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Lesson

Imminent Childbirth

12 min Medical Skip to quiz

Objective: Recognize imminent birth, assist an uncomplicated delivery, handle a nuchal cord without panic, and start newborn warming and stimulation before you reach for gadgets.

Why This Is Hard

You wanted a hospital with lights. The head is out. Recognize imminent birth. Plan for two patients. Assist a term delivery. Know the complications (nuchal cord, breech, prolapse) well enough not to make them worse. Most babies need drying, warmth, and stimulation — not a crash intubation. Routine suction, even with a bulb, is not the default during delivery.

On this truck
  • Crowning, mother saying she has to push, or you can see the head: you are delivering. Do not hold the head in.
  • OB kit, warm towels, a second set of hands, a destination that can take mom and baby if this goes badly.
  • Two patients on the radio from the first sentence.
  • Oxytocin only per protocol after the baby is out — this site does not own units.

Street Sequence

  1. If birth is not imminent, transport on the left side. Do not do a driveway delivery for convenience. If it is imminent, stay and set up.
  2. Support the head. Do not yank. As the head delivers, feel the neck. If there is a nuchal cord (cord around the neck), slip it over the head. If it will not slip and is tight, model language is double-clamp and cut — last resort, because that baby is now off the placenta.
  3. Deliver the anterior shoulder with gentle downward guidance, then the rest. Do not routinely suction the airway during delivery.
  4. Baby to warmth: dry, stimulate, keep warm. If they look term and are crying, delayed cord clamping of at least about 60 seconds is reasonable when you can. If they need resuscitation, that comes first. Then the placenta — do not pull. Mom’s bleeding is the next emergency (see the oxytocin lesson).

Field Rules

  • Imminent: crowning, urge to push, presenting part visible. That is a stay-and-deliver, not a lights-and-siren extra two miles.
  • Nuchal cord: most are loose. Slip over the head. Cutting is a last resort.
  • Do not routinely suction during delivery. Suction if the airway is obstructed.
  • Newborn first minute: warm, dry, stimulate, open the airway. PPV if they are not breathing. Deferred cord clamping of 60 seconds or more if they do not need immediate resuscitation.
  • Complications you do not freestyle: arm or leg presenting, cord prolapse, breech — immediate transport and the position your protocol names. Do not pull a limb.
Say out loud
  • We have two patients
  • Head is out — controlling, not pulling
  • Nuchal — slipping it over
  • Baby: dry, warm, stimulate

Field Pitfalls

  • Holding the head in “until we get to the hospital.”
  • Cutting every nuchal cord.
  • Routine deep suction on a crying term baby.
  • Forgetting the mother after the baby cries.

Practice

60-second drill

Partner: crowning in the bathroom. First 30 seconds. Then: cord around the neck, loose. What do you do before you cut anything?

Related: Eclampsia & Preeclampsia, Oxytocin After Delivery, Cardiac Arrest in Pregnancy.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.

1. If the head is crowning on scene, the usual move is:
2. A loose nuchal cord (cord around the neck) is usually managed by:
3. Routine suction of a crying term newborn during delivery is:
4. If the newborn is term-looking and crying, delayed cord clamping of about 60 seconds:
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