FIELD REFERENCE
Full criteria & treatment guidance
Do not delay resuscitation for scoring
- APGAR describes newborn status at 1 and 5 minutes; it does not determine whether resuscitation should begin.
- Do not pull on the umbilical cord or delay transport for placental delivery.
- Keep mother and newborn warm, prevent falls, and maintain a secure hold during transport.
- Complex presentations, prolapsed cord, significant hemorrhage, depressed newborn, or maternal seizure require immediate escalation and the complete OCEMS procedure.
Recognize imminent delivery
- Prepare for field delivery when childbirth is progressing faster than safe transport to an emergency receiving center. Signs include a visible presenting part, contractions about 3 minutes or less apart, ruptured membranes with contractions, an urge to bear down or have a bowel movement, sudden vaginal bleeding with contractions, or prior vaginal birth with frequent active contractions.
- Request an ALS response if not already present. Reassure the mother, use standard precautions, free clothing from the birth canal, and allow a comfortable position with room for delivery.
Assist a controlled birth
- Let the mother push with contractions when the urge is unavoidable. Support the perineal area with moderate pressure and control delivery of the head to reduce tearing.
- Support the head as it emerges and allow natural rotation. If the cord is around the neck, slip a finger beneath it and move it over the head when possible.
- Support delivery of the shoulders and body without pulling. Keep a secure hold on the newborn and support the head and neck.
- Dry the newborn at the level of the vagina, wipe obvious fluid gently from the mouth and nose, and stimulate by drying. Do not routinely use bulb suction unless clearly needed for ventilation.
- Wait more than 30 seconds after birth before clamping a stable newborn's cord. Place clamps about 4 and 6 inches from the newborn and cut between them. If the newborn is depressed, clamp and cut immediately to begin resuscitation.
Mother, newborn & placenta
- Place a dried, naked, stable newborn skin-to-skin on the mother's abdomen, wrap both warmly, and support feeding when appropriate. If clamps are unavailable, keep the newborn on the mother's chest above the abdomen and uterus during transport.
- Allow the placenta to deliver naturally; never pull on the cord. Package and transport the placenta for receiving-facility examination. Do not delay transport waiting for placental delivery.
- Postpartum bleeding - source discrepancy pending clinical clarification: B-060 (BLS), step 20, describes uterine massage to reduce bleeding after birth of the baby. PR-040 (ALS) explicitly places external fundal massage for postpartum bleeding after delivery of the placenta. This draft does not combine those instructions into one timing rule. Follow the current applicable protocol and obtain medical direction where the discrepancy affects care. PR-040 also calls for monitoring, oxygen as tolerated, IV fluid titrated to perfusion, and ALS escort; do not delay transport waiting for the placenta.
APGAR at 1 and 5 minutes
- Score heart rate, respiratory effort, muscle tone, reflex response, and color from 0-2 each at 1 minute and again at 5 minutes. Resuscitation must not wait for APGAR scoring.
- Heart rate: 0 absent, 1 below 100, 2 at least 100. Respirations: 0 absent, 1 weak cry or hypoventilation, 2 strong cry. Tone: 0 limp, 1 slight flexion, 2 active flexion.
- Reflex response: 0 none, 1 some grimace, 2 cough or cry. Color: 0 blue/pale, 1 pink body with blue extremities, 2 completely pink.
- Total 7-10 suggests a healthy newborn, 4-6 a potentially sick newborn, and 0-3 a severely depressed newborn. At 5 minutes, a score below 7 requires constant monitoring and management as a depressed newborn.
Special presentations
- Prolapsed cord: elevate the mother's hips in left lateral or Trendelenburg position and use a gloved hand to keep the presenting part off the cord until hospital staff assume care; provide ALS escort to an obstetric-capable receiving center.
- Breech: do not pull on an extremity. B-060 directs avoiding touching or stimulating the newborn until the head delivers; PR-040 provides ALS maneuvers for arms or a trapped head. Follow the complete source and transport with ALS escort.
- A depressed newborn needs warmth, an open airway, stimulation, then BVM if not revived. If those steps fail and heart rate is below 60/min, begin compressions. B-060 directs oxygen after about 5 minutes or if chest compressions are initiated; do not wait for five minutes of compressions before providing oxygen. Use the complete newborn-resuscitation pathway.
- A maternal seizure during or after delivery is an extreme emergency: protect the newborn, manage the mother's airway, and immediately notify dispatch of the change in status.
VISUAL FIELD REFERENCE
APGAR: assess at 1 minute and 5 minutes
Maternal & newborn · BLS / ALS
Two timed assessments. Resuscitation must not wait for the score.
- 0–2 each
Heart rate · breathing · tone
Heart rate: 0 absent, 1 below 100, 2 at least 100. Respirations: 0 absent, 1 weak cry or hypoventilation, 2 strong cry. Tone: 0 limp, 1 slight flexion, 2 active flexion.
- 0–2 each
Reflex response · color
Reflex response: 0 none, 1 some grimace, 2 cough or cry. Color: 0 blue/pale, 1 pink body with blue extremities, 2 completely pink.
- Total 0–10
Record and interpret the total
Total 7-10 suggests a healthy newborn, 4-6 a potentially sick newborn, and 0-3 a severely depressed newborn. At 5 minutes, a score below 7 requires constant monitoring and management as a depressed newborn.
- Score heart rate, respiratory effort, muscle tone, reflex response, and color from 0-2 each at 1 minute and again at 5 minutes. Resuscitation must not wait for APGAR scoring.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. B-060 · PR-040 · PR-004
UNDERSTAND THE CARE
Why delivery creates two parallel patient assessments
The mother and newborn need separate ongoing observations after birth. Assign responsibilities when staffing permits so newborn breathing, warmth and secure handling do not distract from maternal bleeding and perfusion. Record the birth time and relevant events clearly for the receiving team.
Applying the guidance
APGAR describes newborn status at the stated times but is not a reason to postpone needed resuscitation. Continue the actual breathing and heart-rate assessment while documenting the score. Maternal hemorrhage, a prolapsed cord, breech presentation or maternal seizure requires the complete complication-specific instructions and prompt escalation. Transport should not wait solely for placental delivery.
Putting it together
Teaching example: the newborn needs support while maternal bleeding continues. Communicate that there are two active patient-care problems, assign tasks and report each patient’s findings and treatment separately.
Diagram text & teaching checkpoints
- Mother
- Bleeding, perfusion and complications.
- Newborn
- Warmth, airway, breathing and heart rate.
- Documentation
- Birth time and APGAR without delaying care.
- Transport
- Secure both patients and escalate complications.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Use birth time to organize two patient reports
Record the birth time clearly, then keep the mother’s findings and the newborn’s findings distinct. For the newborn, document breathing, tone, color, interventions and response. APGAR at the specified times describes status; it should not become a task that delays the resuscitation already indicated by the examination.
For the mother, communicate bleeding, perfusion, delivery complications and whether the placenta delivered. If it has delivered, identify that it accompanies the patient. Do not delay transport merely to complete that part of the record or wait for the placenta.
Assign the observations and documentation tasks aloud when enough personnel are available. A team member calling out the birth time and subsequent assessment times can support continuity while others care for the mother and newborn. At transfer, state which interventions were needed and the current condition of each patient. For a depressed newborn or a complicated presentation, continue the complete applicable BLS/ALS procedure and medical-direction pathway rather than treating the APGAR total as a replacement algorithm.