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It’s an emergency! The procedures you will need to apply

Although most shifts go smoothly, it is important to be aware of potential emergencies and how to deal with it. There are 2 important things to realise, firstly:

1. Everything is shortened to a pneumonic (or its latin!)

2. You many think that everything is going to plan, but women can be unpredictable

If there is any terminology that you don’t understand- look it up as that way you can learn at the same time!

Post partum haemorrhage or (PPH)

This is a common emergency and happens fairly frequently. A PPH is when there is a blood loss over 500mls after birth. We manage a PPH by trying to find out why it has occurred and to help you remember it is going to due to one of these T’s.

Tissue —> The placenta is still in the uterus or a bit of the placenta has been left behind
Tone —> The uterus does not have enough tone to contract to stop the bleeding
Trauma —> There is a need for stitches to be carried out
Thrombin —> There is an issue with blood clotting

Although often linked with caesarean, instrumental or induced birth, it can also occur without any other known risk factors.

 
Here is an example from a midwife:

Mrs.M, chose to have her 2nd baby in a freestanding birth centre. Her first baby was born without any complications.

She had a very normal labour, progressed well in the birthing pool and gave birth to a baby girl. She stayed in the birthing pool to have skin-to-skin with her baby. She decided that she wanted her placenta to come out naturally without the need for any drugs. She got out of the birthing pool and normally by standing up, this helps the placenta come out. After 45 minutes we were still waiting for the placenta, so we decided to sit on the toilet to see whether going to the toilet might help; it did and out came the placenta.

Mrs. M very quickly started to feel faint and not at all well. After a move from the toilet it was obvious that there was quite a bit of blood lost. We weighed the blood loss and she had lost over 1500 mls, remember over 500 mls is a haemorrhage so this is an emergency. Thinking about the 4 T’s

 
We knew it was not:

Tissue —> as the placenta was out and was complete (nothing left behind)
Trauma —> She did not need any stitches
Thrombin —> Thrombin is a very rare condition and this is known prior to birth

So, it was tone. With the use of drugs, giving a fluid drip and going to labour ward in an ambulance, every was fine and Mrs.M did not need a blood transfusion.

Shoulder dystocia

This is when the baby’s shoulder gets stuck on the pubic bone. So ‘bone on bone’. This can happen for many reasons, but the most common are a previous baby has got stuck, diabetes, obesity or just a bigger baby.

To help the baby be born, there is a combination of manoeuvres that we use. So you’ve guessed it; a pneumonic!

HELPERRR
H Call for help
E Evaluate for an episiotomy
L Legs into McRoberts
P Perform suprapubic pressure
E Enter (Rubins 1, 2, reverse woodscrew manoeuvres)
R Remove posterior arms
R Roll
R Repeat

For an interview you would not expect to know this, but if this is something that interests you, you could do further reading before the interview.
 
Example:
We went to Mrs.P at her home, expecting her 2nd baby. This baby was thought to be bigger, so we were all prepared for this emergency in advance.
Once the baby started to be born, it was born very slowly (a sign that there may be an issue with the shoulder’s). Once the head was born, but the rest of the baby was not following the next contraction, we started to follow the pneumonic.

10 minutes after the head was delivered, we welcome a sizable baby boy weighing 13lb 14oz. Both mum and baby were fine.

Cord Prolapse

Is a complication that occurs prior to the birth of the baby, when the cervix is open and the cord drops through the cervix ahead of the baby.

Those at risk are:

  • multiple pregnancy
  • polyhydramnios
  • breech
  • low birth weight
  • preterm
  • head not engaged into the pelvis

No pneumonic on this one – phew!

Call for help
Ensure minimal handling of the umbilical cord
Mother to adopt the ‘knee/chest’ position
Move the presenting part off the cord to prevent cord compression.

Example:

We had transferred a woman from the antenatal ward to labour ward to have an induction of labour. She has expecting her 4th baby and this baby was thought to be small. She had been uncomfortable during the day, but not having any regular contractions. We were about to commence fetal monitoring of the baby’s heart rate, but before we did she decided to go to the toilet first. While she was in the toilet she said “I’m not sure what this is” on coming out of the toilet there was a large loop of umbilical cord between her legs. I called for help , she immediately got on the bed, adopted the ‘knee/chest’ position and the baby’s head was moved away from the umbilical cord. She was taken to theatre where a caesarean section was performed. Her baby boy was born without complications.

There are of course many other complications including eclamptic fit, maternal resuscitation, placental abruption, neonatal resuscitation. You will not be expected to know about management of any emergencies for your interview, but if there is something that interests you- read about it.

About Emily Seddon

Emily is a midwife with many years of experience. She is passionate about supporting midwives of the future. As a clinical mentor, student link and being on university interview panels, she knows what it takes to get a place!

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