1. OB Skills or They had 9 months to plan.. But NOW it’s an Emergency Presented by David James Keeler NREMT – P Virginia Beach EMS

2. Housekeeping Housekeeping  Bathrooms  Smoking  Fire/Flood/Famine/Frogs

3. Goals for the Class Goals for the Class  Regain familiarity with the call we either dream of or try desperately to avoid  Reduce possible anxiety associated with deliveries in the field and promote forward thinking to better handle any emergent issues

4. Initial thoughts.. Timing is everything…..

5. Initial thoughts.. Timing is everything….. A full term pregnancy is 36-40 weeks

6. Initial thoughts.. Timing is everything….. A full term pregnancy is 36-40 weeks Viability is 22 weeks

7. Initial thoughts.. Timing is everything….. A full term pregnancy is 36-40 weeks Viability is 22 weeks Realistic threshold about 25 weeks

8. Initial thoughts.. Timing is everything….. A full term pregnancy is 36-40 weeks Viability is 22 weeks Realistic threshold about 25 weeks Inevitably limited by lung development and neural ability

9. Initial thoughts.. Analyze the risk factors… Mother’s ageMother’s weight Pre natal careMedical Hx Mother’s ageMother’s weight Pre natal careMedical Hx Multiple BirthsFirst Pregnancy NutritionETOH/Drug Use Multiple BirthsFirst Pregnancy NutritionETOH/Drug Use

10. Initial thoughts.. Analyze the risk factors… Mother’s ageMother’s weight Pre natal careMedical Hx Mother’s ageMother’s weight Pre natal careMedical Hx Multiple BirthsFirst Pregnancy NutritionETOH/Drug Use Multiple BirthsFirst Pregnancy NutritionETOH/Drug Use Any others??

11. Decision Time! “Should I stay or should I go” - the Clash Factors to prompt the decision How far apart are the contractions How appropriate is the current scene

12. Decision Time! “Should I stay or should I go” - the Clash Factors to prompt the decision How far apart are the contractions How appropriate is the current scene Decision may be out of your hands Crowning Urge to push

13. Decision Time! “Should I stay or should I go” - the Clash Factors to prompt the decision How far apart are the contractions How appropriate is the current scene Decision may be out of your hands Crowning Urge to push False labor - Braxton-Hicks contractions Occur as early as 3-4 weeks (part of natural stretching) Irregular contractions Located in abdomen

14. Preparing for Delivery Check for crowning Spread legs apart gently Once pushing begins it can’t be slowed down Never attempt to hold mother’s legs together and don’t let her go the bathroom!

15. Delivery You are only assisting the mother Delivery is a BLS skill Guide and support the infant as it is born Support the head with your hand as it emerges

16. Delivering the Infant Check for the cord around the neck Suction the mouth first, then nostrils Let shoulders come out Use towels to dry and hold when it comes out- slippery little things!

17. Postdelivery Care Wrap in a clean, dry towel Keep the face exposed and make sure the top of the head is covered(heat loss) Warm it up! Place baby on Mom’s abdomen if the cord is long enough Clamp and cut the cord

18. Delivery of the Placenta Placenta usually comes out by itself Never pull on the cord Gentle massaging of the uterus after delivery of the placenta helps prevent heavy bleeding Breast feeding helps contract the uterus

19. Apgar Score Appearance Pulse Grimace or irritability Activity or muscle tone Respirations Check at 1 and 5 minutes after birth

21. Hemorrhage If signs of shock, place Mom on left side during transport High flow oxygen Sterile pad over vagina replace as necessary and save the pads Save any tissue that may be passed

22. Breech Presentations Frank Complete Footling

24. Rare Presentations Limb Face Prolapsed cord Nuchal CordCord

27. Twins Need to clamp two cords-label as 1 st and 2 nd Second usually delivers a few minutes after the first Record time of delivery and apgar scores for both infants

28. Decision Time! “Should I stay or should I go” - the Clash Factors to prompt the decision How far apart are the contractions How appropriate is the current scene Decision may be out of your hands Crowning Urge to push False labor - Braxton-Hicks contractions Occur as early as 3-4 weeks (part of natural stretching) Irregular contractions Located in abdomen

29. Any Questions?