UMBILICAL CORD AROUND THE NECK
If the umbilical cord is wrapped around the baby’s head in the birth canal: 1. Try to slip it gently over the baby’s shoulder or head.
2. if you cannot slip it over the baby’s head, and if it is tight around the neck, place clamps or ties on the cord two inches apart, and cut between them quickly; unwrap the cord from around the neck.
3. Deliver the shoulders and body, supporting the head at all times. Limb Presentation If an arm or a leg is first to emerge from the vagina, you must transport the mother im- immediately to the hospital. A limb presentation means that the baby has shifted so much in the uterus that a normal delivery is impossible and that the baby will have to be delivered by surgical technique. Delay can be fatal. DO NOT attempt to pull on the baby by an arm or leg.
If the baby’s shoulders become wedged in place after the head has been delivered:
- DO NOT attempt to pull on the baby.
- Suction the baby’s mouth and nose.
- Make sure that the baby is breathing.
- Transport mother and baby to the hospital.
- Constantly monitor the mother and baby during the transport.
Multiple births generally present no problems, and twins are delivered in the same manner as single babies, one after another.
- Even if the mother is unaware of the fact, you may suspect a multiple birth if the abdomen is still very large after one baby is delivered; there are more strong uterine contractions, and the baby’s size is out of proportion to the mother’s abdomen. Labor contractions start again about ten minutes after the first baby is born.
- When the first baby is born, clamp and cut the cord (as described earlier) to prevent hemorrhage to the second baby. Contractions will continue, and the second and subsequent babies should be born within minutes. Handle the baby as you would for a single birth.
- If the second baby has not been delivered within ten minutes of the first, transport the mother and the first baby to the hospital for delivery of the second twin. After the babies are delivered, the placenta or placentas will be delivered normally.
- Keep the infants warm. Twins are often born early and may be small enough to be considered premature. Special precautions should be taken to prevent a fall in temperature.