Emergency Delivery in Hospital Parking Lot: Management Priorities
The person should not be moved from current location as moving a person in imminent delivery can increase risks and complications for both mother and baby 1. Attempting to transport the patient during active labor could lead to uncontrolled delivery in a less optimal setting.
Immediate Assessment and Management
Initial Steps
- Ensure the person is in a position where they feel comfortable for delivery (typically semi-recumbent)
- If possible, create some privacy using available materials (blankets, jackets)
- Call for additional medical assistance from the hospital
- Request emergency delivery supplies from the hospital
Delivery Position
- Allow the person to choose the position in which they feel most comfortable for delivery 1
- Keep open the option to quickly position the patient in a supine position compatible with the McRoberts maneuver if shoulder dystocia occurs (mother's legs hyperflexed tightly to abdomen) 1
Managing the Delivery
During Delivery
- Support the baby's head as it emerges - do not pull firmly downward on the head
- Check for nuchal cord (umbilical cord around neck) and gently loop it over the head if present
- Allow the shoulders to deliver with the next contraction
- Support the body as it delivers
- Note the time of birth
Immediate Newborn Care
- Keep the newborn at the same level as the mother's uterus before cord clamping
- Dry and warm the baby immediately to prevent hypothermia
- Clear the airway if necessary (wipe mouth and nose)
- Assess breathing and color
- Do not immediately cut the umbilical cord unless absolutely necessary 1
Third Stage Management
- After delivery, administer 5-10 IU of oxytocin (if available) via slow IV or intramuscular injection to reduce the risk of postpartum hemorrhage 1, 2
- Allow for spontaneous delivery of the placenta with minimal cord traction
- Do not perform manual removal of the placenta unless there is severe, uncontrollable postpartum hemorrhage 1
Common Pitfalls to Avoid
- Moving the patient unnecessarily: This increases risk of uncontrolled delivery and complications
- Pulling firmly on the baby's head: This can cause brachial plexus injury
- Rushing the third stage: Aggressive management of placental delivery can increase hemorrhage risk
- Cutting the cord immediately: Delayed cord clamping provides benefits to the newborn
- Performing unnecessary episiotomy: Outside specialized settings, routine episiotomy is not recommended 1
Special Considerations
If Shoulder Dystocia Occurs
- Implement the McRoberts maneuver (hyperflexion of mother's legs to abdomen) with or without suprapubic pressure as first-line intervention 1
- Do not pull firmly downward on the head as this increases risk of brachial plexus injury
Postpartum Hemorrhage Management
- If hemorrhage occurs, administer 1g of tranexamic acid intravenously if available (within 1-3 hours of bleeding onset) 1
- Perform fundal massage to stimulate uterine contraction
- Prepare for immediate transfer into the hospital once delivery is complete
Remember that the priority is ensuring safe delivery where the patient is currently located, as moving someone in active labor can lead to delivery in a less controlled environment with higher risks for complications.