out slowly. As more of the head appears, check to besure that the umbilical cord is not wrapped around theneck. If it is, either gently try to untangle the cord, ormove one section over the baby’s shoulder. If neitherof these actions is possible, clamp the cord in twoplaces, 2 inches apart, and cut it. Once the baby’s chinemerges, support the head with one hand and use thebulb syringe from the pack to suction the nostrils andmouth. Before placing the bulb in the baby’s mouth ornose, compress it; otherwise, a forceful aspiration intothe lungs will result. The baby will now start a naturalrotation to the left or right, away from the face-downposition. As this rotation occurs, keep the baby’s headin a natural relationship with the back. The shouldersappear next, usually one at a time.NOTE: From this point on, it is essential toremember that the baby is VERY slippery, andgreat care must be taken so that you do notdrop it. The surface beneath the mother shouldextend at least 2 feet out from her buttocks sothat the baby will not be hurt if it does slip outof your hands. Keep one hand beneath thebaby’s head, and use the other hand to supportits emerging body.Once the baby has been born, suction the nose andmouth again if breathing has not started. Wipe thebaby’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 deliverypack, 2 inches apart, with the first clamp 6 to 8 inchesfrom the navel. Cut the cord between the clamps. Forsafety, use gauze tape to tie the cord 1 inch from theclamp toward the navel. Secure the tie with a squareknot. Wrap the baby in a warm, sterile blanket, and logits time of arrival.The placenta (afterbirth) will deliver itself in 10 to20 minutes. Massaging the mother’s lower abdomencan aid this delivery. Do not pull on the placenta. Logthe time of the placenta’s delivery, and wrap it up forhospital analysis.Place a small strip of tape ( ½ -inch wide), foldedand inscribed with the date, time of delivery, andmother’s name, around the baby’s wrist.COMPLICATIONS IN CHILDBIRTHUnfortunately, not all deliveries go smoothly. Thefollowing sections cover various complications inchildbirth.Breech DeliveryA breech delivery occurs when the baby’s legs andbuttocks emerge first. Follow the steps for a normaldelivery, and support the lower extremities with onehand. If the head does not emerge within 3 minutes, tryto maintain an airway by gently pushing fingers intothe vagina. Push the vagina away from the baby’s faceand open its mouth with one finger. Get medicalassistance immediately.Prolapsed CordIf 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. Givethe mother oxygen, if available, and gently move yourgloved hand into the vagina to keep its walls and thebaby from compressing the cord. Get medicalassistance immediately.Excessive BleedingIf the mother experiences severe bleeding, treather for shock and give her oxygen, if available. Placesanitary napkins over the vaginal entrance and rush herto a hospital.Limb PresentationIf a single limb presents itself first, immediatelyget the mother to a hospital.SUMMARYA medical emergency can occur at anytime. Youmust be prepared to act expeditiously and confidently,whether you are in a combat situation, on board a navalvessel, or at the Navy Exchange. This chapter coversthe preliminary steps you should follow whenmanaging sick or injured patients. The preliminaryemergency steps include triage, patient assessment,and, when needed, basic life support. Other relatedtopics covered in this chapter are breathing aids, shock,diagnosis and emergency treatment procedures formedical conditions and injuries, morphine use for painrelief, and other common emergencies. In thefollowing chapters, diagnosis and emergencytreatment procedures for medical conditions andinjuries will be discussed.4-71
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