Friday, June 18, 2010

Emergency Unassisted Labor and Delivery Guide

A great deal of women give birth unassisted by a trained healthcare provider. This includes women in developing countries who give birth on the side of the field and then go right back to plowing, women in developing countries who don't have money or access to a care provider or health facility, women all over the world who plan to birth unassisted at home, and women who find themselves having an unplanned unassisted birth before their care provider can be with them.

This post is about the last group of women: the women who hadn't planned on birthing without help, at home or in the car or wherever, but hopefully have access to emergency supplies. Its also a great crash-course for the women, or dad/partner, about the basics of labor and delivery, and mom and baby postpartum.


Amy Romano on Science and Sensibility wrote a great post on Birth during Times of Disaster: Keeping Women and Babies Safe

In it she included a link to an emergency childbirth guide from the American College of Nurse-Midwives that includes a lot of really great information for women and partners who must deal with an emergency birth in a location where there are no skilled birth attendants present. I include some bits of the text below:


FROM THE AMERICAN COLLEGE OF NURSE-MIDWIVES
Giving Birth “In Place”: A Guide to Emergency Preparedness for Childbirth
Deanne Williams, CNM, MSN

This is not a “do-it-yourself”guide for a planned home birth, nor is it all the information you need for every emergency. It is not meant to replace the knowledge and skills of a doctor or midwife. The information is a basic guide for parents-to-be who want to be ready in case they have to give birth before they can get to a hospital or birth center.

CALL FOR HELP
If you think you are in labor, try to get to a hospital, birth
center, or clinic. If you are alone or travel seems unwise,
call the emergency number in your community and ask for
help. After you have called for help, keep your front door
unlocked so that rescue workers can get in if you are unable
to come to the door. Call a neighbor to come and help the
family. If the phones are working, keep talking to emergency
services or your health care provider who can “talk
you through” a labor and birth.
If your labor is going fast and birth seems near, stay at
home and have your baby in a safe place rather than in the
back seat of the car. Fast labors are usually very normal,
and the mothers and babies can both do well. Slow labors
will give you time to get to a hospital or birth center, or for
a health care provider to get to you. Get out your supply kit
and put the supplies where you can easily reach them.
As the helper, your job is to
Keep mom comfortable. It is good for her to walk, take a
shower, get a massage, and move even if she is in bed.
Be sure she drinks lots of fluids. Water, tea, and juice are
the best.
Be sure she goes to the bathroom every hour.
Say and do things that create a calm feeling, even if you
are very nervous.
Wear gloves if you are going to be touching blood.
Wash your hands or gloves often.
Do not let pets into the labor and birth room.
Talk to mom about the sounds of childbirth. Making
groaning or crying noise during labor is ok and can help
the mom-to-be. It can scare the helpers. So mom has to
try to not scream and lose control, and the helpers have
to let mom make the noise that helps her cope.
Decide how to help other members of the family. Will
they be present for the birth? What do they need to
feel safe?


PREPARE THE BED
To keep the mattress from getting wet, cover it and the
sheets with a shower curtain and then cover the shower
curtain with another clean sheet, plastic-backed under pads
and lots of pillows for comfort. The mother may want to
spend a lot of time in bed, or she may prefer to be on her
feet or in a chair. Whatever feels best is okay.

WHEN THE BABY’S HEAD IS COMING FIRST
If you know your baby has been head down during the last
weeks of pregnancy, chances are good that the baby will be
head first at birth. This is the most common position for a
baby. First labors can last for 12 hours or more, whereas the
next babies can come much faster.

The Urge to Push
The longest part of labor is the time it takes for the cervix
to open wide enough for the baby to pass into the birth
canal or vagina (first stage). You can tell the cervix has
feel with your fingers to find out if the cord is around the
baby’s neck. If you find a cord around the neck, this is not
an emergency! Gently lift the cord over the baby’s head, or
loosen it so there is room for the body to slip through the
loop of cord.
The baby’s head will turn to one side and with the next
contraction the mother should push to deliver the body. If
the body does not come out, push on the side of the baby’s
head to move the head toward the mother’s back. The
shoulder will be born. The rest of the body slips out easily
followed by a lot of blood-colored water.

If the Head Is Born but the Body Does Not Come Out After
Three Pushes
The mom must lie down on her back, put two pillows under
her bottom, bring her knees up to her chest, grab her knees,
and push hard with each contraction. After the baby is born,
place her or him on the mother’s chest and tummy, skin to
skin, and cover both with towels. If the baby is not crying,
rub her back firmly. If she still does not cry, lay her down
so that she is looking up at the ceiling, tilt her head back to
straighten her airway, and keep rubbing. Not every baby
has to cry, but this is the best way to be sure the baby is
getting the air she needs.

If the Baby Is Gagging on Fluids in Her Mouth and Turning
Blue
Use the baby blanket to wipe the fluids out of her mouth
and nose. If this does not help, use the bulb syringe to help
clear things out. Just squeeze the bulb, place the tip in the
nose or mouth, and release the squeeze. This will suck fluid
into the bulb. Move the bulb away from the baby and
squeeze again to empty the bulb. Repeat until the fluid is
removed.
If the baby is still not breathing, follow the CPR
directions.

THE UMBILICAL CORD
There is no rush to cut the cord. All you have to do is keep
the baby close to the mom so the cord is not pulled tight. If
you pick the cord up between your fingers, you can feel the
baby’s pulse. Within about 10 minutes the pulse will stop.
At that time you can tie and cut the cord. Remember the
cord is connected to the placenta (afterbirth) which is still
inside the mother.

THE BABY
At the time of birth, most babies are blue or dusky. Some
cry right away and others do not. Do not spank the baby,
but rub up and down her back until you know she is taking
deep breaths. Once the baby starts to cry, her color will be
more like her mom, but her hands and feet will still be blue.
Now is the time to keep the baby warm. Remove the wet
towel that is over the baby and put another dry towel and
blanket over the mother and baby. Put a hat on the baby.
The mother can help keep the baby warm with her body
heat.
Put the baby to breast. Even if you did not plan to
breastfeed, one of the safest things you can do for mom and
baby is put the baby to breast. A breastfeeding baby helps
keep the mother from bleeding too much and gets the food
it needs right away. If the cord is too short to allow the baby
to reach the breast, it is ok to wait until you cut the cord.

CUTTING THE CORD
There are no nerve endings in the cord so it does not hurt
either the baby or the mother when it is cut. It is very
slippery so take your time because there is no rush. Wash
your hands, put on gloves and then get the container with
the scissors and shoelace. Tie one of the laces around the
cord very tightly with a double knot about 3 inches from the
baby’s tummy. The baby will cry when she is uncovered
because she is cold, not because it hurts. Tie the other
shoelace around the cord about 2 inches from the first knot.
Pick up the scissors by the handle without touching the
blades. Cut between the knots you have tied. It is rubbery
and tough to cut especially if you have dull scissors. After
it is cut, place the end of the cord that is still connected to
the mother’s placenta into the mixing bowl. Cover the baby
again to keep her warm.

THE PLACENTA OR AFTERBIRTH (THIRD STAGE)
The placenta looks like a big piece of raw meat with a shiny
film on one side. On the other side it has membranes that
are attached to the placenta (the membranes look like skin
that has been peeled off). When the placenta is ready to
come, you will see a gush of blood from the vagina and the
cord will get a little longer. Put the bowl close to the
mother’s vagina and put more waterproof pads under her
bottom. Ask the mother to sit up and push out the placenta
into the bowl.
There will be a lot of blood and water coming after the
placenta. Firmly rub the mother’s stomach below her belly
button until most of the bleeding stops. This will hurt but
needs to be done. The heaviest bleeding should stop in a
minute and then the bleeding will be more like a heavy
period. If the bleeding increases again, very firmly rub the
mother’s lower belly until the bleeding slows. When it is
firm, you will be able to feel the uterus (womb), which is
the size of a large grapefruit, in the lower belly. A firm
uterus is a good thing because it will stop the mom from
bleeding too much.
Mom’s bottom and her uterus may be sore. You may see
places where the mother’s skin has torn around her vagina.
Most of these tears will heal without any problems. Mom
will feel better when you put an ice pack on her bottom
where the baby came out and then put the sanitary pad on
top of the ice pack. She may want to take a couple of pain
pills at this time.

Put the placenta in a medium-sized trash bag and wipe
off any blood on the outside of the bag. Put this bag into a
second trash bag. Take the placenta with you to the hospital
or birth center. If you cannot leave the house for more than
4 hours, put the bagged placenta in a container with a lid
and put it in the freezer.

CLEAN UP
After the mother has delivered the placenta and the bleeding
has slowed down, give her a drink of juice, soup, or
milk and something to eat like crackers and cheese or a
peanut butter and jelly sandwich. Put on gloves to clean up
the bed. Roll up the sheet and pads inside the shower
curtain and put in a large plastic bag. Have clean under pads
ready to cover the sheets and a sanitary pad for the mother.
The dirty sheets and towels can be washed in cold water
with bleach or ammonia added. Wear gloves when touching
items that are bloody. Put a diaper on the baby or you will
be sorry!

BREASTFEEDING
It is important for the mother to breastfeed the baby in the
first hour after birth and at least every 2 hours until her milk
comes in.
● Breastfeeding will keep the uterus firm and decrease
bleeding.
● Colostrum, the liquid that is in the breasts right after birth
until the milk comes in, will give the baby all of the food
she needs and it will help prevent infection.
● Even if the emergency situation continues for days,
weeks, or months, there will always be a ready supply of
safe and perfect food for the baby.

Getting Started With Breastfeeding
A newborn will nurse best in the first hour after birth when
she is awake and alert. The mother may be more comfortable
if she lies on her side with pillows under her head. The
mother and baby should be face-to-face and belly-to-belly.

The baby will also nurse better if they are skin-to-skin (see
Figure 2).
The mother should place her nipple and breast against the
baby’s lips. The baby will lick and try to nurse. The mother
needs to help out by placing her nipple into the baby’s open
mouth. It may take a few tries before the baby can start
sucking. If the baby is sleepy, rub her belly and back firmly
to wake her up. If the baby is too sleepy, try uncovering her
for a short time and rubbing the mother’s nipple against the
baby’s lips. If the mother gets tired, take short breaks and
start again. Once the baby nurses for the first time it gets
easier.
If the baby sucks a few times and then lets go and the
mom has large breasts, mom may need to help the baby
breathe by using her finger to hold some breast tissue away
from the baby’s nose.

What to Avoid
● Don’t use a pacifier or a bottle to start the baby sucking.
It confuses some babies because they do not suck the
same on the mother’s breast and a bottle or pacifier.
● Do not separate the mother and baby for very long. The
more they stay together, including when they sleep, the
sooner breastfeeding will be well established.

CARE OF THE MOTHER
If you still cannot get to the hospital or birth center to be
checked, the mother should go to the bathroom within
an hour after the baby is born.
If the room is cold, you can use the hot water bottle to
help keep the baby warm. Just wrap the warm bottle
in a blanket and place it next to the baby’s back.

After birth in a hospital, women are usually offered
Tylenol or Advil for pain every 3 to 4 hours as
needed. This would be a good choice at home if the
mother does not have an allergy to this medication.
When a new mother gets out of bed for the first time, she
may feel dizzy. It is important to have her leave the
baby on the center of the bed and get up slowly:
● Sit up on the side of the bed to see how she feels.
● Have an adult take her to the bathroom and wait to be
sure that she is not feeling faint.
● If she says she is going to faint, believe her and have her
lie down on the floor. Do not attempt to walk her back to
bed. You have about 10 seconds to get her down on the
floor before she passes out and bangs her head on the way
down! Once she is down flat, she will wake up and feel
better. Just wait a few minutes and then carefully help her
back to bed.
In a couple of hours the mom may want to take a shower.
Be sure she has had something to eat and is not dizzy when
she gets up. It is good to have someone close by because
dizziness can return quickly.


To read more of this guide, including a list of emergency supplies to keep on hand, what to do if baby comes bottom first, and baby care in the first couple days, click here.

3 comments:

  1. Just wanted to let you know that you are the featured blogger on Monday 6/21. All you need to do is make sure you're following me publicly (kind of like an I scratch your back you scratch mine kind of thing). Can't wait to feature you

    ReplyDelete
  2. This was an awesome guide!! Enjoyed reading it all. Learned a lot. One of my favorites so far. Thanks as usual!

    ReplyDelete
  3. You can also get the Emergency Childbirth Manual by Gregory White from http://www.rixafreeze.com/pdf/gregorywhite.pdf Some of it is out of date (the CPR instructions) but it's very informative.

    ReplyDelete

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