# Birth Scenario Multiple Choice



## rhan101277 (Aug 3, 2008)

While transporting a woman 8 months' pregnant with her first child, she says she feels the need to push. Upon examining her, you see one of the infant's arms hanging from the vaginal opening. What should you do as a EMT-Basic?

A: Go ahead and deliver the infant in the ambulance.

B: Gently push the infant's arm back into the birth canal and rapidly transport the mother to the emergency department.

C: Adjust the stretcher so that the mother's pelvis is higher than her head, tell her to do her best not to push, and rapidly transport.

D: Leave the mother as is, tell her not to push, and rapidly transport.


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## rhan101277 (Aug 3, 2008)

I think answer is A.


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## CFRBryan347768 (Aug 3, 2008)

I am going with C: but then again im not yet an EMT-B.


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## MMiz (Aug 3, 2008)

I'd go with C.  You cover the area with a sterile cloth, elevate the pelvis, give O2 via NRB, and priority transport.

Edit:
How are you going to go with A?  This patient needs a highly trained surgeon, not an EMT-Basic.


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## MedicPrincess (Aug 3, 2008)

Its C.  

You cannot safely deliver this child.  This patient needs a C-Section.


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## rhan101277 (Aug 3, 2008)

MedicPrincess said:


> Its C.
> 
> You cannot safely deliver this child.  This patient needs a C-Section.



I just thought that the baby would be at risk of dying, guess I need to wait till after the course to attempt these questions  Also do doctors do C-Sections when the baby is already presenting.


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## MMiz (Aug 3, 2008)

rhan101277 said:


> I just thought that the baby would be at risk of dying, guess I need to wait till after the course to attempt these questions  Also do doctors do C-Sections when the baby is already presenting.


Sorry, I wasn't trying to be pissy with my response.  Yes, they would perform an emergency c-section if this presented in the hospital.


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## Jon (Aug 3, 2008)

C is correct. A limb presentation is challenging to manage.


B is wrong. If something comes out... don't push it back in... this goes for eviscerations AND births.

The only exception to "don't push it back" is if the head presents with the cord around the neck. Push the baby back slightly to try to remove tension, and pass it over the head... or cut it.

Jon


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## KEVD18 (Aug 3, 2008)

E. grab the arm and pull.


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## MMiz (Aug 3, 2008)

KEVD18 said:


> E. grab the arm and pull.


That's why God gave 'em two, right?


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## mdkemt (Aug 3, 2008)

Jon said:


> C is correct. A limb presentation is challenging to manage.
> 
> 
> B is wrong. If something comes out... don't push it back in... this goes for eviscerations AND births.
> ...



Cut it.....Never taught that.  We were always told to put steril gloves on and hold the face of the infant and get a finger underneath the cord if possible.  Or you can try to get the dord from around the head.

I have also delivered a child in the back of an ambulance with the arm presenting first.  It is challenging but can be done still.  Sometimes first time mothers won't stop pushing.

MDKEMT


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## Jon (Aug 3, 2008)

mdkemt said:


> Cut it.....Never taught that.  We were always told to put steril gloves on and hold the face of the infant and get a finger underneath the cord if possible.  Or you can try to get the dord from around the head.
> 
> I have also delivered a child in the back of an ambulance with the arm presenting first.  It is challenging but can be done still.  Sometimes first time mothers won't stop pushing.
> 
> MDKEMT


MDK... I retract my statement... at least until I can review my info. - I'm not sure where I heard that.


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## MedicPrincess (Aug 4, 2008)

mdkemt said:


> Cut it.....Never taught that. We were always told to put steril gloves on and hold the face of the infant and get a finger underneath the cord if possible. Or you can try to get the dord from around the head.
> 
> I have also delivered a child in the back of an ambulance with the arm presenting first. It is challenging but can be done still. Sometimes first time mothers won't stop pushing.
> 
> MDKEMT


 
Cutting it is an option, if you cannot get the cord from around the neck.



> Also do doctors do C-Sections when the baby is already presenting.


 
Yes.  Especially when it is the safer option.


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## BossyCow (Aug 4, 2008)

Not necessarily a c-section but definitely a high risk delivery. Go fast... very very fast......


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## mikie (Aug 4, 2008)

our protocol for limb presentation births is RAPID TRANSPORT......the lil thing ain't coming out right without more advanced interventions


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## Ridryder911 (Aug 4, 2008)

Remember, if you cut the cord one MUST deliver within a few minutes, that is why it is NOT recommended to do so, unless you can perform an emergency C-section. ( I don't think anyone on this site is). 

One of the NREMT questions is .."when is it allowable to place the EMT's finger into the birth canal?..." this is one of those times... 

Make a V separating the wall of the vagina and release as much pressure off the cord.. and yes, place wings on the side of the truck...

R/r 911


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## WuLabsWuTecH (Aug 4, 2008)

It's gotta be C.  Correct treatment for Limb presentation is to prevent the birth and go hot to the hospital.  Never push anything back in, and certainly don't try to deliver, you don't have the skills to do so.


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## Jon (Aug 5, 2008)

rhan101277 said:


> ...Also do doctors do C-Sections when the baby is already presenting.


Yep.

I was one, many years ago.


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## MagicTyler (Aug 6, 2008)

Jon said:


> The only exception to "don't push it back" is if the head presents with the cord around the neck.
> Jon



Arn't you supposed to push the cord back in if it presents without the baby?


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## mikeylikesit (Aug 6, 2008)

C.............


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