Shoulders stuck; Shoulder Dystocia

What to look for: *Shoulders not delivered within 2 contractions after head *When head is out, neck may not be visible at all What to do: 1. Mother on hands and knees OR 2. Mother in runner’s position: on one foot, and one knee THIS ALONE WILL BE ENOUGH IN MOST CASES 3. Hook index finger UNDER baby’s LOWER arm, rotate TOWARD baby’s FACE DO NOT PULL ON BABY DO NOT TRY TO “SPIN” THE HEAD

Breech Birth
ASSUME HANDS AND KNEES OR UPRIGHT POSITION Leave mother alone--if baby not delivered within 5-7 minutes of navel appearing, assistance may be required. Do not try to intervene at all or free legs until baby is born to navel Meconium is common and not usually a sign of distress NEVER PULL ON BABY BABY’S BACK MUST NOT BE ALLOWED TO TURN TOWARD MOTHER’S BACK (baby must stay FACING MOTHER’S BACK or to the SIDE) Arms must be delivered before head… WHEN ARMPIT IS SEEN BEFORE ARMS A. Push the baby’s shoulder blade toward its spine, usually causes arm to drop down IF NOT EFFECTIVE: B. Slide two fingers along baby’s upper arm, wipe arm down across baby’s chest and out *This method usually easier with the arm closer to mother’s back *If necessary, baby may be rotated 1/3 of a circle to repeat on other arm

Once arms have been delivered: *Insert finger to baby’s mouth to bend CHIN TO CHEST. DO NOT PULL. *If head does not deliver in next contraction, gentle pressure on belly wall behind head can help *If head still does not deliver, make airway for baby to breathe and, if necessary, call 911

Baby Not Breathing
IT IS NORMAL for baby not to cry/breathe for a few minutes (3-4) after birth When baby is born: *Hold face down and to the side *Rub hand up and down spine and allow him to expel mucous What to look for: 1. Baby born pale blue or white 2. Limp--no startle reflex or movement resistance 3. No facial expressions What to do: 1. Wipe out baby’s mouth with cloth 2. Begin artificial respiration as pictured. A. Hold baby with one hand under hips, the other under shoulders and head B. Gently raise hands, turn them inward, and bring them together, bending body at tummy C. Rate of TWELVE per minute, or ONCE EVERY FIVE SECONDS 3. Move baby into bathroom with steaming hot shower, closed door, while doing this 4. 1 drop Rescue Remedy rubbed into each wrist 5. As last resort, begin mouth-to-mouth. DO NOT breathe air from lungs, ONLY hair in cheeks 40 breaths / min

Bleeding / Hemorrhage
What to look for: *Mother fainting or passing out *Top of uterus noticeably expanding *More than 2 cups (500ml) blood lost NOTE: THESE ARE NORMAL *Initial dizziness or brief passing out is normal after birth *Some shivering is normal after birth, especially a water birth *A brief gush of blood generally indicates that the placenta has separated from uterine wall THESE ARE NORMAL. DO NOT CLAMP OR CUT THE CORD Before anything else, make sure you: 1. Keep baby skin-to-skin with mother 2. Nurse immediately 3. Make sure mother and baby are warm 4. Give warm fluids to drink 5. Encourage mother to PEE 6. Encourage mother to lie down with baby Bleeding BEFORE placenta is out: 1. DO NOT tug or pull on cord 2. DO NOT cut or clamp cord 3. Remember, brief gush of blood is a sign that placenta has separated from uterine wall 4. Sit on toilet or over bowl, COUGH, and push 5. Give Placenta Out ONE TEASPOON EVERY FIFTEEN MINUTES AS NEEDED Bleeding AFTER placenta is out: 1. Eat placenta pieces 2. Examine placenta to verify it is all there… if not, take more Placenta Out 3. Nursing or nipple stimulation 4. Fundal massage to check if uterus is contracting IF NOT: fundal pressure to stop RAPID bleed (see pic) 5. Give Wombstringe 2-4 DROPPERFULS IN WATER

When to go to hospital immediately
Cord prolapse: When umbilical cord comes out before birth, and birth is not imminent 1. Assume position of Knees and Chest down, butt in the air 2. Wrap cord in warm, wet towel, loosely 3. If not present with hand or foot, and mother is pushing, encourage her to push HARD 4. DRIVE to nearest hospital, faster than ambulance Transverse baby: Hand presents without any sign of head. Placental abruption: Where placenta separates from uterine wall before birth *Dark, red or brown blood IS OKAY *Fresh, Bright red blood in first stage of labor may indicated PA *Uterus feels painful and tender, board-like and hard, or enlarged with blood *Drop of blood pressure by 10+ pts… REMEMBER MOTHER’S NORMAL BP (90s/60s) *Fetal heart rate slow or absent *Mother showing signs of SHOCK Fetal Distress: Fetal heart rate of less than 110 or more than 180 BETWEEN contractions Fetal heart rate that does not recover AFTER contraction WHAT TO DO: A. Have mother switch positions several times and recheck FHT B. If pushing, continue doing so; try lying on left side C. If FHT drops immediately after water breaks and does not recover, could be hidden cord prolapse… Get in position and transfer D. If FHT does not recover with these measures, transfer SHOCK: ONLY TRANSFER IF TREATMENT INEFFECTIVE Signs: Cold sweat, pale skin Low body temperature, chills, shaking Weak pulse, 90+BPM 10+ pts drop in blood pressure (REMEMBER MOTHER’S NORMAL BP (90s/60s) Restlessness, anxiety, unconsciousness Causes: Bleeding, anemia, dehydration, fear TREAT: 1. 4 drops Rescue Remedy on/under tongue 2. Elevate legs 3. 1 teaspoon salt + ½ teaspoon baking soda in 1 quart water

General info
BABY STATS, post birth: Respiration rate 60-70/min for first hours, then 40-60 Heart rate 120-160 Temperature 97.5-99.7 APGAR:

Pictures Shoulder Dystocia: http://www.shoulderdystociainfo.com/images/rotate-posterior.jpg Breech Birth: White, Gregory: Emergency Childbirth Baby Not Breathing: White, Gregory: Emergency Childbirth Bleeding/Hemorrhage White, Gregory: Emergency Childbirth General info: APGAR: http://www.sweethaven02.com/ObsNewborn/922les8_img_3.jpg Modified APGAR: http://www.mybirthbydesign.com/Enning%20Modified%20APGAR%20Waterbirth.pdf References White, Gregory: Emergency Childbirth, Fifteenth printing 2002 http://docs.google.com/View?docid=dctzrt2v_0cjphv7gf http://www.purebirth-australia.com/ http://www.unhinderedliving.com/childbirth.html And the wonderful mothers of c-birth, MDC, and other UC forums

EMERGENCY PHONE NUMBERS Midwife/Doula Brenda Parrish Home: 229.227.9194 Cell: 229. Phoebe LABOR & DELIVERY 229.312.2800 Palmyra EMERGENCY ROOM 229.434.2000