Childbirth and Related Emergencies Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

Learning Objectives Understand basic reproductive anatomy. Describe recommended first aid kit equipment for childbirth emergencies. List the signs and symptoms of Miscarriage Preeclampsia and eclampsia Imminent delivery Explain the situations in which you would not try to take a pregnant woman to the hospital for delivery. © 2012 Pearson Education, Inc.

Learning Objectives Describe and demonstrate the care for Seizure during pregnancy Vaginal bleeding during pregnancy Ectopic pregnancy Ruptured uterus Vaginal bleeding after delivery Describe how to transport a women in labor to the hospital. Describe and demonstrate normal delivery procedures. © 2012 Pearson Education, Inc.

Learning Objectives Describe and demonstrate care of the newborn. Describe and demonstrate resuscitation of the newborn. Describe and demonstrate how to manage abnormal deliveries. © 2012 Pearson Education, Inc.

Introduction Childbirth is a normal and natural process. Many times, delivery will not occur for hours after labor has started. Only in a few situations involving complications do victims need to be transported rapidly. © 2012 Pearson Education, Inc.

Reproductive Anatomy Understand the following terms used to describe reproductive anatomy and physiology. Uterus – Perineum Birth canal – Crowning Placenta – Bloody show Umbilical cord – Presenting part Amniotic sac – Miscarriage © 2012 Pearson Education, Inc.

Anatomy of Pregnancy © 2012 Pearson Education, Inc.

Labor Overview Labor Begins with uterine contractions and ends with delivery of the baby Three distinct stages Dilation Crowning and infant delivery Delivery of the placenta © 2012 Pearson Education, Inc.

Labor Stages Labor Stage 1 © 2012 Pearson Education, Inc.

Labor Stages Labor Stage 2 © 2012 Pearson Education, Inc.

Labor Stages Labor Stage 3 © 2012 Pearson Education, Inc.

Delivery Equipment First aid supplies for delivery Surgical scissors – Sterile gloves Cord clamps – Baby receiving blanket Umbilical tape – Sanitary napkins Bulb syringe – Plastic bags Five towels – Germicidal wipes © 2012 Pearson Education, Inc.

Predelivery Emergencies Miscarriage is the delivery of fetal tissues prior to 20 weeks of pregnancy. Cramp-like abdominal pain Moderate to severe vaginal bleeding Passage of fetal tissue Inability to feel the uterus Uterus located below the woman’s naval Sometimes referred to as spontaneous abortion. © 2012 Pearson Education, Inc.

Predelivery Emergencies Treatment of a miscarriage Activate EMS, take standard precautions. Ask about last menstrual cycle. Conduct an initial assessment, monitor vitals. Help control bleeding with sanitary pad. Save any passed tissues or evidence of blood loss. Place the patient supine with legs and hips slightly elevated. Provide emotional support. © 2012 Pearson Education, Inc.

Predelivery Emergencies Seizure during pregnancy can be caused by eclampsia, diabetes, heart disease. Treatment guidelines: Treat according to normal seizure protocol. Position the patient on her left side. Protect the airway and breathing. Dim lights and avoid loud noises. © 2012 Pearson Education, Inc.

Predelivery Emergencies Vaginal bleeding in late pregnancy Placenta previa Abruptio placenta Management guidelines: Treat the victim according to normal shock protocol. Place sanitary napkin over vaginal opening. Save any evidence of blood loss or passed tissue. Provide emotional support to the victim and family. © 2012 Pearson Education, Inc.

Predelivery Emergencies Ectopic pregnancy occurs when an egg implants outside the uterus, eventually bursting. Symptoms include: Sudden, sharp lower abdominal pain on one side Vaginal bleeding Missed menstrual period Pain under the diaphragm, tender abdomen Palpable mass in abdomen Lightheadedness, dizziness, shock symptoms Activate EMS, place victim on her back, keep victim warm, and treat for shock. © 2012 Pearson Education, Inc.

Predelivery Emergencies Preeclampsia and Eclampsia Preeclampsia Characterized by high blood pressure, swelling in the extremities, and visual disturbances Eclampsia Life threatening seizures occur Treatment includes keeping the patient on her left side, ensuring a calm and quiet environment, treating for active seizures if present, and activating EMS © 2012 Pearson Education, Inc.

Predelivery Emergencies Ruptured Uterus Can occur from previous cesarean section or other surgical operation, multiple pregnancies, or extended labor. Severe abdominal tearing pain, shock, minimal vaginal bleeding, lack of uterine contractions, palpable fetus Activate EMS, treat victim for shock, and give nothing by mouth. © 2012 Pearson Education, Inc.

Normal Delivery Best if delivery occurs in hospital, when possible Signs of imminent delivery Amniotic sac ruptures Crowning occurs with contractions Contractions less than 2 minutes apart Intense contractions from 45–90 seconds Mother feels need for bowel movement Abdomen feels hard © 2012 Pearson Education, Inc.

Normal Delivery Transporting a woman in labor If EMS cannot transport, keep victim supine. Remove any obstructive clothing. Place clean bedding beneath the buttocks. Constantly watch for crowning. Never delay or restrain delivery process. Watch for vomiting, keep airway clear. © 2012 Pearson Education, Inc.

Normal Delivery Assisting with delivery Use standard precautions when possible. Do not allow patient to use the bathroom. Do not do anything to delay delivery process. Understand normal delivery procedures. © 2012 Pearson Education, Inc.

Delivery Overview © 2012 Pearson Education, Inc.

Normal Delivery Vaginal bleeding following delivery 2 cups of blood considered normal If excessive, place your hand (sideways) just above the pubis at a 90 degree angle. Use your other hand cupped around the uterus, to massage it in a circular motion. The uterus should start to feel like a hard grapfruit. Breastfeeding the baby helps to stop maternal bleeding. Treat for shock as needed. © 2012 Pearson Education, Inc.

Newborn Care Care of a newborn Normal baby should be crying, with a heart rate above 100/min and respirations at least 40/min Dry the neonate very well. Use bulb suctioning on airway as needed. Assess the baby’s color, pulse, and grimace (APGAR scoring). Stimulate the baby to breathe by flicking soles of feet or rubbing back. © 2012 Pearson Education, Inc.

Newborn Care How to stimulate breathing © 2012 Pearson Education, Inc.

Newborn Resuscitation Resuscitating a newborn Provide ventilations at 40–60/min if breathing is inadequate. Provide ventilations at 40–60/min if heart rate is 100 beats per minute. Provide ventilations and compressions if not responding to artificial ventilations and/or the heart rate is less than 60 beats per minute. © 2012 Pearson Education, Inc.

Abnormal Deliveries Prolapsed cord When the umbilical cord is the presenting part Can cut off blood flow to the baby Activate EMS, position the mother supine with hips elevated, place gloved hand into the vagina to relieve pressure off the cord. © 2012 Pearson Education, Inc.

Prolapsed Cord Management of a prolapsed cord © 2012 Pearson Education, Inc.

Abnormal Deliveries Breech birth Baby presents buttocks- or feet-first. Do not pull on the baby. If no full delivery within 10 minutes, create an airway for the baby. Place your gloved hand into the vagina. With the palm facing the baby’s face, create a “V” with your fingers on either side of the nose. Push away the vaginal wall to create an air passage. © 2012 Pearson Education, Inc.

Breech birth Buttocks or both feet are presenting part © 2012 Pearson Education, Inc.

Abnormal Deliveries Limb presentation When an arm or leg protrudes first as presenting part Instruct mother to NOT push with contractions. Activate EMS, do not attempt to deliver the baby. © 2012 Pearson Education, Inc.

Abnormal Deliveries Multiple births Suspect when the mother’s abdomen remains large and firm after first delivery Activate EMS. Deliver 2nd baby with the same care steps as initial delivery. Twins tend to have low birth rates. © 2012 Pearson Education, Inc.

Abnormal Deliveries Passage of meconium Baby’s first feces, found in amniotic fluid Thick, brownish-yellow or green in color Meconium may result in airway occlusion Activate EMS immediately. Suction out nose and mouth before stimulating. Maintain airway thereafter, suctioning frenquently. © 2012 Pearson Education, Inc.

Abnormal Deliveries Premature birth Less than 5.5 pounds body weight, or born before 36 weeks gestation Susceptible to respiratory conditions Keep baby warm. Suction airway. Resuscitate as needed. Prevent bleeding from umbilical cord. Prevent contamination as best possible. © 2012 Pearson Education, Inc.

Summary While many deliveries proceed with no complications, emergencies occasionally arise. Be able to identify when to stay and deliver, and when to instead arrange transport to hospital. After delivery always keep the infant warm, ensure a clear airway, stimulate the baby to breathe, and arrange transport. Premature babies require special treatment. © 2012 Pearson Education, Inc.