Delivering A Baby
Emergency childbirth under all the ideal conditions is a wonderous miracle that needs little to no intervention. However, not every delivery of a baby goes to plan. Some children decide they want out, and they want out now!
Their timing leaves a lot to be desired, and the locations they force the mother to birth them can vary greatly from the safety of a hospital, particularly if the delivery is premature and will require immediate life-saving interventions only accessible in a hospital designed for neonatal care.
In any situation where a woman is giving birth outside of her birthing plan arrangements, call emergency services on 000 in Australia, 911 in the USA and 999 in the UK.
Providing First Aid During Emergency Childbirth
Women have been birthing children since the dawn of humanity. In the last hundred years, medical advances and technology have brought childbirth out of the homes or fields and into a dedicated space with expert midwives, OBGYNs and paediatricians gathered in one location.
Providing emergency First Aid to a woman in labour means that you are only there to offer any assistance needed once the baby has crowned. In a normal, healthy delivery, your active intervention may not be necessary until the baby has been delivered.
Delivering An Emergency Pregnancy Gets Messy
Childbirth involves a lot of blood and opens the newborn and the First Aider to potential infections. Strict hygiene and personal protection need to be in place when and where it is possible when dealing with babies, open bleeding wounds, and where the chance of cross-infection from a contaminated or infected person either to the First Aider or from the First Aider to the mother or child might take place.
It is imperative that you take all possible precautions against infection by washing hands with disinfectant and wearing gloves where it is possible. It will not always be possible in an emergency, so do everything you can within your immediate means to negate infection or cross-contamination. If others are in proximity, order them to get you warm water and soap, hand sanitiser, a clean towel or fabric to dry and wrap the baby, and gloves.
The First Step To Childbirth
The first step to assisting in a childbirth emergency delivery is to ask the mother how far into the pregnancy she is. This will give you an idea of how premature the baby might be and its chances for survival once out of the womb. Establish what, if any, external factors caused her to go into unexpected labour. Domestic violence, a fall, something impacting her stomach with force like a car accident, or if she felt the contractions starting and went into emergency labour unexpectedly.
Then we need to establish how far the cervix has dilated and what stage of labour the mother is in. You can do this by looking to see if any of the following are present:
Show: This is the loss of the mucus plug that keeps the cervix closed. Labour can start any time after the mucus plug has popped and can, in some cases, pop days before the baby arrives.
Water has broken: Once the plug has popped, the amniotic sac around the baby and the amniotic fluid the baby floats in have begun to leak. It can happen suddenly in one giant gush of fluid but is more likely to be a gradual trickle.
Intermittent pain: Contractions of the uterus can take on many forms. Contractions can be felt as painless butterfly-like sensations up to painful cramps that gradually last longer and longer and get closer and closer together until the urge to push arrives. Labour is generally suspected if the contractions last longer than 40 seconds and occur about every three or four minutes, with the period between each contraction getting closer to the one before.
Not all women will experience a pain-filled childbirth and agony. Some will deliver easily without pain or very little until it is time for the baby’s head to crown, at which point the mother will feel a burning sensation like a Chinese burn. This is where the tissue fibres will be tearing. If the muscles haven’t had time to stretch, or the baby is large, they will rupture, often ending up in an unwanted episiotomy that will require sutures post the birth and delivery of the placenta.
Bleeding: In cases where some form of trauma or a miscarriage has occurred, there is a high probability of vaginal bleeding before, during, and after the birth. This should not be confused with the mucus plug show in which small amounts of blood may be present.
Dilation: During the birthing process, the vagina will stretch and expand to a full 10cms, at which point the baby is ready to be delivered. You are not expected to know how many centimetres dilated a woman is, but you can tell if she is fully dilated if your whole hand would easily fit inside the vagina. Anything below that means the cervix is still dilating and needs time to stretch. If the baby is forced out of a cervix too small, it can cause head and brain trauma and damage to the baby and massive internal trauma to the mother resulting in death.
Imminent Delivery: The Baby Is Ready To Emerge
The following are present when the baby is about to enter the world.
- Regular contractions below one minute apart. They may have disappeared entirely.
- The vagina has dilated to 10 cm.
- The urge to push or bear down means the baby is being moved out of the womb, ready to crown. As a general guide, at the pushing stage, the delivery will take place within an hour for the first baby and within 30 minutes for the second and later pregnancies.
- Crowning. The top of the baby’s head is visible in the dilated vagina.
Labour Is Divided Into Three Stages
First stage: The womb contracts meaning the muscles tighten and release to move the baby into and down the birth canal, ready to be delivered.
The first stage can be as short as ten minutes or as prolonged as four days! No two deliveries are remotely alike, and there is no ideal time to be in labour. Every child works to their own delivery schedule. As a very generalised guide, approximately twelve (12) hours for first-time mothers and less for subsequent childbirths.
However, every labour and delivery time is bespoke to the baby in question and can differ greatly in the same mother and from woman to woman. Some women are lucky to have speedy, easy births with little if any tearing and are out of the hospital three hours after giving birth. Others suffer for days in agonising pain and deliver small babies that tear them from front to back and cause significant internal damage upon exit.
Not all babies can be birthed vaginally. Larger babies will have to be delivered through a C-section as the cervix and vagina cannot expand beyond a certain point, and the baby becomes trapped in the birth canal, causing it to become stillborn. In rare cases, this can cause the mother’s and child’s death. Unless you are a qualified Advanced Medic with surgical training, a First Aider will not be able to perform a C-section and save the mother even if they managed to save the baby.
Second stage: The mother receives the urge to push and this, in unison with the contractions, pushes the baby down the birth canal and out into the world.
The second stage starts when the cervix is completely 10 cm dilated. The woman usually feels the sensation of fullness in her vagina or bowel and wishes to push. Most women will swear they need to poo out a watermelon, and that is a good sign. Labour pains in the second stage are more bearable in most mothers as they can actively help themselves by pushing the baby down the birth canal.
Remove any constricting clothing or push it above her waist. Where it is appropriate in a public place, protecting her modesty at all times where possible is the ideal goal. However, modesty will be the last thing on most women’s minds at that point in time. They simply want their baby out as fast as possible! The second stage of labour ends with the delivery of the baby. Delivery times can vary from ten minutes to two hours in first-time labour, and 5 to 60 minutes in subsequent deliveries in the case of multiple births. Women birthing multiple babies will become progressively more exhausted and may require assistance to remain in the push position between contractions.
Squat Position Versus Back Position
Giving birth in the squat position is how mother nature intended for women to give birth to children, not lying flat on their back. A back delivery will take longer and cause more damage than a squat delivery in a healthy, physically mobile mother. Don’t believe me? Look at third-world countries where pregnant women are working in fields and walking endless distances for freshwater only to stop, squat and give birth, then get up and walk off without the intervention of a single person and a perfectly healthy baby in their arms.
TV has a lot to answer for when it comes to instilling the belief that the best way to give birth is flat on your back with your ankles in stirrups. This position is best for the person delivering the baby to see what is going on when there might be complications, not for the mother or child.
Third Stage: When the baby’s head reaches the end of the birth canal, the top of the head will crown during contractions and then become more visible with each push until the head pops out. Do not apply any pressure on the baby’s head to control or help its descent.
Check to ensure that the umbilical cord has not wrapped around the baby’s neck – if it has, loop it over the head and free the neck, so the child isn’t strangled by the cord as the rest of the body is pushed free. Mothers often require a small break between the head emerging and then pushing the child out. However, not all mothers will need this, and once the head has been cleared, the rest arrives in the next push in most cases.
Some minutes after the baby has been delivered, there is another delivery, and that is the placenta. If the umbilical cord has not been cut, it will still be attached to the placenta and needs to be tied off about 10 cm from the baby’s navel and then cut with a clean, sharp knife or scissors. Be sure to tie off the cord firmly before cutting it free from the placenta to stop any infection at the cut site travelling down the cord directly into the baby.
Wipe the baby’s nose and remove any fluid or matter out of the mouth. Hold the baby as it is born and lift it towards the mother’s abdomen. The baby will probably breathe and cry almost immediately. Gently but briskly thoroughly rub dry the baby using a warm, clean towel. This will remove the amniotic fluid and stimulate the baby to breathe. Remove the wet towel and wrap the baby in the clean, dry item of fabric to keep them warm.
Newborn babies are extremely sensitive to temperature changes, having just emerged from a very warm womb in the 36C range to the external environment temperature. That is the equivalent of exiting a sauna and entering a plunge pool filled with ice.
When covered, place the baby on the mother’s breast and encourage her to rub her nipples against the baby’s lips in a position where the mother can attempt to teach the child how to suckle and feed from the nipple correctly and to add extra body warmth to the infant. The action of breastfeeding will also encourage delivery of the placenta.
There will be significant bleeding from the vagina as the womb undertakes the process of shedding the old lining. This shedding is the same process as a normal period and can take anywhere from three to nine days to complete. The blood should be dark red in colour, not bright red. Bright red blood will signify internal bleeding of living tissue fibres, not the dead lining of the old brownish-red blood seen in a typical menstrual cycle and will need immediate surgical intervention.
The placenta should be kept for the midwife or doctor to inspect. Some mothers opt to keep the placenta and take it home to eat or plant in the garden as per individual cultural beliefs and practices dictate.
Stay with the mother until the emergency services or a qualified medical practitioner or health care professional arrives on the scene.
Everything Is Going To Be Just Fine
Almost all emergency births are normal and have no complications. When assisting with an emergency delivery, it is important that you continually reassure the mother and attempt to keep her calm and hydrated. Telling her to breathe is likely to get you yelled at but focusing on the breath and breathing are important as most women hold their breath when they push or receive a contraction. It can cause them to briefly pass out from a lack of oxygen if they continue to do so in rapid succession. In this situation, DRSABCD must be quickly implemented, as providing CPR, if required, takes precedence over delivering the baby.
The link below is one woman’s journey filing her own childbirth.
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