This document provides information about childbirth, including: - Pregnancy is normally divided into three trimesters of three months each. Labor typically occurs in three stages, beginning with contractions and ending with delivery of the placenta. - Potential emergencies during pregnancy or childbirth include vaginal bleeding, miscarriage, trauma, preterm labor, and problems with delivery such as breech presentation. - First responders should gather any available information, prepare for delivery, assist with breathing and warming the newborn, and provide ongoing care until emergency personnel arrive. Procedures are described for non-breathing newborns and potential delivery complications.

1. CHILDBIRTH
LESSON
16

2. CHILDBIRTH
Sometimes occurs outside planned setting
Rarely becomes medical emergency
Problems early/complications become
emergencies

3. PREGNANCY AND LABOR
Begins with fertilization of ovum
Growth/development 40 weeks

4. STAGES OF PREGNANCY
Divided into three trimesters three months
each
Single cell divides into many
First eight weeks an embryo; then fetus

5. STAGES OF PREGNANCY
Fetus develops inside amniotic sac
Embryo attached to placenta
All major organ systems developed by
week 8

6. STAGES OF PREGNANCY
Week 36, fetus fully
formed
Near end of
pregnancy, head of
fetus positioned
downward in pelvis.
Fetus passes
through dilated
cervix and vagina.

7. 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

8. FIRST STAGE
Amniotic sac ruptures before or during
first stage
Uterine contractions begin and eventually
push infant’s head into cervix
10–15 minutes apart initially
2-3 minutes apart shortly before birth
May last few hours to a day

9. SECOND STAGE
Typically lasts 1 – 2 hours
Cervix fully dilated
Contractions powerful and
painful
Infant’s head presses on
floor of pelvis – urge to
push down
Vagina stretches open
Head emerges (crowning)
Rest of body pushed out

10. THIRD STAGE
Placenta separates
from uterus and
delivered
Usually within 30 min of
birth
Uterus contracts and
seals off blood
vessels

11. EMERGENCY CARE DURING
PREGNANCY
Women who receive regular care are
advised about potential problems to
watch for
Although rare, problems may require
emergency care

13. 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

14. ASSESSING VAGINAL BLEEDING
Perform standard assessment
Take repeated vital signs

15. EMERGENCY CARE VAGINAL
BLEEDING
Perform standard patient care
Have female assistant present if possible
Position patient lying on left side
Don’t control bleeding by keeping patient’s
legs together
Give patient towel/sanitary napkins

16. EMERGENCY CARE VAGINAL
BLEEDING CONTINUED
Don’t pack vagina
Save expelled material to give to arriving
EMS
Follow local protocol re: oxygen
Treat for shock

18. 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 woman’s
health, or no known cause
Most women don’t have problems with
later pregnancies

19. ASSESSING MISCARRIAGE
Perform standard assessment
Take repeated vital signs

20. SIGNS AND SYMPTOMS OF
MISCARRIAGE
Vaginal bleeding
Abdominal pain or cramping

21. EMERGENCY CARE FOR
MISCARRIAGE
Provide same emergency care as vaginal
bleeding in pregnancy
Retain expelled materials for EMS
personnel
Be calm and reassuring

23. TRAUMA IN PREGNANCY
Woman’s 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

24. EMERGENCY CARE FOR TRAUMA
IN PREGNANCY
Perform standard patient care
Assume there is internal bleeding
Treat for shock
Follow local protocol re: oxygen
Don’t let patient late in pregnancy lie flat
on her back
Raise right side higher to reduce pressure
on vena cava

26. 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

28. CHILDBIRTH
Remember it is a
natural process
Woman may be
fearful or
distressed
Remain calm

29. 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

30. ASSESSING WHETHER DELIVERY
IS IMMINENT
Labor usually lasts for several hours
In rare occasions, labor progresses
quickly
May begin weeks before due date
Prepare to assist in childbirth

31. GATHER INFORMATION FROM
THE WOMAN
Name, age, and due date
Physician’s 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

32. ASSESSING CHILDBIRTH
IMMINENCE
When did contractions begin?
How close together are they?
How long does each last?
Feels strong urge to push?
Check whether infant’s head is crowning

33. PREPARING FOR DELIVERY
Someone must stay with woman
Gather the items needed or helpful for
delivery
Many First Responders carry OB kit

34. 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)

35. ITEMS NEEDED FOR DELIVERY
CONTINUED
Bowl of hot water (for washing—but not
the infant)
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 infant’s mouth)

36. ITEMS NEEDED FOR DELIVERY
CONTINUED
If help may be delayed:
Clean strong string, shoelaces, or cloth
strips (to tie cord)
Sharp scissors or knife (to cut cord)
Sterilize in boiling water for 5 minutes or hold over
flame for 30 seconds

37. PREPARATION FOR CHILDBIRTH
Prepare birthing bed
Roll up sleeves, wash hands thoroughly for 5
minutes, put on medical exam gloves

38. PREPARE FOR CHILDBIRTH
CONTINUED
Protect your eyes, mouth, and nose from
blood/other fluids
Do not let woman use bathroom
Do not touch vaginal areas except during
delivery
Call dispatch or healthcare provider for
additional instructions
When crowning occurs, move woman into
birthing position
Assist with delivery

39. Help woman lie on
back with knees bent
and apart and feet flat.

40. As infant’s head
appears, have gloved
hands ready to receive
and support the head

41. CHILDBIRTH CARE: ASSISTING
WITH DELIVERY CONTINUED
3. As the head
emerges
(usually face
down), support
the head
4. After the head
is out, have the
woman stop
pushing and
breathe in a
panting manner

42. 5. Hold with head lower
than feet
Suction nose and mouth
with bulb syringe

43. CHILDBIRTH CARE: ASSISTING
WITH DELIVERY CONTINUED
6. Gently dry and wrap the
infant in a towel or
blanket to prevent heat
loss, keeping the cord
loose
7. Follow your local
protocol to clamp or tie
the umbilical cord or
leave it intact for arriving
EMS personnel

44. CHILDBIRTH CARE: ASSISTING
WITH DELIVERY CONTINUED
8. Wait for the delivery of the afterbirth,
the placenta, and umbilical cord
9. Do not pull on the umbilical cord in an
attempt to pull out the placenta

45. CARE OF THE MOTHER
AFTER 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

46. BLEEDING AFTER DELIVERY
Bleeding normally occurs with childbirth
and delivery of placenta
Usually stops after placenta delivered
Use sanitary pads or clean folded cloths to
absorb blood
To help stop bleeding, massage the
abdomen below navel

47. CARE FOR BLEEDING AFTER
DELIVERY CONTINUED
If bleeding persists:
Be sure you are kneading with your palms
Keep mother still and try to calm her
Treat for shock
Follow local protocol re: oxygen
Encourage breastfeeding

49. CARE OF THE NEWBORN
Assess the newborn:
Note skin color, movement, and whether
crying is strong or weak
Normal respiratory rate is more than 40
breaths/minute
The normal pulse is more than 100
beats/minute
Note any changes over time
Provide this information EMS personnel

50. CARE OF THE NEWBORN
CONTINUED
Dry newborn
Ensure that infant stays wrapped,
including the head, to stay warm
Support the newborn’s head if it must be
moved for any reason
Continue to check breathing and the
airway

51. 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

52. NON-BREATHING NEWBORN
If newborn is not crying, gently flick
bottom of feet or gently rub its back
If it is still not crying, check for breathing

53. NON-BREATHING NEWBORN
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
Follow local protocol re: oxygen

54. NON-BREATHING NEWBORN
If infant is not breathing
Pulse 60 – 100 beats/minute, continue
ventilations
If pulse is ≤60 beats/minute, start chest
compressions
Rate of 120/minute
Use thumb-encircling method with second
responder
3 compressions: 1 breath

55. NON-BREATHING NEWBORN
CONTINUED
Reassess breathing and pulse after 30
seconds
If pulse is ≥100 and respiration has improved,
gradually discontinue ventilations

56. CHILDBIRTH PROBLEMS
Most deliveries occur
without problems
Common problems
involve presentation of
infant or maternal
bleeding

57. MECONIUM STAINING
Infant may defecate before/ during
childbirth, staining amniotic fluid brown/
green with meconium
Newborn may inhale fluid with first breath,
causing lung infection
If mother describes amniotic fluid as
having color or if you observe this, tell
arriving EMS personnel

58. BREECH BIRTH
Buttocks or feet
appear in birth
canal
Umbilical cord is
squeezed and
blood flow is
compromised
If infant’s head
becomes lodged in
birth canal and it
tries to breathe, it
may suffocate

59. BREECH BIRTH
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

60. LIMB PRESENTATION
Rarely, arm or leg may emerge first
Emergency requiring immediate medical
assistance

61. LIMB PRESENTATION Put woman in
knee-chest
position
Do not try to
pull infant out
or push arm
or leg back in

62. PROLAPSED CORD
Segment of cord
protrudes through
birth canal before
childbirth
Cord will be compressed
as infant moves through
canal

63. EMERGENCY CARE FOR
PROLAPSED CORD
Follow local protocol to position woman
either in the knee-chest position or lying
on the left side
Place dressings soaked in sterile or clean
water on cord.
Follow local protocol re: oxygen
Don’t push cord back inside mother
If medical personnel have not arrived when
infant presents/ begins to emerge, follow
local protocol

64. EMERGENCY CARE FOR
PROLAPSED CORD CONTINUED
Carefully insert sterile gloved hand into
birth canal and gently push presenting
part away from cord while allowing
birth to continue
If not possible, open a breathing space
with your fingers as for breech
presentation
Check infant immediately and be prepared
to give CPR

65. CORD AROUND NECK
Umbilical cord may be around neck when
infant emerges
Slip it over head or shoulder

66. CORD AROUND NECK
If it is too tight and you cannot release
head, it is a life-threatening emergency
Tie off cord in two places and cut cord
between the two

67. CARE FOR PREMATURE INFANT
Keep premature newborn warm
Provide ventilations or CPR if needed
Follow local protocol re blow-by oxygen

68. STILLBORN INFANT
Infants rarely born dead or die shortly after
birth
Use all resuscitation measures available
Provide comfort for mother