EMERGENCY CHILDBIRTH

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INTRODUCTION

Optimal patient care requires that the EMT-I understands the physiology of pregnancy and management of patients experiencing childbirth. The following topics will be discussed during this lesson:

· Female reproductive anatomy and physiology

· Pregnancy; physiologic changes

· Normal delivery process

· Care of the mother and newborn immediately after delivery

· Potential complications during pregnancy and labor

LESSON OBJECTIVES

At the completion of this lesson the participants will be able to:

1. Identify normal anatomy and physiology of the female reproductive system

2. Discuss physiologic changes during pregnancy

3. Define the role of the EMT-I & EMT-P during emergency childbirth

4. State the priorities of care in an uncomplicated field delivery

5. Identify the stages of labor

6. Discuss the postpartum care of the mother and newborn

7. Identify common complications of pregnancy

8. Identify potential complications and treatment during labor

SKILLS

· Initial assessment, Focused History and Detailed Physical Examination of the pregnant patient and newborn

· Childbirth

KEY VOCABULARY

· Abortion: The expulsion of an embryo or fetus from the uterus before the 20^th week; can occur spontaneously or through a medicalprocedure

· Abruptio placentae: Sudden separation of the placenta from the wall of the uterus

· Amniotic sac: Fibrous sac that is filled with a clear to straw colored fluid called fluid, also called “bag of water”; protects the fetus

· APGAR: Scoring system used to evaluate the condition of a newborn after one and five minute(s) of life

· Breech birth: A birth in which the presenting part of fetus is either the buttocks, foot, or leg of the fetus

· Cervix: Neck of the uterus which dilates during labor to allow passage of the baby into the vagina (birth canal)

· Crowning: Bulging of the perineum when birth is imminent and the presenting part is visible at the vaginal opening

· Eclampsia: Predelivery increase in blood pressure which ultimately results in seizure activity

· Fallopian tubes: Paired canal approximately four inches long connecting the ovary to the uterus

· Gravida: Total number of pregnancies

· Gynecology: The study of diseases of womens reproductive organs

· Labor: Regular uterine contractions that increase in frequency and intensity that propel the fetus from the uterus

· Meconium: Fetal intestinal contents that stains the amniotic fluid green or black; fetus may expel contents of bowels before birth due to stress; indicates a birth complication

· Menstruation: The periodic sloughing of the uterine lining, which is comprised of blood, issue, and cells

· Mucous plug: An accumulation of mucus that forms and interlocks with the capillaries of the cervix during pregnancy; acts as a protective barrier between the cervix and the vagina for the length of the pregnancy

· Obstetrics: The branch of medicine that deals with the management of women during pregnancy, childbirth and 42 days after the expulsion of all contents of pregnancy

· Ovaries: Paired, almond-shaped organs suspended by ligaments in the left and right lower quadrants of the abdomen that release a mature egg once a month in women and girls from the approximate ages of 9 to 50 years

· Ovulation: The release of a mature egg from an ovary once a month

Total number of viable (20 weeks or greater) births

· Perineum: Space located between the vaginal opening and the anal opening

· Placenta: Highly vascular dishlike structure that links the tissue of the mother with that of the fetus. The placenta exchanges oxygen and carbon dioxide between the fetus and mother, transports nutrients and waste by-products, and serves as a temporary source for hormone production necessary to sustain pregnancy

· Placenta previa: Condition in which the placenta implants itself either on or near the opening of the cervix; severe bleeding in late pregnancy occurs when the cervix begins to dilate in early delivery

· Presenting part: The part of the fetus that protrudes initially during the birthing process

· Prolapsed cord: Premature expulsion of the umbilical cord

· Trimester: A 3-month period; there are three 3-month periods, or three trimesters, during a pregnancy

· Tubal pregnancy: Pregnancy in which the fertilized egg implants in a fallopian tube; also known as an ectopic pregnancy

· Umbilical cord: Fibrous, whitish cord that connects the fetus to the placenta

· Uterine rupture: Rupture of the uterus caused by trauma or previous cesarean scarring

· Uterus: Single, pear-shaped, muscular organ located between the rectum and the bladder that houses the fetus during fetal development

· Vagina: Fibromuscular sheath that lead from the uterus and extends to the vaginal opening

KEY CONCEPTS

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

ANATOMY AND PHYSIOLOGY

Female Reproductive Anatomy

• Ovaries

• Fallopian Tubes

• Uterus

• Cervix

• Vagina

• Perineum

Specialized Structures of Pregnancy

• Fetus

• Placenta

• Umbilical cord

• Amniotic sac

• Amniotic fluid

• Mucus plug

Physiologic Changes During Pregnancy

Cardiovascular

• Hypervolemia

• Increased perfusion of the uterus

• Anemia

• Decreased venous return

• Amniotic sac

Respiratory

Abdominal

• Decreased Response to peritoneal irritation

• Bladder elevated out of pelvis

• Decreased peristalsis

Musculoskeletal

• Softening of most joints

• Relaxation of sacroiliac joint

• Widening of the symphysis pubis

FOCUSED HISTORY AND DETAILED PHYSICAL EXAMINATION

(after initial assessment completed)

• Last menstrual period

• Due date

• Prenatal care

• Prior pregnancy history

• Medical problems

• Rupture of membranes

Physical Assessment

• Vital signs

• Mucus plug/bag of waters

• Vaginal bleeding/spotting

• Abdominal/back pain

• Abdomen rigid or hard

• Feeling as though bowels need to move

• Bulging perineum

• Presenting part visible

• Contractions

• frequency/duration/intensity

Transport vs. Field Delivery Considerations

• Number of pregnancies

• Signs of imminent delivery

• Presence of complications

DELIVERY PROCEDURE

Stages of Labor

• First Stage: From the first contraction, until full dilation of the cervix

• Second Stage: From dilation of the cervix, to the birth of the child

• Third Stage: From the birth of the child, until the delivery of the placenta

Assisting with Normal Delivery Process

Preparation

• Universal precautions

• Position mother on her back with her knees bent and spread apart

• Elevate the patient’s buttocks with a towel or blanket

• Create a sterile field around the vaginal opening if possible

• Place a gloved hand on the presenting part and apply slight pressure to prevent an explosive birth

Delivery of Fetus

Delivery of Fetus

• If the amniotic bag has not broken, use a clamp to puncture a hole in the membrane

• Tear the membrane away from the head and mouth of the infant

• Once the head has delivered, feel to ensure that the umbilical cord is not wrapped around the neck

• Aggressively suction the mouth and nose of the infant

• Place both hands on either side of the bay’s head and apply gentle downward pressure to deliver the upper shoulder; then gently apply upward pressure to deliver the lower shoulder

• Support the head and shoulders carefully; the baby will be very slippery

• The rest of the baby will deliver quickly, usually within the next two contractions

• Once the baby is delivered, wipe the blood and mucus from the mouth and nose and suction again

Post-delivery Care of the Mother

• 500cc blood loss is normal for vaginal delivery