OB case: textbook with the wrong treatment?

[mshow00]

When we went over OB in class we talked about the case when the cord get wrapped around the babies head. Now comes my question, the textbook, workbook, and the notes given us all say to clamp and cut around the babies head, BEFORE the baby is fully delivered IF you can not maneuver the cord back over by manual traction, however our medical control Dr. flipped out when we showed him this saying never, ever do that. So I brought this up to several medics I work with and it seems to be 50/50 split. So I ask here what is the "true standard treatment". If I come across this in the field and bad happens which method will land me in more trouble on the stand?

[spenac]

If it will not slip over babys head baby will die a painful strangulation if cord is not cut. Sorry in my humble opinion your medical director failed. Perhaps he misunderstood that this is a last option and not the first option.

[Arizonaffcep]

I completely agree Spenac. It's a standard of care that if you can't get the cord from around the neck...clamp the cord and cut it. Anything less is negligence.

[ERDoc]

I think I may be a little confused. Your doc flipped out because you were trying to get the cord over the head before trying to cut it or because you were trying to cut the cord while around the baby's neck? Agreed with the above, attempt to reduce the cord and if unsuccessful cut it (make sure you cut the part between the clamps).

[scubanurse]

Keep in mind just because cord is around the neck doesn't mean that baby isn't okay.... until baby is fully delivered and cord is cut the baby is receiving oxygenated blood from mama via the placenta and umbilical cord. So if mom and baby seem stable, I would transport ASAP but any signs of deterioration on either front cut the cord and attempt delivery of the rest of the baby.

(edited part) Maybe I am wrong in this thinking though? (edited part)

Just remember...once you cut that cord, baby is on his/her own... so make damn sure it's a last resort to save baby and mama

[Eydawn]

Baby's head out of the womb? Can you suction and ensure open airway? Baby no longer needs cord blood for survival. Try to slip the cord over the baby's head. If unsuccessful, clamp the cord in 2 places and cut between the clamps. I gotta agree with Doc on this one.

Cord around the neck can become very dangerous, very quickly.

Wendy

CO EMT-B

[Arizonaffcep]

Keep in mind just because cord is around the neck doesn't mean that baby isn't okay.... until baby is fully delivered and cord is cut the baby is receiving oxygenated blood from mama via the placenta and umbilical cord.

Not really...think about it...the how big is the cervix and canal? It does expand to fit baby, but it is still a very TIGHT squeeze (hence why it hurts so bad). With this in mind, if baby and cord are present in the canal and cervix, the cord (much more pliable by comparison) gets compressed, thus effectively cutting off the blood supply and O2 source (until delivered). So...clamp and cut...deliver the baby, perform whatever resuscitation you need.

**fixed some spelling errors**

[scubanurse]

it makes sense, but I guess I don't have much experience and it still confuses me a little bit because I remember still hearing from the OB section that the baby is still receiving oxygenated blood from mama which is why we keep baby at level so as not to overload/underload the baby with blood?

[Eydawn]

That's AFTER the baby is completely out of the birth canal and the cord isn't being squished by the baby and mama's vagina and all those contractions. After the baby is completely out, then the cord is basically a large hose through which blood passes...

Make sense? Cord + baby inside vagina = squished cord and no flow. Cord + baby outside vagina = no squish on cord.

Wendy

CO EMT-B

[DwayneEMTP]

it makes sense, but I guess I don't have much experience and it still confuses me a little bit because I remember still hearing from the OB section that the baby is still receiving oxygenated blood from mama which is why we keep baby at level so as not to overload/underload the baby with blood?

You two are talking at cross purposes. He's correct, but he's speaking about a mid delivery scenario where the cord can be crushed between the child and the birth canal walls.

You are correct, but are speaking post delivery..apples to oranges...see?

Dwayne