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Questions and Answers
What is the recommended action if the head of the baby no longer recedes between contractions?
What is the recommended action if the head of the baby no longer recedes between contractions?
What is a characteristic of normal labour?
What is a characteristic of normal labour?
Which scenario does not warrant calling a midwife despite imminent birth?
Which scenario does not warrant calling a midwife despite imminent birth?
What is defined as 'birth imminent'?
What is defined as 'birth imminent'?
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What should be included in the maternity pack for a birth?
What should be included in the maternity pack for a birth?
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What action should not be taken when the baby is born?
What action should not be taken when the baby is born?
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Which colour of amniotic fluid suggests caution?
Which colour of amniotic fluid suggests caution?
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During the second stage of labour, what is the primary physiological change occurring?
During the second stage of labour, what is the primary physiological change occurring?
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Which of the following is most important for supporting the mother during birth?
Which of the following is most important for supporting the mother during birth?
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What is a significant cause for concern during labour?
What is a significant cause for concern during labour?
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In terms of positioning, which method is recommended during childbirth?
In terms of positioning, which method is recommended during childbirth?
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What is the correct definition of crowning during childbirth?
What is the correct definition of crowning during childbirth?
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What should be the immediate action after the baby is born?
What should be the immediate action after the baby is born?
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What does the Maternity Action Tool assist in evaluating?
What does the Maternity Action Tool assist in evaluating?
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Which of the following is NOT a sign of 'birth imminent'?
Which of the following is NOT a sign of 'birth imminent'?
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What happens during the first stage of labour?
What happens during the first stage of labour?
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What typically occurs to the umbilical cord within 5 minutes after birth?
What typically occurs to the umbilical cord within 5 minutes after birth?
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What is a sign that the third stage of labour has not progressed appropriately?
What is a sign that the third stage of labour has not progressed appropriately?
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Which of the following actions can help facilitate the delivery of the placenta?
Which of the following actions can help facilitate the delivery of the placenta?
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In the context of a water birth, what should be done if a midwife is not present?
In the context of a water birth, what should be done if a midwife is not present?
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What is the purpose of creating a separate electronic Patient Care Record (ePCR) for the newborn?
What is the purpose of creating a separate electronic Patient Care Record (ePCR) for the newborn?
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Which of the following is a critical step to determine if birth is imminent during labour?
Which of the following is a critical step to determine if birth is imminent during labour?
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What should be submitted if a maternity/birth experience is not straightforward?
What should be submitted if a maternity/birth experience is not straightforward?
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Which method is not effective for stimulating oxytocin to aid in placenta delivery?
Which method is not effective for stimulating oxytocin to aid in placenta delivery?
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What is a critical sign indicating that birth is imminent?
What is a critical sign indicating that birth is imminent?
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During which stage of labour does the cervix dilate from 0-10 cm?
During which stage of labour does the cervix dilate from 0-10 cm?
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What is considered a cautionary sign regarding the color of amniotic fluid?
What is considered a cautionary sign regarding the color of amniotic fluid?
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What typically occurs during the second stage of labour?
What typically occurs during the second stage of labour?
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Which symptom does NOT indicate a normal labor condition?
Which symptom does NOT indicate a normal labor condition?
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What is the immediate action after the birth of the baby?
What is the immediate action after the birth of the baby?
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What is a common misconception regarding the stages of labor?
What is a common misconception regarding the stages of labor?
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What indicates that the fetal heart rate is within a normal range during labour?
What indicates that the fetal heart rate is within a normal range during labour?
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What is the maximum estimated blood loss that is typically expected during the third stage of labour?
What is the maximum estimated blood loss that is typically expected during the third stage of labour?
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What action can support the natural delivery of the placenta?
What action can support the natural delivery of the placenta?
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Which statement reflects an immediate course of action if the placenta does not deliver within 20 minutes of birth?
Which statement reflects an immediate course of action if the placenta does not deliver within 20 minutes of birth?
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In the context of water births, what should be the first step if a midwife is not present?
In the context of water births, what should be the first step if a midwife is not present?
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What is the recommended way of collecting information for the electronic Patient Care Record (ePCR) for a newborn?
What is the recommended way of collecting information for the electronic Patient Care Record (ePCR) for a newborn?
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What physiological principle can help with the positioning of a woman during the delivery of the placenta?
What physiological principle can help with the positioning of a woman during the delivery of the placenta?
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Which of the following options highlights a critical reason for submitting a Datix after a birth that is not straightforward?
Which of the following options highlights a critical reason for submitting a Datix after a birth that is not straightforward?
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What is NOT a method to stimulate oxytocin for aiding in the delivery of the placenta?
What is NOT a method to stimulate oxytocin for aiding in the delivery of the placenta?
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What should be established to ensure the comfort and dignity of the mother during birth?
What should be established to ensure the comfort and dignity of the mother during birth?
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Which of the following items is NOT found in a maternity pack?
Which of the following items is NOT found in a maternity pack?
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What action should be avoided when managing the umbilical cord immediately after birth?
What action should be avoided when managing the umbilical cord immediately after birth?
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What is the primary consideration when the birth is imminent and calling a midwife?
What is the primary consideration when the birth is imminent and calling a midwife?
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What is a critical step in the assessment of a newborn during the first minute of life?
What is a critical step in the assessment of a newborn during the first minute of life?
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Which method should be utilized to decide on the urgency of assessments during labor?
Which method should be utilized to decide on the urgency of assessments during labor?
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How should the baby be managed as the shoulders and body are being born?
How should the baby be managed as the shoulders and body are being born?
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What is the proper response if a mother experiences vaginal loss during labor?
What is the proper response if a mother experiences vaginal loss during labor?
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Study Notes
Normal Labour
- Starts spontaneously after 37 completed weeks
- Singleton pregnancy
- Cephalic presentation - baby's head is down
- Contractions follow a wave-like pattern
Cause for Concern
- Contractions prior to 37 weeks gestation
- Multiple pregnancy (twins, triplets…)
- Constant abdominal pain
- Any amount of fresh bleeding
Stages of Labour
- First Stage: Cervix dilates from 0-10cm, contractions become more frequent and strong
- Second Stage: From full dilatation to the complete birth of the baby
- Third Stage: From birth of the baby to the expulsion of the placenta + membranes
Birth Imminent
- According to JRCALC: Regular contractions (every 1-2 minutes), urge to push, crowning
Crowning
- When the widest part of the baby’s head is born
- The head no longer recedes between contractions
Making the Call
- Listen to the woman
- Use the Maternity Action Tool
- Be iterative in the assessment
Calling a Midwife
- Limited use when birth is imminent
- Exception: booked for homebirth, safeguarding or medical concerns, and mother declines transfer to hospital
Preparation for Birth
- Ensure a warm environment
- Have the Maternity Pack readily available
- Prepare a safe space for the newborn (NLS area)
- Gather all necessary equipment
Maternity Pack Contents
- 2 x Maternity Pads
- 2 x Poly Aprons
- 1 x New-Born Nappy/Diaper
- 1 x Self Seal Poly bag
- 1 x Umbilical Cord Scissors
- 2 x Hooded Baby Towels
- 1 x Sterile field
- 1 x Large Baby Hat
- 1 Adult ID Band
- 1 x Yellow Bag
- 1 x baby hat
- 4 x White Umbilical Clamps
- 1 x Baby ID Band
- 1 x Absorbent Inco Pad
- 10 x XRD Gauze Swabs (10x10cm)
- 1 x Blizzard Blanket
Supporting the Birth
- Ensure comfort and dignity
- Offer Entonox
- Avoid the supine position
- Keep a calm and reassuring demeanor
- Encourage the woman to pant during crowning
- Hold the baby as the shoulders and body are born
Baby - First Minute of Life
- Keep the cord intact
- Quickly and thoroughly dry the baby
- Undertake ABCDE assessment
- Use ‘Care of the Newborn’ card
Third Stage of Labour
- Woman may experience contractions/pressure
- Cord will lengthen
- May be a gush of blood (does not exceed 200-300mls)
Management of the Third Stage
- Encourage the woman to empty her bladder
- Stimulate oxytocin (breastfeeding, skin to skin, calm environment)
- Position change- gravity is your friend
Water Birth
- Not within the scope of practice for ambulance clinicians
- If a woman is in a pool, ask her to exit
- If she declines, escalate early and explain the risks
Birth Documentation
- Two ePCRs (one for the mother, one for the baby)
- Include detailed information: mother's details, gestation, interventions, time of birth
Not a Straightforward Birth?
- Submit a Datix report
Summary
- Assess each situation holistically using the Obstetric Emergencies Card
- Call for help early
- Prepare an area for birth and NLS
- Do not waste time calling a midwife unless booked for a homebirth or safeguarding issues
- Create a separate ePCR for the newborn
- Submit a Datix for any maternity/birth that isn’t straight-forward
Normal Labour
- Starts spontaneously after 37 completed weeks of gestation
- Singleton pregnancy
- Cephalic presentation (baby's head is down)
- Contractions follow a wave-like pattern
- No red flags or abnormal observations present
Concerning Labour
- Contractions prior to 37 weeks gestation
- Multiple pregnancy
- Constant abdominal pain
- Abnormal observations
- Any amount of fresh bleeding
Stages of Labour
-
First Stage: Cervix dilates from 0-10 cm
- Contractions start irregular and spaced in the latent phase. As labour progresses, contractions become stronger, longer and more frequent.
- Membranes may rupture but not always.
- Amniotic fluid colour matters:
- Clear, straw coloured, or pink is okay.
- Brown or green indicates caution.
-
Second Stage: From full cervical dilatation to complete birth of the baby
- Baby descends through the cervix into the birth canal
- Contractions become expulsive
- Woman may feel an urge to push and bear down with contractions.
- Presenting part of the baby (normally the head) becomes visible followed by the baby's birth.
-
Third Stage: From birth of the baby to expulsion of the placenta and membranes.
- Woman may experience contractions/pressure
- Cord lengthens
- There may be a brisk gush of blood (not exceeding 200-300 ml).
- If the placenta does not deliver within 20 minutes of birth, a pre-alert is necessary.
Birth Imminent
- Regular contractions (every 1-2 minutes)
- Urge to push
- Crowning
Crowning
- Widest part of the baby's head is born.
- Head does not recede between contractions, and will be fully born (chin out) with the next contraction.
Making the Call
- Listen to the woman
- Consider the whole picture: gestation, parity, obstetric history, current risk factors, vaginal loss, and birth imminent signs.
- Use the Maternity Action Tool.
- Assessment should be iterative as things can change quickly.
When to Call a Midwife
- Calling a midwife is of limited use when birth is imminent.
- 2 exceptions:
- Woman is booked for homebirth
- Safeguarding or medical concerns and the mother declines transfer to hospital
Preparing for Birth
- Environment should be warm.
- Assemble the maternity pack.
- Prepare the NLS area.
- Ensure resources are available at the scene.
- Gather necessary equipment.
Supporting the Birth
- Remember comfort and dignity
- Offer Entonox
- Avoid supine position
- Maintain eye contact, use warm touch, and a calm voice
- Keep hands poised as baby births.
- Encourage the woman to pant during crowning.
- Hold the baby as the shoulders and body are born, then lift the baby towards the woman's abdomen.
Baby - First Minute of Life
- Keep the cord intact, regardless of baby's condition
- Quickly and thoroughly dry the baby
- Undertake ABCDE assessment (color, tone, breathing, heart rate).
- Use 'Care of the Newborn' card on JRCALC+.
Baby in Good Condition
- Wait for cord to go white.
- Then clamp and cut the cord.
- Avoid palpating the cord for pulsation as it may stop blood flow to the baby.
Management of the 3rd Stage
- Encourage the woman to empty her bladder.
- Stimulate oxytocin (breastfeeding, skin to skin, calm environment).
- Position change; gravity is helpful.
- Bring the placenta to the hospital for inspection.
Water Birth
- Some women use hydrotherapy for pain relief in labour/during birth.
- This is outside the scope of practice for ambulance clinicians.
- If a woman is in a pool on arrival (and a midwife is not present), ask her to exit the pool.
- If she declines, escalate early and document the discussion, explaining risks to her and her baby.
Birth Documentation
- Complete two ePCRs (one for mother, one for baby).
- Include as much information as possible:
- Mother's details: name, DOB, ethnicity.
- Gestation, parity, presenting complaint, estimated blood loss.
- Time of head delivered, time of birth.
- Any interventions or manoeuvres performed.
Non-Straightforward Birth or Transfer
- For non-straightforward births or transfers with no concerns/red flags, report a DATIX.
Summary
- Determining birth imminence requires a holistic assessment.
- Use the Obstetric Emergencies Card to help with your assessment.
- Be prepared; call for help early, set up the area for birth and NLS.
- Don't waste time calling a midwife unless booked for homebirth or due to safeguarding issues.
- Remember to create a separate ePCR for the newborn.
- Submit a DATIX for any maternity/birth that is not straightforward.
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Description
Test your knowledge on the stages of normal labour, potential concerns, and the signs of imminent birth. This quiz covers key concepts such as cephalic presentation, contractions, and the process of calling for midwife assistance. Prepare to enhance your understanding of childbirth and maternal care.
