16 Childbirth

8/4/2019 16 Childbirth

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Childbirth

Lesson 16


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Childbirth

Sometimes occurs outside planned setting

Rarely becomes medical emergency

Problems early/complications become

emergencies


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Pregnancy and Labor

Begins with fertilization of ovum

Growth/development 40 weeks


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Stages of Pregnancy

Divided into three trimesters three months each

Single cell divides into many

First eight weeks an embryo; then fetus


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Stages of Pregnancy

Fetus develops inside amniotic sac

Embryo attached to placenta

All major organ systems developed by week 8


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Week 36, fetus fullyformed

Near end of

pregnancy, head offetus positioneddownward in pelvis.

Fetus passes

through dilatedcervix and vagina.

Stages of Pregnancy


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Stages of Labor and Delivery

Show or Bloody Show

When mucous plug from cervix released

Can occur up to 10 days before contractions begin

Occurs in 3 stages beginning with contractions


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First Stage

Amniotic sac ruptures before or during first stage

Uterine contractions begin and eventually pushinfants head into cervix

1015 minutes apart initially

2-3 minutes apart shortly before birth

May last few hours to a day


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Second Stage

Typically lasts 1 2 hours Cervix fully dilated

Contractions powerful andpainful

Infants head presses onfloor of pelvis urge topush down

Vagina stretches open Head emerges (crowning)

Rest of body pushed out


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Third Stage

Placenta separatesfrom uterus anddelivered

Usually within 30 minof birth

Uterus contracts andseals off blood

vessels


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Emergency Care DuringPregnancy

Women who receive regular care are advisedabout potential problems to watch for

Although rare, problems may require emergency

care


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Vaginal Bleeding


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Vaginal Bleeding

May be caused by cervical growths or erosion,problem with placenta or miscarriage

In third trimester may be sign of preterm birth

See healthcare provider immediately


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Assessing Vaginal Bleeding

Perform standard assessment

Take repeated vital signs


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Emergency Care VaginalBleeding

Perform standard patient care Have female assistant present if possible Position patient lying on left side Dont control bleeding by keeping patients legs

together Give patient towel/sanitary napkins


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Emergency Care VaginalBleeding continued

Dont pack vagina

Save expelled material to give to arriving EMS

Follow local protocol re: oxygen

Treat for shock


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Miscarriage


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Miscarriage

Loss of embryo/fetus in first 14 weeks

20% - 25% of pregnancies end in miscarriage

May result from a genetic disorder, fetal

abnormality, a factor related to womans health,or no known cause

Most women dont have problems with laterpregnancies


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Assessing Miscarriage

Perform standard assessment

Take repeated vital signs


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Signs and Symptoms ofMiscarriage

Vaginal bleeding

Abdominal pain or cramping


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Emergency Care for Miscarriage

Provide same emergency care as vaginalbleeding in pregnancy

Retain expelled materials for EMS personnel

Be calm and reassuring


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Trauma inPregnancy


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Trauma in Pregnancy

Womans blood volume increases significantly in

pregnancy

Blood loss may not immediately cause signs of

shock Blood flow reduced to fetus

Signs of internal blood loss may not be apparent


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Emergency Care for Trauma inPregnancy

Perform standard patient care

Assume there is internal bleeding

Treat for shock


Dont let patient late in pregnancy lie flat on her

back

Raise right side higher to reduce pressure onvena cava


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Other Problems


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Other Problems

See healthcare provider:

Abdominal pain

Persistent or severe headache

Sudden leaking of water Persistent vomiting, chills and fever,

convulsions, difficulty breathing

Persistently elevated blood pressure

Signs or symptoms related to diabetes


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Childbirth


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Childbirth

Remember it is anatural process

Woman may be

fearful or distressed Remain calm


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Supportive Care During Labor

Ensure plan for transport Help woman rest

Provide comfort measures

Do not let woman have bath

Write down contraction intervals and length

Remind woman to control breathing

Continue to provide reassurance


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Assessing Whether Delivery IsImminent

Labor usually lasts for several hours

In rare occasions, labor progresses quickly

May begin weeks before due date

Prepare to assist in childbirth


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Gather Information from theWoman

Name, age, and due date

Physicians name/telephone number

Ask if she:

Has given birth before Knows whether she may be having twins

Has broken her water and to describe it

Has experienced any bleeding

Has any past or present medical problems

Give this information to arriving EMS personnel


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Assessing Childbirth Imminence

When did contractions begin?

How close together are they?

How long does each last?

Feels strong urge to push?

Check whether infants head is crowning


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Preparing for Delivery

Someone must stay with woman

Gather the items needed or helpful for delivery

Many First Responders carry OB kit


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Items Needed for Delivery

Clean blanket/coverlet

Several pillows

Plastic sheet, or stack of newspapers (to cover

bed surface) Clean towels and washcloths

Sanitary napkins or pads of clean cloth

Medical exam gloves Plastic bags (for afterbirth and clean-up)


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Items Needed for Deliverycontinued

Bowl of hot water (for washingbut not theinfant)

Empty bowl (in case of vomiting)

Clean handkerchief (to wear as facemask) Clean, soft towel, sheet, or blanket (to wrap

newborn)

Bulb syringe (to suction infants mouth)


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Items Needed for Deliverycontinued

If help may be delayed:

Clean strong string, shoelaces, or cloth strips (totie cord)

Sharp scissors or knife (to cut cord) Sterilize in boiling water for 5 minutes or hold over

flame for 30 seconds


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Preparation for Childbirth

Prepare birthing bed

Roll up sleeves, wash hands thoroughly for 5minutes, put on medical exam gloves


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Prepare for Childbirth continued

Protect your eyes, mouth, and nose fromblood/other fluids

Do not let woman use bathroom

Do not touch vaginal areas except duringdelivery

Call dispatch or healthcare provider foradditional instructions

When crowning occurs, move woman intobirthing position

Assist with delivery


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As infants head

appears, have glovedhands ready to receive

and support the head


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Childbirth Care: Assisting withDelivery continued

3. As the heademerges (usuallyface down),

support the head4. After the head is

out, have thewoman stop

pushing andbreathe in apanting manner


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5. Hold with head lower

than feetSuction nose and mouthwith bulb syringe


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6. Gently dry and wrap theinfant in a towel or blanketto prevent heat loss,keeping the cord loose

7. Follow your local protocolto clamp or tie theumbilical cord or leave itintact for arriving EMSpersonnel


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8. Wait for the delivery of the afterbirth, theplacenta, and umbilical cord

9. Do not pull on the umbilical cord in an attemptto pull out the placenta


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Care of the MotherAfter Delivery

Support and comfort mother

Monitor pulse and breathing Replace any blood-soaked sheets/blankets, dispose of

used supplies

The mother may drink water now


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Bleeding After Delivery

Bleeding normally occurs with childbirth anddelivery of placenta

Usually stops after placenta delivered

Use sanitary pads or clean folded cloths toabsorb blood

To help stop bleeding, massage the abdomenbelow navel


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Care for Bleeding After Deliverycontinued

If bleeding persists:

Be sure you are kneading with your palms

Keep mother still and try to calm her

Treat for shock


Encourage breastfeeding


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Care for theNewborn


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Care of the Newborn

Assess the newborn:

Note skin color, movement, and whethercrying is strong or weak

Normal respiratory rate is more than 40breaths/minute

The normal pulse is more than 100beats/minute

Note any changes over time

Provide this information EMS personnel


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Care of the Newborn continued

Dry newborn

Ensure that infant stays wrapped, including thehead, to stay warm

Support the newborns head if it must be movedfor any reason

Continue to check breathing and the airway


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Premature Infants

Premature infant at greater risk for complications

It is crucial to keep a small newborn warm

Resuscitation is more likely to be needed


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Non-breathing Newborn

If newborn is not crying, gently flick bottom offeet or gently rub its back

If it is still not crying, check for breathing


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If infant is not breathing:

Provide two gentle ventilations mouth to mask

Assess breathing and pulse

If breathing is absent, slow, or very shallow,provide ventilations

40-60 breaths/minute



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If infant is not breathing

Pulse 60 100 beats/minute, continueventilations

If pulse is 60 beats/minute, start chestcompressions

Rate of 120/minute

Use thumb-encircling method with second

responder 3 compressions: 1 breath

N b thi N b


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Non-breathing Newborncontinued

Reassess breathing and pulse after 30 seconds

If pulse is 100 and respiration has improved,

gradually discontinue ventilations


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Childbirth Problems

Most deliveries occurwithout problems

Common problems

involve presentation ofinfant or maternalbleeding


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B tt k f t


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Buttocks or feetappear in birthcanal

Umbilical cord issqueezed andblood flow is

compromised If infants head

becomes lodgedin birth canal and

it tries to breathe,it may suffocate

Breech Birth


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Support body as it emerges, do not try to pull head out

If head does not emerge soon, create breathing space

for infant Check infant immediately and give CPR if needed

Breech Birth


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Limb Presentation

Rarely, arm or leg may emerge first

Emergency requiring immediate medicalassistance


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Limb Presentation Put woman inknee-chest

position Do not try to

pull infant outor push arm or

leg back in


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Prolapsed Cord

Segment of cordprotrudes through birthcanal before childbirth

Cord will becompressed as infantmoves through canal

Emergency Care for Prolapsed


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Emergency Care for ProlapsedCord

Follow local protocol to position woman either inthe knee-chest position or lying on the left side

Place dressings soaked in sterile or clean wateron cord.

Follow local protocol re: oxygen Dont push cord back inside mother

If medical personnel have not arrived wheninfant presents/ begins to emerge, follow local

protocol

Emergency Care for Prolapsed


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Emergency Care for ProlapsedCord Continued

Carefully insert sterile gloved hand into birthcanal and gently push presenting part away fromcord while allowing birth to continue

If not possible, open a breathing space with yourfingers as for breech presentation

Check infant immediately and be prepared togive CPR


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Cord Around Neck

Umbilical cord may be around neck when infantemerges

Slip it over head or shoulder


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Cord Around Neck

If it is too tight and you cannot release head, it isa life-threatening emergency

Tie off cord in two places and cut cord between

the two


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Care for Premature Infant

Keep premature newborn warm Provide ventilations or CPR if needed

Follow local protocol re blow-by oxygen


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Stillborn Infant

Infants rarely born dead or die shortly after birth

Use all resuscitation measures available

Provide comfort for mother

16 Childbirth

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