant’s face should be upward at this point.
Maintain a firm grasp on the infant.
Management of Umbilical Cord Around Neck (Nuchal Cord) - CFR scope EMT
Umbilical cord around the neck is an emergency because the baby is not getting oxygen either through the cord or by breathing.
If the cord is around the neck:
Unwrap the cord from around the neck, if possible.
Clamp the umbilical cord with two clamps.
Cut the cord between the clamps.
Management of a Breech Delivery - CFR scope EMT
Support the buttocks or extremities until the back appears.
Grasp the baby’s iliac wings and apply gentle downward traction.
DO NOT pull on the legs or back, as this may cause spine dislocation or adrenal hemorrhage.
Gently swing the infant’s body in the direction of least resistance.
By swinging anteriorly and posteriorly, both shoulders should deliver posteriorly.
Splint the humerus bones with two fingers; apply gentle traction with your fingers.
Gentle downward compression of the uterus will assist in head delivery.
Swing the legs upward until the body is in a vertical position. This will permit delivery of the head.
Management of Prolapsed Cord or Limb Presentation - CFR scope EMT
Place the mother in a face-up position with hips elevated.
Place a gloved hand in the vagina; attempt to hold baby’s head away from the cord and maintain an airway for the baby.
Keep the cord moist using a sterile dressing and sterile water.
Transport as soon as possible to the closest appropriate facility.
Key Points/Considerations
Obtain additional help for multiple births, as needed.
See “General: Childbirth – Newborn / Neonatal Care” for subsequent instructions.
Determine the estimated date of expected birth, the number of previous pregnancies, and the number of live births.
Determine if the amniotic sac (bag of waters) has broken, if there is vaginal bleeding, mucous discharge, or the urge to bear down.
Determine the duration and frequency of uterine contractions.
Examine the patient for crowning:
If delivery is not imminent, transport as soon as possible.
If delivery is imminent, prepare for an on-scene delivery.
If multiple births are anticipated, but the subsequent births do not occur within 10 minutes of the previous delivery, transport immediately.
After delivery of the placenta, massage the lower abdomen.
Take the placenta and any other tissue to the hospital for inspection.
Do not await the delivery of the placenta for transport.
If uterine inversion occurs (uterus turns inside out after delivery and extends through the cervix), treat for shock and transport immediately. If a single attempt to replace the uterus fails, cover the exposed uterus with moistened sterile towels.
If a limb presents during delivery, it is considered a prolapsed limb presentation. In such cases, the protocol is to place the mother in a face-up position with hips elevated, insert a gloved hand into the vagina to keep the baby’s head away from the umbilical cord to maintain an airway for the baby, keep the cord moist using a sterile dressing and sterile water, and transport to the closest appropriate facility as soon as possible.