EMR: Chapter 23 Pregnancy and Childbirth

Braxton Hicks contractions

(false labor pains) intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses

Coaching steps for delivery

-As each contraction begins, have the mother take a deep breath, hold it, and encourage her to gently bear down, or push. -Encourage her to rest between each contraction and to breathe normally. -If available, have the father or someone appropriate at the mother's head to help coach her through each contraction. -As the baby's head emerges, ask the mother to stop pushing and to start panting so that the baby's head can slide slowly out of the birth canal.

limb presentation

when an infant's limb protrudes from the vagina before the appearance of any other body part

crowning

when part of the baby is visible through the vaginal opening

Prolapsed cord

when the umbilical cord delivers first; it is common in a breech birth.

S/S supine hypotensive syndrome

•Pallor •Bradycardia •Sweating •Nausea •Hypotension •Dizziness

Three stages of labor

1) dilation 2) expulsion 3) placenta

EC limb presentation

1. Ask dispatch to notify EMT or ALS responders of the emergency. 2. Do not pull on the limb or try to place your gloved hand into the birth canal. 3. Do not try to place the limb back into the vagina. 4. Place the mother in the knee-chest position to help reduce pressure on the fetus and the umbilical cord. Medical direction and protocols may instruct you to keep the mother in the typical delivery position. Follow your protocols

Caring for a baby

1. Clear the baby's airway. 2. Position the baby on his side with head slightly lower than his body to allow for drainage. 3. Keep the baby's body at the level of the vagina until the cord is clamped. 4. Use a sterile gauze pad or a clean handkerchief to clear mucus and blood from around the baby's nose and mouth E. Make certain that the baby is breathing. If the baby does not breathe on his own by the time you clear the airway (30 seconds), vigorously but gently rub the baby's back. If this fails to stimulate breathing, snap one of your index fingers against the soles of the baby's feet. F. Once you are sure the baby is breathing, perform a quick assessment (skin color, deformities, strength of cry, and whether he moves). After a few minutes, note if there are any changes in those conditions. Give information to transport personnel. G. Clamp or tie off the cord, if protocol allows. H. Keep the baby warm.

timing of labor

1. Contraction time—span of time from the beginning of a contraction until it relaxes 2. Interval time—span of time from the start of one contraction to the beginning of the next contraction (frequency)

EC Mother Delivering the placenta (afterbirth)

1. Delivers anywhere from a few minutes to 20 minutes or longer after the baby is born. 2. The mother should remain at rest until delivery of the afterbirth. 3. Save the placenta, all attached membranes, and all soiled sheets and towels. 4. Try to position a basin or container at the vaginal opening so the afterbirth will deliver into it. 5. Once you collect it, place the container in a biohazard bag. Label the bag with the mother's name.

EC for newborn

1. Dry the baby and wrap him in a clean towel or blanket. 2. Keep the baby's head covered. 3. Suggest and encourage the mother to nurse the baby.

EC nonbreathing newborn

1. Give 2 gentle breaths using mouth-to-mask or BVM technique. 2. Assess breathing and heartbeat. 3. Use appropriate size BVM. 4. Provide ventilations if breaths are shallow, slow, or absent. Ventilate at 40 to 60 breaths per minute. 5. HR greater than 100 and infant is breathing adequately, stop ventilations but provide gentle stimulation, and oxygen. 6. HR below 100 beats per minute and respirations are inadequate, continue to assist ventilations with BVM 7. HR less than 60 continue to assist ventilations and begin chest compressions. Continue until baby is able to maintain adequate breathing and pulse or until a higher level of EMS provider relieves you. 8. Perform CPR of 30: 2 for a 1 rescuer or 15:2 for 2 rescuers. Provide blow-by oxygen.

Questions to ask expectant mother

1. Name, age, and expected due date 2. Are you seeing a doctor during pregnancy?Name and contact number) 3. Is this your first delivery? (first labor will typically last about 16 hours—with subsequent births happening quicker) 4. How long was your labor? (if this is not the first) 5. Did you require a C-section? 6. Do you have any known complications? (e.g., multiple birth) 7. Have your discharged any watery or bloody mucus? 8. How long have you been having labor pains? 9. How frequent are the contractions? 10. has your water broken?, When?, and what color? (clear is normal; cloudy or green indicates stressed fetus) 11. Do you feel strain in your pelvis or lower abdomen, Do you feel the need to move your bowels? Can you feel the baby beginning to move into her vaginal opening? 12. Do you have any significant medical information (e.g., history of seizures, diabetes)

Items needed for infant delivery

1. Personal protective equipment (protective gloves, face masks, eye shields, and gowns) 2. Towels, sheets, and blankets for draping the mother, for placement under the mother, and for drying and wrapping the baby 3. Gauze pads for wiping mucus from the baby's mouth and nose 4. Rubber bulb syringe for suctioning the baby's mouth and nose 5. Clamps and ties for use on the umbilical cord before cutting 6. Sterile scissors or a single-edged razor for cutting the cord 7. Sanitary pads or bulky dressings for vaginal bleeding 8. Basin and plastic bags for collecting and transporting the placenta 9. Red, plastic biohazard bags for storing and disposing of soiled linens and dressings

EC Vaginal bleeding after delivery

1. Place sanitary pad or clean towel over the vaginal opening. Do not place anything in the vagina. 2. Have mother lower her legs and keep together. 3. Feel mother's abdomen until you find a grapefruit-size object. This is the uterus. Gently but firmly massage from the pubis bone at the front of the pelvis upward only and toward the naval to stimulate the uterus to contract. 4. If bleeding continues, provide oxygen and maintain normal body temperature. Arrange transport as soon as possible, continue to massage the uterus, and encourage the mother to nurse if she wants to do so.

Birth appears likely before EMTs can transport

1. Place supplies so they are within your reach during the delivery process. 2. Don your personal protective equipment. 3. Prepare the mother for delivery. Ask if the mother has been receiving prenatal care.

Steps for using the bulb syringe

1. Squeeze the bulb first. 2. Insert the tip about one inch into the baby's nose or mouth. 3. Gently release the pressure to allow the syringe to take up fluids. 4. Remove the tip of the filled syringe from the baby and squeeze out any fluids onto a towel or gauze pad. 5. Repeat this process two or three times for the mouth and for each nostril.

Childbirth complications

1. Younger than 18 or older than 35 years of age 2. First pregnancy or more than five pregnancies 3. Swollen face, feet, or abdomen from water retention 4. High or low blood pressure 5. Diabetes 6. Illicit drug use during pregnancy 7. History of seizures 8. Predelivery bleeding 9. Infections 10. Alcohol dependency 11. Injuries from trauma 12. Premature rupture of membranes

EC Sexual assault

1. professional manner, attitude, and emotional support are important steps 2. she can receive injuries to the external soft tissues, the vaginal canal, and the internal organs. 3. The fetus may receive injuries from direct blows to the abdomen or as a result of injuries to the mother. 4. Provide emotional support and protect the patient from embarrassment from onlookers. 5. Do not clean the vaginal area. Advise the patient not to wash or go to the bathroom (so the hospital can collect evidence). 6. Collect clothing and any items used during the assault for examination and legal needs. Transport evidence in a paper container or wrap it in a towel. Do not place it in plastic. 7. Provide care that will prevent or manage shock and arrange transport as soon as possible. 8. Listen to your patient and talk to her throughout all procedures.

EC preeclampsia

1. rapid transport to a hospital is essential. 2. Support the ABCs as necessary, and provide high-flow oxygen, if protocols allow.

Average process of labor lasts about

16 hours

human gestation period

38 and 40 weeks and is divided into three-month segments called trimesters.

Stillborn deliveries

A fetus that is delivered dead is called stillborn. Some die shortly after birth.

placenta

A structure that allows an embryo to be nourished with the mother's blood supply

Preparing for Delivery

A. Don appropriate face and eye protection, gown, and protective gloves. B. Make sure EMS has been activated. C. Provide emotional support, and help the mother remain calm. D. If the expectant mother complains that she feels as if she needs to go to the bathroom, tell her that this is normal and that it is caused by pressure on her bladder and rectum. Encourage her to remain lying down. E. Place clean sheets or towels under her buttocks. If she does have a bowel movement or urinates, tell her that this is normal. Remove soiled linens, and replace them with fresh ones.

vaginal bleeding - trauma

a. Blunt force and penetrating trauma b. Intercourse c. Sexual assault d. Reproductive organ problems e. Abnormal pregnancy f. Placental tears and uterine rupture

EC meconium staining

Be prepared to wipe the baby's mouth and nose and to suction.

fetus

In humans, the term for the developing organism between the embryonic stage and birth.

Preeclampsia and eclampsia

Most common hypertensive disorder; develops during pregnancy and is characterized by elevated blood pressure, edema and proteinuria; characterized by an increase BP of 30mmHg systolic and/or diastolic increase of 15mmHg diastolic; 10 weeks gestation or 48 hours post delivery; major cause of maternal death, fetal hypoxia and death; predominately primigravida

EC supine hypotensive syndrome

Reposition the mother to a more seated position (semi-Fowler's) or have her lie on her left side.

miscarriage

The expulsion of a baby from the mother's body before week 20 of pregnancy

supine hypotensive syndrome

When the mother lies on her back, the weight of the fetus and other organs press on the mother's inferior vena cava, the large vessel in the abdomen that returns blood back to the heart. The pressure restricts blood return to the heart, causing signs of shock, increased pulse, pale skin, and possibly altered mental status.

amniotic sac

a fluid-filled sac that cushions and protects a developing embryo and fetus in the uterus

S/S of ectopic pregnancy

a. Abdominal pain b. Absence of normal menstrual cycle c. Vaginal bleeding

S/S Preeclampsia and eclampsia

a. Abnormally high blood pressure b. Fluid retention causing swelling of the arms, hands, and face c. Headache d. Nausea

EC Prebirth bleeding

a. Call 911. b. Take BSI precautions c. Place patient on her left side, but do not hold her legs together. d. Provide care for shock, monitor airway, and administer oxygen per local protocol. e. Place sanitary pad or bulky dressings over vaginal opening. f. Replace pads or dressings as they become soaked. Do not place anything in the vagina. g. Save all blood-soaked pads and dressings, as well as any tissues that mother passes. Place them in a biohazard bag for transport to the hospital and examination by a physician. h. Monitor and reassure patient while you wait for EMT or ALS personnel.

EC breech birth

a. Place mother on a high flow oxygen. b. Create airway for baby. Insert gloved hand into the vagina, with your palm toward the baby's face. Form a "V" by placing one finger on each side of the baby's nose. If you cannot do this, place one fingertip into the infant's mouth and push away the birth canal wall with your other fingers. c. Maintain airway. Do not pull on baby. Allow delivery to take place while you continue to support baby's body and head. d. If the head does not deliver in three minutes after you have created an airway, have the mother and infant transported to a medical facility immediately. Maintain airway until higher-level EMS personnel relieve you.

EC miscarriage

a. Place the patient on her side, provide care for shock, and administer oxygen per local protocols. b. Take a baseline set of vital signs. Take vital signs every few minutes thereafter. c. Place a sanitary pad or bulky dressing over the vaginal opening. Do not place anything in the vagina. d. Save all blood-soaked pads and any tissues that are passed. Place them in a biohazard bag. e. Provide emotional support and reassure the patient. Arrange for EMT or ALS personnel to transport immediately

EC prolapsed cord

a. Place your fingers into the vaginal opening in front of the infant's face and make a "V." Do not push the cord back into the birth canal. b. Place the mother in a knee-chest position to reduce pressure on the cord. c. Try to maintain a pulse in the cord. d. Place wet dressings over the cord to keep it moist. e. Wrap the cord in a towel or dressing to keep it warm. f. Provide the mother with high-concentration oxygen as soon as possible. g. Monitor vital signs and arrange for transport immediately.

Cord cutting steps

a. Use sterile clamps and umbilical ties found in the OB kit. b. Apply one tie or clamp to the cord about six inches from the baby's abdomen. c. Place a second tie or clamp about two inches farther from the baby. d. Cut between the two ties or clamps. Never untie or unclamp the cord once it has been cut. Check to see that bleeding has stopped from the cut ends; if it has not, apply another tie or clamp as close to the original as possible

breech birth

abnormal childbirth in which the buttocks, feet, or knees emerge first

meconium staining

amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defecation; an indication of possible maternal or fetal distress during labor.

sexual assault

any intentional sexual attack against another person

Second stage of labor

begins when the baby enters the birth canal and ends when he is born.

Third stage of labor

begins when the baby is born. It ends when the placenta (afterbirth) is delivered

First stage of labor

begins with the onset of regular contractions and ends when the cervix is fully dilated (10 centimeters), allowing the baby to enter the birth canal.

Preterm births

births that take place prior to 37 weeks of gestation

ectopic pregnancy

implantation of the fertilized egg in any site other than the normal uterine location

rupture of membranes

is when the amniotic membranes rupture and allow the amniotic fluid to escape.

imminent birth

mother has urge to bear down, is having contractions two minutes apart or less, or is straining or complaining about having to go to the bathroom.

Labor contractions

occur in cycles of contraction and relaxation

womb, or uterus

the organ in the body of a woman or other female mammal in which a baby develops before birth

labor

the process the body goes through to deliver a fetus. The muscles of the uterus contract and push the baby down through the opening of the uterus (cervix).