Birth Imminent 18.05.2023 v5.pdf

Birth Imminent Mechanism of labour Assessing ‘birth imminent’ Preparing for birth Immediate postnatal and newborn care Water birth Documentation Session objectives Understand the anatomy, physiology and assessment of a pregnant woman Understand fetal physiology and ass...

Birth Imminent Mechanism of labour Assessing ‘birth imminent’ Preparing for birth Immediate postnatal and newborn care Water birth Documentation Session objectives Understand the anatomy, physiology and assessment of a pregnant woman Understand fetal physiology and assessment of newborn babies Understand the process and management of labour Be able to support a normal labour, in accordance with agreed ways of working London Ambulance Service NHS Trust 2 What is normal labour? Starts spontaneously (not induced) after 37 completed weeks Singleton pregnancy Cephalic presentation- baby’s head is down Contractions follow a wave-like pattern No red flags/deranged observations present London Ambulance Service NHS Trust 3 What is cause for concern? Contractions prior to 37 weeks gestation Multiple pregnancy (twins, triplets…) Constant abdominal pain Deranged observations (do not let labour give you false reassurance!) Any amount of fresh bleeding London Ambulance Service NHS Trust 4 Stages of labour How many stages of labour? What is the 1st stage of labour? What is the 2nd stage of labour? What is the 3rd stage of labour? London Ambulance Service NHS Trust 5 1st stage of labour Cervix dilates from 0-10cm Contractions- irregular and spaced in the latent phase. As labour becomes established, contractions become stronger, longer and more frequent Membranes may rupture- but not always Colour of liquor (amniotic fluid) is important: Clear/straw coloured/pink- OK Brown/green- caution London Ambulance Service NHS Trust 6 2nd stage of labour From full dilatation of the cervix- complete birth of the baby Baby descends through the cervix into the birth canal Contractions become expulsive Woman may report an urge to push and bear down with contractions The presenting part of the baby (normally the head) becomes visible and is followed by birth of the baby London Ambulance Service NHS Trust 7 What is birth imminent? According to JRCALC: Regular contractions (every 1-2 minutes)* Urge to push* Crowning* London Ambulance Service NHS Trust 8  Is this crowning? London Ambulance Service NHS Trust 9  Crowning is when the widest part of the baby’s head is born. The head no longer recedes between contractions and will be fully born (chin out) with the next contraction. London Ambulance Service NHS Trust 10 Head visible vs. crowning Crowning London Ambulance Service NHS Trust 11 Making the call Listen to the woman Think about the whole picture (Gestation, parity, obstetric history, current risk factors, vaginal loss, birth imminent signs) Use the Maternity Action Tool Be iterative in your assessment- things can change quickly. London Ambulance Service NHS Trust 13 Call the midwife? Calling a midwife is of limited use when the birth is imminent. 2 exceptions: Booked for homebirth Safeguarding or medical concerns and mother declines transfer to hospital London Ambulance Service NHS Trust 14 Preparation for birth Environment (warm) Maternity pack (incos+++) NLS area Resources to scene Equipment London Ambulance Service NHS Trust 15 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 1 x White Label (10x10cm) 1 x Blizzard Blanket London Ambulance Service NHS Trust 16 Supporting the birth Remember comfort and dignity - Entonox - Position (avoid supine) - Eye contact, warm touch, calm voice Hands ‘poised’ as baby births. Encourage woman to pant during crowning Hold the baby as the shoulders and body are born, then lift the baby towards the woman’s abdomen London Ambulance Service NHS Trust 17 Baby- First minute of life Keep cord intact (regardless of condition) Quickly and thoroughly dry the baby Undertake ABCDE assessment (Colour, tone, breathing, heart rate) Use ‘Care of the Newborn’ card on JRCALC+ London Ambulance Service NHS Trust 18  Baby in good condition? WAIT FOR WHITE Wait Clamp and cut Avoid palpating the cord for pulsation- this may stop the blood flow to the baby. The cord will normally go white after 5 minutes 3rd stage of labour From birth of the baby to expulsion of the placenta + membranes Women may experience contractions/pressure Cord will lengthen May be a brisk gush of blood (does not exceed 200-300mls) If the placenta does not deliver within 20 minutes of birth→ PRE-ALERT London Ambulance Service NHS Trust 20 Management of the 3rd stage How can we use physiology to deliver the placenta? 1. Encourage the woman to empty her bladder 2. Stimulate oxytocin (breastfeeding, skin to skin, calm environment) 3. Position change- gravity is your friend Remember to bring placenta to hospital with you for inspection! London Ambulance Service NHS Trust 21 Water birth Some women opt to use hydrotherapy for pain relief in labour/during birth Births in water are outside of the scope of practice for ambulance clinicians If a woman is in a pool on arrival (and a midwife is not present), ask the woman to exit the pool If they decline, escalate early and explain the risks to her and her baby and document the discussion London Ambulance Service NHS Trust 22 Birth documentation X 2 ePCR (1 for the mother, 1 for the baby) Input as much information as possible: - Mother’s details, including name, DOB and ethnicity - Gestation, parity, presenting complaint, estimated blood loss - Time of head delivered, time of birth - Any interventions/manouvres performed London Ambulance Service NHS Trust 23 Not a straight-forward birth or transfer with no concerns/red flags? DATIX Summary Determining whether or not birth is imminent is challenging and requires a holistic assessment- use Obstetric Emergencies Card Be prepared- call for help early, set up area for birth and NLS Do not waste time by calling a midwife (unless booked for a homebirth or safeguarding issues) Remember to create a separate ePCR for the newborn Submit a Datix for any maternity/birth that isn’t straight-forward London Ambulance Service NHS Trust 26