SOP for Child Birth

[jjesusfreak01]

Would it be problematic for an EMT to assist in a delivery while off duty? I know this would be a rare occasion, but I guess what I am really wondering is what skills can an EMT use when off duty without getting into trouble since they aren't under medical direction.

Worse question. What if you are off duty and are assisting on a delivery (EMS has been called), and you realize that the cord is prolapsed? If you have gloves do you dive in, or run away?

 

[ExpatMedic0]

If you identify yourself as an EMT and the mother consents, I say go for it. If you get scared you could always call medical control to have them walk you through. If you don't help, its probably going to be some poor shmuck with no idea whats going on, or no one at all.
Just remember Body Substance Isolation!

 

[lightsandsirens5]

Well, this situation would be, in my opinion, extremely rare. Most of the time delivery is not a fast thing. I would think in the majority of cases, if you ran across a woman in labor, EMS could be there before delivery.

Now, having said that you know what is going to happen to me this winter when I am at the gas station an hour and a half from the amb station and some poor gal is having a baby.

The way I look at any off duty help is this: If my not helping will result in somone dying whereas my limited intervention would prevent a death, I will help. If not, it can and will wait until EMS arives. Say in my above scenario the woman had a prolapsed cord, the amb was 60-90 minutes out in the snow with a 60-90 minute transport time to a local hospital, you bet I'd be doing something. But if it is in town on a summer day with a 3 minute response and a 2 minute transport, errrmmmmm, on the spot judgement call. Hopefully she has not gotten so far along in a public place as to have a prolapsed cord without someone calling EMS.

Hope that helps.

 

[jjesusfreak01]

I kinda figured that it would be ok to help at least until on duty ems arrives, but isn't a prolapsed cord immediately dangerous to the baby? I was taught if you see the cord, gloved hand goes in and holds the baby off the cord, doesn't come out until they pull the baby out the other way in the OR.

 

[abckidsmom]

I kinda figured that it would be ok to help at least until on duty ems arrives, but isn't a prolapsed cord immediately dangerous to the baby? I was taught if you see the cord, gloved hand goes in and holds the baby off the cord, doesn't come out until they pull the baby out the other way in the OR.

That's right. There's absolutely no time for waiting around with a cord prolapse.

For the OP: Are you planning a homebirth? Are you planning to intentionally attend a birth off-duty?

Unless the situation occurred in such a way that you looked like a good samaritan who happened into it, you could get into some issues, but usually only if the parents pressed the issue, or if something went wrong and the recieving physician wanted to go after someone.

You'd be protected by the "accidental" nature of birth, and by a very hands-off approach to the labor and delivery, which is the best approach in the vast majority of cases.

 

[usafmedic45]

For the OP: Are you planning a homebirth? Are you planning to intentionally attend a birth off-duty?

Unless the situation occurred in such a way that you looked like a good samaritan who happened into it, you could get into some issues, but usually only if the parents pressed the issue, or if something went wrong and the recieving physician wanted to go after someone.

You'd be protected by the "accidental" nature of birth, and by a very hands-off approach to the labor and delivery, which is the best approach in the vast majority of cases.

Keep in mind that the highest malpractice premiums are paid by OB/GYNs. There's a reason for that.

 

[abckidsmom]

Keep in mind that the highest malpractice premiums are paid by OB/GYNs. There's a reason for that.

Yep, cause it's the saddest and most tragic when a baby dies at childbirth.

Best to go in eyes wide open. We had a nearly-unassisted homebirth last year, and everything went fine, but we were prepared for the possibility that everything would run amok and require a choatic run to the hospital.

The good thing is that a in a closely observed labor, the problems will show themselves when they are still just problems, and not necessarily emergencies or life threats. And precipitous labors are shocking and hard on the mom, but very rarely come with any complications to the baby, so no real need to freak out there, either.

 

[usafmedic45]

Yep, cause it's the saddest and most tragic when a baby dies at childbirth.

No, more like "My baby didn't come out with the athletics of Lebron James, the comedy genius of Tyler Perry and the looks of Usher! Somebody screwed up!" The fact the mom was smoking, drinking, doing drugs, had no prenatal care and never took prenatal vitamins on top of being of questionable genetic quality to begin with had absolutely nothing to do with it. There are very few lawsuits over perinatal births (since they are so rare and when they do happen are normally due to some sort of problem with the baby), but there are a lot of really frivilous lawsuits directed at OBs because someone thinks they screwed up.

 

[jjesusfreak01]

On the upside, since EMTs don't make much to begin with, it probably wouldn't be very cost effective to sue an EMT. Also, in my state I think (not 100% sure) that this would fall completely under good samaritan laws.

http://www.cprinstructor.com/NC-GS.htm

If you're on duty in NC you have insurance, and if you are off duty you are covered within SOP.

 

[LucidResq]

The good thing is that a in a closely observed labor, the problems will show themselves when they are still just problems....

Or the rushed resident doesn't give the mother a chance to deliver on her own, dumps a ton of pitocin to "hurry things along", which causes abnormally rapid contractions and therefore stress to the baby, and since they're already paying more attention to the fetal monitor rather than the patient... they decide an emergency section is needed.

The c-section rate in this country is ridiculous, and it's not a good thing. Vaginal deliveries are much safer and less costly when possible.

I'm all for birthing centers and home births monitored by well-educated and trained Certified Nurse Midwives. They know when a pregnancy is too high-risk for them to manage and refer them out, and in the case of unforeseen circumstances during labor, are totally capable of taking crucial initial measures to control to situation and get the patient to the help they need. They are usually equipped with monitoring and resus. equipment.

When I decide to have children, this is the route I plan to take as long as my pregnancy is normal. Sorry, I don't want to be confined to a hospital bed, delivering against gravity and having a high risk of being incised by an overeager surgeon. This is coming from someone who works with such surgeons, who are great doctors who do a great job. But even one of the MDs I work with spent a day at a birthing center and her experience there totally changed her perspective on out-of-hospital birth - she said that she would rather deliver there than a hospital herself.

I'll get off my soap box now.

 

[usafmedic45]

On the upside, since EMTs don't make much to begin with, it probably wouldn't be very cost effective to sue an EMT

It can be and it does happen more often than you would think. They will just take your house, car, garnish your wages until hell freezes over, etc. Kiss your ideas of a comfortable life goodbye.

Also, in my state I think (not 100% sure) that this would fall completely under good samaritan laws.

Only in the true good samaritan situation, not in the home birth scenario.

If you're on duty in NC you have insurance

Never trust a company's insurance to protect you. They will throw you under the bus to save the guy paying the premiums if given the chance. That's why I always carried and still carry my own malpractice insurance (several million dollars worth actually).

 

[abckidsmom]

On the upside, since EMTs don't make much to begin with, it probably wouldn't be very cost effective to sue an EMT. Also, in my state I think (not 100% sure) that this would fall completely under good samaritan laws.

http://www.cprinstructor.com/NC-GS.htm

If you're on duty in NC you have insurance, and if you are off duty you are covered within SOP.

Not if you are intentionally attending a birth without intent to call EMS or tranport the woman to the hospital. And there may not be much monetary value in suing you, but it would sure wreck your financial life to have a large judgment against you.

And if you were convicted of practicing medicine without a license, then you could face actual jail time.

So, it very much depends on how you find yourself in the situation.

I'm currently on baby watch for a friend whose husband is deployed and who is due with her baby. The plan is to get the kids loaded, drop them at her mom's on the way to the hospital and move forward, until the baby is crowning (she has a history of fast labors). She would be thrilled if the baby was born at home, but it is NOT the plan without a legal birth attendent (or without me ).

 

[Veneficus]

Or the rushed resident doesn't give the mother a chance to deliver on her own, dumps a ton of pitocin to "hurry things along", which causes abnormally rapid contractions and therefore stress to the baby, and since they're already paying more attention to the fetal monitor rather than the patient... they decide an emergency section is needed.

The c-section rate in this country is ridiculous, and it's not a good thing. Vaginal deliveries are much safer and less costly when possible.

I'm all for birthing centers and home births monitored by well-educated and trained Certified Nurse Midwives. They know when a pregnancy is too high-risk for them to manage and refer them out, and in the case of unforeseen circumstances during labor, are totally capable of taking crucial initial measures to control to situation and get the patient to the help they need. They are usually equipped with monitoring and resus. equipment.

When I decide to have children, this is the route I plan to take as long as my pregnancy is normal. Sorry, I don't want to be confined to a hospital bed, delivering against gravity and having a high risk of being incised by an overeager surgeon. This is coming from someone who works with such surgeons, who are great doctors who do a great job. But even one of the MDs I work with spent a day at a birthing center and her experience there totally changed her perspective on out-of-hospital birth - she said that she would rather deliver there than a hospital herself.

I'll get off my soap box now.

I had a really great prof who was an OB/Gyn.

His philosophy was " The only time a doctor should be involved with a birth is when something goes wrong."

His MO is to evaluate the pt, and if everything looks ok to refer her to a nurse midwife and then see the pt for just the routine exams. (the Nurse midwife even does the normal in hospital births)

If something is not normal then he handles it himself. If he gets involved at the hospital it is because something has already been identified or something has already gone wrong to the point where only a knife will help.

 

[abckidsmom]

I'll get off my soap box now.

You're preaching to the choir. The obstetrics industry in our country is shocking.

 

[usafmedic45]

I'm all for birthing centers and home births monitored by well-educated and trained Certified Nurse Midwives.

The problem is that a lot of the nurse midwives I've met are cracked out hippie goddess-worshipping nutballs. The one we were assigned when my daughter was due was so anti-anything medicine (no pain control, no C-section as a last resort, etc) that I informed her that if she showed up in the delivery room I would have her escorted out. They want to pump women full of castor oil and other "herbal supplements" to speed things along when none of them have been proven to do anything but give the woman diarrhea.

Until the midwives as a profession started weeding people out (much like we need to do in EMS), I can't in good faith justify putting gullible and uneducated women in their hands as a general practice, especially outside of a hospital where if something goes wrong there is no one to turn to rapidly. I used to have to deal with a lot of the midwives in our area as part of my being an ACLS and NRP instructor and the chips on their shoulders were huge as they felt such training was beneath them since they would never put a patient in a situation, "like a doctor would" (exact words of more than one of them) that would result in the need for a resuscitation. I took a certain degree of professional pride when they, with their "superior knowledge", failed a course taught at a level that the hospital housekeeping staff could pass without much difficulty.

I don't want to be confined to a hospital bed, delivering against gravity

Actually most deliveries are done with the mom damn near vertical. When my daughter was born, you would have thought her mom was in fulminant pulmonary edema they had her set so far up. This has been the practice with every delivery I have ever been to (a lot of hospitals have a policy of putting an RT on the delivery team for all medium- to high-risk births or C-sections, so I've been to enough that I stopped counting long ago), unless the mother's BP won't tolerate the elevation.

I will agree that the C-section rate needs to come down (and it has been) and Pitocin is abused, but that is more a result of out of control malpractice suits and the desire of mothers to "schedule" the birth of their child around their busy schedules than anything else.

 

[abckidsmom]

I had a really great prof who was an OB/Gyn.

His philosophy was " The only time a doctor should be involved with a birth is when something goes wrong."

His MO is to evaluate the pt, and if everything looks ok to refer her to a nurse midwife and then see the pt for just the routine exams. (the Nurse midwife even does the normal in house births)

If something is not normal then he handles it himself. If he gets involved at the hospital it is because something has already been identified or something has already gone wrong to the point where only a knife will help.

This kind of talk just emphasizes that sections save babies. I'd really like to see some statistics from that OB, to see if his actions backed up what he said, because if the midwives were good, the population was low-risk, and the hospital policies allowed women to labor freely, the c/s rate should have been well below 10%.

The image of a doctor racing in in an emergency, surgically removing a baby from the mom, and then heroically talking about how "only a knife would help" perpetuates the myth that there are so many cases where the women were not capable of giving birth.

 

[CAOX3]

Well, this situation would be, in my opinion, extremely rare. Most of the time delivery is not a fast thing. I would think in the majority of cases, if you ran across a woman in labor, EMS could be there before delivery.

Yeah you hope, try Gravida=8, Para=8, all vaginal. That little guy came out like he was on a water slide. h34r:

It seems to be more common now. It used to be when you went out on an OB call you knew you had an hour at least. Now their having them in the toilet.

 

[Veneficus]

This kind of talk just emphasizes that sections save babies. I'd really like to see some statistics from that OB, to see if his actions backed up what he said, because if the midwives were good, the population was low-risk, and the hospital policies allowed women to labor freely, the c/s rate should have been well below 10%.

The image of a doctor racing in in an emergency, surgically removing a baby from the mom, and then heroically talking about how "only a knife would help" perpetuates the myth that there are so many cases where the women were not capable of giving birth.

A knife does not imply a c-section.

Finding and ligating one of the ruptured uterine arteries that retracts into the peritoneum is a very difficult and life saving sugical intervention that cannot be done by a midwife.

 

[Veneficus]

too late to edit

The need for the above described procedure in my experience is usually identified and performed after a normal vaginal delivery.

 

[Sandog]

Never trust a company's insurance to protect you. They will throw you under the bus to save the guy paying the premiums if given the chance. That's why I always carried and still carry my own malpractice insurance (several million dollars worth actually).

Which is why it is a good idea to fork out the $100 or so a year premium for malpractice insurance.