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Initial care of newborn

The most important care is to
– Position
– Dry
– Keep warm
– Stimulate to breathe
• When wrapping newborn, make sure to
cover head

Normal range of vital signs:
– Pulse – greater than 100/min
• Can check pulse at brachial artery
• Can also check pulse at umbilical cord
– Respirations – should be > 30 breaths/min
• A crying baby is a good thing!
– Color – pink is good – may be a little blue at
the extremities initially, but should continue to
pink up

• Repeat suctioning as needed
• Continue to stimulate to breathe if needed
– Rub back
– Flick soles of feet
• If the newborn doesn’t begin to breathe, or
continues to have trouble breathing after 1
minute, additional measures have to be

– Ensure airway open and patent
– Ventilate at rate of 30 – 60 per min using infant BVM
with supplemental oxygen
– Reassess after 1 minute
– If heart rate drops below 100 at any time, assist
ventilations using BVM with supplemental oxygen
– If pulse drops below 60 beats per min, begin CPR,
and reassess after 30 seconds

Abnormal/difficult deliveries
Prolapsed cord – cord presents before the infant – this is a SERIOUS emergency, with the infant’s life in danger
– Usual patient assessment steps, and
• Mother should be given high flow oxygen
• Position mother with head down or buttocks raised (this uses gravity to lessen pressure in the birth canal)
• Update responding EMS of the complication
Breech birth – buttocks or lower
extremities are low in the uterus and will
be the first part delivered – infant at
greatest risk for delivery trauma, prolapsed
cord more common
– Usual patient assessment, and
• Place mother on high flow oxygen
• Place mother supine, with pelvis elevated and
head down
• Notify responding EMS of complication
Limb presentation – occurs when a limb
protrudes from the birth canal.
– Notify responding EMS immediately
– Place mother on high-flow oxygen
– Place mother supine with pelvis elevated,
head down
Multiple births – be prepared; call for assistance
Meconium – amniotic fluid that is greenish
or brownish-yellow rather than clear –
indication of possible fetal distress during
– Do not stimulate the infant to breathe before
suctioning oropharynx
– Suction using bulb syringe, or wipe
mouth/nose with sterile gauze
– Maintain airway
– Always at risk for hypothermia
– Usually require resuscitation

Post-delivery care of the mother
• Keep contact with the mother throughout
the process
• Monitor vitals
• Remember delivery is exhausting
• Replace any blood-soaked sheets and
blankets while awaiting transport
Gynecological emergencies
• Vaginal bleeding
– Remember BSI
– Make sure patient is placed on oxygen
• Trauma to external genitalia – treat as any
other soft tissue injury – don’t pack the
vagina with dressings
Sexual assaults
• Victims of alleged sexual assault require initial
assessment, treatment as needed, and
psychological support
– Maintain a non-judgmental attitude during historytaking
– Protect crime scene if possible
– Examine genitalia only if profuse bleeding present
– Use same-sex provider if possible
– Discourage patient from bathing, voiding, or cleaning
– Required to report

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