How to perform CPR on a person with breasts

Statistically, people seem to worry about performing CPR and using a defibrillator on a person with breasts, to the point where women are less likely to receive CPR from a bystander than men. Sadly, the consequence of this is that women are also less likely to survive following an out of hospital cardiac arrest than men. 

If a person suffers a cardiac arrest and stops breathing, they need immediate CPR and a defibrillator (ideally within the first few minutes), to give them a chance of survival. They also need someone to call 999 immediately. 

Who needs CPR?

If someone collapses, follow DRABC:

  1. Check for DANGER – make sure it’s safe for you to approach. Don’t become a casualty yourself!
  1. Check for a RESPONSE – in a loud voice, ask if they need help. Give them a firm squeeze on their shoulders.
  1. If there is no response and you’re on your own and you haven’t already – SHOUT for help and open their AIRWAY by gently tilting their head back and lifting their chin.
  1. Check for BREATHING – look, listen and feel for up to 10 seconds for normal, regular breathing. Ignore noisy, irregular gasps – that’s not normal breathing. 
  1. If they’re not breathing normally, ring 999 immediately using the loudspeaker function on your phone if you can. If there’s another person there, ask them to ring 999 and locate a defibrillator.
  1. Start CPR.

How to do good quality CPR… on a person with breasts

CPR stands for cardiopulmonary resuscitation. If the heart isn’t able to beat effectively itself – you need to pump their heart for them to push blood around their body and to their brain.

To start CPR, kneel by their side. If you can’t kneel by their side due to lack of space, you may need to try and move them so you can perform CPR.

Put the heel of your hand on the middle of their chest and put your other hand on top of your first hand. This might mean that you touch part of a person’s breast, but that’s ok – the person needs CPR to be given a chance of survival.

Push down hard to compress the chest about 5-6cm, then let the chest fully recoil and come back up. This is so the heart can refill with blood, ready for your next compression to send the blood around the body. The rate you need you compress the chest is about two compressions a second.

After 30 compressions, tilt their head back, pinch their nose, put your mouth over theirs to make a seal and breathe a normal breath into them. If you’ve not been trained in providing rescue breaths or simply don’t feel able to in the situation, just keep giving compressions. 

Giving compressions can be physically tiring, so if there are other people around who are physically able to give compressions, you can swap every couple of minutes to ensure the CPR remains effective. 

How do you use a defibrillator? Do you remove a bra when using a defibrillator?

If someone brings a defibrillator, make sure CPR continues and ask them to turn on the defibrillator and follow the prompts.

The defibrillator will say something like “remove pads, and apply to the patient’s bare chest”. This means your helper needs to cut clothing off (including bras) with the safety scissors provided, to bare the chest. If the casualty is sweaty or wet, there should be a cloth to dry the skin – to help the pads stick properly to the skin.

Your helper will then apply the pads, and it’s important that they don’t rush this part as correct pad placement is vital. They should place the pads exactly as they appear in the pictures on the pads. The first pad should be placed on the upper right side below the collar bone. The second pad should be placed on the casualty’s left side just below the armpit. If the casualty has larger breasts, it’s ok to move the left breast to allow correct placement of the pad on the side of the chest.

The defibrillator will then analyse the casualty’s heart rhythm. Listen to the prompts and when the defibrillator says don’t touch the patient, don’t touch the patient. This also means that CPR should be paused at this point.

If a shock is needed, again make sure that no one is touching the patient, and then press the shock button when instructed by the voice prompt (fully automatic defibrillators will shock automatically after telling everyone not to touch the patient). The prompt will also say when it’s safe to resume CPR.

When to stop CPR

The defibrillator will re-analyse the heart rhythm every two minutes. Just follow the prompts. Keep performing CPR until the emergency services arrive and take over or if the casualty shows signs of life – like breathing, coughing and opening their eyes. 

They’re likely to be confused and agitated, as their brain has been starved of oxygen. Talk calmly to them and leave the defibrillator pads in place, in case they stop breathing again in which case you’ll need to start CPR again and use the defibrillator.

Let’s not forget…

  • You need a hard surface for compressions to be effective. If the person is in a chair or on a bed for example, you’ll need to get them to the floor.
  • Needing to perform CPR on a person with breasts may cause you or others to feel anxious about exposing their chest, and one thing you can do is ask bystanders to look away and create a shield. But remember, to give life saving CPR you’ll need to touch the person and to use a defibrillator, you’ll need to cut their clothes off including a bra.
  • You don’t have to have special training to use a defibrillator – they’re extremely safe and designed to be used by anyone. Check out this article from the Resuscitation Council UK about defibrillation.
  • A defibrillator won’t allow you to shock someone if they don’t need a shock.  

If you have any questions or would like to learn or refresh life saving skills like how to do CPR and use a defibrillator, then we’d love to help. Being able to learn and practice these skills in a safe training environment, with specialist equipment and having the opportunity to ask questions and interact with a knowledgeable trainer – can’t be replaced by a blog!