Lesson Guide / Assessment For Learning (A4L) “Childbirth”

Instructions to the learner: Without using any references, quickly answer the questions in the “Assessment For Learning (A4L)” section below. Then, use the resources listed in the “Lesson Sequence” section to help you fill in any missing answers or verify items where you were uncertain. Finally, complete these same questions again at the end of this document as another assessment of your learning. There is a section at the end of this document with suggested answers and notes for the A4L questions—-use this as a guide. The A4L questions are for your use—-your learning is assessed in the classroom or proctored testing environment.

If you are a BCFPD member and desire CEUs for this learning activity, you may schedule a proctored written learning assessment at Fire District Headquarters by contacting Bryant Gladney at . This activity is worth 4 CEUs in OB/Peds for BLS and 4 CEUs in Specials for ALS.

If you want a digital copy of this document, go to:

or scan:

Objectives / Learning Targets: The learner who successfully completes this course will be able to demonstrate understanding of the following concepts:

Given patients who are pregnant:

•with one or multiple fetuses

•and who have had either no previous children or any number of previous children

•and who may or may not have risk factors for complicated deliveries including drug use, pre-eclampsia, eclampsia, gestational diabetes

•and who may have normal or abnormal presentations

the entry-level paramedic should be able to:

✓Analyze the patient’s situation and correctly choose the proper:

oresources to request

othings to do on the scene

otime to transport

ohelp needed during transport

otransport destination

ouse of standing orders / protocols and online medical control

overbal report to give during transport and at the destination

odocumentation for the patient care report

opoints for discussion after the call

✓Recognize and manage complications that occur pre-delivery, during delivery and post-delivery including:

oVaginal bleeding

oShock

oUterine rupture or prolapse

oSeizures

oHypo or hyperglycemia

oHypo or hypertension

oDyspnea / chest pain / tachypnea

oCardiac arrest

✓Utilize equipment and medications including:

o“OB Kit”

oMagnesium sulfate

oOxytocin / Pitocin

oTerbutaline / Brethine

Answer these questions without using a reference to test your prior knowledge (these questions are the “Assessment For Learning (A4L)”.

  1. What is the organ that produces eggs?
  2. What is the fallopian tube?
  3. Where should the egg implant itself?
  4. What is normal gestation?
  5. What is “full term?”
  6. What is a “premature” birth?
  7. What is the LMP?
  8. What is gravida?
  9. What is para?
  10. How many weeks are in a trimester?
  11. How do you manage a spontaneous abortion?
  1. What is hyperemesis (hyperemesis gravidarum)?
  2. How would you treat hyperemesis?
  3. When are fetal heart tones audible with a doppler stethoscope?
  4. Describe how to use a Doppler to obtain fetal heart tones.
  1. What is a normal rate for fetal heart tones.
  2. What happens to the FHT when the fetus is distressed?
  3. How many weeks until fetal movement is usually detectable?
  4. How many weeks until the fetus is potentially viable?
  5. What is the cervix?
  6. What is dilation of the cervix?
  7. What is effacement of the cervix?
  8. What is the mucous plug?
  9. What is the “bloody show”?
  10. What are Braxton-Hicks contractions?
  1. What is the first stage of labor and how will you know in the field when it ends?
  1. What is the second stage of labor?
  2. What is the third stage of labor?
  3. What is the placenta and what two things does it do?
  1. What is the umbilical cord and what vessels are in it?
  1. What is the amniotic fluid and how much is usually present at full term?
  1. What is meant by “membranes are intact”?
  2. When the “water breaks”, what has happened?
  3. Does labor always start once the water breaks?
  4. What can happen if there is premature rupture of membranes?
  1. How do you time contractions?
  2. How do you use an assessment of contractions to determine if birth is imminent?
  1. What does “Gravida 3, Para 1” mean and how does that impact your decisions?
  1. What factors impact your decision on whether to transport immediately or birth at the scene?
  1. How can the mother control the urge to push during a contraction?
  2. During childbirth, when would you not want to have the mother push?
  1. What is the normal presentation?
  2. What is crowning?
  3. Why is presentation important?
  1. Which direction is the face pointing in a normal (vertex) presentation?
  2. What is a breech presentation and what do you do?
  1. What is a prolapsed cord and what do you do?
  1. What is a limb presentation and what do you do?
  1. When the infant’s head has delivered, what do you do if the amniotic sac is intact?
  1. When you suction the infant, do you do the mouth first or the nose first and why?
  1. What is a nuchal cord and what do you do? What if that fails?
  1. What is shoulder dystocia and how do you manage it?
  1. When do you clamp and cut the cord?
  1. Where do you place the cord clamps?
  1. What do you use to cut the cord?
  2. What do you do if the cut cord end continues to bleed?
  3. What do you do to maintain the baby’s warmth?
  1. When does the placenta deliver?
  2. Should you wait for the placenta to deliver before transporting?
  3. What do you do with the delivered placenta and why?
  1. What is meconium?
  2. How do you know if meconium is present at birth and what do you do with it?
  1. How do you help prevent perineal tears and bleeding?
  2. How do you manage perineal bleeding?
  3. How much blood is typically lost at childbirth by the mother?
  4. What size, flavor, site and rate for the IV in childbirth?
  1. Name two common tocolytics.
  2. What is oxytocin / pitocin and why do we use it?
  1. What can you do about post-partum bleeding? Name 3 things.
  1. How many ambulances do you need for a childbirth?
  2. What is the role of an air ambulance (helicopter) in childbirth?
  3. What is the role of specialty transport teams (Children’s Hospital teams) in childbirth?
  1. What are two differential diagnoses for sudden onset of tachypnea, tachycardia and chest pain in the post-partum mother?
  1. What is uterine inversion and how would you treat it?
  1. What is uterine rupture and how would you assess it and treat it?

Lesson Sequence / Steps

Step One: Complete the A4L to determine what material you already understand.

Step Two: Review the summary and links below. Go back to the A4L and fill in any gaps in your understanding.

Childbirth Part 1Childbirth Part 2Childbirth Part 3

Childbirth Part 4Childbirth Part 5

Short Playlist of Additional Childbirth Videos

Step Three: (for students in initial EMT or Paramedic classes): Review your textbook materials and take the associated quizzes in the publisher’s online package.

•EMT Chapter 31 (AAOS Emerg. Care and Transport. of the Sick and Injured)

•Paramedic Chapter 2.35 through 2.37 (Beebe & Myers Professional Paramedic)

Answer the same questions again to test your current knowledge. If you are applying for CEUs for this learning activity, you can anticipate that the material contained in these questions is key information that will be assessed on the proctored written learning assessment that you will take.

  1. What is the organ that produces eggs?
  2. What is the fallopian tube?
  3. Where should the egg implant itself?
  4. What is normal gestation?
  5. What is “full term?”
  6. What is a “premature” birth?
  7. What is the LMP?
  8. What is gravida?
  9. What is para?
  10. How many weeks are in a trimester?
  11. How do you manage a spontaneous abortion?
  1. What is hyperemesis (hyperemesis gravidarum)?
  2. How would you treat hyperemesis?
  3. When are fetal heart tones audible with a doppler stethoscope?
  4. Describe how to use a Doppler to obtain fetal heart tones.
  1. What is a normal rate for fetal heart tones.
  2. What happens to the FHT when the fetus is distressed?
  3. How many weeks until fetal movement is usually detectable?
  4. How many weeks until the fetus is potentially viable?
  5. What is the cervix?
  6. What is dilation of the cervix?
  7. What is effacement of the cervix?
  8. What is the mucous plug?
  9. What is the “bloody show”?
  10. What are Braxton-Hicks contractions?
  1. What is the first stage of labor and how will you know in the field when it ends?
  1. What is the second stage of labor?
  2. What is the third stage of labor?
  3. What is the placenta and what two things does it do?
  1. What is the umbilical cord and what vessels are in it?
  1. What is the amniotic fluid and how much is usually present at full term?
  1. What is meant by “membranes are intact”?
  2. When the “water breaks”, what has happened?
  3. Does labor always start once the water breaks?
  4. What can happen if there is premature rupture of membranes?
  1. How do you time contractions?
  2. How do you use an assessment of contractions to determine if birth is imminent?
  1. What does “Gravida 3, Para 1” mean and how does that impact your decisions?
  1. What factors impact your decision on whether to transport immediately or birth at the scene?
  1. How can the mother control the urge to push during a contraction?
  2. During childbirth, when would you not want to have the mother push?
  1. What is the normal presentation?
  2. What is crowning?
  3. Why is presentation important?
  1. Which direction is the face pointing in a normal (vertex) presentation?
  2. What is a breech presentation and what do you do?
  1. What is a prolapsed cord and what do you do?
  1. What is a limb presentation and what do you do?
  1. When the infant’s head has delivered, what do you do if the amniotic sac is intact?
  1. When you suction the infant, do you do the mouth first or the nose first and why?
  1. What is a nuchal cord and what do you do? What if that fails?
  1. What is shoulder dystocia and how do you manage it?
  1. When do you clamp and cut the cord?
  1. Where do you place the cord clamps?
  1. What do you use to cut the cord?
  2. What do you do if the cut cord end continues to bleed?
  3. What do you do to maintain the baby’s warmth?
  1. When does the placenta deliver?
  2. Should you wait for the placenta to deliver before transporting?
  3. What do you do with the delivered placenta and why?
  1. What is meconium?
  2. How do you know if meconium is present at birth and what do you do with it?
  1. How do you help prevent perineal tears and bleeding?
  2. How do you manage perineal bleeding?
  3. How much blood is typically lost at childbirth by the mother?
  4. What size, flavor, site and rate for the IV in childbirth?
  1. Name two common tocolytics.
  2. What is oxytocin / pitocin and why do we use it?
  1. What can you do about post-partum bleeding? Name 3 things.
  1. How many ambulances do you need for a childbirth?
  2. What is the role of an air ambulance (helicopter) in childbirth?
  3. What is the role of specialty transport teams (Children’s Hospital teams) in childbirth?
  1. What are two differential diagnoses for sudden onset of tachypnea, tachycardia and chest pain in the post-partum mother?
  1. What is uterine inversion and how would you treat it?
  1. What is uterine rupture and how would you assess it and treat it?

Suggested Answers for: Childbirth

  1. What is the organ that produces eggs? ovary
  2. What is the fallopian tube? duct from ovary to uterus
  3. Where should the egg implant itself? uterine lining
  4. What is normal gestation? 40 weeks
  5. What is “full term?” 38-40 weeks
  6. What is a “premature” birth? prior to 37 weeks
  7. What is the LMP?Last Menstrual Period (date that it started)
  8. What is gravida?number of pregnancies
  9. What is para?number of live births
  10. How many weeks are in a trimester? 13
  11. How do you manage a spontaneous abortion?emotional support, treat for shock if present, collect any “products of conception” and transport with the patient
  12. What is hyperemesis (hyperemesis gravidarum)?persistent nausea and vomiting related to pregnancy
  13. How would you treat hyperemesis?Ondansetron
  14. When are fetal heart tones audible with a doppler stethoscope? 8 weeks
  15. Describe how to use a Doppler to obtain fetal heart tones.Start at the umbilicus and work in circles—-patient may know where the heart beat was detected most recently
  16. What is a normal rate for fetal heart tones.120-160
  17. What happens to the FHT when the fetus is distressed?decreases usually
  18. How many weeks until fetal movement is usually detectable?20 weeks
  19. How many weeks until the fetus is potentially viable?24 weeks
  20. What is the cervix?duct from the uterus to vagina
  21. What is dilation of the cervix? cervix opens in preparation for delivery
  22. What is effacement of the cervix? cervical opening “thins”
  23. What is the mucous plug? mucous that seals the opening of the cervix until it dilates
  24. What is the “bloody show”? release of the mucous plug as dilation occurs
  25. What are Braxton-Hicks contractions?“false labor”—-contractions of the uterus that are not part of labor
  26. What is the first stage of labor and how will you know in the field when it ends?from the beginning of contractions until the cervix is fully dilated—-you won’t know about dilation and effacement in the field as no vaginal exam is available
  27. What is the second stage of labor? from full dilation until the baby has delivered
  28. What is the third stage of labor?from delivery of the baby until placental delivery
  29. What is the placenta and what two things does it do?the organ that interfaces between the fetus and the mother—-contains the umbilical cord
  30. What is the umbilical cord and what vessels are in it? attaches the fetus to the placenta—-has two arteries and one vein
  31. What is the amniotic fluid and how much is usually present at full term?fluid surrounding the fetus within the amniotic sac
  32. What is meant by “membranes are intact”? the amniotic sac has not ruptured
  33. When the “water breaks”, what has happened? the amniotic sac has ruptured
  34. Does labor always start once the water breaks?no
  35. What can happen if there is premature rupture of membranes?infection
  36. How do you time contractions?from start of one to the start of another
  37. How do you use an assessment of contractions to determine if birth is imminent?contractions that are regular and spaced closely signal imminent delivery
  38. What does “Gravida 3, Para 1” mean and how does that impact your decisions?this is the patient’s third pregnancy and she has given live birth once prior (with one abortion—-either spontaneous or elective)—-first time labor is usually longer than subsequent ones
  39. What factors impact your decision on whether to transport immediately or birth at the scene?presentation and signs of imminent delivery
  40. How can the mother control the urge to push during a contraction?controlling her breathing—-panting
  41. During childbirth, when would you not want to have the mother push?once the head delivers and prior to suctioning / assessment or any abnormal presentation
  42. What is the normal presentation?head first, face down
  43. What is crowning?a part is presenting
  44. Why is presentation important?abnormal presentations should be delivered in the hospital and frequently require caesarean section
  1. Which direction is the face pointing in a normal (vertex) presentation?down
  2. What is a breech presentation and what do you do? any presentation other than head first-face down—-urgent transport with measures (positioning, tocolytics) to delay delivery
  3. What is a prolapsed cord and what do you do?urgent transport with measures (positioning, tocolytics) to delay delivery
  4. What is a limb presentation and what do you do?urgent transport with measures (positioning, tocolytics) to delay delivery
  5. When the infant’s head has delivered, what do you do if the amniotic sac is intact?break it and remove it from around the infant’s face
  6. When you suction the infant, do you do the mouth first or the nose first and why?once the head delivers suction mouth then nose (m before n in the alphabet) because there is more fluid in the mouth than the nose and once you stimulate the nose the infant will breathe
  7. What is a nuchal cord and what do you do? What if that fails?gently pull some slack and attempt to slip it over the infant’s head—-if that fails, clamp and cut the cord
  8. What is shoulder dystocia and how do you manage it? the infant’s head has delivered but the shoulders are hanging up on the mother’s pubic bone—-position the mother to line up the axis of the her pelvis in more of a straight line in the “McRobert’s position—-perhaps some gentle pressure on the pubic bone will allow the shoulder to move down and allow the infant to deliver—-urgent transport may be required
  9. When do you clamp and cut the cord?whenever you must separate the mother and infant to deliver care to either
  10. Where do you place the cord clamps?several inches from the mother and then the second clamp further away
  11. What do you use to cut the cord?scalpel from the delivery kit
  12. What do you do if the cut cord end continues to bleed? squeeze the clamps or add more clamps
  13. What do you do to maintain the baby’s warmth?dry them off—-cover them with special attention to cover the head
  14. When does the placenta deliver?usually within 15-20 minutes after the baby
  15. Should you wait for the placenta to deliver before transporting?no
  16. What do you do with the delivered placenta and why?bag it, transport it
  17. What is meconium?fetal stool
  1. How do you know if meconium is present at birth and what do you do with it?thick, green or black material present on the infant or cloudy “pea soup” amniotic fluid
  2. How do you help prevent perineal tears and bleeding?gentle pressure on the infant’s head as it is delivering without pressure on the fontanelles
  3. How do you manage perineal bleeding?absorbent pads from the delivery kit or “trauma dressings”
  4. How much blood is typically lost at childbirth by the mother?about 500cc
  5. What size, flavor, site and rate for the IV in childbirth?18g or larger, NS, TKO unless volume is needed to replace lost blood
  6. Name two common tocolytics.magnesium sulfate, terbutaline
  7. What is oxytocin / pitocin and why do we use it?naturally occurring hormone that promotes uterine contraction delivered via IV infusion
  8. What can you do about post-partum bleeding? Name 3 things.have the infant nurse at the mother’s breast if possible, fundal massage, oxytocin
  9. How many ambulances do you need for a childbirth?depends on local operational issues but a case can be made for one ambulance for the mother and one for the infant (a paramedic for each)—multiple infants probably equals multiple ambulances
  10. What is the role of an air ambulance (helicopter) in childbirth?for urgent transport cases
  11. What is the role of specialty transport teams (Children’s Hospital teams) in childbirth?these teams are for facility to facility transport in our system—-not a field response
  12. What are two differential diagnoses for sudden onset of tachypnea, tachycardia and chest pain in the post-partum mother?amniotic fluid embolus, pulmonary embolus
  13. What is uterine inversion and how would you treat it?the uterus has “turned inside out” and is protruding from the vaginal opening
  14. What is uterine rupture and how would you assess it and treat it?the uterus has “split” due to a weakness or as a result of excessive stress during labor—-prior c-section may predispose—-cephalopelvic disproportion (small mom, large baby) is a possible cause due to the baby being too large to fit through the available opening yet pushing continues

BCFPD EMS Education EMT Education Program