hospital setting. You cannot safely and successfully deliver this baby in the field. Should a single arm or foot emerge from the vagina, do not push the limb back into the vagina. First, cover it with a sterile towel, then give the mother high flow oxygen and take whatever steps are necessary to facilitate rapid transportation of the mother to a hospital.
MULTIPLE BIRTHS
Contrary to popular opinion, twins are not a once- a-century phenomenon. Thanks to the advent of fertility treatments, multiple births are occurring more and more frequently. Twins occur in slightly more than one out of every 100 births. From a patient care perspective, the expectant mother is usually aware that she is carrying multiples. Because twins are usually smaller than a single, full term baby, the delivery can occur without difficulty. Once the first baby is delivered, the second baby will usually deliver within an hour.
There are a couple of important issues to consider regarding the delivery of the placenta(s) when twins are involved. If the twins are identical, they will share a single placenta. Fraternal twins each have their own placenta, so be prepared. With fraternal twins, after the first baby is born, the second baby may deliver before or after the first baby’s placenta delivers. As with any other delivery, save any or all of the placenta(s) that delivers for evaluation at the hospital.
PREMATURE BIRTHS
A baby that is born before 8 months of gestation or who weighs less than five pounds at birth is considered to be premature. Most premature births are problematic and many will require some degree of resuscitative efforts.
Because of their small size, premature babies need to be dried and kept warm immediately as they can quickly suffer from heat loss. They also have a smaller mouth and nose, so special attention must be given to keeping these airway passages clean and open. You should clamp the cord quickly and make certain there is no ongoing blood loss. A little blood is a lot of blood for a premie. Finally, administer oxygen to this fragile little one.
MISCARRIAGE
Delivery of a fetus that occurs before 20 weeks gestation is called a spontaneous abortion or miscarriage. Many occur early in pregnancy, often before the mother even knows she is pregnant. The usual call for help goes out because of vaginal bleeding or infection. With a miscarriage, the fetus is almost certainly lost, and patient care should be geared towards the mother.
Other Medical Emergencies 91
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