Newborn Care and Emergency Childbirth Procedures

Posted on Feb 1, 2025 in Medicine & Health

Initial Care of Newborn

  • The most important care is to:
    • Position
    • Dry
    • Keep warm
    • Stimulate to breathe
  • When wrapping the newborn, make sure to cover the head.

Normal Range of Vital Signs

  • Pulse: Greater than 100/min
    • Can check pulse at the brachial artery
    • Can also check pulse at the umbilical cord
  • Respirations: Should be >30 breaths/min
    • A crying baby is a good thing!
  • Color: Pink is good – may be a little blue at the extremities initially, but should continue to pink up.

Repeat suctioning as needed.

Continue to stimulate to breathe if needed:

  • Rub back
  • Flick soles of feet

If Newborn has Trouble Breathing

If the newborn doesn’t begin to breathe, or continues to have trouble breathing after 1 min, additional measures have to be considered:

  • Ensure airway is open and patent
  • Ventilate at a rate of 30-60 per min using an infant BVM with supplemental oxygen
  • Reassess after 1 min
  • If heart rate drops below 100 at any time, assist ventilations using BVM with supplemental oxygen
  • If pulse drops below 60 beats per min, begin CPR and reassess after 30 seconds.

Abnormal/Difficult Deliveries

Prolapsed Cord

  • Cord presents before the infant – this is a serious emergency, with the infant’s life in danger
  • Usual patient assessment steps and
  • Mother should be given high flow oxygen
  • Position mother with head down or buttocks raised (this uses gravity to lessen pressure in the birth canal)
  • Update responding EMS of the complication

Breech Birth

  • Buttocks or lower extremities are low in the uterus and will be the first part delivered – infant at greatest risk for delivery trauma, prolapsed cord more common
  • Usual patient assessment and
  • Place mother on high flow oxygen
  • Place mother supine with pelvis elevated and head down
  • Notify responding EMS of complication

Limb Presentation

  • Occurs when a limb protrudes from the birth canal
  • Notify responding EMS immediately
  • Place mother on high flow oxygen
  • Place mother supine with pelvis elevated, head down
  • Multiple births: Be prepared, call for assistance

Meconium

  • Amniotic fluid that is greenish or brownish-yellow rather than clear, an indication of possible fetal distress during labor
  • Do not stimulate the infant to breathe before suctioning oropharynx
  • Suction using bulb syringe or wipe mouth/nose with sterile gauze
  • Maintain airway

Premature Birth

  • Always at risk for hypothermia
  • Usually require resuscitation

Post-Delivery Care of the Mother

  • Keep contact with the mother throughout the process
  • Monitor vitals
  • Remember, delivery is exhausting
  • Replace any blood-soaked sheets and blankets while awaiting transport

Gynecological Emergencies

Vaginal Bleeding

  • Remember BSI
  • Make sure the patient is placed on oxygen

Trauma to External Genitalia

  • Treat as any other soft tissue injury – don’t pack the vagina with dressings

Sexual Assaults

Victims of alleged sexual assault require initial assessment, treatment as needed, and psychological support.

  • Maintain a non-judgmental attitude during history taking
  • Protect crime scene if possible
  • Examine genitalia only if profuse bleeding is present
  • Use same-sex provider if possible
  • Discourage patient from bathing, voiding, or cleaning wounds
  • Required to report