Emergency First Aid: How to deliver a baby

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Newborn babyIt happens more often that you’d think – babies are born all over the place. And in emergency situations, it’s not something you can put off until you can find medical help. So get ready to learn what you can do to help bring new life into the world. And remember, if cab drivers can do it so can you!

It’s all quite logical – but you do have to stay calm. Call 911 or have someone else call. The number one alternative is to have a medical professional do this for you. Remember to reassure the mother – she’s probably not that impressed that it’s you and not a real doctor. If her contractions are very strong and 2 to 3 minutes apart or her waters have broken, birth is near. If she starts to yell at you that it’s coming, believe her.

Prepare a birthing area

Put down a large plastic sheet or plastic shower curtain on a large, flat surface such as a bed or table and put clean sheet or towels on top to soak up any fluids. Get a lamp to illuminate the birth and make sure the area is kept warm. Wash your hands with soap and water. Use sterile rubber gloves if your first aid kit has them.

Have the mother dress comfortably and support her head and back with pillows. During the birth, the mother may wish to squat down, or lean forward and grab her knees or lie on her side. Let her decide. If she is lying on her back at the time of delivery place a folded towel or blanket under her right hip to keep her from lying flat – it’s more comfortable.

There will probably be quite a bit of blood or bloody fluid coming from the vagina, which is normal. Have the mother take deep, slow breaths, particularly during contractions. When the baby’s head shows, ask the mother to push during each contraction. Have her take a deep breath, hold it, and push for a count of ten. Exhale and repeat for the duration of each contraction. The mother should not push between contractions.

When the baby’s head is visible in the vaginal opening, the birth is about to occur. Do not pull the baby! Let her push the baby out. Usually, as the baby is born, the face will appear straight down or straight up.

As soon as the head is outside the vagina, put two fingers along the topside of the head and feel around the neck area for a loop of the umbilical cord. It will be about the thickness of your little finger. If you can feel it, hook the loop of cord with your two fingers and slide it gently over the baby’s head. Do not cut it! If it will not slip easily over the baby’s head, don’t worry about it. Instead, continue trying to deliver the rest of the baby.

The baby’s head should then turn toward one side and the shoulders should come out. Help by supporting the baby’s head and shoulders, but remember not to pull. Once the head is delivered, the rest of the baby’s body generally comes out quickly. As soon as the head is out, have the mother stop pushing so that the baby’s mouth and nose can be cleaned. If there is a membrane covering the baby’s mouth and nose, gently wipe it off with a clean cloth or suck it out with a suction bulb (if you have one!). Do not remove the whitish coating on the body.

Place your hands on either side of the baby’s head and gently guide it downwards while the mother pushes until the top shoulder emerges. Then guide the baby upwards and support its head and shoulders as the rest of the baby emerges. If the baby’s shoulder seems stuck, tell the mother to push hard. Do not pull on the baby. Press toward the mother’s back with your hands in the area just above the mother’s pubic area. You can also try lifting the mother’s legs back toward her chest, keeping her knees bent and apart.

Remember:  Newborns are slippery, so hold the baby with a towel.

Once delivered, hold the baby head down and face down, with the feet higher than the head, so that fluids can drain from the nose and throat. Hold the baby at about the same height as the vaginal opening. After the baby starts to cry, suction or wipe the baby’s nose and mouth again with a clean cloth. The baby may be blue, but will turn pink within minutes, if breathing well. Do not hold the baby upside down or slap her. Gently dry off the baby and wrap her in a dry towel or blanket covering the head (not the face) to keep her warm. Do not wash off the baby or wash the face. Place the baby on the mother’s abdomen or chest (but be sure not to pull on the umbilical cord).

Resuscitation

The baby should start breathing on her own and her color should improve as she breathes in oxygen. If the baby does not start breathing, place the baby on her back and gently rub the chest or back or tap the bottoms of the feet. Gently suction the baby’s nose and mouth again to clear secretions, blood and mucus. If you don’t have a suction bulb you’re just gonna have to suck it out with your own mouth over her mouth and nose and then spit. If the baby does not start breathing immediately, give two very, very gentle puffs of air into the infant’s nose and mouth. A tiny breath is sufficient for such small lungs. Continue to stimulate the baby and dry off the skin to prevent cooling.

The cord

Encourage nursing. This will stimulate the mother to have the uterine contractions she needs to expel the placenta. The umbilical cord will pulsate during the birth and afterward, indicating that the baby is still receiving blood from the mother.

Under normal circumstances, there is no rush to cut the umbilical cord. Placing one tie around it and leaving it alone is better than cutting it with unclean instruments. The infant will not be harmed if the placenta remains attached, as long as both mother and baby receive prompt medical help. Hopefully, the emergency response team will have arrived by now!

However, if you are in a really tough position and know you cannot get medical help, you may have to tie and cut the cord after the baby has been delivered. Follow the following steps:

If you have NOT already tied a knot around the cord you will now have to tie two firm knots with clean shoelaces, narrow strips of cloth or thick string. (Do not use thread, as it will cut through the cord.) Tying off the cord is necessary to prevent continued circulation of the baby’s blood to the placenta. The first knot should be no closer than 4 inches from the baby’s navel; tie the second firm knot around the cord about 8 inches from the baby’s navel.

Cut the cord halfway between the knots with a heated knife, a fresh razor blade, or sterile scissors (Boiling in water for ten minutes should do it. Now we know why they always boil water in movies!), The cord should bleed only briefly after being cut. Cover the cut ends of the cord with a clean cloth or sterile dressing.

 

If help doesn’t arrive

The mother will continue to have contractions until the placenta is expelled. (The photo shows what it should look like. Keep it for the medical experts Human_placenta_both_sidesto look at so they can tell if any was left behind.)  Massaging the mother’s abdomen will help the uterus contract and expel the placenta. Wrap the placenta in a plastic bag and be sure it goes to the hospital with the mother and baby.

Once the placenta has been expelled, continue to massage the mother’s abdomen to stimulate uterine contractions. This will help control uterine bleeding. Sometimes the uterus relaxes so completely that all contractions stop — massage can help restore the contractions.

Clean the mother with soap and water. If the mother is bleeding outside the vagina from a skin tear, apply direct pressure with a sterile gauze dressing, washcloth, or a clean sanitary napkin. Keep both mother and baby warm. Hypothermia can occur rapidly in newborns. The mother may be more comfortable reclining while she nurses the baby. It is important that they both get to a hospital as soon as possible for examination.