First Responder EMS Curriculum for Training Centers in Eurasia

a. Delivery ProceduresWhen assisting a patient with the delivery of a baby, the First Responder should followthe delivery procedures listed below:1. Observe body substance isolation precautions.2. Have the mother lie on her back with knees drawn up and legs spread apart.3. Place absorbent, clean materials (sheets, towels, etc.) under the patient’s buttocks.4. Elevate the patient’s buttocks with a pillow or blankets.5. When the infant’s head appears, place the palm of your hand on top of thedelivering baby’s head and exert very gentle pressure to prevent an explosivedelivery.6. If the amniotic sac does not break, or has not broken, tear it open with your fingersand push it away from the infant’s head and mouth.7. As the infant’s head is being delivered, determine if the umbilical cord is wrappedaround the infant’s neck. If it is around the neck, try to slip the cord over the baby’sshoulder. If unsuccessful, attempt to alleviate pressure on the cord.8. After the infant’s head is delivered, support the head as it rotates. Suction the mouthand nostrils of the infant with a bulb syringe, if available. Suction the mouth andeach nostril two or three times. Each time, withdraw the syringe and expulse thesecretions onto a towel. Try to avoid gagging the infant while suctioning. If a bulbsyringe is not available, wipe the secretions from the mouth and nostrils with aclean cloth or gauze.9. As the torso and full body are delivered, support the infant with both hands. Do notpull on the infant. The uterine contractions will force the infant out.10. As the feet are delivered, grasp them.11. Keep the infant level with the vagina.12. You may place the infant on the mother’s abdomen for warmth.13. When the umbilical cord stops pulsating, it should be tied with gauze between themother and the newborn.14. Wipe the blood and mucus from the baby’s mouth and nose with gauze. Suction themouth and nose again.15. Dry the infant. Rub the infant’s back or flick the soles of the feet to stimulatebreathing. Wrap the infant in a warm blanket and place on its side, the head slightlylower than the trunk.16. There is no need to cut the cord in a normal delivery. Keep the infant warm untiladditional emergency medical services personnel arrive with the appropriateequipment to clamp and cut the cord.17. Record the time of delivery.18. If there is a chance of multiple births, prepare for the second delivery.19. Observe for the delivery of the placenta, which may take up to 30 minutes. If theplacenta is delivered, wrap it in a towel with at least three fourths of the umbilicalcord and place it in a plastic bag. Keep the bag at the level of the infant.20. Place a sterile pad over the vaginal opening, lower the mother’s legs, and help herto hold them together.b. Vaginal Bleeding Following DeliveryThe First Responder can expect up to 300 to 500 ml of blood loss following a normaldelivery. This blood loss is generally well tolerated by the mother. It is important toknow this, because it allows the First Responder to alleviate his/her personal194 First Responder EMS Curriculum/AIHA, July 2002