chapter 16

Question 1

Childbirth

Answer 1

a normal, natural part of life

Question 2

Two indicators of an impending birth

Answer 2

a. Frequency of contractions
b. Crowning

Question 3

Uterus

Answer 3

holds the fertilized egg as it develops during a pregnancy.

Question 4

The developing infant (fetus)

Answer 4

is encased in an Amniotic Sac for support and floats
in Amniotic Fluid

Question 5

the birth canal (Vagina).

Answer 5

The external opening

Question 6

stages of labor

Answer 6

1. The pregnant woman’s body prepares for birth
2. The birth of the infant
3. Delivery of the Placenta (Afterbirth)

Question 7

The First Stage of Labor: The pregnant woman’s body prepares for birth

Answer 7

(1) Initial contractions occur
(2) The bag of waters breaks
(3) The bloody show occurs
(4) The infant’s head does not appear during contractions

Question 8

The Second Stage of Labor: The birth of the infant

Answer 8

a. You will see the infants head crowning during contractions.
b. There is no time for transport

Question 9

The Third Stage of Labor: Delivery of the Placenta (Afterbirth)

Answer 9

a. You must assist in stabilizing the condition of the mother and infant and
delivering the Placenta.

Question 10

How frequent are the contractions?

Answer 10

Contractions less than 2 minutes apart usually indicate that the delivery will occur very soon.

Question 11

Timing Contraction Cycles

Answer 11

1. Time the contraction from the beginning of one contraction to the beginning of the
   next.
2. If contractions are less than 3 minutes apart, delivery is close.

Question 12

Detecting Crowning

Answer 12

1. Observe the vaginal opening during a contraction.
2. If you see the head crowning during the contraction, prepare for delivery.
3. Do not risk transporting the woman to hospital.

Question 13

Preparing for Delivery

Answer 13

• Place the patient on a firm surface that is padded with blankets, folded sheets, or
  towels.
• Elevate the woman’s hips 2” to 4” with pillows and blankets.
• Place the woman on her back, with her knees bent and flat on the surface beneath her.

Question 14

Caring for the Newborn

Answer 14

1. Immediately clear the newborn’s mouth and nose using a gauze pad or the cleanest
   object available.
2. If the baby does not begin to breathe spontaneously within a few seconds
   a. Wipe the newborn’s mouth and nose with a gauze pad.
3. Place the newborn on the mother’s abdomen to keep the infant from losing warmth
4. if the newborn is not breathing, wipe the mouth and nose again.
   a. Rub the infant’s back or flick the soles of the infant’s feet to stimulate breathing.

Question 15

Delivery of the Placenta

Answer 15

1. The placenta usually delivers on its own within 30 minutes after delivery.
2. Never pull the umbilical cord.
3. Leave the umbilical cord uncut and attached to the placenta and the infant until the
   EMS unit arrives.
4. If umbilical cord is attached, make sure it remains above the level of the mother.

Question 16

After the placenta is delivered:

Answer 16

a. Wrap it in a towel or newspaper with ¾ of the umbilical cord.
b. Place it in a plastic bag and transport it to the hospital.
c. Keep it at the same level as the infant.

Question 17

If the bleeding does not stop, massage the uterus

Answer 17

a. Place one hand just above the mother’s pubic bone.
b. Use the other hand to press down into the abdomen and, using a circular
motion, massage the uterus until it becomes firm.
c. This should take 3-5 minutes

Question 18

Aftercare of the Mother and Newborn

Answer 18

1. Continue to observe the mother and newborn and keep both warm.
2. About every 3-5 minutes, check the uterus for firmness.
3. Recheck the vagina for any excessive bleeding.
   a. In a normal delivery, the mother will lose 300 to 500 mL (1 to 2 cups) of blood.
4. Continue to massage the uterus if it is not firm or bleeding continues.
5. Clean the mother with clean, moist towels or cloths.

Question 19

Resuscitating the Newborn

Answer 19

1. If the newborn does not breath on its own, perform rescue breathing (1 breath every 3-5 seconds).
2. If the newborn is pulseless (or has a pulse less than 60 bpm), perform infant CPR.

Question 20

Premature Birth

Answer 20

a. Any newborn weighing less than 5 pounds or is delivered before 36 weeks
b. infants are smaller, thinner, and usually redder than full term
newborns
c. Keep premature infants warm because they lose heat rapidly

Question 21

Prolapse of the Umbilical Cord

Answer 21

a. Place the mother in a knee to chest position or Trendelenburg position (lying the
mother on her back with the feet elevated high than the head).
b. Keep the cord covered and moist, do not try to push it back into the vagina.
c. If only the cord is prolapsed and the presenting part has yet to go through the
cervix, gently elevate the presenting part to remove pressure on the umbilical
vessels to permit blood flow through the cord.
d. If the cord is wrapped around the neck, have mother stop pushing and you need
to remove the cord from around the neck. The cord is stretchable.
e. Administer oxygen if it is available and you are trained to use it

Question 22

Breech Birth

Answer 22

a. The newborns buttocks come down the birth canal first rather than the head.
b. Support the newborn’s buttocks and legs as they are delivered, the head usually
follows on its own
c. If the head does not deliver within 3 minutes, insert a gloved hand into the
vagina and use your fingers to keep the infants airway open.
d. In exceedingly rare cases, the arm or the leg is the first part of the infant to
appear in the birth canal, limb presentation cannot be handled in the field.

Question 23

Stillborn Delivery

Answer 23

Sometimes an infant dies in the uterus before labor.

Question 24

Automobile Collisions and Pregnant Woman

Answer 24

• The woman should be examined by a physician.
• Promptly assess the patient.
• In rare cases, a crash can be severe enough to kill the pregnant woman and not the
  fetus.

Question 25

Excessive Bleeding After Childbirth

Answer 25

a. Approximately 1-2 cups of blood is lost during childbirth.
b. If the mother is bleeding severely:
i. Place one or more clean sanitary pads at the opening of the vagina.
ii. Elevate her legs and hips.
c. Massage the uterus with your hand, as mentioned before.