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16 Childbirth
16 Childbirth
Lesson 16
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Childbirth
Sometimes occurs outside planned setting Rarely becomes medical emergency Problems early/complications become emergencies
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Stages of Pregnancy
Divided into three trimesters three months each Single cell divides into many First eight weeks an embryo; then fetus
16-4
Stages of Pregnancy
Fetus develops inside amniotic sac Embryo attached to placenta All major organ systems developed by week 8
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Stages of Pregnancy
Week 36, fetus fully formed Near end of pregnancy, head of fetus positioned downward in pelvis. Fetus passes through dilated cervix and vagina.
16-7
First Stage
Amniotic sac ruptures before or during first stage Uterine contractions begin and eventually push infants head into cervix
1015 minutes apart initially 2-3 minutes apart shortly before birth
16-8
Second Stage
Typically lasts 1 2 hours Cervix fully dilated Contractions powerful and painful Infants head presses on floor of pelvis urge to push down Vagina stretches open Head emerges (crowning) Rest of body pushed out
Third Stage
Placenta separates from uterus and delivered
Usually within 30 min of birth
16-11
Vaginal Bleeding
16-12
Vaginal Bleeding
May be caused by cervical growths or erosion, problem with placenta or miscarriage In third trimester may be sign of preterm birth See healthcare provider immediately
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Miscarriage
16-17
Miscarriage
Loss of embryo/fetus in first 14 weeks 20% - 25% of pregnancies end in miscarriage May result from a genetic disorder, fetal abnormality, a factor related to womans health, or no known cause Most women dont have problems with later pregnancies
16-18
Assessing Miscarriage
Perform standard assessment Take repeated vital signs
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Trauma in Pregnancy
16-22
Trauma in Pregnancy
Womans blood volume increases significantly in pregnancy Blood loss may not immediately cause signs of shock Blood flow reduced to fetus Signs of internal blood loss may not be apparent
16-23
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Other Problems
16-25
Other Problems
See healthcare provider: Abdominal pain Persistent or severe headache Sudden leaking of water Persistent vomiting, chills and fever, convulsions, difficulty breathing Persistently elevated blood pressure Signs or symptoms related to diabetes
16-26
Childbirth
16-27
Childbirth
Remember it is a natural process Woman may be fearful or distressed Remain calm
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Help woman lie on back with knees bent and apart and feet flat.
16-39
As infants head appears, have gloved hands ready to receive and support the head
16-40
5. Hold with head lower than feet Suction nose and mouth with bulb syringe
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6. Gently dry and wrap the infant in a towel or blanket to prevent heat loss, keeping the cord loose 7. Follow your local protocol to clamp or tie the umbilical cord or leave it intact for arriving EMS personnel
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Support and comfort mother Monitor pulse and breathing Replace any blood-soaked sheets/blankets, dispose of used supplies The mother may drink water now
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Premature Infants
Premature infant at greater risk for complications It is crucial to keep a small newborn warm Resuscitation is more likely to be needed
16-51
Non-breathing Newborn
If newborn is not crying, gently flick bottom of feet or gently rub its back If it is still not crying, check for breathing
16-52
Non-breathing Newborn
If infant is not breathing: Provide two gentle ventilations mouth to mask Assess breathing and pulse If breathing is absent, slow, or very shallow, provide ventilations
40-60 breaths/minute
Follow local protocol re: oxygen
16-53
Non-breathing Newborn
If infant is not breathing Pulse 60 100 beats/minute, continue ventilations If pulse is 60 beats/minute, start chest compressions Rate of 120/minute Use thumb-encircling method with second responder 3 compressions: 1 breath
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Childbirth Problems
Most deliveries occur without problems Common problems involve presentation of infant or maternal bleeding
Meconium Staining
Infant may defecate before/ during childbirth, staining amniotic fluid brown/ green with meconium Newborn may inhale fluid with first breath, causing lung infection If mother describes amniotic fluid as having color or if you observe this, tell arriving EMS personnel
16-57
Buttocks or feet appear in birth canal Umbilical cord is squeezed and blood flow is compromised If infants head becomes lodged in birth canal and it tries to breathe, it may suffocate
Breech Birth
Support body as it emerges, do not try to pull head out If head does not emerge soon, create breathing space for infant Check infant immediately and give CPR if needed
Breech Birth
Limb Presentation
Rarely, arm or leg may emerge first Emergency requiring immediate medical assistance
16-60
Limb Presentation
Put woman in knee-chest position Do not try to pull infant out or push arm or leg back in
Prolapsed Cord
Segment of cord protrudes through birth canal before childbirth Cord will be compressed as infant moves through canal
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Keep premature newborn warm Provide ventilations or CPR if needed Follow local protocol re blow-by oxygen
Stillborn Infant
Infants rarely born dead or die shortly after birth Use all resuscitation measures available Provide comfort for mother
16-68