Protocol 2-242 - Childbirth / Labor

CMH EMS & MIH Protocols

In general, this protocol's scope covers management of delivering a baby up to the point of cutting the umbilical cord. After cutting the cord:

• Care for mom following appropriate protocol(s) (i.e., Protocol 2-462 - Gynecologic Emergencies).
• Care for baby/babies following Protocol 2-616 - Newly Born.

EMD:

• MPDS Protocol 24 (Pregnancy) - High risk complications: The following conditions indicate a high-risk pregnancy or childbirth.
• Premature birth, multiple birth, bleeding disorder, placenta abruption, placenta previa, breech, prolapsed cord, OR unknown/ignored pregnancy.

EMR:

• Consider Oxygen if SpO2 less than 88%.
• Inspect for active bleeding/crowning. Determine amount of blood loss.
• Consider applying Cardiac Monitor limb leads.
• Crowning: Stop transport and DELIVER infant. Both crew members should be available during delivery.
• Consider cleaning vaginal area prior to birth.
• Prolapsed cord:
• Place mother on hands and knees.
• Do not handle cord. Cover it with moist dressing.
• Protect cord from compression with fingers.
• Rapid transport to nearest hospital with OB department.
• Breech: Deliver as best you can (see below).
• No complications:
• Provide peritoneal pressure during delivery to prevent tearing.
• Check for cord around neck as soon as head is delivered and slip it over the head if found.
• Guide head down to facilitate delivery of anterior shoulder and then up to facilitate delivery of posterior shoulder.
• Only Suction airway if infant is in distress.
• Dry, warm, and stimulate. Do not routinely Suction.
• Place infant skin-to-skin with mother while she breastfeeds, if possible.
• Clamp and cut cord halfway between mother and infant after 1-3 min. Only clamp cord if full-term gestation baby.
• If resuscitation is needed: Clamp and cut cord as soon as possible.
• Expect placenta within 5-15 min and transport it with patients.
• Perform fundal massage.
• Once delivered: Refer to Protocol 2-616 - Newly Born

EMT:

• Ensure completion of applicable items above.
• NOT crowning:
• Consider orthostatic vital signs.
• Consider transport in left lateral recumbent position to reduce risk of Vena Cava compression.

AEMT:

• Ensure completion of applicable items above.
• IV LR 500-1,000 ml bolus.

RN:

• Ensure completion of all applicable items above.
• Consider IO LR titrated to blood pressure.
• Pain: Consider avoiding narcartic administration.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.
• Refer to MIH Protocol 4-333 - Chronic OB/GYN Management.

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