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Although primiparas may experience unduly rapid labor and delivery, the event is more common among multiparas. Signs to be alert for are an accelerating second stage, such as the abrupt onset of strong contractions, an intense urge to bear down, or the patient's conviction that delivery is imminent. To diminish the urge to push, the woman should be encouraged to pant.
Emergency delivery by health care professionals. If time permits, the health care provider opens the emergency delivery pack, scrubs, and gloves, and places a sterile drape under the patient's buttocks. As crowning occurs, the health care provider uses the dominant hand to gently support the oncoming fetal head and the other hand to support the woman's perineum. If the amniotic sac is intact, the membranes are to be broken. The head should be born between contractions and supported as it emerges. The health care provider immediately feels for a nuchal cord. If the cord loosely encircles the infant's neck, it should be slipped over the infant's head. If it is tightly looped, two clamps are used to occlude the cord and cut it between them; the clamp is left in place. The health care provider unwinds the cord and suctions the infant's nose and mouth. He or she places one hand on either side of the infant's head and gently exerts downward traction to deliver the anterior shoulder. Gentle upward traction assists delivery of the posterior shoulder, and the body emerges as the mother gently pushes. Standard birthing protocols are then followed, such as using a bulb syringe to suction the newborn as needed, drying the infant, and placing the newborn on the mother's abdomen (skin to skin) in a head-dependent position to facilitate drainage of mucus and fluid. The patient is assessed for signs of placental separation (small gush of blood, more cord protruding from the vagina, fundal rebound). Traction on the cord to hasten placental separation is contraindicated. The postdelivery status of the mother and newborn is assessed and recorded.