There’s something about the patient in labor that makes my palms sweat. I’m not alone. Most of us EMS folks get a little anxious at the idea of delivering a baby. Obstetrical calls can go very right and they can go very wrong. The stakes are high.
Here are a few things to consider before you run your next obstetrical call.
1) At full term, pregnant females have a heart rate 10-15 beats per minute faster than when they were prepartum. (Psst…Before they were pregnant.) They also have 25%-30% higher stroke volume and 30%-50% higher cardiac output.
2) Pregnant females will tolerate significant blood loss before they become symptomatic. Once they are symptomatic, they will decompensate rapidly.
3) The official obstetrical term for the mother’s water breaking is “rupture of membranes”. It can be documented with the abbreviation ROM.
4) Unlike the Glasgow Coma Score, you can’t just guess that a healthy baby gets an automatic 10 on the APGAR score. Most healthy babies are born with a score between 8 and 10. In some regions of the United States very few babies are ever scored a 10 at birth.
5) You won’t remember the APGAR score when you’re holding a newborn baby in your hands. Write it on your OB kit.
6) All things considered, moms tends to be the best judge of when labor is eminent.
7) In your EMT class we drilled on the idea that mom should be laid on her left side. More recent research has indicated that getting mom on her side is the important part. Whether she’s on her left side or right side makes no real difference.
8.) Designate the person with the least to do as the official time keeper. Make sure they have access to the most accurate clock available.
9) 600 ccs of blood pass between mom and baby every minute. Mom can loose 1,000-1,500 ccs of blood before she becomes symptomatic. Typical postpartum hemorrhage should be in the neighborhood of 500 ccs.
10) Delay transport if delivery is eminent. Don’t delay transport for delivery of the placenta. It can take hours. Once baby is out, package for transport.
11) Aggressive (uncomfortable) fundus massage is still the best method to slow postpartum hemorrhage.
12) Cut the cord between the clamps. (Seriously…it happens.)
13) When delivering twins, both babies will deliver first. Both placentas will deliver after. Any other ordering is an obstetrical emergency.
14) Fetal trauma cannot be ruled out in the prehospital setting. Lack of vaginal bleeding or pain on palpation does not rule out fetal trauma. Pregnant mothers who have suffered any significant mechanism to the abdomen should be transported for evaluation. (They will typically be observed for 12-24 hours.)
15) Don’t forget to prepare for two patients.
Now it’s your turn: What OB tips would you add to the list?