support the baby with both hands. Be careful not to grasp or squeeze the baby’s neck or chest, but hold it firmly as the baby will be very slippery.
Place the newborn on the mother’s chest, skin-to-skin and cover them both with blankets to maintain body heat. Lay the newborn face down with the head and neck in a neutral position to maintain an open airway. Try to leave the umbilical cord alone, ensuring it isn’t kinked or pulled tight.
Only cut the umbilical cord if absolutely necessary! If you must cut it, wait until the cord stops pulsing. This will take about
10 minutes. If an emergency childbirth kit is available, use the cord clamps and scissors. If not available, utilize gauze to tie a double knot about 3 inches from the baby. Repeat this knot about 2 inches farther away. Using scissors or a knife, cut between the ties. There are no nerve endings in the umbilical cord, so do not worry about hurting the mother or child. Again, only cut the umbilical cord if absolutely necessary.
DELIVERY OF THE PLACENTA
Once the baby is delivered and assuming the baby is breathing well, place the newborn at the mother’s breast. As the baby nurses it will stimulate the uterus to contract and help deliver the placenta. If the baby is not breathing well, your attention should be on that problem.
The placenta usually delivers shortly after the baby, but it may take as long as a half hour. There will be mild bleeding after the delivery of the baby, but for the most part it should stop after the placenta delivers. You may help speed up the delivery of the placenta by slowly massaging the mother’s lower abdomen using a firm, circular motion with your fingers.
Under no circumstances should you pull or tug on the umbilical cord in an attempt to get the placenta to deliver. To do so may produce serious or life- threatening bleeding. Once the placenta delivers, wrap it in a towel. EMS will transport it, along with mother and baby, to the hospital for evaluation.
While you wait to land, monitor the mother’s vital signs and administer some oxygen to her while keeping an eye on the baby at the same time. It is vital to keep the infant and the mother warm.
NEWBORN RESUSCITATION
Within moments of being born, the baby will begin to cry and breathe. If not, tap or flick the soles of the feet
90 Other Medical Emergencies
to stimulate it. If the newborn does not respond and start breathing independently within 10 to 15 seconds, begin resuscitation efforts, following current CPR guidelines.
ASSESSING THE NEWBORN
A newborn baby should be breathing at least 40 times a minute and have a brachial pulse of at least 100 beats per minute. The baby should be pink and moving all extremities. While the baby may have had cyanotic (bluish color) extremities at birth, they should pink up quickly. A baby that has adequate respirations and pulse but remains cyanotic should have oxygen at 10 to 15 liters per minute blown as close to the baby’s face as possible. High flow oxygen for short periods of time poses no threat to the baby.
ABNORMAL DELIVERIES PROLAPSED CORD
Although this is quite rare, on occasion the umbilical cord may prolapse out of the vagina before the baby. This is a serious situation because the baby’s head will compress the cord as it delivers. This in turn cuts off all circulation to the baby.
Should this occur, place the mother on a flat surface with her hips elevated and her head down. Place your gloved hand carefully into the vagina and gently push the baby away from the cord, being careful not to push on the fontanelles (soft spots) on the top and back of the head. This will keep the baby off the cord. Continue holding this position until emergency medical personnel arrive to assume care.
BREECH BIRTH
On rare occasions, babies are born buttocks first rather than head first. Unfortunately, you won’t know this is happening until you realize what you’re seeing is not the baby’s head. Of course, by the time this happens, it’s too late to do anything. While it would be best to have this occur in a hospital setting, that is not always the case. If you must deliver a breech baby, be alert for a prolapsed cord and expect the delivery to take longer.
LIMB-FIRST PRESENTATION
A limb-first presentation is a very infrequent occurrence and one that needs to be addressed in a
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