Childbirth: Emergency

  1. Perform hand hygiene and apply gloves.
  2. Verify patient's identity in accordance with institutional policy.
  3. Place the mother on the floor, or if time allows, on a stretcher.
  4. Obtain a precipitous delivery kit and call physician (preferably an obstetrician).
  5. Obtain a brief history to determine the presence of conditions that may complicate the delivery or resuscitation of the infant.
  6. Position the mother in a dorsal recumbent position with her knees bent or in a side-lying (preferably left) position with her knees bent. Observe the perineum for crowning, prolapsed cord, or presenting part (other than the head).
  7. Cleanse the mother's perineum with soap and water or pour antiseptic solution over the area moving in an anterior to posterior direction. Drape the perineal area with sterile towels.
  8. If time permits, obtain vital signs, including fetal heart tones.
  9. Place a clean towel, drape, or absorbent pad under the mother's buttocks.
  10. Instruct the mother to pant as the head is being delivered.
  11. Support the perineum just above the anus with a sterile towel or sterile gauze dressing.
  12. As the infant's head emerges, place gentle pressure on it with the palm of your hand.
  13. Support the head with both hands and allow it to rotate naturally toward one of the mother's thighs.
  14. If the membranes are intact when the head is delivered, snip them at the nape of the neck and pull them away from the infant's face.
  15. Check with your fingers to ascertain whether the umbilical cord is around the neck. If it is, attempt to slip it over the infant's head. If this is not possible because the cord is too tight, immediately clamp the cord in two places and cut the cord between the clamps.
  16. Deliver the shoulders by placing the palms of your hands, one on each side of the infant's head, and applying gentle downward traction. To assist with delivery of the posterior shoulder, gently direct the infant's head upward.
  17. The rest of the infant is delivered rapidly; support the body securely.
  18. Note the time of delivery.
  19. Clamp the umbilical cord in two places: 4 to 5 cm from the infant's abdomen and 4 to 5 cm toward the mother. Cut the cord between the two clamps with sterile scissors or a scalpel.
  20. Rapidly assess the infant: Is this a full term gestation? Is the amniotic fluid clear and without evidence of infection? Is the child breathing or crying? Does the child have good muscle tone? If the answer is "no" to any of these questions, proceed to appropriate resuscitation procedures.
  21. Determine the Apgar score at 1 minute and again at 5 minutes.
  22. Withdraw 20 to 30 ml of blood from one of the umbilical veins. Transfer to lab tubes per institutional protocols.
  23. Keep the infant warm and place the infant to the mother's breast.
  24. Deliver the placenta and administer oxytocin as ordered.
  25. Palpate the firmness of the uterus and massage, as needed.
  26. Monitor the mother's and infant's vital signs, the firmness of the uterus, and the cord stump for bleeding every 5 minutes or until the patient is stable.
  27. Wash the mother's perineum and apply a sterile perineal pad.
  28. Place identification bands on both the mother and the infant.
  29. Discard supplies, remove gloves, and perform hand hygiene.
  30. Document the procedure in the patient's record.
  31. Transfer care of mother and infant to appropriate receiving service(s).
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