Emergency Delivery

Signs of Imminent Delivery
■ Regular contractions that are less than 2 minutes apart.
■ Urge to have a bowel movement or strong urge to push.
■ Bulging vaginal opening or crowning (baby’s head is visible).

Normal, Uncomplicated Delivery
■ Position mother on a flat surface with back supported by pillows.
■ Don gloves and drape so that vaginal opening is exposed.
■ During contractions, instruct mother to take slow, deep breaths.
■ If birth is imminent, instruct the mother to push during each contraction (discourage pushing between contractions).
■ With your gloved hand, apply gentle pressure against the baby’s head to help slow rate of delivery minimizes perineal tearing.
■ Suction: Once the head is delivered, support it with one hand while using your free hand to suction the nose and mouth with a bulb syringe (discourage mother from pushing while suctioning).
■ Assess Location of Cord: If umbilical cord is wrapped around the baby’s neck, gently but quickly slip it over the baby’s head.
■ Once the head is delivered, place your hands on either side of the baby’s head and gently guide it downwards while the mother pushes until the top shoulder emerges. Then guide the baby upwards and support its head and shoulders as the rest of the baby emerges.
Note: Newborns are slippery; use a dry towel to hold the baby.
■ Keep the baby at the same level as the perineum.
■ Suction the baby’s nose and mouth with a bulb syringe to clear secretions, blood, and mucus.
■ Stimulate the baby to breathe with vigorous rubbing and drying.
■ Hypothermia can occur rapidly in newborns; dry and wrap the baby in dry towels to prevent excessive heat loss.
■ Place the baby on the mother’s abdomen or chest. Do not pull on the umbilical cord if placenta has not been expelled yet.
■ Encourage breastfeeding to stimulate uterine contractions. This will help to expel the placenta.
■ Clamp umbilical cord 8 inches from baby and place a second clamp 2 inches beyond first clamp and cut in the middle with a sterile scalpel. Assess number of cord vessels (2 veins, 1 artery).
■ Once placenta has been expelled, save for analysis by physician.
■ Massage mother’s abdomen to stimulate uterine contractions.
■ Assess and document APGAR at 1 and 5 minutes after delivery (see APGAR Score).

Complicated Delivery
■ Assess for postpartum hemorrhage or other complications. These are basic guidelines and are not meant to be exhaustive in content nor direction. The intent is not to replace established hospital protocols designed to address these specific complications, but rather prepare the reader for what to anticipate if these complications occur. Note: It is assumed that ABCs, O2, IV have been established.

Meconium-Stained Amniotic Fluid
■ During delivery: Suction nose and mouth with a bulb syringe prior to delivery of the shoulders (once the shoulders are delivered, the baby can inhale, resulting in meconium aspiration).
■ After delivery: Minimize stimulation and delay ventilation until meconium can be suctioned from airways to prevent aspiration.

Cord Presentation
■ Place mother in Trendelenburg position with knees to chest.
■ Relieve cord pressure by applying gentle pressure to baby’s head.
■ Monitor cord pulses and cover with saline-soaked gauze.
■ Discourage pushing and prepare for an emergency c-section.

Breech Presentation (feet first)
■ Support baby’s legs and buttocks and gently pull during
contractions.
■ Once (if) shoulders are delivered, avoid pulling on baby.
■ Place gloved fingers between the baby’s face and the vaginal
wall to create an airway for the baby.
■ Prepare for an emergency c-section.

Limb Presentation
■ Place mother in Trendelenburg position with knees to chest.
■ Support presenting limb and assess pulse if possible.
■ Discourage mother from pushing during contractions (pant instead).
■ Prepare for an emergency c-section.

Postpartum Hemorrhage
■ Massage fundus or put baby to breast, if appropriate, to stimulate uterine contractions.
■ If bladder is distended, encourage Pt to void, straight cath.
■ Place Pt in Trendelenburg position.
■ Establish 2nd large-bore IV access and infuse 1–2 liters of
crystalloid.
■ Medication such as oxytocin may be administered.
■ Possible hysterectomy if medical management is
unsuccessful.