Here is the first prize for the Prepper Contest. Submitted by “Bayou”.
Emergency Childbirth Preparedness
As preppers we gather materials and learn skills to help us and those around us deal with emergency situations. Whether it’s a SHTF scenario or life as usual and whether you are one of the expectant parents or merely a bystander, emergency childbirth is a situation that you could find yourself in. This document is meant to serve as a basic overview of the normal birth process and the steps you should take to assist in the delivery and care of a newborn. In no way should this be taken as a guide to replace professional medical care. Additionally, I will not go into how to choose between the different types of birth professionals. These are personal and situation dependent decisions, and I will leave it to you to decide whether a medical doctor, certified nurse midwife, certified professional midwife, or lay midwife best suits your needs and expectations. That being said, children are born in cars, elevators, homes, etc. every day, and you should be prepared to assist if you find yourself in one of these situations.
I am not a birth professional by any means, but I do have three children with our forth on the way. I did take courses and read many books on childbirth to prepare for each of their arrivals, and my goal is to share some of that information and experience with you here. Personally, my wife and I chose to have a hospital birth attended by an obstetrician for our first child, a home birth attended by a certified professional midwife (CPM) for our second, and we will have a home birth attended by a certified nurse midwife (CNM) for our fourth child soon since CPMs aren’t legal in our new home state. You may have noticed that I left out our third child, and in that case I did find myself in a situation where we had the baby without professional help. We lived an hour and a half away from our midwife, and she didn’t make it in time. Knowing that the midwife had a long drive and that my wife’s labors were fast, I was prepared for the possibility that I would have to deliver the baby unassisted. What could have been a stressful or even dangerous situation if I had been unprepared ended up being very peaceful and is one of the greatest experiences of my life. It is unfortunate that pregnancy is treated like a disease and that birth is something that is thought to require medical intervention in our society. Keep in mind that if labor starts at a less than ideal time and moves along quickly it probably means that everything is normal and no medical interventions are necessary.
Supplies – Let’s start off with the supplies that you will need:
During labor –
- Clean shower curtain or plastic mattress protector – put under the sheets to protect the mattress from blood, amniotic fluid, etc.
- Large-size under pads with plastic backing – put on top of the sheets under the mother to contain the fluids
- Box of sterile disposable gloves – to prevent contamination of the birth canal
- Clean bath towels – to clean up messes
- Emergency contact list – to call for help if time permits
For the birth –
- Large trash bags for dirty laundry and under pads
- Sharp, sterile scissors and sterile white shoe laces – boil them for 15 minutes, allow to cool, and store in sterile gloves. Tie the shoe laces to the umbilical cord about 3 inches from the baby’s navel about an inch apart and cut between the two laces when you are ready to cut the cord.
- A large bowl – put the placenta in this after it is delivered and set it aside to be inspected. Medical personnel will want to be sure that it is intact because if pieces are still attached to the uterus it can lead to hemorrhaging.
For the baby –
- Newborn hats
- Bulb syringe to suction the mouth and nose
- A mother who is prepared to breastfeed (La Leche League is a great source of information)
Stages of Labor – If you find yourself in a situation where birth is imminent and medical help is unavailable, it is important to understand the normal progression of labor.
- First stage – This is the early part of labor where the cervix dilates to allow the baby to exit the uterus and enter the birth canal and “true” contractions (not Braxton-Hicks contractions or “false labor”) occur. “False labor” contractions are weak, irregular interval and duration, and often fade when walking or moving. These will typically occur in the weeks leading up to delivery to prepare the uterus for the birth. “True” contractions come at regular intervals, last 30-70 seconds, do not stop when moving or walking, and get longer, stronger, and closer together over time. This stage of labor typically lasts between 6-14 hours but can last as long as 19 hours depending on whether this is the mother’s first or subsequent pregnancy, the baby’s position in the uterus, the strength of the contractions, and other factors. Her water may break in this stage, meaning that the amniotic sac ruptures releasing the amniotic fluids, but don’t worry if it doesn’t. Some babies are even fully delivered in an intact amniotic sac and are believed to be destined to become great spiritual leaders in some cultures. When the water does break it is widely believed that the baby should be delivered within 24 hours to reduce the risk of uterine infection.
What to do – During the early part of labor it is usually best to allow the mother to stay occupied or rest depending on her preference. Nature knows what to do, so let her trust her instincts without becoming overly tired. Going for a walk will help to determine if the contractions are the real thing or not and will actually help labor to progress if they are. If it is possible to seek medical attention, this would be the time to do it. Your primary role will be to stay calm, encourage the mother, provide water and food if desired, and definitely stay close by. If medical attention isn’t an option, now would be a good time to gather and check your birth supplies.
You should also reassure the mother that what she is feeling is normal and help her to relax. One technique is called abdominal breathing where you instruct the mother to go limp like a rag doll and breathe deeply making the abdomen rise and fall like you do when you are about to fall asleep. This helps to keep the mother and baby oxygenated and relieves tension that fights the contractions causing pain. Squatting or lying down in a tub of lukewarm water can also help to relieve the discomfort of the contractions. When the contractions are strong, 3-4 minutes apart (from the beginning of one to the beginning of the next), and last from 50-60 seconds (ask her to tell you when they start and end, or place your hand on the abdomen to feel the hardening and relaxing) you are moving into stage two. This is not a hard and fast rule though. In three labors my wife has never had a contraction longer than 45 seconds or an interval less than 5 minutes.
What NOT to do – Do NOT leave the mother alone. This seems like common sense, but don’t be tempted to go for help or anything else that would leave the mother alone. If she can’t come with you, you don’t need to go because you can’t know how fast labor will progress in your absence. Do NOT attempt to check for dilation of the cervix and don’t wipe away any vaginal secretions. This could contaminate the birth canal. Do NOT look nervous, scared, or distressed. This can inhibit labor, and she will be able to sense your emotions (you married guys know this already!). Do NOT talk about how slowly labor is progressing, how pale or tired she looks, or whisper to others. This will irritate the mother causing her to smack you, and you will deserve it! Finally, do NOT let the mother get dehydrated, and don’t withhold food. Withholding food is common in hospitals, but this is because they are usually giving an epidural and want to prevent aspiration.
- Transition – This is the stage of labor that you always see on T.V. where the mother is throwing things, crying, and screaming “I HATE YOU, YOU DID THIS TO ME!”. These feelings of anger, fear, panic, and quitting are perfectly normal. She may also vomit, tremble, feel hot or cold, and have intense back pain as the baby’s head rubs against the nerve bundle in her sacrum. You job here is to stay calm and positive, assure her that she is doing a great job and everything is normal (she will immediately scream “This is NOT normal, how would YOU know anything about THIS!”), and don’t take any of the things she says personally. Definitely do not leave during this stage, even if she tries to throw you out. You can duck around the corner, but don’t go far because the baby will be coming soon.
- Second stage – This is the stage of labor where the cervix is fully dilated to 10cm, but you won’t know that because you’re not checking, right? The contractions may get further apart and will now make the mother want to “push”. When the contraction starts the mother should take a deep breath, hold it, and gently push through the contraction. She may want to take several short breaths during the contraction, and that is fine. The key here is to reassure her to take her time and not exert too much force when pushing. There’s no hurry, and you don’t want her to be exhausted when the final pushes are needed. When the contraction subsides the mother should breath normally to recover and rest or sleep until the next contraction comes. This stage of labor generally lasts between 30 minutes and 4 hours. It is recommended to seek medical attention if second stage lasts more than 4 hours.
What to do – Put your sterile gloves on and stay calm! Reassure the mother, hold her up if a contraction comes while she is standing or squatting, and remind her to breathe and push gently. Keep any unnecessary onlookers away because you don’t want to slow labor at this point or aggravate the mother. Use sterile materials or the cleanest available to include sheets, towels, and gloves. Avoid direct contact with the vagina to prevent contamination. Allow the mother to squat (with your support), lie on her side with knees apart, or get on all fours while pushing. When the baby’s head reaches the birth canal, crowning, the top of the head will be visible during contractions, but may disappear between contractions. If at any point the feels like the contractions are not productive, have the mother change positions to squatting or kneeling on all fours. Gravity never fails, so use it.
As the baby crowns the mother will feel a stretching and burning sensation affectionately known as the “ring of fire”. She should resist the urge to push and “pant like a dog” during this time to allow the perineum to stretch and prevent tearing. Place a sterile gauze pad on your hand and apply supporting pressure to the perineum as the baby’s head is born to help prevent tearing and to catch and support the baby’s head. Allow the baby’s head to emerge between contractions if possible to minimize trauma, and remind the mother not to push.
The baby will usually be face down at first, so support the head to keep the baby’s face out of the puddle of amniotic fluid. DO NOT pull on the baby’s head! Use your finger to see if the umbilical cord is wrapped around the neck. If it is, try to hook it with your finger and pull it around the baby’s head. Check again because sometimes it is wrapped more than once. As the shoulders are born the baby’s head will turn toward the mother’s thigh. The baby will usually pop right out at this point, but, if not, it is okay for the mother to push the rest of the baby out after the shoulders are born. If the mother is having difficulty delivering the shoulders, have her lie on her back and pull her knees toward her chest while she pushes. This helps to move her pelvis over the baby’s shoulders. If the shoulders are not born after several contractions, reach in with two fingers and try to hook an armpit and rotate the baby counterclockwise while gently pulling. Remember, the baby will come quickly after crowning, so be prepared to cradle the head for support and have clean towels, pads, or gauze ready to receive the baby. Remember to record the time and location of the baby’s birth.
Being careful to not pull on the umbilical cord, support the baby’s head while raising the body slightly higher than the head (not upside down!) to allow any mucus to drain. Babies are slippery, so be careful! If the baby doesn’t breathe or cry almost immediately, gently rub the baby’s back to stimulate it. Use a bulb syringe to suction any mucus from the baby’s mouth and nose. If this doesn’t work, I’ll talk about neonatal resuscitation shortly. If the cord is long enough, allow the mother to hold the baby skin-to-skin and cover them both with a blanket. This will stimulate suckling, and this is the best thing to do. Breastfeeding as soon as possible will stimulate production of oxytocin that will help to reduce bleeding during the next stage of labor when the placenta detaches. If the cord is too short, place the baby on the mother’s abdomen skin-to-skin and help her to hold it there. Do not cut the cord until after the placenta has been delivered.
What NOT to do – Do NOT panic! Second stage labor with my third child was the point where I realized that the midwife wasn’t going to make it. I had a very brief “Oh crap, I’m about to deliver this baby solo!” moment, but I had prepared for that beforehand so I moved through it quickly and did what I knew I was supposed to do. Do NOT force the mother to push while on her back. This is what you see on T.V., but it pushes the mother’s sacrum forward making it difficult for the baby to move through the birth canal. NEVER pull on the baby’s head and always support the head. The baby’s neck is very weak and you could cause spinal damage. Do NOT pull on the umbilical cord. This can cause incomplete separation of the placenta from the uterus and lead to hemorrhaging. Do NOT cut the cord immediately. Again, they do this on T.V. and even in the hospital, but there’s no hurry at all. The blood in that cord belongs to the baby, so give it time to flow back into the baby’s blood stream. The cord will turn creamy white and stop pulsing when it is done, but even then you shouldn’t be in a hurry to cut the cord. In fact, some cultures like the Inuits will not cut the cord at all and carry the baby with the placenta around until it naturally detaches 2-3 days after birth (Lotus birth). I’m not saying you should go that far, but it doesn’t hurt anyone to wait to cut the cord for a while. Do NOT use a pacifier to stimulate suckling. This confuses the baby, and breastfeeding is best for mother and baby.
- Third Stage – You have a baby now, but you’re not done yet. Third stage is where the placenta, or afterbirth, is delivered. This typically occurs within several minutes to two hours after birth. All you do here is wait, and watch the mother for shock. You should never pull the cord to try to remove the placenta. Let it be delivered naturally and watch for bleeding. Rubbing the mother’s lower abdomen firmly over the firm, grapefruit sized uterus will help to control the bleeding. A slow trickle of blood followed by a few blood clots is normal after the placenta is delivered. Anything more than this could be a result of hemorrhaging, and I’ll tell you how to deal with that in a bit. The other problem to look for is signs of shock such as a blank stare, dilated pupils, pale or clammy skin, weak and rapid pulse, irregular breathing, dizziness or vomiting. I’ll go into how to treat shock in the next section. If you don’t have any of these problems, focus on keeping mother and baby warm, give the mother food, water, and pain pills if desired, and clean up. Above all, stay with the mother to watch for hemorrhage and shock.
- Breech birth – Most baby’s are born head first, but some come feet first and this is known as breach birth. If this happens, have the mother move to the edge of the bed and prepare a soft landing area on the floor for the baby. Have the mother pull her knees to her chest when pushing. As the baby’s legs, body, and arms are delivered you should be looking at the baby’s back. It is important to NOT TOUCH the baby while the head is still in the birth canal. You will be afraid that the baby will fall, but you must let the baby dangle over the soft landing area. This is important because touching the baby can stimulate breathing, and that isn’t a good idea until after the head is born. If the baby’s arms are born but the head is not after the next push, have the mother squat to push and this should take care of it.
- Hemorrhaging – Massage the uterus firmly to keep it contracted. An ice pack on the abdomen can help keep the uterus contracted too. Have the mother lie on her back with the bottom of the bed elevated. Have the baby nurse if at all possible to assist in stimulating uterine contractions. If blood is still flowing more than a heavy period, place one hand on the mother’s abdomen near the belly button. Use your other hand to fold the loose skin of the stomach and the abdomen over the first hand and apply firm pressure to the point of discomfort but not pain. This will clamp the uterus between your two hands and apply pressure to stop the bleeding.
- Shock – Keep the mother warm but not overheated. Loosen any clothing around the neck and elevate her legs. Lower the lights, talk softly, and calm the mother. No not give any food or drink, and turn her head to the side if she vomits. Seek medical attention.
- Neonatal resuscitation – About 10% of all newborns require some sort of assistance breathing immediately following birth, but less than 1% require extensive resuscitation. If the baby is not breathing or is having difficulty breathing, your first action should be to firmly rub the baby’s back. If this doesn’t work, lay the baby on its back and lift the chin slightly to open the airway. Suction the mouth with a bulb syringe to remove any mucus or amniotic fluid. If CPR is still needed, it is important to note the differences in neonatal and infant/adult CPR. For a neonate, place to fingers on the sternum on an imaginary line between the nipples. Perform 3 rapid but smooth compressions of ½ – ¾ inch depth followed by a gentle breath into the baby’s mouth (just enough to make the chest rise slightly). The ideal rate is 30 of these cycles (90 chest compressions and 30 breaths) per minute. Continue administering CPR until the baby’s heart rate is above 80 beats per minute.