Ch 16 Childbirth

Introduction

  • EMRs may assist in childbirth, planned or unplanned.

  • Childbirth is natural; assistance is often minimal.

  • Focus is on helping, guiding, and supporting the newborn.

  • Key indicators: contraction frequency, crowning.

Anatomy and Function

  • Ovaries produce eggs; uterus holds the developing fetus.

  • Gestation is typically 40 weeks.

  • Egg travels via fallopian tubes to uterus.

  • Birth canal: uterus lower part and vagina.

  • Fetus is in amniotic sac with amniotic fluid.

  • Placenta provides nutrients via umbilical cord.

Assessing the Birth Situation

  • Decide whether to transport or deliver on-site based on labor stages.

Stages of Labor

  • First Stage: Body prepares for birth.

    • Initial contractions, water breaks, bloody show (mucus plug).

    • No crowning.

  • Second Stage: Birth of the newborn.

    • Crowning occurs, prepare for delivery.

  • Third Stage: Delivery of placenta (afterbirth).

    • Stabilize mother and newborn, assist with placenta delivery.

Determining Time to Reach Hospital

  1. First pregnancy usually longer.

    • Ask for due date.

  2. Bloody show indicates labor beginning.

  3. Bag of waters breaking indicates progress.

  4. Contraction frequency:

    • More than 5 minutes apart: transport.

    • Less than 2 minutes apart: prepare for delivery.

    • 3-4 minutes: consider other factors.

  5. Urge to move bowels indicates imminent delivery.

  6. Crowning means delivery in minutes.

  7. Transportation availability.

Timing Contractions

  • Time from the beginning of one to the beginning of the next.

  • Less than 3 minutes apart suggests delivery is close.

Detecting Crowning

  • Observe vaginal opening during contraction.

  • If crowning, prepare for delivery; do not transport.

Preparing for Delivery

  • Calm the woman and yourself.

  • Be as clean as possible; wash hands, use gloves.

  • Place patient on firm, padded surface; elevate hips.

  • Have clean towels ready.

Standard Precautions

  • Use sterile gloves, face/eye protection, and gown to avoid body fluids.

  • Report any direct exposures.

Equipment

  • OB delivery kit:

    • Sterile gloves, umbilical cord clamp, sterile drapes/towels, sanitary pads, gauze pads, newborn towel/blanket, bulb syringe, plastic placenta bag.

  • Additional needs: sheets/towels, suction, oxygen, newborn-size face mask.

Assisting With Delivery

  • Consider both mother and newborn's lives.

  • Assess the woman and monitor vitals every 15 minutes.

  • Do not let her go to the bathroom or hold her legs together.

  • Support the newborn's head as it emerges; tell the woman to stop pushing.

  • The newborn will turn to the side spontaneously.

  • Support the newborn's head/body; grasp feet as delivered.

  • Keep the newborn's head at the level of the vagina.

  • Tear amniotic sac if unbroken.

  • Check for umbilical cord around neck; slip it over the head if possible; do not pull.

Caring for the Newborn

  • Lay the newborn between the mother's legs in a clean towel.

  • Clear blood/mucus from the newborn's mouth/nose (gauze or bulb syringe).

  • Suction mouth first, then nostrils.

  • If not breathing spontaneously, suction again; rub back or flick soles of feet.

  • Dry, wrap in blanket, and keep the newborn warm.

  • Place on side with head slightly lower to aid drainage.

  • Clamp umbilical cord when it stops pulsating.

Managing the Placenta

  • Allow placenta to deliver spontaneously; don't pull the cord.

  • Wrap placenta in a towel/newspaper with most of the cord; place in a plastic bag.

  • Keep placenta at the same level as the newborn during transport.

Aftercare of Mother and Newborn

  • Continue observing and keeping them warm.

  • Recheck uterus for firmness every 3-5 minutes; massage if not firm.

  • Check vagina for excessive bleeding (normal = 10-16 fl oz).

  • Clean the mother; cover vaginal opening with a sanitary pad.

  • Give small amounts of water if thirsty.

Newborn Vital Signs

  • Respiratory rate > 40 breaths per minute.

  • Pulse rate > 100 beats per minute (brachial pulse).

Resuscitating the Newborn

  • Dry and warm the newborn if they don't cry immediately after birth.

Complications of Pregnancy and Childbirth

Ectopic Pregnancy and Shock

  • Severe abdominal pain/shock signs in childbearing age women.

  • Treat for shock; prompt transport.

Miscarriage and Vaginal Bleeding

  • Miscarriage: fetus before 20 weeks.

  • Save the fetus and tissues.

  • Control bleeding, treat for shock; arrange transport.

Premature Birth

  • Newborn < 5 lbs or before 36 weeks.

  • Keep the newborn warm; prompt transport.

Unbroken Bag of Waters

  • Carefully break the bag; suction the newborn's mouth/nose.

Prolapse of Umbilical Cord

  • Cord appears before the fetus.

  • Elevate hips, keep cord covered/moist; administer oxygen; rapid transport.

Breech Birth

  • Buttocks first.

  • Transport promptly. Support buttocks/legs; if head doesn't deliver in 3 minutes, insert gloved hand to keep airway open.

Stillborn Delivery

  • Fetus dies before labor; unpleasant odor, no life signs.

  • Wrap the newborn and support the mother.

Multiple Births

  • Another set of contractions will begin shortly after the first.

Excessive Bleeding After Delivery

  • Normal loss: 1-2 cups (300-500 mL).

  • Place sanitary pads, treat for shock, rapid transport.

  • Encourage nursing and massage the uterus.

Vehicle Crashes and Pregnant Women

  • Examine by a physician even in minor crashes.

  • Monitor airway, breathing, circulation; administer oxygen; transport on left side.