Page 73 - 2026 SMOG

CHILDBIRTH
Signs and Symptoms Possible Complications
• Gravidity/Parity • Preterm labor
• Any pregnancy complications • Placenta previa
• Vaginal fluid/bleeding? • Prolapsed cord
• Painful uterine contractions/back pain/stomach • Abnormal presentations (i.e., breech)
pain • Spontaneous vaginal delivery (i.e., natural
• Duration of contractions and time between outcome)
• Crowning/urge to push
• Any complications expected with the newborn
Treatment
• O if hypoxemic, IV/IO, cardiac monitor, and blood glucose check
2
• Place in left lateral decubitus or pad under right hip
• Hyper/hypotensive? Any abnormal bleeding? Refer to OBSTETRIC EMERGENCY PROTOCOL
• Visually inspect to see if the patient is crowning. If crowning is present, assist with the birth of the
child. If no, continue to monitor, reassess, and transport the patient to the nearest MTF
• Prep for birth: Position the mother in a supine supported position, prepare 2 sets of hemostats and
scissors/scalpel, umbilical cord clamp if available, bulb suction
• If delivery is inevitable:
˚ Deliver the fetal head, supporting the perineum with a gloved hand or towel
˚ Use slight downward pressure on the fetal head to deliver the anterior shoulder, then slight upward
pressure to deliver the posterior shoulder
˚ Place the infant on a warm, dry towel/blanket or directly on the maternal abdomen for skin-to-skin.
˚ Suction the mouth, then the nose, with bulb suction if there is an obvious obstruction from
secretions
˚ Clamp the cord after 1–3min with 2 hemostats and cut between the clamps. Wrap the infant with
a dry towel/blanket to prevent hypothermia, or cover the infant while maintaining skin-to-skin
contact. SPECIAL POPULATIONS
˚ Deliver the placenta within 30min. DO NOT PULL. Keep the placenta for evaluation by MTF.
˚ Externally massage the uterine fundus to encourage contraction/limit bleeding.
˚ Continue to monitor and reassess the mother and neonate en route to the nearest MTF, and refer to
the NEWBORN PROTOCOL.
Notes, Cautions, Warnings
• If the umbilical cord (i.e., nuchal cord) is around the neck, you deliver by keeping the fetal head near
the mons or attempt to reduce it manually prior to delivery of the shoulders (should feel a ropelike
structure around the neck). As a last resort, and if unable to keep pressure off the cord, clamp and cut
the cord before delivery of the shoulders
• If the umbilical cord is seen (i.e., prolapsed cord), elevate the presenting part with a vaginal hand* and
maintain elevation until delivery via C-section. **Do not place pressure on the cord or monitor pulse
via the cord**
• If the neonate appears to be stuck in the birth canal (i.e., turtling of the head) without delivery of the
anterior shoulder, remove the hand from the head, flex the mother’s hips (both knees to chest), and
attempt delivery with gentle downward pressure.
*Vaginal hand is the hand in the vagina that is being used to elevate the presenting part. The other hand remains
free to perform any concurrent actions.

2026 Standard Medical Operating Guidelines (SMOG) • 65