Emergency Procedures Checklist

1. Summary of Emergency Situations

DANGER SIGNS IN PREGNANCY
1. Bleeding: If a woman begins to bleed during pregnancy, even a little, this is a danger sign. She could be having a miscarriage (loose the baby) or the baby could be developing outside the womb (ectopic pregnancy).
a. What to do?

The woman should lie quietly and send for a health worker.
Bleeding late in pregnancy (after 6 months) may mean the placenta (afterbirth) is blocking the birth opening (placenta previa).
Without expert help, the woman could quickly bleed to death.
Do not do a vaginal exam or put anything inside her vagina.
Try to get her to a hospital at once!

2. Severe anemia: If the woman is weak, tired, and has pale or transparent skin (view signs of anemia in annexe 1) she might have severe anemia. If not treated she might die from blood loss at childbirth.
a. What to do?

If anemia is severe, a good diet is not enough to correct the condition in time
See a health worker and get pills of iron salts (annexe 1)
If possible, have baby in hospital in case extra blood is needed.

3. High blood pressure or other signs of pre-eclampsia: Blood pressure of 140/90 or greater can be a sign of a serious problem called pre-eclampsia (toxemia). Other signs include a lot of protein in the urine sudden weight gain, and swelling. Pre-eclampsia can lead to seizures (convulsions, fits) and even death.
a. What to do?

If women has high blood pressure, ask her to lay down and rest more often.
Help her get plenty of good foods to eat and to eat a lot of protein.
She should avoid salty packaged foods and snaks.
Re-check her blood pressure in a couple of days.
If you can’t test for high blood pressure or protein in the urine, watch out for these other signs of pre-eclampsia

1.    Swollen face, or swelling all over in the morning upon awakening
2.   Headaches
3.   Dizziness
4.   Blurred vision
5.   Pain high in belly

If her blood pressure keeps going up (to 160/110 or higher) or if she shows any of these signs--get help fast!

b. What to do if she is already having seizures?

Try to keep the pregnant women from hurting herself: move away all hard or sharp objects
Put nothing in her mouth while she is having a seizure—no food, drink, medicine, nor any object to prevent biting her tongue!
After seizure, she might be very dull or sleepy—let her sleep.
If seizure last more than 15 minutes, put liquid diazepam in the anus using a plastic syringe without a needle.

1. Dosage: 5 to 10mg of liquid diazepam (valium) or crush one diazepam tablet and mix with water and put liquid in anus.
2. Do not inject phenytoin, phenobarbital, or diazepam into the muscles!

2. Difficult Births

1.    Labour stops or slows down, or lasts a very long time after being strong or after water break. This has several possible causes:
a.   The women may be frightened or upset: This can slow down or even stop contractions.
i.     What to do?

Talk to her. Help her relax. Try to reassure her. Explain that the birth is slow, but there are no serious problems.
Encourage her to change her position often and to drink, eat, and urinate.
Stimulation of the nipples can help speed labour.

b. The baby may be in an unusual position: Feel the belly between contractions to see if the baby is sideways.
i. What to do?

Sometimes the midwife can turn the baby through gentle handling of the woman’s belly
Try to work the bay around little by little between contractions, until the head is down.
But do not use force as this could tear the womb or placenta, or pinch the cord.
If the baby cannot be turned, try to get the mother to the hospital.

c. The baby’s head may be too large to fit through the woman’s hip bones: This is more likely in a woman with narrow hips or a young woman or girl whose body is not full grown. You may feel that the baby is not moving down.
i. What to do?

If you suspect this problem, try to get the mother to a hospital as soon as possible, as she may need an operation (caesarean).
Woman who are of very short stature (dwarfs), have very narrow hips, or are especially young should have at least their first child in or near a hospital.

d. If the mother has been vomiting or has not been drinking liquids: she may be dehydrated. This can slow down or stop contractions.
i. What to do?

Have her sip Rehydration Drink or other liquids after each contraction.

2. Breech delivery (The bottocks come out first): Sometimes the midwife can tell if the baby is in breech position by feeling the mothers belly (how to feel the mothers belly in annex 1) or listening to heart beat (annexe 1)
a. What to do?

A breech birth may be easier in this position (draw a picture of woman giving birth on all fours)
If the baby’s legs come out, but not the arms, wash your hands very well, rub them with alcohol (or wear steril gloves), and then:

1.    Slip fingers indise vagina and push the baby’s shoulders toward the back,like this (draw picture on p.268, left (Where there is no doctor)), or
2.   Press his arms against his body, like this (draw picture on p.268, right (WTIND))

b.   If the baby gets stuck…

Have the mother lie face up. Put fingers in the baby’s mouth and push the baby’s head down by pressing on the mother’s belly like this (draw image on p.268, third from top)
Have the mother push hard, but never pull on the body of the baby!

3. Presentation of arm
a. What to do?

If the hand comes out first, get medical help right away.
An operation may be needed to get the baby out.

4. Sometimes the cord is wrapped around the baby’s neck so tightly that he or she cannot come out all the way.
a. What to do?

Try to slip the loop cord from around the baby’s neck.
If you cannot do this, you may have to clamp or tie and cut the cord.
Use boiled blunt tipped scissors.

5. Feces in the baby’s mouth and nose: When the waters break, if you see they contain a dark green (almost black) liquid, this is probably the baby’s first stools (meconium). The baby might be in danger. If he breathes any of the feces into his lungs, he may die.
a. What to do?

As soon as his head is out, tell the mother not to push, but to take short, rapid breaths.
Before the baby starts breathing, take time to suck the feces out of his nose and mouth with a suction bulb.
Even if he starts breathing right away, keep sucking until you get all the feces out.

6. Twins: Giving birth to twins is often more difficult and dangerous—both for the babies and mother—than giving birth to a single baby.
a. What to do?

To be safe, the mother should give birth to twins in a hospital!
Because with twins labour often begins early, the mother should be within easy reach of hospital after the seventh month of pregnancy.
During the last months, if the woman rests a lot and is careful to avoid hard work, twins are less likely to be born too early.
Twins are often born small and need special care.

1. However, there is no truth in beliefs that twins have strange or magic powers.

b. What are the signs that a woman is likely to have twins?

The belly grows faster and the womb is larger than usual, especially in the last months
If the woman gains weight faster than normal, or the common problems of pregnancy (morning sickness, backache, varicose veins, piles, swelling, and difficult breathing) are worse than usual, be sure to check for twins.
If you can feel 3 or more large objects (heads and buttocks) in a womb that seems extra large, twins are likely.
Sometimes you can hear 2 different heartbeats (other than the mother’s)—but this is difficult.

Annex

The signs of anemia:

Pale or transparent skin
Pale insides of eyelids
White fingernails
Pale gums
Weakness and fatigue
Face and feet swollen
Rapid heartbeat
Shortness of breath

Iron salt pills

name: Iron sulfate (ferrous sulfate)
Tablets: 200mg or 325mg pills (both contain 65mg iron)
1 pill 3 times a day with meals
Must be given 3 months prior to pregnancy
Warning: Be sure dose is right! Too much is poisonous! Keep tablets out of reach of children.
Do not give ferrous sulfate to severely malnourished persons.

How to feel mothers belly

To make sure the baby is head down, in the normal position for birth, feel for his head, like this (insert picture of p. 257 Where there is no doctor)
Have the mother breath out all the way
With the thumb and 2 fingers, push in here, just above the pelvic bone
With the other hand, feel the top of the womb

If it feels larger at the top, and harder and rounder at bottom= but up (normal and safe)
If feels larger down, and hard and round on top = bottom down (breech position, danger)

Listen to baby’s heart beat

You can try putting your ear against the belly, but it may be hard to hear. It will be easier if you get a fetoscope (or make one using fired clay or hard wood works well –insert picture of homemade fetoscope)

If the baby’s heartbeat is loudest below the navel in the last month, the baby’s head is down and will probably be born heads first.
If the heartbeat is heard loudest above the navel, his head is probably up. It may be a breech position.

A baby’s heartbeat beats about twice as fast as an adult’s. If you have a watch with a second hand, count the baby’s heartbeats. From 120 to 160 per minute is normal.
If less than 120, something is wrong, or you miscounted the mothers heartbeat.
Take mother’s pulse.
The baby’s heartbeat is often hard to hear.
It takes practice.

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