A severe choking incident is a life-threatening emergency where a person cannot cough, speak, or breathe, indicating a completely obstructed airway. In this situation, rapid intervention is necessary to prevent brain damage from lack of oxygen. For a pregnant individual, the standard Heimlich maneuver, which involves forceful abdominal thrusts, must be modified immediately. This modification is a requirement to safely and effectively clear the airway while protecting both the mother and the developing fetus.
Why Standard Abdominal Thrusts Are Avoided
The traditional Heimlich maneuver applies significant, quick pressure to the upper abdomen, specifically a region located just above the navel and below the ribcage. This technique is designed to compress the lungs, creating an artificial cough to dislodge the foreign object. However, this action is dangerous for an expectant mother because of her altered anatomy. The growing uterus, especially in the later stages of pregnancy, occupies a large portion of the abdominal cavity. Applying forceful thrusts to this area risks causing severe trauma to the mother’s internal organs and carries the significant risk of placental abruption, where the placenta separates prematurely from the uterine wall.
Placental abruption can lead to massive internal hemorrhage for the mother and oxygen deprivation for the fetus. Therefore, the force must be redirected from the soft, vulnerable abdomen to the solid structure of the chest. The goal remains the same—to compress the lungs and expel the obstruction—but the location of the force is shifted to the sternum (breastbone), a bony area that can safely tolerate the necessary pressure.
Performing the Modified Chest Thrusts
The first step when a person is choking is to confirm a complete airway obstruction, indicated by the universal sign of clutching the throat, a silent struggle, or the inability to make any sound. Before starting any maneuver, if a second person is available, instruct them to call 911 or emergency services immediately. The current first aid protocol for a conscious pregnant individual requires alternating between five back blows and five chest thrusts.
To perform the back blows, stand to the side of the victim and support their chest with one arm while leaning them forward significantly. This angle helps gravity work in your favor once the object is dislodged. Deliver five separate, firm blows with the heel of your free hand directly between the person’s shoulder blades.
If the obstruction is not cleared after the back blows, transition immediately to chest thrusts. Stand directly behind the person and wrap your arms under their armpits and around their chest. Position your hands on the middle of the breastbone (sternum), avoiding the ribs.
Make a fist with one hand, placing the thumb side against the center of the breastbone, ensuring this placement is well above the enlarged abdomen. Grasp your fist with your other hand, then deliver five quick, inward thrusts straight back toward you. Continue to alternate between five back blows and five chest thrusts until the object is expelled or the person loses consciousness.
Responding When the Victim Becomes Unconscious and Post-Emergency Care
If the person loses consciousness, immediately stop the thrusts and gently lower them to the floor on a firm, flat surface. If 911 was not called earlier, do so now, as this situation escalates the emergency to a cardiac arrest protocol. You must then begin Cardiopulmonary Resuscitation (CPR).
Before starting chest compressions, open the person’s mouth and look for the foreign object. If you can clearly see the obstruction and it is within reach, remove it with your fingers. Never perform a blind finger sweep, which can push the object further down the throat. Begin chest compressions at a rate of 100 to 120 per minute, maintaining a depth of at least two inches.
A crucial modification during CPR for a pregnant woman after the 20th week of gestation is preventing the enlarged uterus from compressing the inferior vena cava and aorta, major blood vessels that return blood to the heart. This compression, known as aortocaval compression, significantly reduces the effectiveness of chest compressions by impeding blood flow. To counteract this, continuous manual left uterine displacement (LUD) must be performed.
If a second rescuer is present, one person should push the uterus manually toward the mother’s left side and away from the midline while the other performs chest compressions. If you are alone, place a wedge, rolled-up towel, or blanket under the person’s right hip, creating a 15 to 30-degree tilt to the left to help displace the uterus.
Even if the object is successfully dislodged and the mother appears recovered, she must receive immediate medical evaluation at an emergency room. Internal injuries, such as bruised ribs or lung damage, can occur. A medical team needs to assess the fetus for any complications related to oxygen deprivation or trauma.