Emergency Childbirth Medical Directive

Question 1

Emergency Childbirth MD

What are the indications for the emergency childbirth MD?

Answer 1

Pregnant patient experiencing labour; OR
Post-partum patient immediately following delivery and/or placenta.

Question 2

Emergency Childbirth MD

What are the conditions for delivery?

Answer 2

Age: Child-bearing years
Other: Second stage labour
AND/OR
Imminent birth
AND/OR
Shoulder dystocia
AND/OR
Breech delivery
AND/OR
Prolapsed cord

Question 3

Emergency Childbirth MD

What are the conditions for umbilical cord management?

Answer 3

Age: Childbearing years
Other: Cord complications
OR
If neonatal or maternal resuscitation is required
OR
Due to transport considerations

Question 4

Emergency Childbirth MD

What are the conditions for external uterine massage?

Answer 4

Age: Childbearing years
Other: Post-placental delivery

Question 5

Emergency Childbirth MD

What are the conditions for oxytocin administration?

Answer 5

Age: Childbearing years
SBP: <160 mmHg
Other: Postpartum delivery
AND/OR
Placental delivery

Question 6

Emergency Childbirth MD

What are the contraindications to delivery?

Answer 6

N/A

Question 7

Emergency Childbirth MD

What are the contraindications to umbilical cord management?

Answer 7

N/A

Question 8

Emergency Childbirth MD

What are the contraindications to external uterine massage?

Answer 8

Placenta not delivered

Question 9

Emergency Childbirth MD

What are the contraindications to oxytocin administration?

Answer 9

Allergy or sensitivity to oxytocin
Undelivered fetus
Suspected or known pre-eclampsia with current pregnancy
Eclampsia (seizures) with current pregnancy
≥4 hours post placenta delivery

Question 10

Emergency Childbirth MD

For shoulder dystocia deliveries, how many times should ALARM be performed?

Answer 10

Two times. If successful, deliver neonate. If unsuccessful; transport to closest appropriate facility.

Question 11

Emergency Childbirth MD

How long since umbilicus was visualized should we attempt the Mauriceau Smellie-Veit maneuver in breech deliveries?

Answer 11

Once the hairline is visible AND/OR 3 minutes have passed.

Question 12

Emergency Childbirth MD

What should you do if there is a cord prolapse?

Answer 12

If a cord prolapse is present, the fetal part should be elevated to relieve pressure on the cord. Assist the patient into a knee-chest position or exaggerated Sims position, and insert gloved fingers/hand into the vagina to apply manual digital pressure to the presenting part which is maintained until transfer of care in hospital.

Question 13

Emergency Childbirth MD

What is the dosing for oxytocin?

Answer 13

Route: IM
Dose: 10 units
Max 1 dose