EMERGENCY CHILDBIRTH: NORMAL

1. OBTAIN FOCUSED HISTORY (Refer to the OBSTETRICAL/GYNECOLOGICAL Guidelines):

• Estimated date of confinement (“EDC” or “due date”)
• Contractions: Frequency, duration, intensity
• Amniotic sac rupture (time and presence of meconium)
• Previous pregnancies and deliveries (especially multiple births, complications, vaginal or C-section)
• “AMPLE” history (especially hypertension, pre-eclampsia, diabetes, seizures, cardiac)
• Medications taken prior to labor, including over-the-counter
• Prenatal care (especially any identified pregnancy complications)
• Vaginal bleeding and/or abdominal pain

2. ASSESS MATERNAL VITAL SIGNS & IMPLEMENT CONTINUOUS MONITORING:
   • Heart Rate (HR), BP, Respiratory Rate, SpO2, Temperature
   • ECG and SpO2 monitoring
3. PREPARE FOR DELIVERY:
   • Prepare delivery area and open OB kit: prepare bulb syringe, cord clamps, towels, newborn blanket
   • Remove patient’s clothing and place clean pad under patient
4. DELIVER THE NEWBORN:
   • During contractions, urge patient to push
   • Deliver and support the emerging fetal head
   • Check for and manage nuchal cord, if present
   • Assess for and document presence of meconium
   • Deliver the shoulders, then the rest of the body
   • Place newborn on mother’s abdomen or level with the mother’s uterus
   • Note the time of birth (and the time of placenta delivery)
   • Control maternal hemorrhage, if needed, and document the mother’s vital signs; continue continuous monitoring
5. NEWBORN CARE – Refer to the NEONATAL CARE Guidelines

• Birth to 30 seconds postpartum:
• Warm and dry; clear the airway, if needed (because of apnea or “drowning” in secretions)
• Stimulate the newborn by rubbing the back & wrap in blankets or towels to prevent hypothermia
• 30 to 60 seconds postpartum:
• If HR less than 100 bpm and or respirations are absent or gasping, initiate PPV with room air. Monitor SpO2 on the infant’s right hand or wrist. Oxygen may be supplemented to achieve mean per minute goal saturations**, but this is secondary to effective ventilation.
• Clamp and cut the umbilical cord
• Place the newborn on the mother’s chest to retain warmth
• Calculate and document the 1-Minute APGAR score
• More than 1 minute postpartum:
• If HR less than 100 despite PPV, take corrective steps to improve ventilation, per “MRSOPA”:
• Mask: check the seal
• Reposition: make sure infant is in sniffing position
• Suction (mouth before nose)
• Open the mouth
• Pressure increase (gentle!)
• Alternative airway (either intubate or place LMA, if available)
• If no improvement, begin 2-person CPR at a rate of 120 events per minute (90 compressions, 30 ventilations); compression-to-ventilation ratio of 3-to-1; use 2-thumb-encircling-hands compressions
• If no improvement, consider 1:10,000 epinephrine 0.01 mg/kg (0.1 mL/kg) IV/IO (rarely needed)

• 5 Minutes postpartum:
• Calculate and document the 5-Minute APGAR score

6. Continue to monitor maternal and newborn vital signs; prepare for transport to an appropriate facility.
   
   
7. For patient care considerations not covered by this procedure, consult BioTel.