1. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Childbirth

2. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Outline Review of A & P Labor Assessment Assisting with Delivery Special Considerations

3. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Don’t be scared… Out-of-hospital childbirth is an infrequent call for EMS providers Because the knowledge and skills needed to assist with delivery are seldom used, many EMS providers are anxious when confronted with an impending delivery

4. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Terminology Fetus = from the end of the second month of pregnancy to birth Newborn = from birth to age 1 month Pregnancy normally lasts about 266 days (9 calendar months)

5. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Stages of Labor Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Is the Birth Imminent? What is the due date? Is this a single birth or multiple birth? Has there been any bleeding or discharge, or has the water broken? Is the mother feeling pressure like a need to move her bowels?

9. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. It’s Time! If the mother is having frequent, strong contractions and feels the urge to move her bowels, you will need to check for crowning If crowning is present, prepare for delivery

10. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Preparing for Delivery Use BSI (gloves, eye protection, gown) Do not touch the vaginal area except to control the head of the infant as it emerges Do not attempt to delay the delivery Have the mother lie back with her knees bent and legs apart

11. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Preparing for Delivery Elevate the buttocks with a folded blanket or pillow covered with clean towels or blankets Open the delivery kit and have it within your reach Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. The contents of a delivery kit. Delivery Kit – this is what you get… Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. This is what you want… This is a fluid-filled environment. BSI is very important here Use gloves, gown, and eye protection

14. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting Normal Delivery 1.Apply gentle pressure to infant’s head during crowning to allow gradual, controlled delivery –Exert very gentle pressure on baby’s head with your hands to avoid explosive delivery

15. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting Normal Delivery 2. Once head has been delivered, use bulb syringe to suction out baby’s mouth & nose 3. Use your index finger to feel for & remove loop of umbilical cord if around infant’s neck

16. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting Normal Delivery 4. Support infant’s head as it rotates

17. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting Normal Delivery 5. Gently guide infant’s head downward to deliver anterior shoulder –Allows anterior shoulder to slip out from under pubic bone

18. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Get a Good Grip They come out slippery!

19. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Umbilical cord Fasten one clamp approximately 6 inches away from the infant’s belly Fasten the second clamp approximately 2 inches away from the first clamp With sterile scissors, cut between the two clamps and pat with sterile gauze Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

20. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting with the Delivery Dry the infant with a receiving blanket Wrap the infant in a second blanket to keep him warm; the body and head should be covered, with only the face exposed –Infants quickly lose heat, especially from the scalp –They may quickly become hypothermic, even in a relatively warm room

21. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Assisting with the Delivery If necessary, wipe mucus from the nose and mouth with sterile gauze Place the infant on the mother’s abdomen Record the time of delivery –Wait for additional EMS responders to arrive

22. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Delivery of the placenta Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

23. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Multiple Births Will need to prepare for delivery of the second infant after caring for the first The delivery of subsequent infants is handled the same as the first Infants are usually smaller and born earlier

24. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Abnormal Presentations Normally the infant’s head is the first part to be delivered If the feet, buttocks, or other body part present first, the delivery may be very complicated –Instruct the mother not to push –Notify incoming EMS responders of the situation –Reassure the mother that more help is on the way

25. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Care of the Newborn Normally, infants will begin to cry at birth Normal vital signs –Heart rate > 100/minute –Respiratory rate > 40/minute

26. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Infant is not responding normally Does not cry, is limp, and/or has cyanosis of the face or torso Stimulate the feet by lightly flicking the soles of feet or rub the back If this does not improve the infant’s condition within one minute, further resuscitation is needed

27. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Newborn Resuscitation Make sure the airway is open and clear of fluids Ventilate gently at 40-60 times per minute Reassess after one minute If the heart rate is ≤ 60 bpm, begin chest compressions

28. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Care of the Mother Observe for delivery of the placenta, which may take up to 30 minutes There will be vaginal bleeding as the placenta delivers If the placenta delivers, wrap it in a towel and keep it at the level of the infant Place a sterile pad over the vaginal opening and help the mother lower her legs

29. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Post-Delivery Bleeding 300 to 500 mL of blood loss is normal following delivery If vaginal bleeding excessive –You may need to massage the uterus –Treat for shock –Encourage breastfeeding

30. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Uterine Massage Remember to communicate with the mother and keep her informed of what you are doing Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

31. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Childbirth Video

32. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Summary The majority of births are uncomplicated and only some require special assistance This is one of the few times EMS personnel have the opportunity to participate in a happy event It is essential to remember that newborns have a special need to be kept warm

33. Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Questions?