| Regional Emergency Medical Advisory Committee of New York City
Prehospital Basic Life Support Protocols
Copyright January 1996 (8/96)
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441 EMERGENCY CHILDBIRTH
Assess the mother for shock and treat, if appropriate. (See Protocol #415.)
If the mother is in active labor, perform a visual inspection of the perineum for bulging or crowning.
If delivery is imminent, proceed as follows:
Request Advanced Life Support assistance, if appropriate.
| NOTE: | ADVANCED LIFE SUPPORT ASSISTANCE MUST BE REQUESTED FOR PREMATURE OR MULTIPLE BIRTHS, OR IF THE AMNIOTIC FLUID IS MECONIUM STAINED.
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Apply gentle pressure against the newborn's head to prevent tearing of the perineum.
Do NOT apply pressure to the soft spots (fontanelles).
As the head presents, clear the airway if time permits.
First suction the mouth, inserting the bulb syringe, no more than 1½ inches, then the nose, inserting the bulb syringe no more than ½ inch. Depress the bulb syringe prior to insertion into the infant's mouth and nose.
| NOTE: | SUCTIONING IS CRITICAL.
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Support the head and thorax as the newborn delivers.
Momentarily position the head lower than the body to allow for drainage. Repeat suctioning as necessary prior to spontaneous or stimulated respirations.
Thoroughly but rapidly dry the newborn with a clean, dry towel.
Monitor the newborn's airway.
To stimulate breathing, first rub the lower back, then gently snap the soles of the feet.
| NOTE: | SPONTANEOUS RESPIRATIONS SHOULD BEGIN WITHIN 30 SECONDS AFTER BIRTH.
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Resuscitate if necessary. (See Protocol #443.)
Place the first clamp 10 inches from the newborn and the second clamp 7 inches from the newborn. Cut between the clamps and immediately check both ends for bleeding.
If continuous bleeding is seen from either end of the cord, leave the clamps already applied and add a second clamp to the end that is bleeding.
Cover the newborn with a clean, dry towel or blanket, then wrap in a silver swaddler, exposing only the newborn's face.
| NOTE: | NEWBORN INFANTS ARE SUBJECT TO RAPID HEAT LOSS AND MUST BE KEPT WARM AND DRY.
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Do NOT delay transport waiting for the placenta to deliver.
For Special Considerations, administer oxygen to the mother, and see below.
Re-assess the mother for shock and treat, if appropriate. (See Protocol #415.) If postpartum hemorrhage occurs, see Protocol #440.
For care of the newborn, see Protocol #442.
Transport.
| NOTE: | IF MISCARRIAGE OR STILLBIRTH OCCURS, BRING ALL EXPELLED MATERIAL TO THE HOSPITAL WITH THE MOTHER.
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SPECIAL CONSIDERATIONS
| NOTE: | AN ABNORMAL DELIVERY SHOULD BE TREATED AS AN EMERGENCY WITH TRANSPORT BEING A PRIORITY WHILE PROVIDING APPROPRIATE CARE.
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ABNORMAL PRESENTATION
Breech Presentation:
Support the thorax of the newborn as it delivers.
| NOTE: | A FULL DELIVERY MAY OCCUR.
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If the head does not deliver immediately, place sterile, gloved fingers between the newborn's face and the wall of the birth canal to establish an air passageway. This position must be maintained until the head delivers.
Limb Presentation:
- Elevate the mother's hips and legs.
Prolapsed Cord:
- Elevate the mother's hips and legs.
- If the cord is not pulsatile, place sterile, gloved fingers into the birth canal and push the head back 1 to 2 inches towards the cervix until the cord begins to pulsate.
- Wrap saline-moistened, sterile dressings around the cord.
| NOTE: | DO NOT ATTEMPT TO INSERT THE CORD BACK INTO THE UTERUS. THE CORD SHOULD BE CONTINUOUSLY MONITORED FOR THE PRESENCE OF A PULSE.
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COMPLICATIONS DURING BIRTH
Cord Around the Neck:
- If the cord is loose, gently slip the cord over the newborn's head.
- If this is not possible, immediately place 2 clamps on the cord and cut between them.
Amniotic Sac Not Ruptured:
- Immediately remove the sac from around the face using sterile, gloved fingers only.
Wedged Shoulders:
- Guide the head downward to aid in the delivery of the upper shoulder.
MULTIPLE BIRTHS
Clamp and cut the umbilical cord of the first newborn prior to the next birth.
If the second birth does not occur within 10 minutes, begin transport.
