Obtain history and gestational age of pregnancy. Time any contractions.
Perform focused physical examination including:
a. Lung sounds
b. Abdominal exam
c. External vaginal exam (only if patient feels pressure or possibility of crowning exists)
Mandatory interventions:
a. Oxygen
b. IV access
If crowning is present, do not transport. Prepare for imminent delivery while maintaining patient privacy. Place gloved hand on fetal head (if this is presenting part) to prevent explosive delivery. Have assistant prepare infant resuscitative equipment including suction bulb/apparatus.
Once head is delivered, suction nose and mouth with bulb suction. Check neck for cord entanglement. If found, gently attempt to maneuver cord over infants’ head. If this proves difficult, clamp umbilical cord in 2 places at least 2” apart and cut with sterile scissors. Remove cord from around infants’ neck.
Deliver infant as gently as possible. Once delivered, note the time, clamp, and cut the cord as above.
Keep infant as warm as possible while assessing respiratory status, muscle tone, crying attempts, and skin color. Suction as needed. Apply blow-by oxygen to infant. If infant is distressed or not responding appropriately, follow instructions under Neonatal Resuscitation protocol.
Assess mother for immediate delivery of placenta. If not imminent, begin transport while monitoring vital signs. Secure infant during transport in most effective way possible.
If mother and child are STABLE, emergent transport not necessary. This is to minimize potential for injury to rear compartment occupants during transport.
Contact Medical Control ASAP so that the Labor & Delivery Department can be notified.
If patient is in eclampsia (seizures), follow Seizure protocol.