out slowly. As more of the head appears, check to be sure that the umbilical cord is not wrapped around the neck. If it is, either gently try to untangle the cord, or move one section over the baby’s shoulder. If neither of these actions is possible, clamp the cord in two places, 2 inches apart, and cut it. Once the baby’s chin emerges, support the head with one hand and use the bulb syringe from the pack to suction the nostrils and mouth. Before placing the bulb in the baby’s mouth or nose, compress it; otherwise, a forceful aspiration into the lungs will result. The baby will now start a natural rotation to the left or right, away from the face-down position. As this rotation occurs, keep the baby’s head in a natural relationship with the back. The shoulders appear next, usually one at a time. NOTE: From this point on, it is essential to remember that the baby is VERY slippery, and great care must be taken so that you do not drop it. The surface beneath the mother should extend at least 2 feet out from her buttocks so that the baby will not be hurt if it does slip out of your hands. Keep one hand beneath the baby’s head, and use the other hand to support its emerging body. Once the baby has been born, suction the nose and mouth again if breathing has not started. Wipe the baby’s face, nose, and mouth clean with sterile gauze. Your reward will be the baby’s hearty cry. Clamp the umbilical cord as the pulsations cease. Use two clamps from the prepackaged sterile delivery pack, 2 inches apart, with the first clamp 6 to 8 inches from the navel. Cut the cord between the clamps. For safety, use gauze tape to tie the cord 1 inch from the clamp toward the navel. Secure the tie with a square knot. Wrap the baby in a warm, sterile blanket, and log its time of arrival. The placenta (afterbirth) will deliver itself in 10 to 20 minutes. Massaging the mother’s lower abdomen can aid this delivery. Do not pull on the placenta. Log the time of the placenta’s delivery, and wrap it up for hospital analysis. Place a small strip of tape ( ½ -inch wide), folded and inscribed with the date, time of delivery, and mother’s name, around the baby’s wrist. COMPLICATIONS IN CHILDBIRTH Unfortunately, not all deliveries go smoothly. The following sections cover various complications in childbirth. Breech Delivery A breech delivery occurs when the baby’s legs and buttocks emerge first. Follow the steps for a normal delivery, and support the lower extremities with one hand. If the head does not emerge within 3 minutes, try to maintain an airway by gently pushing fingers into the vagina. Push the vagina away from the baby’s face and open its mouth with one finger. Get medical assistance immediately. Prolapsed Cord If the cord precedes the baby, protect it with moist, sterile wraps. If a physician cannot be reached quickly, place the mother in an extreme shock position. Give the mother oxygen, if available, and gently move your gloved hand into the vagina to keep its walls and the baby from compressing the cord. Get medical assistance immediately. Excessive Bleeding If the mother experiences severe bleeding, treat her for shock and give her oxygen, if available. Place sanitary napkins over the vaginal entrance and rush her to a hospital. Limb Presentation If a single limb presents itself first, immediately get the mother to a hospital. SUMMARY A medical emergency can occur at anytime. You must be prepared to act expeditiously and confidently, whether you are in a combat situation, on board a naval vessel, or at the Navy Exchange. This chapter covers the preliminary steps you should follow when managing sick or injured patients. The preliminary emergency steps include triage, patient assessment, and, when needed, basic life support. Other related topics covered in this chapter are breathing aids, shock, diagnosis and emergency treatment procedures for medical conditions and injuries, morphine use for pain relief, and other common emergencies. In the following chapters, diagnosis and emergency treatment procedures for medical conditions and injuries will be discussed. 4-71