Childbirth (Emergency Delivery)
Emergency childbirth may occur in women who:
Have had a previous rapid delivery
Have certain connective-tissue diseases (Marfan's syndrome or Ehrlos-Danlos syndrome)
Have a condition that makes the cervix incapable of staying closed
Have a history of premature labor
Have been injured or seriously ill
Emergency childbirth can also occur in otherwise healthy pregnant women who simply can't make it to the hospital on time. Should you ever be in an emergency situation with a woman who is about to give birth, it is important to understand the normal course of labor and childbirth. Labor has three stages:
In the first stage, the uterus begins to contract in order to open and push the baby down through the birth canal.
During the second stage, the baby is born when the mother bears down or pushes along with the contractions.
In the third stage, the afterbirth or placenta is expelled.
Labor generally lasts twelve to twenty-four hours for first-time moms. Subsequent births usually last three to eight hours. Because these time frames are highly variable and babies often come sooner than expected, if a woman tells you she is about to give birth, you should believe her!
First Aid for Emergency Childbirth
You should call for help as soon as possible. You may also be able to get someone on the phone to help guide you through the birth. If there is no other help around, you have no choice, and must deliver the baby yourself. Follow these steps during the first stage of childbirth:
Keep the mother occupied, but do not overtire her.
Encourage her to remain calm, relax between contractions, and breathe deeply and slowly in the midst of contractions, particularly as they become stronger. As labor progresses, she will have regular contractions that are prolonged, stronger, and closer together.
Prepare a place to deliver the baby that is clean and where the mother-to-be can either lie down or sit in a leaning position with her back supported.
When labor begins, she may experience a low backache and irregular cramping in her lower abdomen as her uterus contracts and her cervix begins to dilate. Her contractions will then become stronger and more regular, and will last longer. Assess contractions by placing your hand on her abdomen. You will feel a hardening during contractions, and can then time the interval from when the uterus begins to harden until it relaxes completely.
Time the intervals between the beginning of a contraction and the beginning of the next contraction — as the time decreases between contractions, her labor is progressing.
Sometimes standing or walking is helpful to move labor along. Let her have small amounts of food and liquids in order to give her more energy.
Don't try to wipe away any vaginal secretions because you may contaminate the birth canal.
If her bag of water ruptures, there will be a flow of blood-tinged mucous. The end of the first stage is commonly referred to as “transition” and is the most uncomfortable part of labor.
The latter part of the first stage is when regular contractions occur every three to four minutes, lasting from fifty to sixty seconds. At this point, you should prepare for and expect the delivery of the baby.
The mom needs your encouragement now because she may feel tired, discouraged, and irritable. She may have a lot of emotions, complain of pain and backache, may vomit and tremble, feel scared or even panicky, and she may cry and act angry. So be sure to give her lots of encouragement and reassure her that things are progressing as they should. You might help her with some relaxation techniques and some deep abdominal breathing. Encourage her to start each contraction with a deep breath to keep her body relaxed so that she will not intensify the pain and her contractions will be easier. Coach her to slow down her breathing and to breathe deeply and rhythmically. Pressing on her lower back firmly may also help relieve the backache.
When her cervix is almost fully opened, the baby begins to enter the birth canal as the second stage of labor begins. When this occurs, follow these steps:
Her contractions may come further apart and she may feel inclined to push. She should then take a deep breath with the contraction, hold her breath, and push gently. There isn't any hurry at this stage — she should rest or sleep between contractions.
Try to remain calm and be prepared to give any necessary first aid to both the mother and baby, such as CPR for the baby and hemorrhage control and prevention of shock for Mom.
Try to use sterile supplies or at least the cleanest available. You can use clean towels, clothing, or even newspaper under the mother during delivery. If she is on the ground, try to fashion some sort of covering under her, like a blanket.
Have her lie on her back with her knees bent and opened wide, and have her hold her knees back and apart.
You will see the top of the baby's head when it reaches the opening of the birth canal.
Ask her to pant like a dog while you apply a gentle pressure to the lower edge of the vagina as the baby's head starts to show, in order to prevent the baby from coming too fast and causing the vaginal tissues to tear.
Instruct her to pant, not push, until both of the baby's shoulders have been delivered.
As the baby emerges, support the area with a sterile gauze pad or washcloth while the head eases out.
Wipe the babies face with a clean or sterile cloth and quickly check around the neck for the cord.
If you feel the cord, hook it with your finger, pulling it around the baby's head. Some cords are wrapped one or more times around the baby's neck, so check again, and if it's too tight to slip over the baby's head, wait until the delivery is complete to untangle it.
After both shoulders have emerged, one at a time, the baby will slip out quickly.
If after several contractions a shoulder doesn't appear, slip two fingers in and feel for an armpit, hook your fingers under the armpit, and try to turn the shoulder counterclockwise as you are pulling out.
Cradle the head gently in your hands; don't pull or exert pressure while you guide the shoulders out.
Thousands of babies have been successfully delivered with no medical attention. If you find yourself having to assist with a birth try to remain calm and follow the outlined procedure carefully and remember that most births proceed without complications, even unaided.
Be aware that the baby will be very slippery, so you need to be careful not to drop it, and not to pull on the umbilical cord when picking the baby up. Instead, do the following:
Hold the baby at the ankles with a finger between the ankles.
With your other hand, hold the shoulders with the thumb, middle finger around the neck, and your fore-finger on the head.
Hold the baby with the body a little higher than the head so that mucous and other fluids will drain from the nose and mouth.
Suction the mouth and nose with a bulb syringe if you have one, or use a straw to suck out the mucous or wipe it carefully with a clean cloth.
If the baby doesn't breathe right away, clear the mouth of mucous very gently with a bulb syringe or your finger while gently rubbing the back. This should stimulate crying.
If there is still no breathing, pull the lower jaw back and give very gentle puffs at twenty puffs a minute.
If the baby doesn't breathe and there is no pulse, proceed with CPR as outlined in Chapter 2.
Clamp the cord immediately by tying a double knot with a shoelace or any other tie about four inches from the baby's umbilicus.
Do not push on the baby's head in the birth canal, hold the mother's legs together, allow a laboring mother to sit on the toilet during delivery, try to pull the baby from the vagina, or pull on the umbilical cord.
If the umbilical cord is long enough, let the mom hold her baby in her arms. If the cord is too short, you can place the baby on the mom's abdomen, gently helping to support it. Allowing the baby to breastfeed offers benefits to the baby and helps to deliver the placenta with less bleeding. As the placenta begins to appear:
Do not try to pull on the cord to make it come out; gently rotate it clockwise and allow it to slip out.
After the placenta emerges, there may also be a small amount of additional bleeding and blood clots.
The uterus should contract slightly and feel like a firm grapefruit just below the mother's navel. If the uterus feels soft, try to get the baby to nurse to stimulate the uterus to contract, and gently massage the uterus at the area just below the umbilicus to lessen the chances of bleeding.
Keep the mother flat with the foot of the bed elevated.
Place a cold pack on her lower tummy to help the uterus contract.
Using several sanitary napkins and your hand, apply pressure to the area between the anus and the opening to the vagina.
Watch for any symptoms of shock such as dilated pupils, faint and rapid pulse, shallow and irregular breathing, dizziness, and vomiting. For any of these signs, manage for shock as outlined in Chapter 2.
If there is no imminent medical help (hours or even days) after the placenta is delivered, tie another firm knot about two inches from the other knot and then cut the umbilical cord with scissors you have sterilized in boiling water or alcohol.
Make sure to save the placenta and any other membranes for a doctor to look at.
Record the estimated amount of vaginal bleeding — it should be about one to two cups.
Keep the mom and baby warm but not overheated, and continue to monitor the baby's color and respiration.
If you feel the baby has poor color or stops breathing, you may flick the soles of the baby's feet gently with a couple of fingers to encourage crying.
Don't cut the tied umbilical cord unless you are not going to have medical care for many hours. Leave it and the placenta attached to the baby to avoid potential infection to the baby.
Give the mother something to eat and drink and let her rest and hold the baby as desired. She should be free to get up and go to the bathroom, and you may also do this safely. Although almost all emergency births are normal and without complications, this is still a precarious time for the mother, as hemorrhage and shock may occur, so someone needs to stay with her at all times until she gets medical attention.