Pre-hospital and emergency births are more common than most people think. Sometimes this is because the baby has come prematurely, there is a confusion as to the expected birthing date, or because the mother and father have elected to have a home birth and something has gone wrong. At any case, paramedics are often the first line of emergency care to provide aid in an emergency birth.
So how do paramedics deliver a baby out of hospital?
The firs thing you have to remmember is is that woman have been delivering babies for thousands of years (before doctors, midwives and hospitals were ever around) – and the baby will come out or it wont come out, irrespective of anything that you as a paramedic can do while out of a hospital. So, rellax… (or at least look rellaxed for the expectant mother’s sake).
1. Assess the mother’s ABCDE and make general observations of the mother’s vital signs (ensure you take a systolic and diastolic BP to rule out risks of pre-eclampsia or eclampsia)
2. Although oxygen does not need to be routinely administered to a mother. High levels of oxygen to the mother should be administered if the mother is having an obsteteric emergency, such as:
* Antepartum haemorrhage
* Postpartum haemorrhage
* Prolapsed umbilical cord
*Pre-eclampsia or eclampsia
*Supine hypotensive syndrome
3. Monitor maternal contractions – time both the duration of the contraction and the length of time in between contractions
4. Position the mother laterally to avoid the possibility of supine hypotensive syndrome. But ensure that you are governed by the mother’s choice and comfort, what is comfortable for one mother may not be for another.
5. Consider pain management if required. Avoid all opioids such as morphine or fentanyl, due to the risk of that this will affect the baby’s respiratory effort post birth. Consider methoxyflurane or nitrous oxide, due to the fact that neither drug will cross over through the placental barrier and both wash out of the mother’s system rapidly.
6. Help make the mother comfortable as much as possible during the birth. Consider letting her place her feet on your hip and her husband/partners hips, allowing her to get leverage while she pushes (you would be surprised how much easier this is for her – although you may end up with bruises to your hip).
7. Let the baby come at its own rate – the only interventions that you may be required to do is to gently pull the baby’s shoulders down (one at a time) so that it can squeeze through the vaginal opening; however this shouldn’t be required during a normal birth.
8. If the baby has a lot of mucous membranes around its nose a mouth – you may suction this with a bulb suction device (see picture).
9. Clamp the cord at approximately 10 and 15 cms from the baby (I like to put a third clamp at 20 cms just to be safe) and then cut inbetween. Don’t forget to ask Dad if he wants to cut the cord (this is disgusting, but some Dad’s seem keen).
10. Once the baby’s out, dry it thoroughly and wrap it up in a blanket. One of the greatest risks to a newborn baby is to become hypothermic and hypoglycaemic as it attempts to keep warm. So keep him or her well wrapped up, and close to mum.
11. Calmly take this mum and baby to hospital for further tests.