EMT Exam: How to Perform an Abnormal Delivery

By Arthur Hsieh

Unfortunately, on rare occasions a delivery runs into trouble. The EMT exam will expect you to be prepared. You can manage a few situations; others require immediate recognition of a serious problem that requires rapid transport to a hospital capable of handling such cases. Here are some of the abnormal delivery conditions you may face in the field.

Condition Signs and Symptoms Specific Treatment
Breech presentation Both legs or buttocks present first. Cradle the emerging body with one arm while creating a V-
V-shaped space with two fingers to create a small space for the
newborn to breathe while the head is still in the birth canal.
Limb presentation Only one arm or leg appears first. Nondeliverable scenario. This is a life-threatening event
requiring immediate transport.
Multiple births Strong contractions begin after first birth. Deliver as normal. There may be more than one placenta to
deliver afterwards. Call for additional resources.
Nuchal cord As head emerges, umbilical cord is wrapped around the
neck.
Use palm of one hand to push against the motion of the infant,
and use the fingers of the other hand to unloop the cord from
around the neck. If you are unable to slip the cord around the
head, clamp and cut the cord and remove it from baby’s
neck.
Postpartum bleeding Up to 500 mL is normal. A larger amount is a sign of serious
bleeding. Signs of shock may appear.
Treat for shock by keeping patient supine and maintaining body
temperature. Administer oxygen if there is respiratory distress or
oxygen saturation levels fall below 94 percent. Begin immediate
transport.
Prolapsed cord A loop of the umbilical cord appears first. The newborn’s
head or shoulder puts pressure on the cord, cutting off
circulation.
Nondeliverable scenario. This is a life-threatening event
requiring immediate transport. Ensure there is a pulse in the cord.
If there is no pulse, place hand in vagina and apply pressure to
lift the head off the cord in order to maintain circulation.
Placing the mother in a knee-chest position may help take pressure
off the cord.

Regardless which situation presents, remember to remain calm and professional. The mother will be frightened and in pain; your demeanor will help her through a terrifying episode in her life.

[Credit: Illustration by Kathryn Born, MA]
Credit: Illustration by Kathryn Born, MA

A full-term pregnant woman tells you she is in great pain and that she needs to push. When you inspect the vaginal opening, you notice a 5-inch length of umbilical cord protruding from it. You should immediately

  • (A)open your OB kit and prepare to deliver the newborn.

  • (B)move the patient to the ambulance and transport rapidly.

  • (C)check the cord for a pulse.

  • (D)place the mother in a knee-chest position and deliver the newborn.

The best answer is Choice (C). This is a nondeliverable situation, ruling out Choices (A) and (D). Rapid transport, Choice (B), is indicated, but you want to check for the presence of a pulse in the cord first and, if necessary, relieve the compression of the cord by the newborn’s head or shoulders immediately.