Basics of Birth for those who don't know nothin' 'bout birthin'
babies!
(sometimes called Emergency Childbirth, but Birth is An Emergence,
not an Emergency)
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These are easy to read and understand and are beautifully presented.
NOTE - Do not Panic if you don't have any special
supplies. All you really, really need to assist at a birth
is your heart and your hands. It helps if your brain is
engaged, too, but many people are so overwhelmed at a birth that
you can't really count on this. It helps if you have some
towels and some clean sheets or pillowcases handy. And at
some point, you'll find that it's easier to hold the baby if the
placenta isn't attached. You don't need a special clamp;
after a couple of hours, blood will have stopped flowing through
the cord, and the cord will be limp and white, like thick
spaghetti. Then you really don't need to clamp it anymore,
although if you happen to have some sterile string or a sterile
shoelace, that's great. You can sterilize string, a
shoelace, a knife or a scissors by soaking it in alcohol or
hydrogen peroxide for 30 minutes. Or if you really cannot
create a sterile situation for cutting the cord, you can wait a
few hours after the birth and then cut the cord about 5 inches
from the baby. You can also sterilize baby blankets,
handkerchiefs or pillow cases by baking them for 2 hours at 220
degrees. (Keep an eye on it so it doesn't burst into flame
. . . it helps to have a baking pan with some water to create
steam in the oven.) Or you can iron a handkerchief or
pillowcase at the highest tolerable setting to sterilize
it. Even 20 minutes in a dryer on high will kill a lot of
germs.
If you are assisting a family member at a birth, it's probably
OK if you don't have any medical gloves handy. It's
important to WASH YOUR HANDS before assisting at the birth, and
to try to keep them clean by washing as necessary.
If you're ever uncertain about what to do, count to ten and
then reassess. It's better to be calm and centered and
acting judiciously than to be forging ahead without some
thought. Remember, birth was designed to happen without
any help at all, so you can always just be there and wait until
it's really, really clear that your help is needed.
A Primer for Doing Your Best to assist at an unplanned
unassisted birth. This was written for our local CERT
(Community Emergency Response Team) and assumes that you have a
standard emergency OB kit. (NOTE - If your kit contains
latex gloves, it's best to try to replace them with non-latex
gloves. You can buy single pairs of sterile vinyl or nitrile
gloves from Cascade Healthcare
Products. You need at least 2 minimum - 1 for catching the
baby and 1 in the rare case that you need to go in after the
placenta. Ideally, you would have at least 4 pairs of sterile
gloves so that you don't have to be perfect in your timing of
putting them on for the birth.)
Act as if you're calm and keep your voice quiet.
This really helps! Try to breathe slowly and
deeply. Birth is not an emergency . . . . it is an
emergence. Reassure her that you have the birth supplies
and that everything is fine.
If this is not a first baby for her and mom is pushing,
then go directly to Step 6.
Provide as much emotional and physical support as the mom
wants, which may not be any if she is an experienced
birther. If she has supportive family that she wants
present, they're probably scared, too, so just ask them to
breathe slowly and deeply and stay close to hold her hand if she
needs and to offer her a sip of water in between
contractions. Clear out non-helpful bystanders. Anyone who
might touch the baby should wash their hands. Assist the
mother to wash her hands if they appear dirty. Baby wipes
can be used to clean hands if there's no water.
For a first baby, just support the mom to do whatever
she wants. Anytime she looks scared or says she can't do it, reassure
her that she is doing a great job and that everything is going
well. She needs to drink at least 1 cup of water or
non-acidic juice every hour and to empty her bladder regularly;
recommend that she try to urinate at least once each hour but
it's OK if she can't. She can eat whatever she wants,
although it's best to eat simple foods: yogurt, pasta, soup or
just honey. A first baby labor is usually 12 to 24 hours. If
she is getting tired, you can help her to get into a
supported sitting position, such as sitting on a pillow on a
kitchen chair and leaning on a pillow on the kitchen
table. Or you can create supports with pillows on her bed
or the sofa, but lying down during labor is usually very
uncomfortable, and reclining on her back can move the baby into
an unfavorable position.. At some point, she may start to
enter the "transition" to the pushing stage: she may appear to
be in a great deal of distress, she will probably say that she
can't do it, and she may feel very hot and then feel chilled and
then feel very tired and just want to go lie down for a little
bit. At this point, it's fine if she really wants to lie
down and it's the most comfortable position for her; help her to
get comfortable lying on her left side, with her right knee bent
forward a little bit, supported by a pillow. At some point, she
will start making grunting noises, and then she will obviously
be "pushing", i.e. bearing down. [NOTE - ] Then stay
present to her but still support her in doing whatever she wants
until you see at least a 2" diameter of the baby's head that
stays there even when she's not pushing. (If she needs a
suggestion about a good pushing position, she might try being on
her knees and leaning on a sofa. Or if she is struggling
to find her rhythm for more than 15 minutes, you might suggest
that she try pushing on the toilet, but remind her to tell you
when she feels the head starting to come out.) Then go to Step
6.
If you have time, you can create some absorbent underpads
by opening up some clean newspapers and stacking them to about
an inch thick. Cover them with a clean sheet or fold them
into a clean pillowcase or just cover them with a clean
towel. It's nice to have at least one large one for the
birth and immediate postpartum and then a clean one for after
the birth. Even more is even better - up to 6 is
nice. (Optionally, you can use clean towels on top of
plastic or clean sheets on top of blankets on top of
plastic. The key is to try to have something clean next to
her and the baby; have something absorbent underneath that; and
try to protect the surroundings from anything that might soak
through.)
When the birth is imminent, help her to lie down on her
side on the clean overdrape or any clean cloth, sheet,
towel on a bed, sofa or the floor. (You want to make sure
there's no way the baby could fall a long distance when he/she
emerges; babies are very slippery!) A side-lying position
also helps to prevent perineal tearing. (Do not fight her
about the position but maybe put a cushion on the floor if she
is standing up. Hands and knees or kneeling positions are
generally fine. Or she may want to sit on the edge of the
sofa and catch the baby herself.) Use a baby wipe to remove any
obvious stool (fecal matter) that is pushed out as the baby's
head comes down. It is OK if the baby comes into contact
with the mother's stool, although it's nicer to wipe it
away. If you have time and her hands are dirty, help her
to wash them or at least wipe them on a baby wipe.
Put on sterile gloves so you'll be ready to touch the
baby if the baby needs help. At most births, you will
not need to touch anyone. (Reserve at least one pair of
sterile gloves in case you need them to remove the placenta.)
Reassure her that she is doing a great job and that
everything is going well.
It may take a while for the baby's head to emerge fully so
that you're seeing more than the top of the baby's head.
Encourage the mother to stop pushing once you see 4" across the
top of the baby's head; explaining that this helps avoid a tear.
. She can pant or give short, grunty pushes if she needs
to. Her body will keep pushing the baby out even if she
isn't trying; this is ideal.
Finally, there will be one contraction that births the head
fully so the baby's chin is out. Then there will be a pause of
about 60 seconds. The head will probably rotate about a quarter
turn on its own. You do not need to touch the baby at
this point.
Encourage the mother to reach down and touch her baby's head
and then to reach down and help her baby out with the next
contraction. This will help prevent perineal
tearing. It's fine if she wants you to be the one to catch
the baby.
The baby needs to be warm in order to begin getting oxygen
from breathing. The baby continues to get oxygen
through the umbilical cord for 5-10 minutes after the birth so
it is OK if baby takes a minute before taking a big breath, and
it's OK if the baby is sputtering and coughing and clearing out
mucous for five minutes or so.
Help the mother to dry the baby thoroughly with clean
cloths. This will help stimulate the baby to
breathe. Remove wet cloths and cover the baby with a
dry cloth. Keep the baby skin-to-skin on the mother's warm
body, covered with the receiving blanket and then the
plastic-lined underpad to keep the heat in if it's cold.
Shield the baby from breezes and shade the baby's eyes if the
light is bright.
Typically, the baby takes a few minutes to cry, sneeze,
cough, sputter and cry some more to get the breathing working
properly. Then the baby will start looking around for the
mother's face; encourage her to look at her baby and talk gently
and lovingly to welcome her baby. At about 15 or 20
minutes after the birth, the baby will start to look interested
in breastfeeding; baby will be sucking on the hand, licking the
lips, turning the head from side to side or bobbing the head. Help
the mother to lie down comfortably on her back, with her head
on a pillow. Place the naked baby with the head between
her breasts and allow the baby to maneuver to the breast and
latch on by himself/herself. If the baby is not able
to move to find the nipple after 15-30 minutes, then you can
position the baby with the mouth directly over the mother's
nipple. The mother may need to shape the nipple by
compressing the breast with her thumb and forefinger about two
inches back from the nipple to make it more pointy and fit into
the baby's mouth better. Ideally, there will be someone
who can help with breastfeeding, but the most important thing is
for the baby to stimulate the mother's nipples to control the
bleeding and help bring the milk in. Allow the baby to
nurse for as long as desired, even up to 2 hours. Babies
often poop a few minutes after they start nursing. You can
just put a diaper under the baby's bottom to keep the mother
clean, or you can diaper the baby if the mother prefers. [NOTE -
Normal newborn poop (meconium) is like black tar for the first
couple of days. You get bonus points if you can get some
olive oil or baby oil on the baby's bottom with every diaper
change so the meconium doesn't stick so much.]
Meanwhile . . . the placenta usually comes about 5-10 minutes
after the birth; the baby can remain in the mother's arms and
even keep nursing through all the placental activity unless
there is a major emergency. Watch for sudden gush of blood
and lengthening of cord. This means the placenta has
detached and is ready to be born. The placenta will
usually be pushed out easily by mother. You can assist the
mother to kneel or stand (still holding the baby) to allow the
placenta to fall out; be prepared to catch it in a bowl or pot
as a splattering placenta is really messy, AND it is still
attached to the baby! Or if the mother chooses to remain
lying down, you can use one of the gauze pads to grasp the cord
close to the mother's body. Ask her to tell you when she
is having a contraction, and then GENTLY tug on the cord with
gentle downward pressure to assist it in coming through the
birth canal. STOP if the mother complains of discomfort.
After the placenta is out, immediately press fingers slowly
and gently into abdomen at the mom's belly button - you'll
feel the top of the uterus. It may be somewhat spongy or
slightly firm or rock hard if she's having a contraction.
Do slow and gentle circular massage to encourage contraction of
the uterus. This is extremely important, especially if
there's a constant flow of blood. (You can put the placenta into
a clean plastic bag to contain the mess, and just tuck it
alongside the mother's hip as the baby nurses.)
Ideally, you can help the mother into a safe, comfortable
location within 15 minutes of the birth and then keep her
lying down for the next 1.5 to 2 hours. Women
usually feel strong for about 15-20 minutes after the birth, but
then weird things happen to blood pressure, and women often
faint if you try to get them up too soon after the birth.
At about 1.5 to 2 hours after the birth, she will need to
empty her bladder. Walk with her to the toilet
and stay with her in case she starts to feel faint. (You
can turn your back and check in every minute or so to assess her
well-being.) Ideally, you will have some clean (warm?)
water that she can squirt over her perineum to relieve the
stinging as she urinates and to clean the perineum
afterwards. Help her back to bed. She should urinate
at least every couple of hours while she is awake; a full
bladder prevents the uterus from staying contracted and may
increase her postpartum bleeding. Provide her with food
and drink as she desires.
Do not cut the cord until at least an hour after the
birth, unless the mother specifically requests it, or if you
need to move the mother and baby a long way to a safer location.
If you are moving the baby a short distance, you can just carry
the placenta close to the baby, with some slack in the
cord. Before you cut the cord, put an identifying band of
some kind on the baby with the mother's name and date of birth,
and put a matching band on the mother and father or other family
member. TO CUT THE CORD: use the sterile plastic
umbilical clamps to clamp the cord about 3 inches from the
abdomen, then 2 inches beyond that, and cut between the 2 clamps
with the disposable scalpel or any sterile knife or
scissors. You can sterilize a knife or scissors by
scrubbing it clean and then boiling for 20 minutes or soaking in
alcohol or hydrogen peroxide for 20 minutes.
Once you are safely past 2 hours after the birth, then just
encourage the mother to hold the baby close to keep the baby
warm. At this point, she may want to take a nap, so make
sure she and the baby are safe, warm and comfortable, and give
them quiet space to rest and recover. It's a good idea for
someone to remain in earshot for the next 24 hours at least.
DO NOT MESS WITH ANYTHING UNLESS HELP IS OBVIOUSLY
NEEDED. For example:
IF THE BABY IS BREECH - Most
babies are born head first, but 3-4% are born butt first, i.e.
breech. If you see a black tar-like substance coming out
of the mother, this may mean that the baby is coming butt
first. Or you may see feet, knees or the baby's butt
emerging. The reason breech is a concern is that the
largest part of the baby (the head) may not be easily
delivered. It is a clear benefit to the baby to have
professional help with a breech baby; if there is any way to
get help, do that now! If this is not a
first baby or the baby is a few weeks early or smallish, then
things will probably be completely fine and you should just
keep your hands off unless it's clear that help is
needed. However, if this is a first baby and seems large
or the mother is past her due date, then she may need some
assistance. Assist her in laboring as she desires until
she feels a clear urge to push. Then, help her as
follows:
Assist the mother to a position where she is lying mostly
flat on her back on a bed with her bottom at the edge and
her feet supported by chairs on either side. Encourage
her not to push until she absolutely has to; you can help
her not to push by panting with her through the contraction
with short breaths (one to two per second), like blowing out
individual birthday candles. Or she may find it helps
to vocalize like singing opera.
Once she is no longer able to pant through her
contractions and starts pushing involuntarily, it is helpful
to encourage her in strong bearing down efforts.
Keep your hands off the baby until the baby is
born to the level of the belly button. NOTE
THE TIME as the baby's head must be born within 8 to 10
minutes.
Then, wrap a warm towel or blanket around the baby's hips
to help support the baby's weight. As the shoulders
are being born, GENTLY help to rotate the baby's body so
that the baby's belly is towards the ground. The baby
must be facing towards the mother's back in order to
facilitate the birth of the head. When you see the
nape of the neck, allow the body to hang down completely,
with your hands off the baby but ready to catch the baby as
the head is born and released from the mother's body.
Encourage her to push strongly with the next two
contractions. If the contractions are spaced out so
that there is more than 30 seconds of resting time in
between, then it is a good idea to have someone do nipple stimulation to make the
contractions stronger and closer together. Have
a helper put the forefinger on one side of the breast, about
2" back from the nipple, and then put the thumb on the
opposite side of the nipple, also about 2" back from the
nipple,and squeeze firmly and hold the breast tissue as if
you were putting pressure where the baby's gums would
be. If you can roll your thumb towards the nipple,
that helps even more. Do this every 2 seconds and
don't be afraid to squeeze hard if necessary to save the
baby's life.
There is a lot of disagreement as to whether
non-professionals should do anything more at this point
because rough manipulation or excessive force may injure the
mother as well as the baby. So, proceed with more
advanced maneuvers only if you are calm enough to use very
gentle movement to help facilitate the birth. If you
have a choice among attendants to assist with internal
maneuvers, keep in mind that smaller hands may be more
helpful.
WHEN IN DOUBT - DO NOTHING!
If the shoulders or arms are stuck, gently slide a hand
up the baby's back and feel over the nearest shoulder and
then gently cup the baby's elbow or hold the baby's hand
to bend the baby's arm across the belly and then
straighten the arm to bring the hand out. Then do
this with the other shoulder and arm to bring the other
hand out. It is fine to rotate the baby's body a bit
by the hips to make more room for your hands to move from
one shoulder to the other. Be gentle or you may severely
injure the baby!
Once the nape of the neck is visible and the mother has
pushed very strongly with two contractions and the baby's
head still has not been born, you may need to take action
to save the baby's life. If the head is not
delivered within 3 minutes of the shoulders, gently raise
the baby’s legs to the ceiling until you can see the face
(do not pull the baby from the mother). Use two fingers or
your hand to press back the wall of the vagina away from the
baby's face. Wipe the face clear and suction the mouth
and then the nose so the baby can breathe. If the baby
does not make a sound or seem to breathe within ten seconds,
you should milk the cord to push oxygenated blood from the
cord into the baby's body. Do this by gently pulling
as much cord as you can out of the mother's body until you
feel more than a little resistance. Then push the
blood that is in the cord into the baby's belly.
Continue to encourage the mother to keep pushing until the
head is delivered. If the baby is breathing, then you
have lots of time for the head to finish being born.
Again, it is imperative for the safety of the mother
and the baby that your movements are very gentle . . .
just strong enough to get things moving. If the baby
is showing no signs of life, then you must further assist
the birth of the head so you can properly resuscitate the
baby. You can help by flexing or bending the baby's
head so the baby's chin is closer to the chest. You
do this by using your forearm to support the weight of the
baby's body as you gently bring you hand to the baby's
face. Put your middle finger in the baby's mouth to
make contact with the tongue and put gentle pressure on
the baby's lower jaw; put the second and fourth fingers on
the baby's cheekbones to help bend the baby's face closer
to the chest. This makes the head seem smaller to
the pelvis.
IF THERE IS CORD AROUND THE NECK
that is preventing the baby's body from being born - If
the cord is loose enough, you can loop it over the baby's head
or make a wider loop for the body to come through. If
that still doesn't work, then bring the baby's head up onto
the mom's thigh so the body can be born without the baby's
neck having to come away from the mother's body. DO
NOT CUT THE CORD UNDER ANY CIRCUMSTANCE. The cord
provides oxygenated blood to the baby for about 5 minutes
after the birth and is the best form of resuscitation.
Cutting the cord is cutting the baby's lifeline.
IF THE SHOULDERS ARE STUCK
- If it has been more than two minutes since the head emerged
fully to the baby's chin/neck, and the next contraction didn't
bring the baby, then the shoulders may need some help.
Assist the mother into a hands and knees position,
which will help to rotate the shoulders. If the next
contraction doesn't bring the baby, then help her to stand
up and put one foot up on a chair at her side and sort of do
a lunge. BE PREPARED TO CATCH THE BABY! If
the next contraction doesn't bring the baby, then you need to
assist with the birth by putting a hand inside with your
palm along the baby's back and then go sideways to help the
baby bend one shoulder forward and then go back across the
baby's back to help bend the other shoulder forward.
If you can hook a finger under the baby's armpit, you
can use gentle force to help bring the baby's shoulder out. If
the head is turning dark purple, then it is URGENT to get the
baby out as soon as possible. Go through all the
positions again: hands and knees, lunge against chair (try
other side this time), hands and knees again so you can try
bending the baby's shoulders forward again. If there is
someone present with smaller hands, ask them to try bending
the baby's shoulders forward. DO NOT PULL ON THE BABY'S
HEAD!
IF THE BABY IS UNCONSCIOUS
- If the baby is limp, with eyes closed and not making any
sound of any kind and no muscle activity, then the baby needs
help to start breathing. First, milk the cord.
This is the act of gently but firmly clamping two
straightened fingers (ring and index fingers) on either side
of the baby's umbilical cord, near the vagina, and quickly
moving the fingers towards the baby's belly so that the
blood from the umbilical cord is pushed inside the baby's
body. This achieves the same
effect as CPR but is quicker and simpler and requires no
equipment. If there is still reddish purple blood in
the umbilical cord, you can milk the cord a second
time. . . . If the baby still seems
unconscious or simply doesn't seem to be taking a breath,
then you can blow 3 times on the baby's face/mouth, as
if you're blowing out birthday candles. Use the bulb
aspirator to suck mucous out of the baby's mouth: Squeeze it
before putting it into the mouth, suck out the mouth, and then
squeeze out any contents onto a clean towel. Then
suction each of the baby's nostrils. If the baby is still
unconscious, then you need to start mouth-to-mouth
resuscitation. If you breathe too hard into the baby's
lungs, you can cause the lung to explode. So don't take
a big breath of air; just breathe in normally through your
nose, and then gently breathe out into the baby's mouth/nose,
keeping a good seal. Do this a couple of times and then
see if baby is breathing on its own. If not, breathe 15
times more for the baby, SMALL, SHORT puffs, about one per
second. If you can tell for sure that there is no heartbeat
(ideally by listening to the baby's heart with a stethoscope
or your ear), then you need to start chest compressions on the
baby. Use VERY gentle force - just two fingertips
between the baby's nipples, but turned sideways so they're in
line with the baby's sternum. CPR on a baby is done with
3 chest compressions to 1 puff of air, about 1 second for each
action.
IF THE BABY IS BREATHING BUT
NOT BREATHING WELL - It is OK if the baby is still
coughing or sneezing a bit, and it is normal for babies to
breathe about once per second, but if the baby is still
struggling to breathe about 2 minutes after the birth, it may
help to have the mother hold the baby with the head lower than
the body, with the mouth towards the floor, to help drain the
baby's airway. You could use the bulb aspirator to
suction the baby's mouth and then the nose. If the
baby's hands are cold, you need to find a way of warming the
baby. You could have the baby lying between the mother
and another family member to create a very warm space for the
baby. The baby must be naked to get warmth from naked
skin. Cover them all with a towel to create a warm area,
but make sure the baby can get enough air easily.
IF THE MOTHER IS BLEEDING TOO
MUCH - If you are not used to being at births, even
normal bleeding will look like way too much to you. It
is normal for the placenta to come with up to a cup of liquid
blood or blood clots. And it is normal for a woman to
lose up to another cup of blood over the next 15
minutes. But it's possible that she may bleed too much
(defined below). The baby's nursing helps to contract
the uterus to stop the bleeding, or you can do other forms of
nipple stimulation. When you don't have
appropriate medications, then the best way to stop bleeding is
with nipple stimulation, which causes the mother's body to
produce hormones to cause the uterus to contract, which is
what stops the bleeding. If the baby will nurse
vigorously, that is excellent. If not, then if the
mother has another young child who can nurse, then
that is very good. Or the mother's partner could
simulate breastfeeding by sucking with the nipple about
2" into their mouth. Alternatively, her helpers can
do manual breast compressions every 2 seconds, which is
very much like milking a cow if anybody there knows how.
Or you can put your forefinger on top of the breast, about 2"
back from the nipple, and then use your thumb on the bottom of
the breast, about 2" back from the nipple, and squeeze and
hold the breast tissue as if you were putting pressure where
the baby's gums would be. If you can roll your thumb
towards the nipple, that helps even more.
If the placenta is STILL
INSIDE and she is bleeding profusely (a river of blood -
more than a cup a minute) then it is best to do whatever you
can to get the placenta out. Use firm nipple stimulation to
create contractions. Try gentle, gradual pulling on the cord
while she is having a contraction.. If that doesn't
work, put your hand on the mother's abdomen, with the thumb
pointing downward and the top of your hand at her belly
button. Imagine that there is a small 8" cushioned
dinner plate that needs to be squeezed from the inside of a
cantaloupe. Put gentle pressure with your hand about
halfway down her abdomen. Do not push so hard that you
turn the uterus inside out; this could kill her; if this
happens, make a fist in the birth canal and shove the uterus
back inside to turn it the right way again. (If the mother
has already lost more than 3 cups of blood and the placenta
is still inside, then you need to put on fresh sterile
gloves and go inside the mother's body; find the
placenta by following the cord up until you feel firm tissue
like liver that is about the size of a small dinner plate but
about 1-2" thick. If you can grasp part of it and remove it in
one piece, that's great. If it's still partially
attached, make your hand like a spatula and gently work your
hand between the placenta and the mother's insides until the
placenta is fully separated and can be brought out in one
piece.) [NOTE - If you don't have any sterile gloves or
any gloves at all, it is OK to do this with the cleanest
possible hands and worry later about infection; it's a lot
better than watching her bleed to death.]
If the placenta is OUT and
she is bleeding profusely - After the placenta is out,
then if it ever seems that the blood is flowing so fast that
she is losing more than half a cup a minute, then you need to
take action as described in Step XX. After the
placenta is out, you can "rub up a contraction"--after
the birth, the uterus is like a cantaloupe between her pubic
bone and her belly button. You can massage her belly
below the belly button until you feel the uterine muscle
contracting under your hand. If nothing else is
working, you can put a fist in the middle of her abdomen,
halfway to the belly button. Then push down gently but very
firmly; she may complain of pain, but this is the only kind of
pressure that will stop the bleeding. (Putting pressure
on the outside of the birth canal - the vulva - does nothing
to stop the bleeding.)
IF THE MOTHER'S PERINEAL TISSUES
HAVE TORN BADLY - Most women do not need suturing when
the baby is born calmly in a side-lying position. Many
women will have a perineum that looks very bruised and
swollen, and it is very difficult even to tell if the tissues
are torn. Suturing can wait 6-12 hours in an emergency.
Ideally, you will be able to find someone within that time
frame who can evaluate the perineum and suture the tissues if
necessary. In any case, you do not need to clean a
perineal wound if the birth occurred in a reasonably clean
area. If the area was dirty, you could gently pour the
saline irrigation fluid over the perineum to wash out the
tears a bit. Then instruct the mother to keep her knees
mostly close together while the tissues are healing.
(Try to keep the insides of the knees within 18" of each
other; no tailor sitting to breastfeed!) She should keep
her knees together and clench her bottom when she gets up and
down from bed or the floor.)
IF THE MOTHER IS WEAK FROM BLOOD
LOSS - Help her to drink at least 2 cups of fluid.
If she has lost a lot of blood, help her to drink 2 more
cups. This will keep her blood pressure up so she will
not lose consciousness. If she starts losing
consciousness, treat for shock (lying down with head lower
than body, legs raised) and get as much fluids into her while
she is still conscious. Do not give fluids to someone
who is unconscious. In addition to lowering her head,
you can also have multiple people massaging her legs to move
blood towards the heart and brain. Sheets or towels
wrapped tightly around the legs can help keep blood pressure
up. Once she regains consciousness, have her drink 4
cups of fluid within five minutes and wait until she feels
very solid before allowing her to raise her head again.
IF THE BABY IS NOT ABLE TO NURSE
- A healthy full-term baby in a warm, stress-free environment
can go for 24 hours without food. However, if the baby
looks skinny (no baby fat) or if you cannot keep the baby in a
warm, stress-free environment or the baby needed help
breathing, then the baby must nurse within 2 hours after the
birth and then every 2-3 hours. Or if the baby's body feels
cold or the baby is very jittery, then the baby needs some
nutrition right away. If the mother is not well enough
to nurse the baby, but will probably be well enough in a few
hours, then you can tide the baby over with some corn syrup or
maple syrup on the baby's gums or even some white or brown
sugar or molasses in sterile water on a clean spoon. (NEVER
USE HONEY as this may contain botulism spores.) The baby
doesn't need much--just about a teaspoon of sugar at each
feeding, anytime the baby wakes or cries from hunger. If
you think that the mother will not be well enough to feed the
baby for more than a day, then try to find another woman in
her family who is currently lactating and will be able to
nurse the baby on an ongoing basis. Do not ask a
stranger to do this unless it's a matter of life and death, as
HIV and other blood-borne diseases can be transmitted through
breastfeeding. If you cannot find anyone to nurse the
baby at all, then use one of the approved syrups (NOT HONEY!)
until you can find some prepared formula for the baby.
In a real pinch, any nursing mother could express milk onto a
clean spoon to be used to feed the baby; this protects the
nursing mother from the baby's germs.
