XXII. Childbirth
Childbirth is a natural process. Thousands of children all over the world are born
each day, without complications, in areas where no medical care is available. By
following a few simple steps, you can effectively assist in the birth process. Labor begins
with the rhythmic contraction of the uterus and the dilation of the cervix.
Dilation allows the baby to travel from the uterus through the birth canal.
Labor has three distinct stages. The length and intensity of each stage vary:
Stage One—Preparation
Stage Two—Delivery of the Newborn
Stage Three—Delivery of the Placenta
If you must care for a pregnant woman, you will want to determine whether she is in
labor. If she is in labor, you should determine in what stage of labor she may be and
whether she expects any complications.
Ask the following questions:
1. Has 9-1-1 or the local emergency number been called?
2. Is this her first pregnancy?
3. Does she expect any complications?
4. Is there a bloody discharge?
5. Has the amniotic sac ruptured (or water broken)?
6. What are the contractions like? Are they close together? Are they strong?
7. Does she have an urge to bear down or push?
8. Is the newborn’s head visible?
You can help the expectant mother cope with the discomfort and pain of labor. Suggest
that the mother try specific physical activities that she can do to relax, such as regulating
breathing by—
1. Deep breathing—inhaling slowly and deeply through the nose and out through
the mouth.
2. Focusing her attention on an object in the room while regulating her breathing.
3. Stay calm, firm and confident, offering encouragement.
Assisting with Delivery
Assisting with delivery of the newborn is often a simple process.
1. Begin by positioning the mother.
2. Establish a clean environment.
3. Protect yourself.
4. As crowning begins, place a hand on the top of the newborn’s head and apply
light pressure.
5. Ask the mother to change her breathing pattern.
6. After the head emerges, lower the head and guide one shoulder out at a time.
7. Do not pull the newborn.
8. Use a clean towel to catch the newborn.
9. Place the newborn on its side, between the mother and you.
10. Note the time the newborn was born.
Caring for the Newborn
You have two priorities at this point.
1. Your first priority is to see that the newborn’s airway is open and clear.
a. Clear the nasal passages and mouth thoroughly.
b. If the baby does not spontaneously breathe or cry, flick the soles of his
or her feet to stimulate crying.
c. If the baby does not begin to breathe on his or her own, begin rescue
breathing. If the baby does not have signs of circulation, begin CPR.
2. Your second priority for the newborn is to maintain normal body temperature.
1. Dry and wrap the baby in a clean, warm towel or blanket.
2. Continue to monitor breathing, circulation and skin color.
3. Place the wrapped baby on the mother’s abdomen.
Caring for the Mother
Help the mother to begin nursing the newborn if possible. This will simulate the
uterus to contract and help slow bleeding. As the uterus contracts, it will expel the
placenta, usually within 30 minutes. As the placenta emerges, place it in a towel or
container for transport with the mother and baby to the hospital. It is not necessary to
separate the placenta from the newborn.
Gently clean the mother using gauze pads or clean towels. Place a sanitary pad or
a towel over the vagina. Do not insert anything in the vagina. Gently massage the lower
portion of the abdomen. Keep the mother positioned on her back. Keep her from getting
chilled or overheated and continue to monitor her condition.
Scenario
A car pulls into your driveway. The driver jumps out screaming for help for his
wife, who is in the back seat. The woman is 35 years old and full term in her pregnancy.
Her contractions are less than 2 minutes apart. She says that the baby is coming and she
feels the need to push. Her husband tells you this will be their fourth child.
How do you respond?
Complications
Complications during pregnancy are rare; however, they do occur. One such
complication is miscarriage, or spontaneous abortion. Concern yourself with recognizing
signals that suggest a serious complication during pregnancy.
Two important signals you should be concerned about are vaginal bleeding and
abdominal pain. An expectant mother showing these signals needs to receive advanced
medical care quickly. While waiting for EMS personnel—
1. Place a pad or other absorbent material between the mother’s legs.
2. Take steps to minimize shock:
3. Help the expectant mother into the most comfortable position.
4. Keep the expectant mother from becoming chilled or overheated.
Complications during childbirth require the help of more advanced medical care.
More common complications include—
1. Persistent bleeding.
2. Prolapsed umbilical cord.
3. Breech birth.
4. Multiple births.