Labour and Birth in the Emergency Room

Guidelines for Assessing Labour, Facilitating Imminent Delivery, and Initiating Transfer when Possible

The majority of women in Nova Scotia give birth in a hospital with an active maternity service. Occasionally, pregnant women arrive in active labour in the emergency or outpatient area of a facility where a maternity service is unavailable. Health care professionals must be able to accurately assess these situations to determine the safest and most effective way to care for these women. In some cases the assessment may indicate that a transfer to the nearest facility with an active maternity service is possible. When it is possible that the birth will occur before completing a transfer, physicians and nurses at the local site should support the woman and her family through labour and birth to optimize a healthy outcome for both mother and infant. Transfer should not be attempted if it is suspected that birth may occur en route.

The following document has been developed to support health care professionals in those facilities where an active maternity service is not available. It is intended to provide guidance and support to safely and effectively care for childbearing women who present in labour to these facilities. Included are guidelines for:

• Assessment of the labouring woman and her fetus
• Indications for transfer and transfer process, including a directory of all facilities within the province who provide a maternity service
• Care and documentation during labour and birth when transfer is not possible
• Basic neonatal resuscitation skills
• Assessment and care following birth
• Equipment
• Medications to keep in stock for obstetrical emergencies and routine birth
• Laboratory tests

Labour and Birth in the Emergency Room (Revised September 2009)