EMT & AEMT/PARAMEDIC STANDING ORDERS

This protocol should be used for an imminent delivery prior to arrival at the hospital. Imminent delivery is evidenced by crowning at the vaginal opening.

• Routine Patient Care. Obtain OB history.
• Check for crowning. If there are no signs of crowning proceed with transport. If crowning is present prepare for delivery. Notify receiving facility.
• Uncomplicated labor and delivery does not require emergent transport.
• Place the mother in a comfortable, supine position. Place sterile drapes about the perineum.
• Prepare the OB kit and pediatric resuscitation equipment.
• Gently and carefully assist expulsion of the newborn from the birth canal in its natural descent. Do not pull or push the newborn. Prevent explosive delivery of the baby’s head by placing your gloved hand on the baby’s head.
• Upon complete presentation of newborn’s head:
  • Instruct the mother to stop pushing.
  • Support the head. Bulb-suction the mouth then nostrils if obstructed.
  • Check to be certain the umbilical cord is not wrapped about the neck. Unwrap if necessary or if unable to remove apply two umbilical clamps and cut between the clamps to release the cord.
  • Once the newborn’s airway is clear and the cord is free from around its neck, instruct the mother to push on her next contraction to complete delivery.
• For care of newborn see Newborn Care Protocol (73 Medical) For newborns requiring resuscitation, see Newborn Resuscitation Protocol (75 Medical)
• Following delivery of the newborn, the mother’s vagina may continue to ooze blood. Do not pull on the umbilical cord
• Apply firm continuous massage manually to the mother’s lower abdomen (uterine fundus) to help reduce postpartum hemorrhage. Encourage breastfeeding if the mother prefers, as this will aid in the contraction of the uterus which will help stop the bleeding and facilitate delivery of the placenta.
• Do not attempt to examine the patient internally. Never pack the vagina to stop bleeding. Apply a sanitary napkin to the vaginal opening.
• If the placenta does deliver, preserve it in a plastic bag and transport it with the mother. Do not delay transport to wait for the placenta to deliver.

PEARLS:

• OB assessment:
  • Length of pregnancy.
  • Number of pregnancies.
  • Number of viable births.
  • Number of non-viable births.
  • Last menstrual period.
  • Due date. o Prenatal care.
  • Number of expected babies.
  • Stimulant or depressant drug use.
• Signs of imminent delivery:
  • Membrane rupture or bloody show.
  • Contractions.
  • Urge to move bowels.
  • Urge to push.