Childbirth is imminent when the baby's head is crowning, the mother feels a strong urge to push or contractions come 2 minutes apart or closer. In that case delivering on scene is safer than transport, while staying ready for complications.
Key symptoms
- Strong, regular contractions 2 to 3 minutes apart or closer
- Urge to push or to have a bowel movement
- Rupture of membranes (water breaking)
- Bloody show
- Crowning visible at the vaginal opening
What you find on exam
- Prenatal history: due date, number of babies, prior births, complications
- Visual check for crowning, bleeding, meconium or a prolapsed cord
- Contraction timing and maternal vital signs
- Fetal heart rate if equipment is available
- Signs of preeclampsia: high blood pressure, headache, seizures
Tests
- Maternal blood pressure and pulse
- Glucose if diabetic or altered
- Apgar score at 1 and 5 minutes
- Estimate of blood loss after delivery
Treatment basics
- Prepare a warm area, an obstetric kit and newborn resuscitation equipment
- Support the head, check for a cord around the neck, guide the shoulders out
- Dry, warm and stimulate the baby; skin-to-skin; delay cord clamping 30 to 60 seconds
- Deliver the placenta, massage the uterus, encourage breastfeeding
- Postpartum bleeding: fundal massage, oxytocin or tranexamic acid per protocol
Red flags
- Prolapsed cord, breech or limb presentation
- Shoulder dystocia
- Blood loss over 500 mL or signs of shock in the mother
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); NCSBN 2026 NCLEX-RN Test Plan. Written by Making Synapses. Making Synapses is not affiliated with these organizations.