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can clamp the cord and reexamine it.
e. Making the Baby Safe and Comfortable. Wrap the baby in a sterile
blanket. Be sure to keep the baby warm at all times.
2-14. DELIVERY OF THE PLACENTA
Hopefully, you will have an assistant who can watch the baby while you attend to
the delivery of the placenta. The placenta is usually delivered within 20 minutes after
the baby has been born. Proceed as follows:
MD0584 2-15
 a. Expect some bleeding. One or two cups (less than 500 ml) is normal. This
bleeding occurs as a result of the separation of the placenta from the wall of the uterus.
b. Gently massage the mother's abdomen over the uterus. This causes the
uterus to contract.
c. You can also put the infant to the mother's breast to stimulate the uterus to
contract and control bleeding.
CAUTION: NEVER pull on the umbilical cord in an attempt to hasten the delivery of
the placenta.
c. When the placenta is delivered, place it in a basin or plastic bag. Take the
placenta to the hospital. The placenta will be examined to be sure that all the afterbirth
has been expelled.
d. Examine the perineum which is the skin between the anus and vagina for
lacerations. Apply pressure to any bleeding tears.
e. Place a sanitary pad over the vaginal opening.
f. Lower the mother's legs.
g. Prepare for transport.
2-15. ASSESSMENT OF THE BABY - APGAR
a. Life-threatening problems the newborn may have are your first concern.
Therefore, begin your assessment by checking the newborn's airway, breathing, and
circulation. Included in your initial assessment is the newborn's ability to adapt to his
new environment upon birth. The Apgar score is used to measure this adaptability.
b. The Apgar scoring system was devised by an American anesthesiologist to
assess the physical condition of a newborn baby. This method assesses various
aspects of the newborn's health at one minute after birth and at five minutes after birth.
Evaluated are the infant's color (appearance), respiratory effort, muscle tone, reflex
irritability (grimace in response to slap), and heart rate (pulse). Each feature is given a
score of from 0 to 2. The numbers are added to give a total possible score of 10 (2
points in each of the 5 categories).
c. The Apgar score at the one-minute check and the five-minute check indicate
how the newborn is doing in the first few minutes of life. A low score on the one-minute
test will often improve on the five-minute test. This indicates that the problem was
temporary and has been corrected. Look at tables 2-1 and 2-2 to see the scoring
system and the meaning of the scores.
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SCORE 0 1 2
Blue Body pink
Color Completely pink
Pale Extremities blue
Heart Rate Absent Less than 100/min More than 100/min
Weak cry Good crying
Respiratory Effort Absent
Irregular breathing Regular breathing
Active motion
Muscle Tone Limp Bending of some limbs
Limbs well-flexed
Grimace and cough
Reflex Irritability Absent Grimace
or sneeze
Table 2-1. Apgar scoring system.
7 - 10 points Baby is in excellent condition
5 - 7 points Newborn is mildly depressed
Lower than 5 points Newborn is severely depressed
Table 2-2. Meaning of an Apgar score.
2-16. RESUSCITATION OF A NEWBORN
Follow these procedures:
a. Suction the baby's airway.
b. Lay the baby on its side with its head lower than the body.
c. Snap your index finger against the bottom of its feet. If there is no response,
continue as follows:
(1) Apply gentle mouth-to-mouth or mouth-to-nose resuscitation.
(2) Continue resuscitation until the baby's breathing starts, then administer
oxygen to the infant.
(3) Apply cardiopulmonary resuscitation if there is no pulse.
(4) Continue cardiopulmonary resuscitation until the baby breathes or is
pronounced dead.
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Section IV. ABNORMAL DELIVERIES
2-17. BREECH PRESENTATION
In a breech delivery, the baby's buttocks appear first instead of the head. Make
every effort to get the mother to a hospital if it appears the baby will be a breech
delivery. If there is no time to do this, follow these procedures:
a. Make the same preparations as for a normal delivery.
b. Allow the baby's buttocks and trunk to deliver spontaneously. [ Pobierz całość w formacie PDF ]