Why Are You Learning This?
Patient Voices – Obstetric Violence in Pre-Hospital Care
"I felt very violated... I thought his job was to just get me to the hospital. I don’t know why I had a drip because all my births had been natural."
"Look, I need to push... And I put my hand down and her head had already started to come out."
"If I’d only had that birth [in the ambulance] I wouldn’t have wanted to have another baby ever again."
Key fact: 1 in 10 Australian women experience obstetric violence (Keedle et al. 2022). NSW Parliament Select Committee on Birth Trauma (2024) highlights the need for respectful, patient-centred care.
Paramedics must listen to birth plans, respect autonomy, and avoid unnecessary interventions.
Assessment & History Taking of the Pregnant Patient
Key History Questions (Learning Outcome 1)
- Gestational age / due date
- Parity (G/P), previous births, complications
- Contractions: timing, duration, intensity, progression?
- Show / rupture of membranes (colour, odour, amount)
- Fetal movements
- Birth plan / preferences (e.g., delayed cord clamping, skin-to-skin, perineal massage)
- Cultural / support needs
Physiology of Labour & The 5 P’s
Initiation of Labour
Foetal hypothalamic-pituitary-adrenal (HPA) axis → placental CRH → positive feedback loop → placental oxytocin + Prostaglandin E₂ (cervical ripening).
Normal Labour Definition
- Foetus at term (37–41 weeks)
- Cephalic presentation
- Spontaneous completion in <18 hours
- Placenta delivered
- No complications
The 5 P’s: Passage (pelvis), Passenger (foetus), Powers (contractions), Psych(ology), Position (maternal).
False vs True Labour
| Feature | False Labour | True Labour |
|---|---|---|
| Contractions | Irregular, decrease with rest/sleep | Regular, progressive, increase with activity |
| Cervix | No change | Progressive effacement & dilation |
| Show | Usually absent | Usually present |
| Pain location | Lower abdomen/groin | Back to abdomen |
First Stage of Labour
Signs & Paramedic Role (Learning Outcome 2)
Onset of regular, strong contractions → cervical dilation to 10 cm.
DO: Support, calm, listen to birth plan, offer analgesia, consider cultural needs.
DO NOT:
- Palpate abdomen unnecessarily
- Perform vaginal examination
- Auscultate fetal heart (out-of-hospital limitations)
- Force positions
"Remember the earlier quotes from mothers – trust and listening matter."
Imminent Labour & Safe Second Stage Delivery (Learning Outcome 3)
Signs of Imminent Delivery
- Urge to push / bearing down
- Visible crowning / bulging perineum
- Rectal pressure / grunting
Safe Hands-Off Delivery Steps
- Position of comfort (mother-led)
- Support perineum gently if needed (no forced control)
- Hands-off head delivery unless indicated
- Check for nuchal cord – manage gently
- Deliver shoulders & body
- Immediate skin-to-skin, delayed cord clamping (unless compromised)
- Dry & stimulate baby
Third Stage & Placenta Delivery (Learning Outcome 4)
Safe Management
- Allow physiological delivery (no routine traction)
- Observe for signs of separation (gush of blood, cord lengthening, uterine rise)
- Support placenta delivery into sterile bag
- Inspect for completeness
- Monitor for PPH (fundal massage if needed)
Newborn Care & Illustrated APGAR Scoring
APGAR Score (at 1 & 5 minutes)
Illustrated APGAR – source: National Institute of Child Health and Human Development (NICHD)
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Appearance (colour) | Blue/pale | Body pink, extremities blue | Completely pink |
| Pulse (heart rate) | Absent | <100 bpm | >100 bpm |
| Grimace (reflex) | No response | Grimace | Cry/pull away |
| Activity (tone) | Limp | Some flexion | Active movement |
| Respiration | Absent | Slow/irregular | Strong cry |
Total score: 7–10 = normal; 4–6 = moderate depression; 0–3 = severe depression requiring resuscitation.