Labor & Delivery Question

[highvelocity84]

I don't know where to put this question, so I'm putting it here.

I’m in an EMT class and we’ve now reach Obstetrics. Yes, I’m giving my full attention to this chapter since it seems not many do as well on the NRE.

Here’s my question:

Let’s say you’re an EMT out in the field and that delivery of a baby from its mother is imminent. How are you going to know that the cervix is completely dilated? I know that the "bloody show" is an indicator that its dilating...

I hope this question isn’t stupid b/c I thought that in the hospital, they have a way of figuring out how dilated you are.

Thanks for your help everyone!!

 

[KEVD18]

when the baby starts to crown, its time!

 

[Sasha]

I don't know where to put this question, so I'm putting it here.

I’m in an EMT class and we’ve now reach Obstetrics. Yes, I’m giving my full attention to this chapter since it seems not many do as well on the NRE.

Here’s my question:

Let’s say you’re an EMT out in the field and that delivery of a baby from its mother is imminent. How are you going to know that the cervix is completely dilated? I know that the "bloody show" is an indicator that its dilating...

I hope this question isn’t stupid b/c I thought that in the hospital, they have a way of figuring out how dilated you are.

Thanks for your help everyone!!

As an EMT or Medic, you really dont have to be concerned with how dilated she is, just if a head or bum is pushing through or not!

 

[highvelocity84]

That's what I thought! I was thinking crowning, but I wasn't for sure.

Thanks so much to both of you!

 

[piggy16]

Here is a goofy little animation with explanations of what happens during each centimeter of dilation

http://pennhealth.com/health_info/animationplayer/cervical_dilation.html

 

[jochi1543]

Our instructor said, "if she says she feels like she needs to go #2, get ready to deliver in the field." Otherwise (as long as nothing's showing, of course), transport ASAP.

 

[MSDeltaFlt]

I don't know where to put this question, so I'm putting it here.

I’m in an EMT class and we’ve now reach Obstetrics. Yes, I’m giving my full attention to this chapter since it seems not many do as well on the NRE.

Here’s my question:

Let’s say you’re an EMT out in the field and that delivery of a baby from its mother is imminent. How are you going to know that the cervix is completely dilated? I know that the "bloody show" is an indicator that its dilating...

I hope this question isn’t stupid b/c I thought that in the hospital, they have a way of figuring out how dilated you are.

Thanks for your help everyone!!

Here's the deal. You won't know it she's completely dilated. If she feels like she has to push or have a BM, then you have to look. We don't check cervix's in the field, and thank God for that.

The only time your hand goes into an OB is to support the cord when it is being compressed by the cervix in either a prolapsed cord or breach birth phenomenon.

If the baby is crowning (ie: you see the top of the head), prepare for imminent birth.

99 times out of 100, it's going to be a routine trip to the hospital.

A lot of EMS folk tend to get wound up a little tight when an OB gives birth on them in the field. We've been doing it that way for tens of thousands of years before the invention of EMS. It's natural. It's normal. It's what happens when you have unprotected sex.

 

[Melbourne MICA]

Cervical Dilatation

Establishing cervical dilatation is done by manual digital examination via the vagina. As the guys pointed out - we no do this.

Also if there is a head or a bum on view as the guys said, you can bet your life tha cervix is already full dilated. Though not having experienced child birth personally the process is fairly intense to say the least and mum usually knows when the penultimate event is occuring.

Usually

Its typically over very quickly.

Enjoy - after all the blood and guts, pain and suffering, child birth will be an experience you enjoy assisting with. It's nice to see pts smile.

But be ready - its messy.

MM

 

[Ridryder911]

I can understand why EMT's cannot check for dilatation but Paramedics are taught by NHTSA curriculum to be able to re-insert a prolapsed uterus?

As a RN I can check for dilatation but not as a Paramedic? Yet, in nursing we did study obstetrics for 16 weeks.

R/r 911

 

[Melbourne MICA]

I can understand why EMT's cannot check for dilatation but Paramedics are taught by NHTSA curriculum to be able to re-insert a prolapsed uterus?

As a RN I can check for dilatation but not as a Paramedic? Yet, in nursing we did study obstetrics for 16 weeks.

R/r 911

There is no justifiable clincial purpose affecting outcome or treatment for the use of this invasive and unpleasant procedure by EMT's in the field. As the general scenario for calling an ambulance is an unexpectedly rapid or imminent delivery such an exam would be redundant anyway. There may also be risks associated with infection and cervical trauma attached.

A uterine prolapse is an obstetric emergency necessitating intervention though I'm very surprised this is included in EMT procedures in the US.

Thus the decision is one made on the basis of comfort and privacy issues for the patient not whether we have the training or ability to carry out a particular skill or not.

MM

 

[alphatrauma]

..."if she says she feels like she needs to go #2, get ready to deliver in the field."

"I just peed myself" is a close 2nd

 

[rhan101277]

Our instructor said, "if she says she feels like she needs to go #2, get ready to deliver in the field." Otherwise (as long as nothing's showing, of course), transport ASAP.

Same, as well as crowning.

 

[Ridryder911]

"I just peed myself" is a close 2nd

Not really, depending upon the gravida if the 'water' has broken how soon delivery is prominent. I have seen deliveries not occur for 48 hours afterwards or have to break the bag while delivering the infant.

Definitely something to ask though.

Now, I ask why does everyone assume that childbirth is an emergency back to the hospital? It is a natural occurrence that happens every second somewhere in the world. So why is it EMT's so afraid and what makes it an emergency, if everything is okay?

R/r911

 

[MSDeltaFlt]

A lot of EMS folk tend to get wound up a little tight when an OB gives birth on them in the field. We've been doing it that way for tens of thousands of years before the invention of EMS. It's natural. It's normal. It's what happens when you have unprotected sex.

Yeah, Rid, I'm kinda wondering the same thing.

 

[alphatrauma]

Now, I ask why does everyone assume that childbirth is an emergency back to the hospital?

Many people are terrified of newborns, and mortified by gaping vaginas... put 'em both in the same scenario and it's lights and siren all the way baby

 

[LucidResq]

Now, I ask why does everyone assume that childbirth is an emergency back to the hospital? It is a natural occurrence that happens every second somewhere in the world. So why is it EMT's so afraid and what makes it an emergency, if everything is okay?

R/r911

I agree with you, but childbirth itself is such a dramatic process and it's pretty rare in the field that it's bound to make EMTs with little to no experience with OB antsy.

Besides most EMTs are well aware that they are dealing with 2 patients, one of them more helpless, innocent and tiny than any other patient they will ever treat, and that the other patient is more concerned about the tiny patient than anything else in the world. Kind of adds to the pressure.

I think it would be a good idea to have EMTs spend some time on L&D as part of their training. It would probably greatly reduce their anxiety about childbirth and give them some confidence. I'm sure there's nothing worse than having a medical professional arrive to help deliver your baby, only to see that they're sweating bullets, stuttering and fumbling with the OB kit equipment.