Obstetrical Emergencies Flashcards
Key reminders whe
If a pregnant woman is about to give birth, summon EMS personnel. Important information to give to the dispatcher includes the pregnant woman’s age and expected due date, the length of time she has been having labor pains and the number of previous pregnancies she has had.
You also should speak with the woman to help her remain calm.
Do not let the woman get up or leave to find a restroom. (Most women at this point feel a desire to use the restroom.)
Remember, the woman delivers the baby, so be patient and let it happen natural.
Expect delivery to be imminent when you observe what signs and symptoms?
Expect delivery to be imminent when you observe the following signs and symptoms:
o Intense contractions are 2 minutes apart or less and last 60 to 90 seconds.
o The woman’s abdomen is very tight and hard.
o The mother reports feeling the infant’s head moving down the birth canal or has a sensation like an urge to defecate.
o Crowning occurs (the infant’s head appears at the opening of the birth canal).
o The mother reports a strong urge to push.
What is your job for the delivery process and how can you be prepared?
Assisting with the delivery is often a simple process. The expectant mother does all the work; your job is to create a clean environment and to help guide the baby from the birth canal, minimizing injury to the mother and baby.
Begin by positioning the mother. She should be lying on her back, with her head and upper back raised, not lying flat. Her legs should be bent, with the knees drawn up and apart. Position the mother in a way that will make her more comfortable.
Establish a clean environment for delivery. Because it is unlikely that you will have sterile supplies, use items such as clean sheets, blankets, towels or clothes. To make the area around the mother as sanitary as possible, place these items over the mother’s abdomen and under her buttocks and legs. Keep a clean, warm towel or blanket handy to wrap the newborn.
Because you will be coming into contact with the mother’s and baby’s body fluids, be sure to wear disposable gloves. Wear protective eyewear and a disposable gown, if they are available, to protect yourself.
Other items that can be helpful include supplemental oxygen; a bulb syringe to suction secretions from the infant’s mouth and nose; gauze pads or sanitary pads to help absorb secretions and vaginal bleeding and a large plastic bag or towel to hold the placenta after delivery.
Continually check the mother for indications the baby is crowning. You may see the head of the baby appear, or the vagina may be bulging. Once crowning takes place, take the following steps to assist with delivery:
As crowning occurs, place a hand on the top of the baby’s head and apply light pressure. By doing so, you allow the head to emerge slowly, not forcefully. Gradual emergence will help prevent tearing of the vagina and injury to the baby.
At this point, the expectant mother should stop pushing. Instruct the mother to concentrate on her breathing techniques. Have her pant. This technique will help her stop pushing and help prevent a forceful birth.
You may have to puncture the amniotic sac with your fingers if the water has not yet broken.
As the head emerges, the baby will turn to one side, which enables the shoulders and the rest of the body to pass through the birth canal.
Check to see if the umbilical cord is looped around the baby’s neck. If it is, gently slip it over the baby’s head. If you cannot slip it over the head, slip it over the baby’s shoulders as they emerge. The baby can slide through the loop.
Guide one shoulder out at a time. Do not pull the baby.
What do you do as the baby emerges?
As the baby emerges, it will be wet and slippery. Use a clean towel to receive/hold the baby.
Place the baby on its side, between the mother and you. By doing so, you can provide initial care without fear of dropping the newborn.
- It is vital you ensure that the nasal passages and airway are clear of secretions. Clear the airway if it is obstructed with secretions after drying, warming and positioning the infant. You can do this by using your finger, a gauze pad or a bulb syringe if one is available. Squeeze a bulb syringe before insertion in the mouth and nose. Clear or suction the mouth before the nose. Repeat this until you are sure the airway is clear.
- If the newborn does not breathe, you must begin giving ventilations.
- Most newborns begin crying and breathing spontaneously. If the newborn has not made any sounds, stimulate a cry reflex by tapping your fingers on the soles of the feet.
- If possible, note the time the baby was born.
What do you do after delivery?
After delivery, wrap the newborn in a clean, warm blanket or towel and place them on the mother’s chest.
After delivery, continue to meet the needs of the newborn while caring for the mother.
1. Help the mother to begin nursing the newborn, if possible. This will stimulate the uterus to contract and help to slow the bleeding.
- The placenta still will be in the uterus, attached to the newborn by the umbilical cord. Contractions of the uterus usually will expel the placenta within 30 minutes. Do not pull on the umbilical cord. Catch the placenta in a clean towel or container. It is not necessary to separate the placenta from the newborn.
Follow local protocols and medical direction for guidance on cutting the cord. Remember the following things if cutting the umbilical cord:
- The umbilical cord will stop pulsating not long after the baby is born.
- When it does, clamp or tie the cord very securely with gauze in two places between the mother and child.
- The clamp closest to the newborn should be about 6 inches from the baby. There should only be about 3 inches between the two clamps.
