LABOR AND DELIVERY
Posted by Rachel Murphy
CHILDBIRTH
In
the event that a wide spread natural disaster should strike our area
there would be several expectant mothers who would go into labor either
because it is time or they would experience premature delivery because
of the shock and trauma they have experienced in the disaster. Inasmuch
as hospitals and other medical facilities would not be accessible or
perhaps even be nonexistent it is necessary that a thorough
understanding of the birthing process be had to insure as safe and as
easy a birth as possible under the circumstances. Birth is a natural
event and should not
be feared, even if no medical facilities,
doctors, or nurses are available. The following guidelines are intended
to assist you in this natural process and will be applicable to most
births. It is especially important to remember that during times of
natural disaster great care should be taken to insure proper sanitary
conditions are maintained during childbirth.
LABOR IS DIVIDED INTO THREE STAGES:
1) First stage – The womb contracts by itself to open and to bring the baby down to
the birth canal
2) Second stage – The mother pushes (bears down) with the contractions of the
womb to help the baby through the birth canal and out into the world
3) Third stage – The afterbirth is expelled
First Stage
In
this early part of labor it is often helpful for the mother to keep
occupied as long as she does not get too tired. She should be patient
and clam, relaxing as the contractions come and go and breathing slowly
and deeply during the contractions as they become stronger. Emptying the
bowels and frequent urination will help to relieve discomfort. The
mother will know she is in true labor if she has regular contractions of
the womb which are prolonged and become stronger and closer together.
When she knows the baby is on the way, she should choose a place to have
the baby that will be clean and peaceful. She should be able to lie
down or sit in a leaning position (with her back well supported).
The following events occur as part of the first stage of labor and delivery.
1) The state of dilation; the first signs may be only noticeable to the mother – dull, low
backache and irregular cramping pains (contractions in the lower abdomen).
2) As labor progresses, the contractions become stronger, last longer, and become more
regular. When the contractions recur at regular 3-4 minute intervals and last from 50-
60 seconds, the mother is in the latter part of the first stage.
3) The contractions will get stronger and more frequent. Occasionally the mother may
make an involuntary, deep grunting moan with contractions. The delivery of the baby
is now imminent
During
“First Stage: those helping the mother should know how to time the
contractions. This information will give them an idea as to how far into
labor the mother is and how much time remains until the baby comes.
Place a hand on the mother’s abdomen just above the umbilicus. As
contractions begin, you will feel a hardening ball. Time the interval
from the moment the uterus begins to harden until it completely relaxes.
Time the intervals in minutes between the start of one contraction and
the start of the next contraction. As labor progresses this time will
decrease.
DON’T LEAVE THE MOTHER ALONE
Do
not attempt to wipe away vaginal secretions, as this may contaminate
the birth canal. The bag of water may rupture during this stage of labor
and blood-tinged mucous may appear. At the end of the first stage, the
mother may feel tired, discouraged, and irritable. This is often
referred to as “transition” and is the most uncomfortable part of labor
and such feelings are perfectly normal. The mother may have a backache,
may vomit, may feel either hot or cold (or both at the same time), and
may tremble. Firm hand pressure on the lower back by those attending the
mother may help to relieve the backache. Alternately, the mother may
prefer to lean her back against a firm surface. Deep rhythmical
breathing helps to relieve annoying symptoms. The discomfort seldom
lasts for more than a dozen contractions. When the womb is (almost)
fully opened, the baby may enter the birth canal, and there may be a
vocalized catch in the mothers breathing when she has a contraction.
This will signal the onset of the second stage.
Second Stage
The
contractions of the second stage are often of a different kind. They
may be further apart and the mother usually feels inclined to bear down
(push) with them. When she gets this feeling she should take a deep
breath as each contraction comes, hold her breath and gently push. There
is no hurry here. The mother should feel no need to exert great force
as she pushes. She may want to push with several breaths during each
contraction. After it passes, a deep sigh (cleansing breath), will help
her recover her breath. She should then rest until the next contraction.
She may even sleep between
contractions.
The following are general instructions for the second stage of labor:
1) Be Calm! Reassure the mother and be prepared to administer first aid to both the
mother and the baby (possible respiratory and cardiac resuscitation for the baby and
hemorrhage control and prevention of shock for mother).
2) Prevent onlookers from crowding around the mother.
3) Use sterile materials or the cleanest materials available. Clean towels or parts of the
mother’s clothing can be used. Place newspaper under the mother if it is available. If
she must lie on the ground, place a blanket or other covering under her.
4) In order to prevent infection, refrain from direct contact with the vagina.
5) Prepare for the delivery by assisting the mother to lie on her back with her knees bent
and separated as far apart as possible. Remove any constricting clothing or push it
above her waist.
6)
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. The mother will
now feel a stretching, burning sensation. She must now no longer push during the
contractions, and to avoid this, should pant (like a dog on a hot day). This will allow the
baby’s head to slide gently and painlessly out of the canal.
If possible allow the head to emerge between contractions.
This
will prevent the mother’s skin from tearing and will minimize trauma to
the baby’s head. It is important that the mother pant instead of
pushing until both of the baby’s shoulders have emerged.
DELIVERY OF THE BABY
As
the baby’s head emerges, it is usually face down. It then turns, so
that the nose is turned towards the mother’s thigh. Support the baby’s
head by cradling it in your hands. Do not pull or exert any pressure.
Help the shoulders out. For the lower shoulder (which usually comes
first), support the head in an upward position. As the both shoulders
emerge be prepared for the rest of the body to come quickly. Use the
cleanest cloth or item available to receive the baby. Make a record of
the time and approximate location of the birth of the baby. With one
hand, grasp the baby at the ankles, slipping a finger between the
ankles. With the other hand, support the shoulders with the thumb and
middle finger around its neck and the forefinger on the head (Support
but do not choke). Do not pull on the umbilical cord when picking the
baby up. ‘Raise the baby’s body slightly higher than the head in order
to allow mucous and other fluid to drain
from its nose and mouth. BE VERY CAREFUL, as newborn babies are very slippery.
The baby will probably breathe and cry almost immediately. If the baby doesn’t breathe
spontaneously,
very gently clear the mouth of mucous with your finger and stimulate
crying by gently rubbing its back. If all this fails, give extremely
gentle mouth-to-mouth resuscitation.
Gently pull the lower jaw
back and breathe gently with small puffs (a minute). If there seems to
be excess mucous, use your finger to gently clear the baby’s mouth. The
mother will probably want to hold the baby. This is desirable. If the
umbilical cord is long enough, let her hold the baby in her arms. If the
cord is short, support the baby on the mother’s abdomen and help her
hold it there.
It is of benefit to the baby and makes the afterbirth
come with less bleeding if the baby can be allowed to suckle at the
breast as soon as it is born. The cord should not be cut until the
afterbirth has completely emerged.
Third Stage
The
placenta delivery or afterbirth is expelled by the womb in a period of a
few to several hours after the baby is born. No attempt should be made
to pull it out using the cord. Immediately following the afterbirth,
there may be additional bleeding and a few blood clots. The womb should
feel like a firm grapefruit just below the mother’s navel. If it is
soft, the baby should be encouraged to nurse, and the mother may be
encouraged to gently massage the womb (others may do this for her if she
feels too weak). These actions will cause the womb to contract and
lessen the chances of bleeding. The baby has some danger of getting an
infection through the cut cord, so it should not be cut until sterile
conditions are available. If there is a possibility of getting medical
help within a few hours, do not cut the cord but leave it and the
afterbirth attached to the baby. If there will be no medical help, wait
until the afterbirth is out, or at least until the cord is whitened and
empty of blood. After the baby begins breathing, the cord should stop
pulsating and become limp. As the placenta separates from the uterus,
the cord will appear longer. Wait for the delivery of the placenta. It
will usually be about 10 minutes or longer before the placenta is
delivered (though it could be a few hours). Never pull on the cord. When
the placenta appears, grasp it gently and rotate it clockwise. Then tie
the cord in two places – about six inches from the baby using strips of
material that has been boiled or held in a hot flame. The placenta and
attached membranes must be saved for a doctor’s inspection. Leaving the
cord and placenta attached to the baby is messy but safe. Save all
soiled sheets, blankets, cloths, etc., for a doctor’s examination. Check
the amount of vaginal bleeding; a small amount (1 to 2 cups) is
expected. Place sanitary pads; or other sanitary material over the
vaginal and perineal areas. Then cover mother and baby but do not allow
them to overheat. Continue to check the baby’s color and respiration.
The baby should not appear blue or yellowish. When necessary, gently
flick your fingers on the soles of the baby’s feet; this will encourage
it to cry vigorously, thus filling his lungs with oxygen and promoting
the cardio-vascular system to function properly. The mother will
probably need light nourishment and will wish to rest and watch her
baby. She should keep her hands away from the area surrounding the birth
outlet. If uncontaminated water is available, she may wish to wash off
her thighs. She may get up and go to the bathroom or seek better
shelter.
All care should be taken to avoid introducing infection into
the birth canal. The mother can expect some vaginal discharge for
several days. This is usually reddish for the first day or so but
lightens and becomes less profuse within a few days.
Stay with the mother until relieved by competent personnel. This is a relatively dangerous period for the mother, as hemorrhage and shock may occur.
Almost
all emergency births are normal. The babies typically thrive and
mothers recover quickly. It is very important when assisting with all
emergency deliveries that you continually reassure the mother and
attempt to keep her calm.
Jan Jone Youngs Inforamtion on Birthing
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