How To Deliver A Baby In An Emergency. Almost all emergency births are normal and have no complications. Under the ideal conditions, childbirth is a miracle. However, not every delivery of a baby goes to plan. Their timing leaves a lot to be desired, and the locations can vary greatly from the safety of a home birth or a hospital, particularly if the delivery is premature and requires immediate life-saving interventions only accessible in a neonatal care unit. In any situation where a woman is giving birth outside of her birthing plan arrangements, call emergency services on 000 in Australia.
In the last hundred years, medical advances and technology have brought childbirth out of the homes or fields and into a dedicated space equipped with the latest technology, expert midwives, OBGYNs and paediatricians gathered in one location should an emergency delivery unfold.
Delivering emergency First Aid to a woman in labour means that you offer any assistance and reassurance needed during the delivery process. In a normal, healthy delivery, you won’t need to do anything but offer reassurance and support until the baby crowns.
Childbirth is open to infection. 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 around, direct them to get you warm water, soap, hand sanitiser, a clean towel, and something warm to wrap the baby.
The First Step
Establish what, if any, external factors caused her to go into early 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 early labour with a miscarriage. Then we need to establish how far the cervix has dilated and what stage of the delivery the mother is at. 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. Sometimes, the plug may have popped hours or days before the baby arrives and cannot be found.
Water has broken: Once the plug has popped, the amniotic fluid the baby floats in has begun to leak. It can happen suddenly in one gush of fluid but is more likely to be a steady 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 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 together.
Not all women will experience a pain-filled, agonising childbirth. Some will deliver quickly and easily with little pain until the baby crowns. Crowning is the point where the mother will feel a burning sensation like a Chinese burn. The tissue fibres will be tearing at the entrance of the vagina. If the muscles haven’t had time to stretch, they will rupture, often ending up in an unwanted episiotomy requiring sutures and medical treatment post the delivery of the baby and placenta.
Bleeding: In cases where some 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, or the post uterus lining shedding as per a normal period womb cleansing.
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 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 that isn’t fully dilated, it can cause head and brain damage to the baby and massive internal trauma to the mother, potentially resulting in death.
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, down the cervix, ready to crown. As a general guide, at the pushing stage, the delivery will take place within an hour for first-time deliveries and within 30 minutes for the second and later pregnancies.
• Crowning. The top of the baby’s head is visible in the dilated vagina.
Three Stages Of Labour
First stage: The womb contracts. 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 deliveries, easily birthing nine-pound babies with little tearing, and are out of the hospital three hours after giving birth. Others suffer for days in agonising pain and deliver small six-pound babies that tear them from front to back and cause significant internal damage upon exit.
Not all babies can be birthed vaginally. Larger babies inside petite women must be delivered through a C section as the cervix and vagina cannot expand beyond a certain point, and the baby becomes wedged in the birth canal. Sadly, without surgical intervention, this results in a stillbirth. If the mother cannot get a surgical release, this can cause the death of the mother as well as the child. 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 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 say it feels like the baby is emerging from the wrong hole. 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. Fatigue in the mother can become an issue if the birthing process is prolonged.
Remove any constricting clothing or arrange it above her waist. Where appropriate, in a public place, always protect her modesty where possible. 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. Keep up the fluids where possible. Water and sports drinks with electrolytes are highly recommended.
Giving birth in the squat position is how mother nature intended women to give birth to children, not laying on their back as depicted in TV dramas. A back delivery will take longer and cause more damage than a squat delivery due to the birth canal being in the wrong position making life harder for the mother and the 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 cord doesn’t strangle the child as the rest of the body is pushed free. Mothers often require a small break between the head emerging and 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 or two in most cases.
Some minutes after the baby has been delivered, there is a placenta delivery. 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 infection at the cut site from travelling down the cord directly into the baby, causing infection.
Wipe the baby’s nose and remove any fluid or matter out of the mouth. Hold the baby face down and lift it towards the mother’s abdomen with the bottom higher than the head. The baby will probably breathe and cry almost immediately. Gently but briskly rub dry the baby using a warm, clean towel. This will remove the amniotic fluid and stimulate the baby to breathe. Remove the dirty 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 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 nipple against the baby’s lips in a position where the mother can attempt to teach the child how to suckle and feed on 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, which can take anywhere from three to nine days to complete.
The placenta should be kept for the midwife or doctor to inspect and for the mother to keep if they so desire for cultural reasons. Stay with the mother until the emergency services or health care professional arrives on the scene to take over.
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. 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 and tire them prematurely. In a situation where the mother loses consciousness, DRSABCD must be quickly put into place, as providing CPR, if required, takes precedence over delivering the baby.
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