Post on 07-Apr-2018
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Childbirth
Lesson 16
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Childbirth
Sometimes occurs outside planned setting
Rarely becomes medical emergency
Problems early/complications become
emergencies
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Pregnancy and Labor
Begins with fertilization of ovum
Growth/development 40 weeks
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Stages of Pregnancy
Divided into three trimesters three months each
Single cell divides into many
First eight weeks an embryo; then fetus
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Stages of Pregnancy
Fetus develops inside amniotic sac
Embryo attached to placenta
All major organ systems developed by week 8
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Week 36, fetus fullyformed
Near end of
pregnancy, head offetus positioneddownward in pelvis.
Fetus passes
through dilatedcervix and vagina.
Stages of Pregnancy
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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
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First Stage
Amniotic sac ruptures before or during first stage
Uterine contractions begin and eventually pushinfants head into cervix
1015 minutes apart initially
2-3 minutes apart shortly before birth
May last few hours to a day
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Second Stage
Typically lasts 1 2 hours Cervix fully dilated
Contractions powerful andpainful
Infants head presses onfloor of pelvis urge topush down
Vagina stretches open Head emerges (crowning)
Rest of body pushed out
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Third Stage
Placenta separatesfrom uterus anddelivered
Usually within 30 minof birth
Uterus contracts andseals off blood
vessels
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Emergency Care DuringPregnancy
Women who receive regular care are advisedabout potential problems to watch for
Although rare, problems may require emergency
care
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Vaginal Bleeding
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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
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Assessing Vaginal Bleeding
Perform standard assessment
Take repeated vital signs
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Emergency Care VaginalBleeding
Perform standard patient care Have female assistant present if possible Position patient lying on left side Dont control bleeding by keeping patients legs
together Give patient towel/sanitary napkins
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Emergency Care VaginalBleeding continued
Dont pack vagina
Save expelled material to give to arriving EMS
Follow local protocol re: oxygen
Treat for shock
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Miscarriage
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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 womans health,or no known cause
Most women dont have problems with laterpregnancies
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Assessing Miscarriage
Perform standard assessment
Take repeated vital signs
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Signs and Symptoms ofMiscarriage
Vaginal bleeding
Abdominal pain or cramping
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Emergency Care for Miscarriage
Provide same emergency care as vaginalbleeding in pregnancy
Retain expelled materials for EMS personnel
Be calm and reassuring
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Trauma inPregnancy
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Trauma in Pregnancy
Womans 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
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Emergency Care for Trauma inPregnancy
Perform standard patient care
Assume there is internal bleeding
Treat for shock
Follow local protocol re: oxygen
Dont let patient late in pregnancy lie flat on her
back
Raise right side higher to reduce pressure onvena cava
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Other Problems
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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
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Childbirth
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Childbirth
Remember it is anatural process
Woman may be
fearful or distressed Remain calm
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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
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Assessing Whether Delivery IsImminent
Labor usually lasts for several hours
In rare occasions, labor progresses quickly
May begin weeks before due date
Prepare to assist in childbirth
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Gather Information from theWoman
Name, age, and due date
Physicians 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
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Assessing Childbirth Imminence
When did contractions begin?
How close together are they?
How long does each last?
Feels strong urge to push?
Check whether infants head is crowning
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Preparing for Delivery
Someone must stay with woman
Gather the items needed or helpful for delivery
Many First Responders carry OB kit
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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)
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Items Needed for Deliverycontinued
Bowl of hot water (for washingbut not theinfant)
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 infants mouth)
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Items Needed for Deliverycontinued
If help may be delayed:
Clean strong string, shoelaces, or cloth strips (totie cord)
Sharp scissors or knife (to cut cord) Sterilize in boiling water for 5 minutes or hold over
flame for 30 seconds
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Preparation for Childbirth
Prepare birthing bed
Roll up sleeves, wash hands thoroughly for 5minutes, put on medical exam gloves
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Prepare for Childbirth continued
Protect your eyes, mouth, and nose fromblood/other fluids
Do not let woman use bathroom
Do not touch vaginal areas except duringdelivery
Call dispatch or healthcare provider foradditional instructions
When crowning occurs, move woman intobirthing position
Assist with delivery
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As infants head
appears, have glovedhands ready to receive
and support the head
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Childbirth Care: Assisting withDelivery continued
3. As the heademerges (usuallyface down),
support the head4. After the head is
out, have thewoman stop
pushing andbreathe in apanting manner
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5. Hold with head lower
than feetSuction nose and mouthwith bulb syringe
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Childbirth Care: Assisting withDelivery continued
6. Gently dry and wrap theinfant in a towel or blanketto prevent heat loss,keeping the cord loose
7. Follow your local protocolto clamp or tie theumbilical cord or leave itintact for arriving EMSpersonnel
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Childbirth Care: Assisting withDelivery continued
8. Wait for the delivery of the afterbirth, theplacenta, and umbilical cord
9. Do not pull on the umbilical cord in an attemptto pull out the placenta
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Care of the MotherAfter 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
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Bleeding After Delivery
Bleeding normally occurs with childbirth anddelivery of placenta
Usually stops after placenta delivered
Use sanitary pads or clean folded cloths toabsorb blood
To help stop bleeding, massage the abdomenbelow navel
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Care for Bleeding After Deliverycontinued
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
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Care for theNewborn
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Care of the Newborn
Assess the newborn:
Note skin color, movement, and whethercrying is strong or weak
Normal respiratory rate is more than 40breaths/minute
The normal pulse is more than 100beats/minute
Note any changes over time
Provide this information EMS personnel
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Care of the Newborn continued
Dry newborn
Ensure that infant stays wrapped, including thehead, to stay warm
Support the newborns head if it must be movedfor any reason
Continue to check breathing and the airway
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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
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Non-breathing Newborn
If newborn is not crying, gently flick bottom offeet or gently rub its back
If it is still not crying, check for breathing
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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
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Non-breathing Newborn
If infant is not breathing
Pulse 60 100 beats/minute, continueventilations
If pulse is 60 beats/minute, start chestcompressions
Rate of 120/minute
Use thumb-encircling method with second
responder 3 compressions: 1 breath
N b thi N b
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Non-breathing Newborncontinued
Reassess breathing and pulse after 30 seconds
If pulse is 100 and respiration has improved,
gradually discontinue ventilations
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Childbirth Problems
Most deliveries occurwithout problems
Common problems
involve presentation ofinfant or maternalbleeding
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B tt k f t
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Buttocks or feetappear in birthcanal
Umbilical cord issqueezed andblood flow is
compromised If infants head
becomes lodgedin birth canal and
it tries to breathe,it may suffocate
Breech Birth
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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
Breech Birth
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Limb Presentation
Rarely, arm or leg may emerge first
Emergency requiring immediate medicalassistance
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Limb Presentation Put woman inknee-chest
position Do not try to
pull infant outor push arm or
leg back in
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Prolapsed Cord
Segment of cordprotrudes through birthcanal before childbirth
Cord will becompressed as infantmoves through canal
Emergency Care for Prolapsed
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Emergency Care for ProlapsedCord
Follow local protocol to position woman either inthe knee-chest position or lying on the left side
Place dressings soaked in sterile or clean wateron cord.
Follow local protocol re: oxygen Dont push cord back inside mother
If medical personnel have not arrived wheninfant presents/ begins to emerge, follow local
protocol
Emergency Care for Prolapsed
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Emergency Care for ProlapsedCord Continued
Carefully insert sterile gloved hand into birthcanal and gently push presenting part away fromcord while allowing birth to continue
If not possible, open a breathing space with yourfingers as for breech presentation
Check infant immediately and be prepared togive CPR
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Cord Around Neck
Umbilical cord may be around neck when infantemerges
Slip it over head or shoulder
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Cord Around Neck
If it is too tight and you cannot release head, it isa life-threatening emergency
Tie off cord in two places and cut cord between
the two
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Care for Premature Infant
Keep premature newborn warm Provide ventilations or CPR if needed
Follow local protocol re blow-by oxygen
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Stillborn Infant
Infants rarely born dead or die shortly after birth
Use all resuscitation measures available
Provide comfort for mother