Childbirth is both exciting and terrifying. What we will discuss here is normal birth with few complications. Major complications need to be discussed in major detail per situation. The fact is that many women will have children during a SHTF timeframe. There is much more than just pushing. Whether you will be on your own or part of a group, someone must learn how to assist in the childbirth process. I assure you, it will happen. Let’s begin with the basics.
When dealing with a pregnant woman, these are the first questions that you need to ask:
-vaginal bleeding, tissue expulsed, amount
-pain, severity, radiation, location, duration
-vaginal discharge, color, odor
-current sexual activity
-last menstrual cycle (last period)
-prior pregnancies, hours of labor, complications, losses
-prior c-sections, other abdominal surgeries
-past pertinent medical history (diabetes, hypertension, etc), meds, allergies
-due date
-STD’s past and present
-prenatal care
-contraction times
-bloody show or water breakage
These questions will help a caregiver to determine the best course of action, but will also help the layman to deliver a baby.
With normal labor, you will begin with contractions. This will continue until the cervix is fully dilated. This phase can take between 7-15 hours. Contractions tend to begin short in duration and are farther apart. Contractions that are one minute or longer or are closer than two to three minutes apart mean that birth is imminent. Mother needs to be positioned one her back, with the back elevated around ten degrees. A pillow under mom’s rear will help. Whatever position of the legs make mom feel comfortable will be appropriate. Just make sure that both legs are equal to take pressure of mom’s pelvis.
By this time, the child is moving out of the uterus and into the birth canal. It’s very important to comfort mother throughout this process as much as possible. During this time, mom has an urge to push. This is when you will begin to see a presenting part, and in a normal birth, it will be the head. By this stage, you should be in sterile gloves, or at least cleaned washed hands, doused in hand sanitizer. Make sure that you have warm, clean blankets or cloths nearby along with a bulb syringe. This is so you can suck all of the fluids out of baby’s mouth and nose once the head is delivered. Having all of your items close at hand and organized is essential. Here are some items that need to be at hand:
-Clamps
-Gloves, both sterile and non sterile
-Bulb syringe
-Warm, clean blankets and towels and lots of them
-Warm, clean, sterile water and lots of it
-Emesis basin or puke bucket
-A place for comfortable and clean delivery. On your bed is probably not the best place since the bed will be covered in goop. Or have some sort of covering on top of the bed.
-At least one other person to help you if need be
-Sterile shears or scissors
If you can come across these and know how to use them:
-BVM pediatric
-Defibrillator/AED with pediatric settings
- Magnesium Sulfate
-Sterile gowns, mask, eyewear
-Epinephrine 1:10000
-IV supplies
-Oxygen with supplies
You will also need two umbilical clamps. This could be the sterile hospital type, or simply two strands of boot string. Once you begin to see the head, you MUST provide a support system. This helps baby’s head to come in a neutral position, while preventing the fast “canon shot.” Babies, especially in later pregnancies, can shoot out fast just like a canon.
Make sure to never pull on the baby’s head. Do apply gentle downward traction while someone pushes firmly down superior to mother’s pubic bone. Once the baby delivers the top shoulder, then release all pressure by everyone and tell mom to push. This will help to deliver the bottom shoulder. Baby should be facing either left or right. Once both shoulders are through the vaginal cavity, baby will deliver with normal force. Special notice needs to be applied as to the pressure you are applying. Too much can cause serious and permanent damage to baby. Be prepared that the baby will be very slippery. Use a firm grip without hurting baby.
Once baby is delivered, clamp the first clamp four inches away from baby. The second clamp will be six inches away from baby. Now cut the cord in the two inch section between the two clamps. Now bring baby to the chest of mom. Clean and cover baby and mom in warm blankets. Allow baby to suckle the breast if it is willing. This is very important. When breastfeeding occurs, oxytocin will stimulate the uterus into contractions.
Now that baby is born, you have a second delivery on the way. It’s the placenta, or bag, that was around the baby in the womb. This can take up to 45-60 mins. Once the placenta is delivered, you need to massage the uterus until it is firm. This will stop bleeding. Just above the pubic bone and at the belly button is typically where your hands need to be. Start massaging and squeezing in circular motions. This will not be gentle. You want to really squeeze. Do this until you feel the uterus tighten up about the size of a grapefruit.
While it may not help you. It could help a future provider if you can give an APGAR score. Here is how it’s broken down.
A=Appearance
0=blue or pale
1= blue legs/arms, pink trunk
2=all pink
P=Pulse
0=none
1=less than 100
2=more than 100
G=Grimace
0=no response
1=grimace
2=coughing,sneezing,crying
A=Activity
0=limp
1=slow movement
2=active movement
R=Respiratory Effort
0= none
1=slow and/or irregular
2=good with crying or cooing
Some items that I would like to touch on would be minor complications. One such issue is that the “water never broke” or the placenta has not ruptured. If this is the case. you will have to rupture the placenta. Be careful that you do not hurt baby. Try to pull the membrane away from the baby and make a small puncture or incision. Then pull it apart with your fingers.
Another issue is when the cord wraps around the babies neck. If you see that the cord is around the neck when the head is out, try to slip your fingers between the baby’s neck and the cord. What you are trying to do is keep the airway open for baby.
Another scenario is a prolapsed cord. This is where the umbilical cord pops out of the vagina. Unfortunately, this normally requires a C-section. Unless you have a surgeon on hand, you’ll have to do the best that you can on your own. Keep the cord moist at all times. The cord is baby’s lifeline. If the cord begins to dry out, the baby cannot receive it’s life support from mom anymore. Try to keep the cord from being compressed, as this will also shut off the supply to baby.
Meconium is baby poop. It’s generally a dark green or yellowish color. This can mean that baby has already been stressed in the womb. Babies do not normally poop while in the womb. Babies can also inhale the meconium and die. This is where suction of the mouth and nose becomes especially important once the head is delivered.
Minor trauma may also occur to mom while in delivery. Soft tissues may tear as she pushes. Once the baby is delivered along with placenta, examine the vaginal and rectal tissues to see if there is any trauma. If minor, simple bandaging may be sufficient treatment. However, if the trauma is severe, sutures may be required. This can pose a problem to the non-health professional.
Always make sure that you are there for mom as well as baby. Mom may have a variety of emotions. Childbirth is not just a medical practice but also a psychological one as well. If family and friends are not nearby, YOU will be taking the brunt of the emotions. Be prepared that at one moment, she will hate you and love you at the same time. She will hate you for not making her childbirth easy, but will love you for helping her become a mommy. You also have to be prepared to take care of her emotionally if the birthing process takes a wrong turn. If the child dies after birth, during birth, or pre-birth, you will have to be there to comfort her. Understand your patient and her wishes. If she wished to have the placenta buried or tossed in the trash, do it. Your ideas may not match hers but her wishes rule during this time frame.
There are plenty of complications that can occur. Maybe I’ll write on them someday. Until now I think this is sufficient. Remember that birth is a natural process that normally doesn’t need any intervention. Hopefully you will have someone experienced in this should it happen. If not, you now have a head start. Children have been born for a long time without doctors. You can help just like a doctor would. There are plenty of things to prepare for in a SHTF scenario. Some will happen, some will not. I promise you that childbirth is the one that WILL happen.