First aid for emergency childbirth

The safest place for the mother who is about to deliver her baby is in the maternity department (unless another location has been planned!), sometimes this is not possible and pre-hospital delivery of the baby is necessary.Childbirth

Remember that women have been performing the function of childbirth for a long time, and the process is natural. First aiders are there to provide any help that may be required during a process that is controlled by the mother. Your active intervention is necessary only in extreme situations.

The initial step is to decide what has happened and what stage of delivery the mother is at. Attempt to determine if any of the following are present:

  • Show. This is a loss of mucus, often blood stained, from the plug that keeps the cervix closed. Labour can start any time after this although it could be as long as a few days.
  • Waters have broken. This means the membranes holding the amniotic sac, which contains the baby and the amniotic fluid, have started to leak. It can happen suddenly, but is more likely to be a gradual trickle.
  • Intermittent pain. There is usually pain accompanying contractions of the uterus. It’s probably labour if the contractions last more than 40 seconds and are occurring about every three or four minutes.
  • Bleeding. There is a possibility of vaginal bleeding before, during and after labour. This should not be confused with the show

For delivery deemed to be imminent, at least two of the following are present:

  • regular contractions at one to two minute intervals;
  • an urge to push or bear down. In general, if the mother has the urge to push, the delivery will take place within an hour for the first baby, but within 30 minutes for second and later pregnancies.
  • crowning (the top of the head visible in the vagina).

If there are any potential complications, such as severe vaginal bleeding, prolapsed cord (cord protruding from the vagina), continuous abThree stages of labourdominal pain, pres-entation of part of the baby other than the head) immediately request for further medical assistance.

Childbirth is open to infection. It is imperative that you take all possible precautions against infection from yourself and from the surroundings. Ensure that you wear gloves (if available) during the process.

Labour is divided into three stages:
> First stage – the womb contracts and the baby moves into the birth canal

Second stage – the mother pushes with the contractions of the womb to help the baby through the birth canal and out

> Third Stage – the placenta is expelled

First stage

The first signs are low-backache and irregular contractions. The contractions cause the baby’s head to be pressed down through the pelvis and against the inside of the cervix. This causes the cervix to stretch open allowing the baby’s head to pass through into the vagina and onwards into the outside world.

When this stage is reached, then the first stage of labour is completed and the second stage is about to begin. The first stage generally lasts up to 12 hours in a first labour and ten hours in subsequent deliveries, but each labour is different.

First aid management of the first stage is simply reassurance for the mother and preparation for later stages.

Second stage

The second stage starts when the cervix is completely open (10 cm dilated). The woman usually has the sensation of fullness in her vagina or bowel and wishes to push. Most women will find that the labour pains in the second stage of labour are more bearable, as they can now actively help themselves by pushing.

Support the mother in a comfortable position.  Remove any constricting clothing or push it above her waist, protecting modesty at all times though the use of blankets or similar.

The second stage of labour ends with the delivery of the baby. It usually lasts for 30 minutes to two hours in a first labour and 10 to 60 minutes in subsequent deliveries.

When the baby’s head reaches the outlet of the birth canal, the top of the head will first be seen during contractions but will then become visible all the time. 

Do not apply any pressure on the baby’s head to control descent, simply allow the head to slowly advance with each contraction. Check to see if the cord is around the babies neck – if it is, loop it over the head. 

Wipe the baby’s nose and also any fluid 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.

Quickly and thoroughly dry the baby using a warm towel ensuring that the head, trunk, axilla and groin are dry. This will remove the amniotic fluid and encourage the baby to breathe. Remove the wet towel and wrap in a towelling baby robe or similar and another blanket.

When covered, place the baby with its mother in a position where the mother can feed if she wants to and help keep the baby warm. The action of breast feeding will also encourage delivery of the placenta and reduce bleeding.

Third stage

The placenta or afterbirth is expelled by the womb in a period of a few minutes to several hours after the baby is born. No attempt should be made to pull it out using the cord as this could rupture the cord, making delivery of the placenta difficult and causing excessive bleeding.

The placenta should be delivered into a bowl or plastic bag and ensure the placenta, blood and membrane are kept for for the midwife to inspect. Immediately following the afterbirth, there may be additional bleeding (normally less than 300 mls) and a few blood clots.

If bleeding continues after the delivery of the placenta, palpate the abdomen and feel for the top of the uterus. The womb should feel like a firm mass just below the mother’s navel. If it is soft, the baby should be encouraged to feed and uterus massaged with a circular motion to encourage womb contraction and reduce the bleeding. Monitor the mother and treat for shock if necessary. 

Stay with the mother until relieved by a midwife or other health care professional. Almost all emergency births are normal. The babies typically thrive and the mothers recover quickly. It is very important when assisting with an emergency delivery that you continually reassure the mother and attempt to keep her calm.

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