Childbirth & Neonatal Care
Field deliveries are rare, high-stakes, and completely within your scope. Most of the time the mother does the work and you keep two patients safe — but you have to know the sequence cold, spot the handful of complications that change everything, and be ready to resuscitate a newborn who doesn't come out crying. This guide covers all of it.
1Deliver here, or transport?
Start with the right mindset: most deliveries need a catcher, not a doctor. Childbirth is a natural process — mom does the work, the baby knows the way out, and your job is to guide, protect, and manage what comes next. The moment the baby delivers, you have two patients, and each one gets a full assessment.
The first real decision on scene is whether this baby is coming now. Delivery is imminent — prepare to deliver on scene — when any of these are true:
- Crowning — the baby's head is visible at the vaginal opening during contractions. This is the single most reliable sign.
- Contractions less than ~2 minutes apart, strong and regular.
- Mom feels the urge to push or bear down, or says the baby is coming. Believe her — she's usually right.
If none of those are present, transport and monitor. If they are, don't gamble on the drive time: set up where you are. A delivery in a controlled living room beats one on a freeway shoulder.
2Three stages of labor
Labor runs in three stages. Knowing which stage you've walked into tells you how much time you have — and stage two with crowning means you have none.
| Stage | Starts / ends | What you'll see |
|---|---|---|
| 1 — Dilation | Onset of contractions → full cervical dilation | The longest stage. Contractions become stronger, longer, and closer together; bloody show; the amniotic sac may rupture. Usually time to transport. |
| 2 — Expulsion | Baby enters the birth canal → delivery of the baby | Urge to push; crowning happens in this stage. If you see it, you're delivering here. |
| 3 — Placental | Delivery of the baby → delivery of the placenta | The placenta usually delivers within 30 minutes. Never wait on scene for it — transport can happen first. |
3Delivery, step by step
When delivery is imminent, the sequence below is the whole job. Everything you need is in the OB kit; everything else is patience and clean technique.
4Newborn care & APGAR
The first minute of newborn care is three words: dry, warm, stimulate. Dry the baby thoroughly, wrap it warm, and stimulate by flicking the soles of the feet or rubbing the back. Newborns lose heat fast and hypothermia makes everything worse — and most newborns respond to drying and stimulation alone with a strong cry.
You quantify how the baby is doing with the APGAR score, assessed at 1 minute and 5 minutes after birth. Each of five signs scores 0, 1, or 2:
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (color) | Blue or pale all over | Body pink, extremities blue | Completely pink |
| Pulse | Absent | <100/min | ≥100/min |
| Grimace (irritability) | No response | Grimace | Cough, sneeze, or vigorous cry |
| Activity (muscle tone) | Limp | Some flexion | Active motion |
| Respirations | Absent | Slow, irregular, or weak cry | Strong cry |
Interpret the total: 7–10 is normal, 4–6 is moderately depressed (stimulate and support), and 0–3 is severely depressed (active resuscitation, next section).
5Neonatal resuscitation — the inverted pyramid
Neonatal resuscitation is built as an inverted pyramid: the interventions almost every depressed newborn needs sit at the wide top, and the ones almost none need sit at the narrow bottom. Warmth and stimulation fix most babies; ventilation fixes most of the rest; compressions are rare.
6When it goes wrong: complications
A small set of presentations turn a "catch" into an emergency. For almost all of them, the EMT answer is the same shape: position, protect, never pull, and drive.
| Complication | What it is | What you do |
|---|---|---|
| Breech presentation | Buttocks or legs deliver first | Support the body as it delivers — never pull the head. If the head doesn't deliver, insert gloved fingers to form a "V" around the baby's nose and mouth to keep the airway open, and transport rapidly. |
| Prolapsed cord | The cord presents before the baby and gets compressed — the baby's oxygen line is being pinched | Position mom knee-chest or hips elevated; insert a gloved hand to lift the presenting part off the cord; cover the cord with a moist sterile dressing. Do NOT push the cord back in. Emergency transport. |
| Limb presentation | An arm or leg presents first — the baby cannot deliver this way | Never pull the limb. Position mom (hips elevated), give oxygen, and transport rapidly. This delivery happens at the hospital. |
| Multiple births | Twins (or more) — often smaller babies and often earlier | Clamp the first baby's cord before the second delivers. Expect smaller babies who need aggressive warming; call for a second unit. |
| Preeclampsia / eclampsia | Pregnancy hypertension with swelling, headache, and visual changes; eclampsia adds seizures | Handle gently, dim the lights, minimize stimulation, transport on her left side, and be ready for seizures. |
| Postpartum hemorrhage | More than ~500 mL of bleeding after delivery | Fundal massage, treat for shock, high-flow oxygen, rapid transport. External pads — nothing packed into the vagina. |
One positioning rule for every late-pregnancy patient
Late in pregnancy, a supine mother's uterus can compress the inferior vena cava and drop her blood pressure — supine hypotensive syndrome. Transport any patient in late pregnancy in the left lateral recumbent position (or tilt the backboard left) to keep the uterus off the vena cava and blood returning to the heart.
7Self-check
Answer before you expand. If you miss one, re-read that section — then go run some calls.
Q1What findings tell you to prepare for delivery on scene instead of transporting?
Q2The head delivers and you find the cord wrapped around the baby's neck. What do you do?
Q3One minute after birth: body pink with blue extremities, pulse 120, grimaces to stimulation, some flexion, strong cry. APGAR?
Q4A newborn's heart rate is still below 60 after 30 seconds of effective PPV. What's next?
Q5You see the umbilical cord presenting at the vaginal opening before the baby. First actions?
