Accidental out-of-hospital delivery

Abstract

Unexpected out-of-hospital delivery represents 0.5% of the total number of deliveries in France. The parturient lays down across the bed in supine position, the bottom on the edge of the mattress, pillows raising the height of the pelvis and each leg leaning on a chair. The parturient is placed under continuous multiparametric monitoring. Foetus heart rate is monitored using foetal Doppler. Analgesia is performed using a high-concentration mask providing 50% oxygen and 50% nitric oxide. The help of mobile paediatric pre-hospital medical service may be required in certain circumstances like premature birth, gemellary pregnancy, maternal illness or foetal heart rate impairment. Maternal efforts should start only when the newborn’s head reaches the pelvic floor, if membranes are ruptured, and dilation is complete. The expulsion should not exceed 30 minutes. Episiotomy should not be systematically performed. A systematic controlled placenta birth is recommended. Routine newborn care like warming and soft drying is performed when the following conditions are present: clear amniotic liquid, normal breathing, crying and good tonus. Assessment of newborn’s heart rate, breathing and muscular tonus is recommended every 30 seconds. Birth certificate is a legal obligation fulfilled by the attending physician.