First Responder EMS Curriculum for Training Centers in Eurasia

The first stage of labor begins with regular contractions of the uterus and continues untilthe fetus enters the birth canal. During the first stage, the cervix gradually thins anddilates to 10 cm, allowing the fetal head to move into the birth canal. As the cervixdilates, blood and mucus are passed (bloody show), indicating imminent delivery.The second stage of labor begins when the fetus enters the birth canal and ends whenthe baby is delivered. The presenting part of the fetus is the first body part that can beseen at the vaginal opening. In normal presentations this is usually the head. Other bodyparts may present first, however, indicating a more complicated delivery process.Crowning occurs when the head, or other presenting part, bulges against the vaginalopening.The third stage of labor begins after the baby is delivered and ends after the placenta hasbeen delivered. It may take up to 30 minutes after the baby is delivered for the placentato detach from the uterus and pass through the birth canal. The length of labor variesgreatly among women. In general, the length of time a woman spends in labor decreaseswith each pregnancy and delivery.It should be noted here that some pregnancies end prematurely. A miscarriage is thedelivery of the fetus before it can live independently of the mother. A miscarriageusually occurs in the first 3 months of pregnancy, but may occur at any time during thepregnancy. Women will usually experience cramping and vaginal bleeding from theexpulsion of the products of conception. These products of conception (blood clots andtissue) should be transported to the hospital with the patient in a pad or towel. Beprepared to treat for shock, if the bleeding is heavy.3. DeliveryIn general, most deliveries occur without complication or need for medical intervention.The First Responder’s role is to provide support and assistance to the mother as shedelivers the baby and to provide post-delivery care to the mother and newborn, asnecessary.In general, it is best to transport a mother in labor to the hospital unless delivery isanticipated within a very short time. When trying to decide whether to transport the patientor to assist with delivery at the scene, the First Responder should ask the followingquestions to determine if delivery is imminent:1. What is your due date?2. Is there any chance of multiple births?3. Is there any bleeding or discharge from the vagina?4. Do you feel as if you are having a bowel movement, with increasing pressure in thevaginal area?Examine the patient for crowning. If the patient answers yes to questions 3 and 4, andcrowning is present, prepare to assist with delivery. Observe body substance isolationprecautions. Do not touch the vaginal area except during delivery (a secondary partner orwitness is preferred). Do not let the mother go to the bathroom, and do not hold themother’s legs together to slow the delivery process. If the head is not the presenting part,this may be a complicated delivery requiring medical intervention. Tell the mother not topush, and transport to the hospital as quickly as possible.First Responder EMS Curriculum/AIHA, July 2002 193