OB SkillsOB Skillsoror

They had 9 months to plan.. But NOW it’s They had 9 months to plan.. But NOW it’s an Emergencyan Emergency

Presented by

David James Keeler NREMT – P

Virginia Beach EMS

HousekeepingHousekeeping

BathroomsBathrooms

SmokingSmoking

Fire/Flood/Famine/FrogsFire/Flood/Famine/Frogs

Goals for the ClassGoals for the Class

Regain familiarity with the call we either dream of or Regain familiarity with the call we either dream of or try desperately to avoidtry desperately to avoid

Reduce possible anxiety associated with deliveries in Reduce possible anxiety associated with deliveries in the field and promote forward thinking to better the field and promote forward thinking to better handle any emergent issueshandle any emergent issues

Initial thoughts..Initial thoughts..Timing is everything…..

Initial thoughts..Initial thoughts..Timing is everything…..

A full term pregnancy is 36-40 A full term pregnancy is 36-40 weeksweeks

Initial thoughts..Initial thoughts..Timing is everything…..

A full term pregnancy is 36-40 A full term pregnancy is 36-40 weeksweeks

Viability is 22 weeksViability is 22 weeks

Initial thoughts..Initial thoughts..Timing is everything…..

A full term pregnancy is 36-40 A full term pregnancy is 36-40 weeksweeks

Viability is 22 weeksViability is 22 weeks

Realistic threshold about 25 Realistic threshold about 25 weeksweeks

Initial thoughts..Initial thoughts..Timing is everything…..

A full term pregnancy is 36-40 A full term pregnancy is 36-40 weeksweeks

Viability is 22 weeksViability is 22 weeks

Realistic threshold about 25 Realistic threshold about 25 weeksweeks

Inevitably limited by lung Inevitably limited by lung development and neural development and neural abilityability

Initial thoughts..Initial thoughts..Analyze the risk factors…

Mother’s ageMother’s age Mother’s Mother’s weight Pre natal careweight Pre natal care Medical Medical HxHx

Multiple BirthsMultiple Births First First Pregnancy NutritionPregnancy NutritionETOH/Drug UseETOH/Drug Use

Initial thoughts..Initial thoughts..Analyze the risk factors…

Mother’s ageMother’s age Mother’s Mother’s weight Pre natal careweight Pre natal care Medical Medical HxHx

Multiple BirthsMultiple Births First First Pregnancy NutritionPregnancy NutritionETOH/Drug UseETOH/Drug Use

Any others??Any others??

Decision Time!Decision Time!“Should I stay or should I go”

- the Clash

Factors to prompt the decisionHow far apart are the contractions

How appropriate is the current scene

Decision Time!Decision Time!“Should I stay or should I go”

- the Clash

Factors to prompt the decisionHow far apart are the contractions

How appropriate is the current scene

Decision may be out of your hands Crowning

Urge to push

Decision Time!Decision Time!“Should I stay or should I go”

- the Clash

Factors to prompt the decisionHow far apart are the contractions

How appropriate is the current scene

Decision may be out of your hands Crowning

Urge to push

False labor - Braxton-Hicks contractionsOccur as early as 3-4 weeks (part of natural stretching)Irregular contractionsLocated in abdomen

Preparing for DeliveryPreparing for Delivery

Check for crowning

Spread legs apart gently

Once pushing begins it can’t be slowed down

Never attempt to hold mother’s legs together and don’t let her go the bathroom!

DeliveryDelivery

You are only assisting the mother

Delivery is a BLS skill

Guide and support the infant as it is born

Support the head with your hand as it emerges

Delivering the InfantDelivering the Infant

Check for the cord around the neck

Suction the mouth first, then nostrils

Let shoulders come out

Use towels to dry and hold when it comes out- slippery little things!

Postdelivery CarePostdelivery Care

Wrap in a clean, dry towel

Keep the face exposed and make sure the top of the head is covered(heat loss)

Warm it up!

Place baby on Mom’s abdomen if the cord is long enough

Clamp and cut the cord

Delivery of the PlacentaDelivery of the Placenta

Placenta usually comes out by itself

Never pull on the cord

Gentle massaging of the uterus after delivery of the placenta helps prevent heavy bleeding

Breast feeding helps contract the uterus

Apgar Score Apgar Score

Appearance

Pulse

Grimace or irritability

Activity or muscle tone

Respirations

Check at 1 and 5 minutes after birth

HemorrhageHemorrhage

If signs of shock, place Mom on left side during transport

High flow oxygen

Sterile pad over vagina replace as necessary and save the pads

Save any tissue that may be passed

Breech PresentationsBreech Presentations

Frank

Complete

Footling

Rare PresentationsRare Presentations

LimbFaceProlapsed cordNuchal Cord

TwinsTwins

Need to clamp two cords-label as 1st and 2nd Second usually delivers a few minutes after

the firstRecord time of delivery and apgar scores

for both infants

Decision Time!Decision Time!“Should I stay or should I go”

- the Clash

Factors to prompt the decisionHow far apart are the contractions

How appropriate is the current scene

Decision may be out of your hands Crowning

Urge to push

False labor - Braxton-Hicks contractionsOccur as early as 3-4 weeks (part of natural stretching)Irregular contractionsLocated in abdomen

Any Questions?Any Questions?