Imminent Childbirth

Why this matters

You may have planned a hospital delivery. The head is already out. First, decide that birth is about to happen and prepare for two patients. Check the neck for a nuchal cord, which is the umbilical cord wrapped around the baby's neck. Do not hold the head in, and do not cut the cord as the first move. Most babies need drying, warmth, and stimulation, not an immediate intubation. Routine suction, even with a bulb, is not the default during delivery. Breech and cord prolapse are complications you should not make worse.

Clinical sequence

1. If birth is not imminent, transport on the left side. Do not deliver in a driveway for convenience. If birth is imminent, stay and set up.
2. Support the head. Do not pull. As the head delivers, feel the neck. If the cord is around the neck: (1) slip a loose cord over the head; (2) if it is tight, try to deliver the baby through the loop or bring the cord over the shoulders, if your protocol includes that step; (3) double-clamp and cut only if delivery cannot proceed. Cutting is a last resort, because the baby is then off the placenta.
3. Guide the anterior shoulder downward gently, then deliver the rest. Do not suction the airway during a routine delivery.
4. Warm the baby: dry, stimulate, and keep warm. If the baby looks term and is crying, waiting about 60 seconds before clamping the cord is reasonable. If the baby needs resuscitation, that comes first. Do not pull on the placenta. Bleeding in the mother is the next emergency. See the oxytocin lesson.

Teaching points

• Imminent birth. Crowning, an urge to push, or a presenting part you can see means you stay and deliver. Do not leave to drive a short distance once the head is out.
• Nuchal cord. A nuchal cord is the umbilical cord around the neck. Slip a loose cord over the head. If it is tight, try to deliver through the loop or over the shoulders per protocol. Double-clamp and cut only if the baby cannot be delivered otherwise. Cutting is a last resort.
• Suction. Do not suction during a routine delivery. Suction if the airway is obstructed.
• The first minute. Warm the baby, dry the baby, stimulate the baby, and open the airway. Give positive-pressure ventilation if the baby is not breathing. Delay cord clamping for 60 seconds or more if the baby does not need immediate resuscitation.
• Do not improvise these. An arm or a leg presenting, a prolapsed cord, or a breech delivery means immediate transport and the position your protocol names. Do not pull a limb.

Common errors

• Do not hold the head in until you reach the hospital.
• Do not cut every nuchal cord. Cutting is the last resort.
• Do not suction a crying term baby as a routine.
• Do not forget the mother after the baby cries.

Practice

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.

• NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; your protocol still decides care
• NASEMSO 2022: Childbirth / neonatal resuscitation — imminent birth, nuchal cord, no routine suction, two patients
• AHA/AAP 2025 Neonatal Resuscitation — dry, stimulate, warm; deferred cord clamp ≥60 s if they do not need immediate resuscitation