EMERGENCY CHILDBIRTH

Alternative names
Delivery - emergency; Emergency delivery - childbirth; Birth - emergency

Definition
An emergency childbirth is the delivery of a baby when no health care professional is present.

What to Do

1. Let nature be your best helper. Childbirth is a very natural act.

2. At first signs of labor assign the best qualified person to remain with mother.
3. Be calm; reassure mother.
4. Place mother and attendant in the most protected place in the shelter.
5. Keep children and others away.
6. Keep hands as clean as possible
7. Keep hands away from birth canal
8. See the baby breathes well.
9. Place the baby face down across the mother’s abdomen.
10. Keep baby warm.
11. Wrap afterbirth with baby.
12. Keep baby with mother constantly.
13. Make mother as comfortable as possible.
14. Identify baby.

What Not to Do

1. DO NOT hurry.
2. DO NOT pull on baby, let baby be born naturally.
3. DO NOT pull on the cord, let the placenta (afterbirth) come naturally.
4. DO NOT cut and tie the cord until the baby AND the afterbirth have been delivered.
5. DO NOT give medication.
DO NOT HURRY - LET NATURE TAKE HER COURSE.

If it becomes necessary for families to take refuge in fallout shelters there will
undoubtedly be a number of babies born under difficult conditions and without medical
assistance.

`Every expectant mother and the member of her family should do all they can do to
prepare for emergency births. They will need to know what to do and what to have ready. (See
“Expectant Mother’s Emergency Childbirth Kit.”)
SPECIAL SAFEGUARDS

A pregnant woman should be especially careful to protect herself from radiation

exposure. She should have the most protected corner of the shelter and not be allowed to risk
outside exposure.

She should not life heavy objects or push furniture. If food shortages exist, she should be
given some preference.

Fear and possible exertion involved during an atomic attack will probably increase the
number of premature births and of miscarriages.

MOMENT OF BIRTH

The person helping the mother should always let the baby be born by itself. No attempt
should be made to pull the baby out in any way.

Usually the baby’s head appears first, the top of the head presenting and the face
downward. Infrequently, the baby will be born in a different position, sometimes buttocks first,
occasionally foot or arm first. In these infrequent situations, patience without interference in the
birth process is most important. The natural process of delivery, although sometimes slower, will
give the child and the mother the best chance of a safe and successful birth.

The baby does not need to be born in a hurry, but usually about a minute after the head
appears the mother will have another bearing down feeling and push the shoulders and the rest of
the baby out.

As the baby is being expelled, the person helping the mother should support the baby on
her hands and arms so that the baby will avoid contact with any blood or waste material on the
bed.

If there is still a membrane from the water sac over the baby’s head and face at delivery it
should immediately be taken between the fingers and torn so that the water inside will run out
and the baby can breathe.

If, as sometimes happens, the cord, which attaches the child from the navel to the
placenta in the mother’s womb, should appear, try to slip it quickly over his head so that he will
not strangle.

After the baby is born, wrap a fold of towel around his ankles to prevent slipping and
hold him up by the heels with one hand, taking care that the cord is slack. To get a good grip,
insert one finger between the baby’s ankles. Do not swing or spank the baby. Hold him over the
bed so that he cannot fall far if he should slip from your grasp. The baby’s body will be very
slippery. Place your other hand under the baby’s forehead and bend its head back slightly so that
the fluid and mucus can run out of its mouth. When the baby begins to cry, lay him on his side
on the bed close enough to the mother to keep the cord slack.
 He baby will usually cry within the first minute. If he does not cry or breathe within 2 or
3 minutes, use mouth-to-mouth artificial respiration.

Very little force should be used in blowing air into the baby’s mouth. A short puff of
breathe about every 5 seconds is enough. As soon as the baby starts to breathe or cry, mouth-to-
mouth breathing should be stopped.

CUTTING THE CORD

There should be no hurry to cut the cord. Take as much time necessary to prepare the ties
and sharp instruments.

You will need two pieces of sterile white cotton tape or two pieces of 1-inch-wide sterile
gauze bandage about 9 inches long to use to tie the cord. (If you do not have sterile material for
tying the cord but do have facilities for boiling water, strips of sheeting—boiled for 15 to 20
minutes to make them sterile—can be used.) Tie the umbilical cord with the sterile tape in two
places, one about 4 inches from the baby and the other 2 inches farther along the cord toward the
mother, making two or more simple knots at each place. Cut the cord between these two ties with
a clean sharp instrument such as a knife, razor blade, or scissors.

A sterile dressing about 4 inches square should be placed over the cut end of the cord at
the baby’s navel and should be held in place by wrapping a “bellyband” or folded diaper around
the baby. If a sterile dressing is not available, no dressing or bellyband should be used.
Regardless of whether a dressing is applied or not, no powder, solution, or disinfectant of any
kind should be put on the cord or navel.

If the afterbirth has not yet been expelled, cover the end of the umbilical cord attached to
it (and now protruding from the vagina) with a sterile dressing and tie it in place.
EXPECTANT MOTHER’S EMERGENCY CHILDBIRTH KIT

The public health and civil defense agencies of one State have planned a 1 ½ pound
emergency childbirth kit made up of basic supplies that can be carried in a 1-yard-square
receiving blanket.

The kit consists of the following:

One-yard square of outing flannel, hemmed (receiving blanket).

Plastic (polyethylene flexible film) for outer wrapping of the kit if desired. (Do
not wrap the baby in this plastic film.)

One or two diapers.

Four sanitary napkins (wrapped).

Adhesive tape identification strips for mother and baby.

Short pencil.

Soap.

Sterile package containing:

Small pair of blunt-end scissors (cheapest scissors will do), or a safety razor blade

with a guard on one side.

Four pieces of white cotton tape, ½ inch wide and 9 inches long.1

Four cotton balls.

Roll of 3-inch gauze bandage.

Six 4-inch squares of gauze. 1

Two or more safety pins.

Placenta Previa
Is the development of the placenta in the lower uterine segment, partially or completely
covering the internal cervical os.

Types of Placenta Previa:

1. Complete or Total Placenta Previa – the placenta completely covers the internal os
when the cervix is fully dilated.
2. Partial Placenta Previa – the placenta partially covers the internal os.
3. Marginal Placenta Previa – the edge of the placenta is lying at the margin of the
internal os.
4. Low lying Placenta Previa – the placenta implants near the internal os, its edges can be
felt by the examining finger on IE.

Predisposing Factors:

1. Multiparity (80% of affected clients are multiparous)

2. Multiple Pregnancy
3. Advanced maternal age (older than 35 years old in 33% of cases)
4. Previous cesarean section and abortion
5. Uterine incisions
6. Prior placenta previa

Clinical Manifestations:

1. Bleeding that is painless, sudden and profuse during the end of second trimester, or
during third trimester.
2. Soft, nontender abdomen; relaxes between contractions, if present.
3. FHR stable and within normal limits.
4. Normal uterine tone
5. Leopold’s maneuver: the fetus is in breech, oblique or transverse position.
6.

Laboratory and Diagnostic Study Findings:

 1. Transabdominal ultrasonography confirms suspicion of placenta previa.
2. CBC: decreased Hb and HCT levels if bleeding is present.

Nursing Management:

1. Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh
saturated perineal pads to assess maternal blood loss.
2. Maintain bedrest and elevate the head of the bed.
3. Provide fluid administration, usually with lactated Ringer’s solution, through a large-bore
IV line to maintain fluid balance.
4. Consider cesarean delivery if the placenta previa is more than 30% or if excessive
bleeding occurs.
5. Measure fundal height to assess for rising fundus, which may reveal concealed bleeding.
6. Disallow rectal or vaginal examinations, to minimize the danger of bleeding.
7. Prepare the patient and family emotionally and physically for delivery.
8. Observe for meconium in the amniotic fluid; may indicate fetal distress.
9. Provide emotional support to the patient and family.

Abruptio Placentae
Alternative names
Premature separation of placenta; Accidental hemorrhage; Ablatio placentae; Abruptio
placentae; Placental abruption

Definition
Abruptio placenta is premature separation of the normally implanted placenta after the 20th week
of pregnancy, typically with severe hemorrhage.

Two types of abruption placentae:

Concealed hemorrhage - the placenta separation centrally, and a large amount of blood is
accumulated under the placenta.

External hemorrhage – the separation is along the placental margin, and blood flows under the
membranes and through cervix.

Risk Factors:

1. Uterine anomalies
2. Multiparity
3. Preeclampsia
4. Previous cesarean delivery
5. Renal or vascular disease
6. Trauma to the abdomen
 7. Previous third semester bleeding
8. Abnormally large placenta
9. Short umbilical cord

Common Clinical Manifestations:

1. Intense, localized uterine pain, with or without vaginal bleeding

2. Concealed or external dark red bleeding
3. Uterus firm to boardlike, with severe continuous pain
4. Uterine contractions
5. Uterine outline possibly enlarged or changing shape
6. FHR present or absent
7. Fetal presenting part may be engaged

Nursing Management:

1. Continuous evaluate maternal and fetal physiologic status, particularly:

o Vital Signs
o Bleeding
o Electronic fetal and maternal monitoring tracings
o Signs of shock – rapid pulse, cold and moist skin, decrease in blood pressure
o Decreasing urine output
o Never perform a vaginal or rectal examination or take any action that would
stimulate uterine activity.
2. Asses the need for immediate delivery. If the client is in active labor and bleeding cannot
be stopped with bed rest, emergency cesarean delivery may be indicated.
3. Provide appropriate management.
o On admission, place the woman on bed rest in a lateral position to prevent
pressure on the vena cava.
o Insert a large gauge intravenous catheter into a large vein for fluid replacement.
Obtain a blood sample for fibrinogen level.
o Monitor the FHR externally and measure maternal vital signs every 5 to 15
minutes. Administer oxygen to the mother by mask.
o Prepare for cesarean section, which is the method of choice for the birth
4. Provide client and family teaching.
5. Address emotional and psychosocial needs. Outcome for the mother and fetus depends on
the extent of the separation, amount of fetal hypoxia and amount of bleeding.
Umbilical Cord Prolapse
Definition: umbilical cord that lies below/beside presenting part

 Usually immature gestation

 Results in fetal hypoxia & death
 > 5 min results in CNS damage/ death

Precipitating factors:
 Long umbilical cord
 Abnormal location on placenta
 Small or preterm infant
 Polyhydramnios
 Multiple gestation
 Amniotomy before fetal head is engaged

Clinical Manifestations:
 Cord observed or palpated
 Bradycardia following ROM
 Repetitive, variable decelerations that do not respond to medical intervention
 Prolonged decelerations (>15 bpm lasting 2 mins or longer yet <10 mins)

Nursing interventions:
 Apply gentle upward pressure on presenting part
 Knee chest position

Medical management:
 Immediate delivery of viable infant
 C-section
 NORZAGARAY COLLEGE

Norzagaray, Compound

EMERGENCY CHILD BIRTH

PLACENTA PREVIA

ABRUPTIO PLACENTAE

CORD PROLAPSE

In Partial Fulfillment of the Requirement in

EMERGENCY ROOM (Dr. Jose N. Rodriguez Memorial Hospital)

Tala, Caloocan City

Submitted by:

Jay-R P. Molase

(Group C-2)

Submitted to:

Ms. Tryzz,R.N

(Clinical Instructor)

March 10, 2010