If the woman becomes unconscious, follow the next steps.The universal sign of choking is the hands clenched around the throat; however, this signal may not be present. Other immediate indications include not being able to talk or difficulty breathing or wheezing.
If the pregnant woman can cough forcefully, then she should keep coughing. If the woman cannot talk, cry, or laugh, then initiate a modified Heimlich maneuver. In this situation, you protect the developing fetus by using chest thrusts versus abdominal thrusts to dislodge the object.
- If you are the only rescuer, initiate chest thrusts before calling 9-1-1 or emergency services. If another person is available, have that person call for help while you begin first aid.
- For stability, position yourself behind the pregnant woman with one leg in between theirs.
- Place your arms underneath each of the woman’s armpits.
- Place your fist—thumb side towards the woman with your knuckles pointing towards the sky—in the center of the chest between the breasts.
- Deliver repeated chest thrusts to the woman, straight inward in a quick, sharp manner to compress the lungs.
- Continue chest thrusts until the object is relieved or the woman becomes unconscious.
- Lower her to a supine position and make sure to call emergency services if not already done.
- Perform 30 chest compressions, do a head tilt/chin lift, check for the object, and sweep it out if possible. *Do not* attempt a finger sweep if you *cannot* see the foreign body.
- Attempt a rescue breath. If no rise and fall of the chest, reposition the airway and attempt a second breath.
- If air does not fill the lungs, perform 30 chest compressions, check for the object again, and sweep it out if possible.
- Attempt another rescue breath. If you do not see a rise and fall of the chest, reposition the airway and attempt the breath again. Repeat this process until the airway is open.
- At this point, check for a pulse for a maximum of 10 seconds.
- If the pulse is present in the absence of normal breathing, continue rescue breathing for one breath every five seconds for two minutes.
- After two minutes, reassess the pulse and check for normal breathing.
- If no palpable pulse, begin full CPR until: (a) an EMS arrives, (b) an AED arrives, or (c) the woman revives.
- Once revived, the pregnant woman should be placed on her left side to increase blood flow to the heart and baby.
- The pregnant woman should see her healthcare provider as soon as possible; internal injuries can occur.