Chapter 15: Childbirth

Cognitive Objectives

6-1.1 Identify the following structures: birth canal, placenta, umbilical cord, amniotic sac.

6-1.2 Define the following terms: crowning, bloody show, labor, abortion.

6-1.3 State indications of an imminent delivery.

6-1.4 State the steps in the pre-delivery preparation of the mother.

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Cognitive Objectives

6-1.5 Establish the relationship between body substance isolation and childbirth.

6-1.6 State the steps to assist in the delivery.

6-1.7 Describe care of the baby as the head appears.

6-1.8 Discuss the steps in delivery of the placenta.

6-1.9 List the steps in the emergency medical care of the mother post-delivery.

6-1.10 Discuss the steps in caring for a newborn.

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Affective Objectives

6-1.11 Explain the rationale for attending to the feelings of a patient in need of emergency medical care during childbirth.

6-1.12 Demonstrate a caring attitude toward patients during childbirth who request emergency medical services.

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Affective Objectives

6-1.13 Place the interests of the patient during childbirth as the foremost consideration when making any and all patient care decisions.

6-1.14 Communicate with empathy to patients during childbirth, as well as with family members and friends of the patient.

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Psychomotor Objectives

6-1.15 Demonstrate the steps to assist in the normal cephalic delivery.

6-1.16 Demonstrate necessary care procedures of the fetus as the head appears.

6-1.17 Attend to the steps in the delivery of the placenta.

6-1.18 Demonstrate the post-delivery care of the mother.

6-1.19 Demonstrate the care of the newborn.

Knowledge and Attitude Objectives

1. Explain the three stages of the labor and delivery process.

2. Describe the equipment you should have for an emergency childbirth situation.

3. Describe the steps in resuscitating a newborn infant.

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Knowledge and Attitude Objectives

4. Describe the steps you should take in caring for the following complications of childbirth:• Unbroken bag of waters• Breech birth• Prolapse of the umbilical cord• Excessive bleeding after delivery• Miscarriage• Stillborn• Premature birth• Multiple births

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Skill Objectives

1. Resuscitate a newborn infant.

Childbirth

• First responders may be called to assist with the birth of a child.

• Remember that childbirth is a natural process; you are there simply to assist.

The Female Reproductive System

• Ovaries: Produce eggs• Uterus: Holds fertilized egg as it develops• Fallopian tubes: Connect ovaries and uterus• Birth canal (vagina): External opening

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The Female Reproductive System

• Fetus: Developing baby• Umbilical cord: Delivers nutrition and removes waste

products from developing infant• Placenta: Draws nutrients from uterus which are then

transported through umbilical cord

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Anatomy of a Pregnant Woman

Stages of Labor

• Stage one– Initial contractions occur, water breaks, bloody show

occurs, but no crowning visible• Stage two

– Involves actual delivery of baby• Stage three

– Involves delivery of placenta (afterbirth)

Key Questions

• Has the woman had a baby before?• Has the woman experienced a bloody show?• Has the bag of waters broken?• How frequent are the contractions?

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Key Questions

• Does the woman feel an urge to move her bowels?• Is the baby’s head crowning?• Is transportation available?

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Preparation for Delivery

• Wash your hands thoroughly.• Place a towel or sheet under the woman.• Have plenty of towels on hand.• Place the woman in a comfortable position (often on

back with knees bent and legs drawn up and apart).

Timing Contraction Cycles

BSI and Childbirth

• BSI techniques should be used during delivery. • Try to avoid getting blood and fluids on you. • Use sterile gloves whenever possible.

Equipment for Delivery

• Sterile gloves• Sterile drapes and towels• 4 x 4 gauze pads• Bulb syringe• Umbilical cord clamp• Sanitary pads• Towel or blanket for baby

Assisting With Delivery

• Have the woman lie on her back with her knees drawn up and apart.

• Tell the mother to breathe rapidly. • Do not attempt to pull the baby during delivery.

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Assisting With Delivery

In a normal birth, the baby will turn to its side by itself after the head emerges.

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Caring for the Newborn

• Clear mouth and nose.• Dry infant with towel.• Wrap child to keep warm.• Place infant on side with head slightly lower than trunk.

Suctioning to Clear theNewborn’s Airway

Suctioning the mouth Suctioning the nose

Aftercare of the Mother

• Observe mother and baby.• Recheck firmness of uterus.• Recheck vagina for excessive bleeding.• Clean mother with towels.• Cover vaginal opening.

Aftercare of the Newborn

• The newborn infant should:– Breathe at a rate greater than 40 breaths per minute.– Begin crying right after birth.– Have a pulse greater than 100 beats per minute.

Resuscitating the Newborn

• Tilt the infant’s head down. • Suction the mouth and nose. • Begin mouth-to-mouth-and-nose breathing.

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Resuscitating the Newborn

• Check for a brachial pulse. • If you cannot feel a brachial pulse, begin closed-chest

cardiac compressions. • Continue CPR.

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Automobile Crashes

• Pregnant women involved in auto crashes should be examined by physician.

• Promptly assess and transport. • Treat for shock. • Have woman lie on her left side to relieve pressure on

uterus.

Childbirth Complications

• Unbroken bag of waters• Breech birth• Prolapse of the umbilical

cord• Excessive bleeding after

delivery

• Miscarriage• Stillborn delivery• Premature birth• Multiple births

Breech Birth

• Arrange for prompt transport.• Support baby as it is delivered.• Use your fingers to keep baby’s airway open by forming

a pocket over the infant’s nose and mouth.

Prolapse of Umbilical Cord

• Umbilical cord comes out of the vagina before the baby is born.– A serious emergency that requires rapid transport

• Prop the mother’s hips and legs higher than the rest of her body.

• Keep cord covered and moist.

Premature Birth

• Any baby weighing less than 5 1/2 pounds or delivered before 37 weeks

• Keep premature babies warm. • Arrange for prompt transport.