Notes – Childbirth

Childbirth

Patient Safety Considerations

  1. Supine Hypotension Syndrome:
  2. If mother has hypotension before delivery, place patient in left lateral recumbent position or manually displace gravid uterus to the left is supine position necessary
  3. Knee-chest position may create safety issues during rapid ambulance transport
  4. Do not routinely suction the infant’s airway (even with a bulb syringe) during delivery
  5. Newborns are very slippery, take care not to drop the infant
  6. Do not pull on the umbilical cord while the placenta is delivering
  7. If possible, transport between deliveries if mother is expecting twins

Notes/Educational Pearls

  1. OB assessment:
    1. Length of pregnancy
    2. Number of pregnancies
    3. Number of viable births
    4. Number of non-viable births
    5. Last menstrual period
    6. Due date (gestational age)
    7. Prenatal care
    8. Number of expected babies (multiple gestations)
    9. Drug use and maternal medication use
  2. Notify direct medical oversight if:
    1. Prepartum hemorrhage
    2. Postpartum hemorrhage
    3. Breech presentation
    4. Limb presentation
    5. Nuchal cord (around neck)
    6. Prolapsed cord
  3. Some bleeding is normal with any childbirth
    1. Large quantities of blood or free bleeding are abnormal

APGAR Score

Sign 0 1 2
Appearance: Blue,
Pale		 Body pink,
Extremities blue		 Completely pink
Pulse: Absent Slow
(less than l00)		 100
Grimace: No
response		 Grimace Cough or
Sneeze
Activity: Limp Some flexion Active motion of extremities
Respirations: Absent Slow,
Irregular		 Good,
Crying

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914155 – OB/GYN-Childbirth/Labor/Delivery
  • 9914161 – OB/GYN-Pregnancy Related Disorders
  • 9914163 – OB/GYN-Post-Partum Hemorrhage

Key Documentation Elements

  • Document all times (delivery, contraction frequency and length)

Performance Measures

  • Recognition of complications
  • Documentation of APGAR scores
  • Maternal reassessment

References

  1. Stallard T, Burns B. Emergency delivery and perimortem C-section. Emerg Med Clin N Am. 2003;21:679-93.
  2. WHO, United Nations Population Fund, UNICEF. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice (3rd edition). Geneva, Switzeralnd: WHO Press; 2015.