00:01
Let's talk about
the next complication,
a precipitous labor.
00:05
So a precipitous labor
is one that lasts
less than three hours
from the onset of contractions
to delivery.
00:12
Now, that might actually sound
like a great plan.
00:15
What's wrong with
a precipitous labor?
It's actually a complication.
It's not what we want.
00:19
And we'll talk about why
in just a minute.
00:22
So let's first talk about
risk factors.
00:24
The first one is an
abruption of the placenta.
00:27
So if the placenta breaks away
from the uterine wall
before the baby comes out,
then we might have a uterus
that tries really hard
to push the baby out
really quick.
00:36
So not only is the
placental abruption a bad thing,
then we have a fetus
that's coming through really quick,
and that's not good either.
00:44
The next risk factor
is uterine tachysystole
Tachysystole, if you remember
from tachycardia means fast.
00:53
And so if we have a uterus
that is contracting really quickly,
then we may push
the baby out really fast.
01:01
One of the things that can cause
uterine tachysystole is drug use,
specifically, cocaine use.
01:07
So if we have a patient
that's done cocaine prior to
coming to the hospital,
or they come in the hospital,
and they're experiencing
a precipitous labor,
one of the things that might
be done is a drug screen
to make sure that there are
no drugs in the system,
because that might be
the cause.
01:25
So how will the nurse know
that the patient might be
experiencing a precipitous labor?
Well, the most obvious way
is that they tell you.
01:34
So if a client comes in and says,
"I'm feeling pressure."
Maybe you let them go
to the restroom
to collect a urine sample,
and while they're in there,
they'll say,
"Oh, I'm feeling something coming."
Hmm, believe them,
because it might be a baby.
01:47
Might be pop, out comes the baby
right in the toilet.
01:50
So if they tell you that, listen.
01:52
The next thing
that you might notice,
once you get them on
the monitor
is that you see a
contraction pattern
that looks like this.
01:59
Take a look at what's going on
at the bottom of this graph.
02:02
You can see that these contractions
are really close together.
02:06
And that will let you know
this baby is moving out quick,
fast in a hurry.
02:11
So pay attention to that.
02:12
So what do we need to do?
we're going to separate this into
in the hospital experiences
and out of the hospital experience,
because that can happen.
02:22
If you're in the hospital,
the first thing you're going to do
is call for a
precipitous birth kit.
02:27
One of the really cool things
on units, all units
in the emergency room,
in labor and delivery
in the ICU,
anywhere in the hospital
where a patient might
actually deliver a baby
there are what we call
precipitous labor kits
that have all the things
you need
in order to safely deliver
the baby right then
call for one,
you will need it.
02:47
The next thing you want to do
is there's not really a lot
of fancy things
to help prepare the baby,
or prepare the mom,
or do any of those things,
you want to make sure
that you support the baby
because it will come
flying out.
03:00
And you want to make sure
that you protect the fetus
from any sort of
emergency or trauma
that might happen
as they move out of the uterus
and protect the skin of the labia,
and the vaginal vault,
because a baby
coming out really fast
is not good for
either one of them.
03:18
Also thinking about
the transition of the fetus
as they make their way out,
we depend on that squeeze
through the uterus
to help clear the fluid that
might be there for the fetus.
03:28
And if the baby
comes out really fast,
there's not an opportunity for that.
03:33
So the possibility of aspiration
is really high.
03:35
So we want to slow that delivery
down as much as possible.
03:41
Now, let's think about
what we would do
if we're not in the hospital.
03:45
So actually, this is like
one of my dreams in life
is to be on an airplane
and someone say,
"Is there someone
who can deliver a baby?"
and I will say, "Yes."
and I will go up,
and I will deliver the baby
and get free
airline tickets forever.
04:00
But anyway,
first thing we need to do
is call 911.
04:04
Because we want
emergency services coming
so that whatever is going to happen
and whatever could happen,
we have backup,
because you're likely not to have
a precipitous kit
anywhere with you.
04:16
The next thing we want to do
is to keep the client
calm and warm.
04:21
So let's say
you're in a car,
then this is a time when you might
want to move to the backseat
and turn the heat way up.
04:28
Now, nobody's usually going to be
particularly excited
except for me on the airplane
if a baby's coming out,
and you're not
where you're supposed to be.
04:35
So keeping everybody calm
is going to be really important.
04:38
Maybe even yourself.
04:41
We still want to support
the delivery of the baby.
04:43
So we're trying
to prevent injury
to the fetus
and to the vaginal tract.
04:48
So we want to support the baby
as it emerges really slow.
04:51
We don't need to check the patient.
04:53
We don't need to do any of that
because it doesn't matter.
04:56
If she's 10 centimeters
or tensimeters
and + 2, or 3, or 4 station,
it's not going to change anything.
05:03
There's no need to introduce
the fingers into the vagina,
just make sure
that everything is clear.
05:09
And you can see.
And that's all you need to do.
05:12
After delivery,
you want to place the baby
on the mother's chest.
05:16
And that's a good way
to keep them warm.
05:19
Think about skin to skin.
05:20
If we have
other articles of clothing,
then we can wrap that around
both of them.
05:25
But don't wrap the baby up and
then put them on the chest.
05:28
Take the baby out of
any sort of wrappings,
put them straight on the chest,
and then wrap
the patient and the baby together.
05:35
And again, if you're in the car,
crank up that heat
and keep them both
as warm as possible.
05:40
The next thing we want
to think about is the cord.
05:43
Now, we don't need to cut the cord
because that could
introduce infection,
and a lot of blood and all kinds
of things that we don't need.
05:50
You can however,
tie it off.
05:52
So a shoestring or
some kind of hair tie,
or whatever you have
a torn piece of clothing,
you can tie off the cord.
05:59
And that will make it easier
to move the fetus around
or actually now the baby
because it's outside.
06:05
Then once you do that,
you can consider whether you need
to deliver the placenta or not.
06:11
The placenta can really stay in
for maybe up to 30 minutes
without any problem.
06:16
Now, if you call 911,
they're on their way,
they can deliver the placenta
and all is good.
06:22
If it's going to be
a long time,
or if you find that the client
has actually started to bleed,
then we need to deliver
the placenta.
06:30
So that requires
just some gentle traction,
a couple of pushes from the client,
and hopefully, the placenta
will just slide right out.
06:38
The next thing we can do
is we can go ahead
and encourage
the client to breastfeed.
06:43
Once we start breastfeeding
the body naturally releases
oxytocin,
which causes contractions
of the uterus,
which will help stop any of that
postpartum bleeding.
06:54
There we go.