First Responder EMS Curriculum for Training Centers in Eurasia

2. IntroductionChildbirth can occur both in the pre-hospital setting as well as in-hospital. Although caringfor a mother giving birth to a child is not a frequent scenario that First Respondersencounter, situations may occur in which there is not enough time to transport the motherto the hospital for delivery. In situations where pre-hospital delivery is likely, the FirstResponder on scene must be ready to assist the mother in the childbirth process.In this lesson, we will discuss the reproductive anatomy and physiology of the woman andher developing, unborn child. We will discuss emergency care for pre-deliveryemergencies that may occur. We will review the stages of labor in a normal delivery, aswell as the resuscitation of the newborn and post-delivery care of the mother. With thisbasic knowledge and skill, the First Responder will be able to effectively assist a mothergiving birth to a child.a. Reproductive Anatomy and PhysiologyThe woman has a unique anatomy that allows pregnancy and delivery to occur, usuallywithout any medical intervention. The uterus is the muscular organ in which the babydevelops, and finally contracts to force the baby out through the birth canal. The cervixis the lowest portion of the uterus. During labor, the cervix dilates, and a mucus plugeventually dislodges, indicating imminent delivery. The birth canal is the lower part ofthe uterus and vagina, which leads to the external opening in the female. The perineumis the area of skin between the vagina and the anus. This area of skin often tears duringchildbirth.An unborn, developing baby is called a fetus. The fetus grows and develops inside theuterus. The fetus is nourished with oxygen and nutrients from the mother through anorgan called the placenta. The placenta is composed of fetal and maternal tissue and isattached to the wall of the uterus. The placenta attaches to the fetus via an umbilicalcord. This cord contains two arteries and one vein. Blood flows from the fetus to theplacenta and back to the fetus. Maternal and fetal circulations are independent, but theplacenta and umbilical cord allow for effective nourishment and waste exchangebetween the mother and fetus. The fetus is surrounded by an amniotic sac, whichcontains 1 to 2 liters of fluid. This fluid helps to cushion and protect the developingfetus during pregnancy. Before childbirth, this sac ruptures, and the amniotic fluid helpslubricate the birth canal.Many changes occur in a woman’s physiology during pregnancy, and the FirstResponder should be generally aware of these changes. The pregnant woman has anincreased blood volume, increased heart rate, increased respiratory weight, and slightlydecreased blood pressure. Digestive processes slow and urinary frequency increases.During pregnancy, the uterus expands to accommodate the growing fetus. The fetusgrows for approximately 9 months, or 40 weeks. To estimate a woman’s date ofdelivery, add 9 months plus 7 days from the first day of the woman’s last menstrualperiod.b. Stages of LaborLabor can be defined as uterine contractions that increase in frequency and intensity,resulting in the delivery of both the fetus and the placenta. Labor can be divided intothree stages.192 First Responder EMS Curriculum/AIHA, July 2002