How to deliver a baby in the Emergency Department
Unplanned vaginal births in the ED are uncommon but require prompt, structured care. Priorities are maternal and neonatal safety, rapid mobilisation of teams and equipment, and early escalation to maternity and neonatal services (NICE NG235; Resuscitation Council UK NLS).
This section gives a practical ED‑adapted approach: immediate assessment and escalation, a rapid delivery checklist, stepwise actions for the second and third stages, first‑line management of postpartum haemorrhage (PPH), newborn care and escalation, and local governance points.
Immediate priorities and rapid assessment
- Treat any woman with a fully dilated cervix, strong expulsive urges, bulging perineum or crowning as imminent delivery and prepare to deliver immediately.
- Call early for help: midwife or obstetric registrar, neonatal/pediatric team and anaesthetics/ICU as per local pathways.
- Assign clear roles immediately (maternal lead, neonatal lead, airway/assistant, scribe/runner).
- Escalate immediately for the following red flags: maternal collapse, major antepartum haemorrhage, suspected placental abruption or placenta praevia, cord prolapse, shoulder dystocia, severe hypertensive disorders, abnormal fetal heart trace (if available), retained placenta (>30 minutes) or heavy PPH.
- Document the decision to proceed with ED delivery and the reason transfer to the maternity unit could not occur.
Rapid ED delivery checklist
Prepare two adjoining workspaces in resuscitation: one for the mother and one warmed area/resusitaire for the newborn. The following compact...
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