Caring for the Newborn

Welcome to the second part of our comprehensive two-part series, where we continue our exploration of emergency births and the invaluable contributions of first responders. In the initial segment, we delved into the preparations and assistance offered during the childbirth process. Now, as we progress into Part 2, our focus intensifies on the pivotal steps undertaken by first responders to ensure the immediate well-being of both the newborn and the mother post-delivery.

This installment delves deeper into the critical aspects of post-birth care, revealing the intricate measures that first responders execute to stabilize the newborn and provide essential support to the mother. We'll navigate through the essential processes of promoting the newborn's well-being, utilizing tools like the APGAR scale to assess their condition. Simultaneously, we address the importance of postpartum care for the mother, emphasizing vigilant monitoring and timely interventions to manage postpartum bleeding.

With these multifaceted actions, first responders display their unwavering commitment to preserving life and fostering well-being during the immediate aftermath of childbirth. Join us on this journey as we uncover the intricacies of post-birth care, shedding light on the dedication and expertise that first responders bring to these unforeseen situations.

Vigorous Drying Techniques:

If the newborn does not exhibit signs of breathing or crying, immediate action is essential. Begin by employing vigorous drying techniques. Take a clean, soft towel and gently rub the baby's back, arms, and legs. This tactile stimulation often prompts a response by initiating their reflexes.

Assessing the Response:

After performing vigorous drying for approximately 30 seconds, pause and closely observe the baby's reaction. Look for any movements, breathing, or vocalizations. This assessment helps determine the baby's level of responsiveness and guides further intervention.

Using a Bag-Valve-Mask (BVM):

If the newborn remains unresponsive, it's time to provide assisted ventilation using a BVM. Ensure a proper seal by placing the mask over the baby's nose and mouth. Administer gentle breaths at a rate of 1 ventilation every 3 seconds. This method delivers a controlled supply of oxygen to the baby's lungs.

Ventilation and Pulse Assessment:

During the 30-second period of ventilation using the BVM, closely monitor the newborn's response. Afterward, assess the baby's pulse. If the pulse is below 60 BPM, it's an indication that immediate intervention is necessary.

Neonate CPR Protocol:

When the pulse remains below 60 BPM, initiate neonate CPR. Begin with 3 gentle chest compressions, followed by 1 breath using the BVM. Continue this cycle, maintaining a ratio of 3 compressions to 1 breath. As you administer CPR, be vigilant about monitoring the baby's heart rate.

Optimal Heart Rate:

A newborn's optimal heart rate typically falls between 140 and 160 BPM. Continuous heart rate monitoring informs you about the baby's response to the resuscitative efforts. Continue with primary assessment once neonates ABC’s are considered stable. Begin conducting a baseline set of vitals if possible.

APGAR Scale

The APGAR scale is a valuable tool used to assess the overall condition of a newborn immediately after birth. Named after its creator, Dr. Virginia Apgar, this assessment helps medical professionals and first responders quickly evaluate the baby's physical status and determine if any immediate interventions are required. The APGAR scale evaluates five key factors:

1. Appearance (Skin Color):

   The baby's skin color is assessed. A newborn with a pink or rosy skin tone receives a score of 2, while pale or bluish skin results in a lower score.

2. Pulse (Heart Rate):

   The baby's heart rate is evaluated. A heart rate of 100 to 140 BPM is considered normal and receives a score of 2. A lower heart rate receives a score of 1, and a heart rate of less than 100 BPM gets a score of 0.

3. Grimace Response (Reflexes):

   The baby's reflexes are tested by gently stimulating their nose or feet. A newborn who responds with a sneeze, cough, or grimace (frowning) gets a score of 2. A sluggish response results in a score of 1, and no response gets a score of 0.

4. Activity (Muscle Tone):

   The baby's muscle tone is assessed. If the baby exhibits active movement and flexion, they receive a score of 2. If the limbs are partially flexed, the score is 1. If there is minimal or no movement, the score is 0.

5. Respiration ( Rate and Effort):

   The baby's breathing rate and effort are observed. If the baby is crying and breathing normally, they receive a score of 2. Irregular or slow breathing results in a score of 1, and no breathing receives a score of 0.

When and How the APGAR Scale is Conducted:

The APGAR assessment is typically performed twice: at 1 minute after birth and again at 5 minutes after birth. Each factor is assigned a numerical rating of 0, 1, or 2. The scores are then added together to yield a total score out of 10. The assessment helps medical professionals and first responders quickly identify any issues that require immediate attention and determine if the baby is adapting well to life outside the womb.

Caring for the Mother Post Delivery

After stabilizing the newborn, it's essential to provide comprehensive care to the mother, addressing both physical and emotional needs. Here's a closer look at postpartum care for the mother:

Encouraging Breastfeeding:

Following the stabilization of the newborn, encouraging the mother to breastfeed is a vital step. Breastfeeding stimulates the uterus to contract, which in turn helps reduce bleeding. This process, known as uterine involution, assists the mother's body in returning to its pre-pregnancy state. Moreover, breastfeeding establishes a strong bond between mother and baby and offers a multitude of benefits for both.

Placenta Handling:

In line with recommended practices, refrain from cutting the placenta from the newborn unless local protocols or medical direction dictate otherwise. Instead, carefully wrap the placenta in a plastic bag and towel for transport with the family. This approach respects the physiological connection between the placenta and the newborn and ensures a smooth transition.

Managing Postpartum Bleeding:

In cases where postpartum bleeding is a concern, gentle and non-invasive techniques are employed. Use sterile gauze or a clean towel to gently clean the mother's perineal area. This process helps slow down bleeding without resorting to any interventions that may pose risks.

Monitoring and Recognizing Excessive Bleeding:

Keeping a vigilant eye on postpartum bleeding is crucial. Differentiating between normal and excessive bleeding is essential for the mother's well-being. Excessive bleeding may result from the uterus not contracting as it should. This information will be instrumental in determining the appropriate interventions.

Addressing Shock Symptoms:

It's important to be aware that mothers might present symptoms similar to shock, which can include pale skin, rapid heartbeat, and altered mental state. In cases where these symptoms persist or worsen, rapid transportation to a medical facility becomes imperative. This is particularly crucial if bleeding remains a concern.

Through these measures, first responders offer a holistic approach to postpartum care for the mother. From promoting uterine contraction through breastfeeding to respecting placenta connection, these actions contribute to the mother's comfort and well-being. Vigilant monitoring, appropriate interventions, and the utmost sensitivity to the mother's condition reflect the dedicated commitment of first responders in ensuring the holistic health and safety of both the newborn and the mother during this critical phase.

Conclusion

Throughout this enlightening two-part series, we've unveiled the crucial role that first responders undertake in emergency births. From cultivating a sterile environment to aiding childbirth and offering essential postpartum care.

Join us in our advanced first aid class where we offer comprehensive obstetrics training. Collaborate with seasoned paramedics who have delivered babies in the field, gaining practical insights that prepare you to confidently assist during emergency births.