Teaching class TOMORROW - What do you think paramedic students need to know???

[hopefulfaith]

Hi! I'm teaching class tomorrow for the paramedic program in our region. I am doing their 1-day long OB section.

Here's my question: what do you think that paramedic students need to know?

They will be responding to out-of-hospital birth situations and so we're doing the usual run of emergency topics (prolapse, etc.). I cover them very briefly, and then we're breaking out the mannequin and doing scenarios (how exactly to catch the baby, how to put a pg mama on a backboard s/p trauma, etc.).

What else do you think I should cover?

I plan to give a brief spinoff on breastfeeding and perhaps a "who are the birth professionals?" bit - types of midwives, doulas, etc.

What else?

TIA!

[Veritaserum]

What has bothered me personally is that the paramedics are sometimes taught to put a woman (whose baby is clearly going to be born NOW) onto her back and they are taught how to cut an episiotomy. So, I think perineal support would be a great thing for them to learn. Also, they should learn advantages of "alternative" positions for various circumstances and the disadvantages of pushing on your back.

[heartandhandsdoula]

I have had one experience of a paramedic birth (they got there right after) They cut the cord immediately and started using the delee suction on the baby?? Everybody was fine, but they still did that. THen they wouldn't give baby to mom or let mom stand up(I was suggesting moving around to help placenta come out.) Also, they had no idea what a doula was, so they thought I was there to catch the baby! So definitely letting them know that cutting the cord is not necessary. I have heard other stories where people were praised for knowing how to cut the cord when a baby was born at home:

[Midwife Kris]

This is probably too late but I think paramedics/EMTs need to know that the midwife who is ALREADY there is the 1st responder who knows more about the case they are about to assume and they need to get report and advice before pushing everyone out of the way to "do their job".

[bryonyvaughn]

It can be difficult to retain gobs of individual instructions from a full day seminar. I think they'll implement your instructions better if you can briefly state the *why* followed by the logically ensuing instruction.

Originally Posted by heartandhandsdoula

...So definitely letting them know that cutting the cord is not necessary...

Oooh, yes, and even describe the cord and placenta as nature's own respiratory support for a newborn... that with *very* few exceptions babies do better with O2 while attached to the cord than with O2 without placental support.

Originally Posted by Veritaserum

What has bothered me personally is that the paramedics are sometimes taught to put a woman (whose baby is clearly going to be born NOW) onto her back and they are taught how to cut an episiotomy.

<shudder> Explain the uselessness of most episiotomies in terms of cutting soft tissue not resolving bone blocking the passage of bone. That might be a good segue into gravity assisted birthing positions. When you speak about newborn care you could bring up gravity again as a way to drain the nasal passages and lungs alone or combined with gentle suction.

I think hitting a few key concepts repeatedly throughout the day as they relate to various aspects of emergency birth will help the paramedics remember and act more supportively and less ... uhm, heroically?

Good luck with your talk. The more you do the more you learn and more effective you become.

~BV

[Jane]

I think I would like to show them a nice homebirth video - the naked baby on the mother's chest, no cord clamping, no oxygen, no suctioning, etc. to give them an idea of what the mother wants/expects from her birth. They may be trying to recreate a hospital birth at home, and that's not what anyone really wants...
I have seen a video of a home shoulder dystocia and the baby getting PPV from the midwife, then the paramedics arriving, prepping for transport, but the baby came around nicely, they checked everyone and left. It was a good handling of an unexpected situation.
I did see a paramedic video that encouraged blow-by oxygen for an otherwise healthy baby. That's probably less intrusive than suctioning for the team that wants to do something when nothing needs to be done.
One more thing - I'd enphasize the need for warmth. Babies with infections can't keep their temperatures up. When a baby arrives at the hospital in an ambulance, and has a low temperature, the doctors won't be able to determine if it's infection or just poor temperature control on the ride over. It means more invasive tests for the baby- and it can prevent good care if the docs think infection when there's another reason for the baby's condition. Also, the cold sets the baby up to get an infection.

[QueenOfThePride]

Babies can't maintain their own body temperature regardless. The best place for the newborn to stay warm is skin-to-skin on mama's chest. And emphasize that the cord should not be cut, tied, or clamped. Cutting can be safely delayed for hours. You could probably teach the Apgar evaluation too. Immediate breastfeeding is also ideal for full-term newborns.

[1stimestar]

Originally Posted by bryonyvaughn

I think hitting a few key concepts repeatedly throughout the day as they relate to various aspects of emergency birth will help the paramedics remember and act more supportively and less ... uhm, heroically?

~BV

Or that by protecting the mother's birth memories they will be MORE heroic!

[mezzaluna]

don't pull on the baby... good general rule.

[birthgreeter]

Hope you get this in time.....
I use to work at a birth center, and if we had a transport, the EMT's or Paramedics were usually worried they would have to do the birth. Most are not looking forward to that, (at least the ones in my area) so as a general rule are happy if you continue to do what you are doing.

But I agree: teach them to NOT cut, to NOT pull on baby, and to support moms bottom, and not have her "PUSH-PUSH" as they like to yell their encouragement of a hurried birth.

Remind them that birth is NORMAL, and we can avoid problems by working to keep it normal!

[hopefulfaith]

Thanks so much, everyone. MDC is the best. I knew I could get some good things here.

[pamamidwife]

yeah, I think the whole cord cutting (in fact, why isn't it standard to leave the cord intact until they arrive at the hospital??) and baby suctioning thing is HUGE. it's crazy.

[bryonyvaughn]

Originally Posted by hopefulfaith

Thanks so much, everyone. MDC is the best. I knew I could get some good things here.

Let us know how it went, will you?

~BV