- To assist in the safe delivery of a baby.
- Prepare for Neonatal resuscitation
- All relevant infection control methods to be utilised.
- Consider vehicle for back-up.
- Prepare equipment required:
- Adult and infant BVM
- Baby mucus extractor & bacterial filter
- Oxygen
- Plastic bag
- Small combine
- Space blanket
- Sterile gauze pad
- Sterile scissors
- Towel
- Umbilical clamps
- Incontinence sheets
- Reassure mother, remove constrictive clothing and place an incontinence sheet below pelvis.
- Place in position of comfort.
- Administer high flow oxygen if indicated.
- Insert IV cannula if clinically indicated
- Consider appropriate analgesia.
Delivery of the child
- Identify if delivery is imminent by evidence of crowning[1], contractions 2-3 minutes apart or an urge to push.
- Coach mother to breathe deeply to relax between contractions and push with contractions.
- Be mindful of maternal faecal matter; only wipe away if at risk of soiling foetal airway (pressure placed on the mothers anus during childbirth can result in activation of pelvic floor muscles and delay the birth).
- As the baby’s head delivers provide support with one hand to prevent rapid delivery, spreading fingers to evenly distribute pressure on fontanels.
- Use the other hand to support the perineum with a dressing pad.
- Once the head is delivered, perform a visual check of the back of the head and neck to ensure cord is not wrapped around neck.
- If cord is present around neck and loose slide the cord over the baby’s head prior to the next contraction. Only if it is too tight and preventing the birth of the body, place two clamps on the cord approximately 3cms apart and cut between the clamps.
- Guide the baby’s head downwards to deliver the upper shoulder and then gently guide the head upwards to deliver the lower shoulder while supporting the baby[2].
- Allow the baby to deliver itself without pulling.
- Only suction the mouth and nose of the newborn using the Penguin Suction Device to ensure airway cleared if required.
- Stimulate baby to induce crying, e.g. rubbing with towel on back.
- The cord does not need to be cut in the prehospital setting, unless the baby or mother requires immediate intervention. Delayed cord clamping is encouraged, maximum benefits have been achieved by 3-4 minutes.
- Should immediate intervention be required, make best effort to keep cord intact. If not possible due to environmental constraints, clamp and cut the umbilical cord with two cord clamps. Place the first clamp 4 fingers from the baby’s body, place the second clamp 2 fingers further away from the baby away and cut between the 2 clamps. If bleeding persists on either end, apply a third clamp.
- If the umbilical cord has been ruptured or torn, the cord must be clamped as a priority to prevent neonate volume loss. This is to be done regardless of if there is visible blood loss from the cord
- Record delivery time, second officer to perform APGAR (3) and care for newborn.
| Sign | 0 Points | 1 Point | 2 Points | |
|---|---|---|---|---|
| A | Appearance (Skin Colour) | Blue-gray, pale all over | Normal, except for extremities | Normal over entire body |
| P | Pulse | Absent | Below 100 bpm | Above 100 bpm |
| G | Grimace (Reflex Irritability) | No Response | Grimace | Sneeze, cough, pulls away |
| A | Activity (Muscle Tone) | Absent | Arms and Legs Flexed | Active Movement |
| R | Respiration | Absent | Slow, irregular | Good, crying |
Placenta Delivery
- Skin to skin contact and the suckling of the newborn will induce the delivery of the placenta. The mother will experience the same contractions as with delivery of the baby.
- Prepare a Bio-hazard bag to place the placenta into when delivered.
- Do not pull on cord.
- The placenta may take up to 60 minutes after the delivery of the baby to be expelled.
- Ensure the placenta is taken with the mother to hospital.
Care of the Mother
- Apply pad to vagina post delivery, and ensure no excessive blood loss has occurred.
- Instruct mother to keep pad in place by keeping legs closed.
- Remove the soiled linen from under buttocks and wipe off any fluids from mother’s legs.
- Cover mother and keep warm.
- Monitor mother and baby en route to hospital.
- Record APGAR at 1, 5 and 10 minutes.
Potential complications:
- Bleeding prior to delivery
- Cord prolapse
- Malpresentation
- Placenta previa
- Postpartum haemorrhage
- Premature birth
- Shoulder dystocia
- Cord rupture
| Settings | |
|---|---|
| Extended Care: | |
| Colour assist: | |
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