# Live Birth anomalies



## AustinNative (Feb 27, 2011)

I just saw a Cesarean Section performed during my L&D rotation, and it was a single nuchal birth, with no problems.  I understand what steps to take when presented with this in a Vaginal Birth in the field, but wonder if any of you have had this happen to you.  I am also curious as to what unusual births you may have witnessed/participated in?  Did the standard/traditional treatments work on all of these?  It would be nice to know any hard-earned tips.  I appreciate any information you can give me.


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## systemet (Feb 28, 2011)

My daughter was a nucchal cord (APGAR 3/7/9) in hospital.  That was a little too exciting.  A little PPV, no problems now.

In 10 years, I got to quite a few deliveries where the baby was out, and the cord needed cutting, but only one where we actually delivered.  The rest of the patients that I've taken to hospital in labour have stayed in labour until arrival.

This was a 29 week gestation premie, that weighed 1200g  (not bad for gestational age:  http://www.phac-aspc.gc.ca/rhs-ssg/bwga-pnag/index-eng.php).

The mother had been smoking crack, started having abdo pain.  Stood up in front of us, and freaked out as her membranes ruptured, and 8 mins later we had a tiny little neonate.  Both baby and mother did well to the hospital -- although the baby developed RDS later and required NICU care.

I also arrived after the delivery of a term baby (in the bathtub) to a 20 year old who denied knowing she was pregnant.  Her boyfriend also seemed quite suprised.  She was not obese, and both denied any psych history.  


So, for tips:-

- be aware of the potential for premature delivery in patients abusing cocaine

- (especially) premature babies need to be kept really warm.  Crank the truck heater.  If you're not sweating, it's not hot enough. They've just come from 37 degree weather, and their thermoregulatory systems are not mature (they'll go ketotic very easily if you let them get too cold).

- NRP is a good course, especially for paramedics.

- take a look at your ob kit before you have to use it.

- you need a neonatal bagger.  Be aware you may need to depress / switch off the pop-off valve for the first couple of ventilations in a flat newborn. It can take a little bit of extra pressure to expand the lungs for the first time.

- only a fraction of all births require any aggressive care.  The majority of these respond positively to 30-60 seconds of PPV.  Actually having a neonate that requires CPR or epinephrine is very rare.  But you should know how to these things well.

- I think childbirth/delivery/neonatal care is one of those skills that you really have to practice / refresh periodically.  It's like cricothyrotomys, or central line insertion, pediatric arrest management.  Even in a busy system, it's something you're going to see/do very rarely, so you can't rely on experience alone to carry you through.  You need to periodically revisit these skills, because you may have to use them when you least expect it.


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## Sam Adams (Feb 28, 2011)

5 births. 4 live, 1 stillborn to a pregnant 15 yo who didn't know she was pregnant. 3 of the live ones needed rescusitation. 

If you're still in your L&D rotation, try and hook up w/ one of the mid-wives. They're a fount of "natural" delivery knowledge. Ask specifically for tips on shoulder distocia.


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## awildstein (Apr 10, 2011)

My first (and only) delivery was an en-caul birth, meaning the amniotic sac never ruptured and the infant was born completely inside the sac. After the entire child was out, the sac was cut and the child pulled out by one of the medics on scene (she consulted med control immediately after noting the sac bulging out). Once the child was removed there were  no further problems as she pinked-up right away.


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## 18G (Apr 10, 2011)

> the sac was cut and the child pulled out by one of the medics on scene (she consulted med control immediately after noting the sac bulging out).



Really? The Medic needed to consult Med Command to know to puncture the amniotic sac?


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## awildstein (Apr 10, 2011)

18G said:


> Really? The Medic needed to consult Med Command to know to puncture the amniotic sac?



Honestly, I am not exactly sure why command was call. I am not familiar enough with that hospital's protocols to say if the call was completely necessary, though it does seem like common sense that a clear airway takes top priority. Mind you, these types of births are rare occurring in about 1 in 80,000 births.


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## usafmedic45 (Apr 10, 2011)

My count of deliveries:
-Normal vaginal delivery, no complications; threw up and passed out afterwards
-Breech vaginal delivery, no further complications (pt's physician lived down the street and came over to assist when he saw the ambulance);  threw up and passed out afterwards
-Normal vaginal delivery, no complications; threw up and passed out afterwards
-Normal vaginal delivery, no complications; did not throw up or pass out but did smell like deer urine while delivering the kid.


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## 18G (Apr 10, 2011)

I agree that the membranes normally rupture on their own but its not all that uncommon that a provider needs to puncture the sac... either because it presents or to try and kick start labor. 

Granted, pre-hospital we will not puncture to be kick starting labor but it is a pretty elementary principle.

Unfortunately, I must say that after 18yrs of active volunteer and career EMS work I have never had a field delivery!!! what is up with that! I am jealous of those who have had several. I would love to bring life into the world.


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## EMT-IT753 (Apr 10, 2011)

I just finished my clinical rotation in L&D this past Tuesday. I hit the dang jackpot with 1 C-section and 3 vaginal births. All of them were healthy and required nothing other than suctioning and getting them dried off. I went into that clinical not really wanting to actually see any deliveries, but left very glad I did get to see it.

I did have a certified midwife doing the delivery with one of them. As soon as she heard I was a paramedic student, she called me over and had me right next to her during the process. She pointed out all the things to look for and how to position yourself and your hands to "catch" the infant. She also pointed out how to squeeze the perineum together and put pressure on the head to reduce tearing and control the birth. If I ever have to deliver in the field, I will be much more comfortable after that day in L&D.


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## MrBrown (Apr 10, 2011)

The only children Brown plans to deliver are the ones that come out of Mrs Brown

We missed a 24 (childbirth) on Brown's last night shift and got sent to a sick anaphylaxis, seems like a good trade


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## ffemt8978 (Apr 10, 2011)

Never delivered in the field yet...although in my first 3 years I went to 7 miscarriages with spontaneous abortions.  Bagging fetuses for autopsy truly sucks.


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## LucidResq (Apr 10, 2011)

Had a patient in for D&C for either a miscarriage or severe anomaly (can't remember) who turned out to have placenta accreta. 

The amount of hemorrhage was crazy. So bad the OB-GYN and I took her from the clinic to the ER across the street ourselves via pram, where they gave her some fluids and such, and then we ran her right up to the OR within 10 min or so. 

She was ok, in the end, thankfully. 

It wasn't in the field, and it wasn't a live birth, but it is something that can very easily go undetected until you as an EMT or medic have an immediately postpartum woman bleeding out in front of you. 

I do remember that this patient had something like 4-5 c-sections in the past, which apparently is a risk factor for accreta. Something to consider when taking a history, I suppose.


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## mycrofft (Apr 10, 2011)

*Mom's lifstyle needs to be part of your eval*

Even if you are not delivering, use your "rolling confessional" on the way in to get an idea about alcohol, opiates, and other chemical useage. Mom's kicking opiates will lose the fetus in many cases unless detox is put off until post partum. Coke and crank and smoking tobacco can all contribute to prematurity and low birth weight, alcohol has a whole constellation of "minor variations" it can introduce. If you can get that info you're a MVP.


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## usafmedic45 (Apr 11, 2011)

> Bagging fetuses for autopsy truly sucks



There are few things that are as disturbing as having to submerge a stillborn full-term baby into a container of formalin.


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## mycrofft (Apr 12, 2011)

*...Or a fetus carried to delivery after it's death.*

I suppose that is a sidetrack from the OP.
Why do they do that?:sad:


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## usafmedic45 (Apr 12, 2011)

mycrofft said:


> I suppose that is a sidetrack from the OP.
> Why do they do that?:sad:


Less risk to the mother than the alternatives.


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## Wolfpack87 (Apr 26, 2011)

usafmedic45 said:


> did not throw up or pass out but did smell like deer urine while delivering the kid.



You or the Pt? and in either case...wahuh?


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## SD EMT OPS (Apr 27, 2011)

*Live Birth outside ER*

I was outside an ER when a Truck pulled up and guy jumped out shouting "help the Baby's coming" I ran over to find a lady with one foot on the dash board and one foot on the door jam straddling the passenger seat. her baby's head crowning. I yelled at my new hires I was with to grab the OB kit which they could not find. I had one glove in my pocket, put that on just in time to catch the rest of the Baby and try to hang on to it. the baby's head was purple and had the cord wrapped around its neck. i reached down and unwrapped the cord and in few seconds it started to move and breathe. I handed off the baby to a midwife that came up behind me and walked into he ER. i was standing in the middle of the ER asking if anyone wanted to go outside and help me with the baby i just delivered in the parking lot. they all looked at me not believing me until i held up my arms that were now covered in birth fluids, then they all ran out while i ran into the bathroom to Decon.   ..


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## usafmedic45 (Apr 28, 2011)

Wolfpack87 said:


> You or the Pt? and in either case...wahuh?



Me.  I had fallen asleep while deer hunting and when my pager for the volunteer fire department when off I fell backwards out of the tree stand, landing in a snow covered bush about 15 ft below.  I wasn't seriously hurt, but it did crush the plastic bottle of "buck lure" (doe urine) that was in my back pocket.  You might be a redneck EMT if....

After I was done delivering the baby, the dad looked at me, sniffed and goes "Why do I smell buck lure?".  You might be a redneck father if....

BTW, this happened on my birthday and the parents wound up naming the kid after me as they had been expecting a little girl and needed a boy's name.


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## MrBrown (Apr 28, 2011)

Sorry 45 you might be in the neighbourhood but Kate can take her chances with Brown delivering our babies 

Oh and we *are* having the girls first, so sorry bro you don't get to have any little Brown's named after you


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