Have Medical Questions? Ralph La Guardia M.D., author of The Doomsday Book of Medicine, will answer them! Here is a question that we had that he answered. See below for more details!
Question: When delivering a baby in a primitive environment without professional medical assistance such as a cabin in the woods or barricaded in an emergency medical shelter, what are the minimal steps to ensure the baby is delivered safely as well as protecting the health of the mother?
As Prepper’s besides severe trauma cases the delivery of a baby could be one of our most challenging scenarios. It is very likely that we will find ourselves in this situation , especially as time goes on and the medical system as we know it collapses completely from a combination of personnel loss , lack of power , loss of medications and the eventual fragmentation of the survivors into smaller and smaller groups which food supplies will eventually necessitate.
As with all disaster scenarios the delivery of a baby will be made infinitely easier if you have someone in your group that has experience with deliveries . This could be a doctor , nurse , midwife or physicians assistant . If you do not have anyone with such experience then you will have to follow the steps I outline below.
Once the mother to be presents herself to you and determines that she might be going into labor the first thing you must do is to figure out how far along she is . Labor comes in two stages , the latent stage and the active stage. To determine which stage you are in you need to evaluate the cervix. First lets define what a cervix is. The cervix is a cylinder shaped neck of tissue above the vagina , it is at the far end of the vagina and is the passage between the vagina and the uterus.above it. The bottom of the cervix has a mouth like opening that can be felt at the top of the vagina and is often referred to as the cervical os . This is the part that allows you to determine what stage of labor the mother is in.
During the latent stage the body is getting ready to deliver the baby and as you imagine it has to open up the cervix to allow the baby to pass from the uterus to the vagina . This opening of the cervix is known as dilation . Depending on how many children the mother has already delivered , it may be short if she has had many children or this latent stage is frequently long in first time mothers. To determine the current stage she is in you need to insert your hand in her vagina and go to the top of it and feel the cervix. Now in a non pregnant female it will feel hard like the tip of your nose . In a pregnant woman it will be soft like the lips to your mouth , and you will be able to slip your fingers into it. That is the tricky part , you need to measure how dilated the cervix is. When it is fully dilated ( and delivery is imminent ) the cervix will be dilated to 10 cm ( approx. four inches ) . What that means is that you will be able to slip (gently) four fingers into the cervix and circle them around. When you reach this level of four fingers into the cervix then get ready the delivery is coming and you are in what is known as ” active labor” . At this stage you may feel the head of the baby as it starts to cross the cervix towards the vagina , this is known as “crowning”.
Next you need to consider her “contractions” to determine how close she is to delivery. Contractions are a shortening of the uterus musculature , the body does this to squeeze the baby out thru the cervix into the vagina to be delivered. You will need to time the contractions . When contractions are ten minutes apart or less the mother has entered into active labor. As the birth of the child nears two things will happen the contractions will become more frequent and they will last longer. First time mothers are likely to give birth when the contractions are three to five minutes apart and last from 40 to 90 seconds each, with this pattern increasing in strength and frequency for at least an hour. When the contractions are two minutes or less apart get ready to rock and roll little Ralphie is about to be delivered. Hey, I get to name the baby this is my article. Keep in mind , mothers who have already had children will go more rapidly to the delivery stage than first time mothers. Another hint that the birth is about to happen is that the mother will think she is having a bowel movement , this sensation is the baby passing thru the cervix into the vagina , the reason being is that the passage of the baby puts pressure on the rectum and mimics the feeling of a bowel movement.
At around this point in time , you need to clean your hands and fingernails as best as possible. Scrub your hands and forearms all the way up to your elbows on both sides , being extra careful to clean any dirt from under your fingernails. Scrub yourself thoroughly for at least one minute . If you have any alcohol based hand sanitize-rs then now is the time to use them.
Giving birth is a very messy process, so do so in an area that you have already prepared with clean sheets etc. Provide a chair or bed where the mother can be as comfortable as possible , after all she is going through a very traumatic , painful process , so a little comfort can go a very long way. If you have a helper available then he or she can act as a birth coach , encouraging the mother and reassuring her , this too will help facilitate an easier delivery for everyone involved.
Get a bunch of clean towels , put a tarp or a waterproof barrier below the mother , such as a vinyl shower curtain . Keep some clean , warm towels to wrap the baby in once it is delivered , it will need to be kept warm. Get a bucket handy in case the mother vomits. Get the following items: A large bowl with warm water , a pair of scissors, some lengths of string, rubbing alcohol , cotton balls , sanitary napkins or paper towels ( to help stop the bleeding that may occur after the birth ) .
Encourage the mother to breathe , slow deep breaths , avoid hyperventilating ( breathing very rapidly ) . Speak in a slow , reassuring voice to help keep her calm The mother should be encouraged to take long deep breaths in through her nose and out through her mouth. I would remind an anxious mother that this has been done for thousands of years outside of hospitals all over the world without any problems.
Positioning of the mother can help her pain and discomfort and facilitate the birth. There are four basic positions the mother can assume to help with her delivery. The first is squatting, this is the age old method still done in most third world countries, the reason being that it allows gravity to aid in the delivery. This position also helps open the birth canal about 25 percent more than any other position. Another complication to keep in mind is a “breech” birth , this means that instead of the baby’s head coming out first , the baby is rotated and the feet are first. If a breech presentation occurs , squatting is the easiest way to deliver the baby because it allows the most room to rotate the baby. Note: someone should kneel behind the mother and support her back.
The second position is on all fours, this is gravity neutral but many women still prefer this position , especially if they suffer with hemorrhoids that may be painful during the birthing process.
The third position is lying on her side, this can lead to a slower descent of the baby thru the cervix , and thus allows for more stretching of the mothers body and less trauma such as tearing and bleeding. She should lie on her side with her knees bent and lift her top leg, while propping herself up on one elbow.
The fourth is the most common position and is with the woman lying on her back with both legs bent at the knee. This is the one used in most hospitals and is known as the lithotomy position . Put a few pillow under her back to support her and keep her comfortable. This is the easiest for the assistants but the most painful for the mother due to pressure on the mothers spine resulting in back pain.
The next step is one of the trickiest , guiding the mother in her pushing. The pushing naturally helps the passing of the baby thru the mothers birth canal. One of the first things to do is to have the mother lean forward and tuck her chin onto her chest. That position helps the baby pass thru the pelvis. The mother should be instructed to hold her knees or legs with her hands and pull them back. Hopefully at this point you will see her vagina begin to bulge out and then the crowning occurs ( you see the head of the baby as it emerges ). Now it is time to rock and roll and the mother really has to push to assist the birth. Tell the mother to push as hard as she can , tell her as if she was straining to pass a large bowel movement. Try to have her make each push last for six to eight seconds , therefore having about three or four pushes per contraction. Also encourage the mother to stay calm and take long deep breaths , this will greatly help the birthing process, keep reassuring her that everything is going fine and little Ralphie is on his way. It is very likely at this point that she will either urinate or have a bowel movement or both, this is normal .
KEY POINT ; As the baby’s head emerges be very careful to support it gently and NEVER pull on the baby’s head or pull the umbilical cord, either of which can cause nerve damage to the baby. Frequently the cord is wrapped around the baby’s neck , in this case gently lift it over the baby’s head or carefully loosen it to allow the baby to slip thru the loop. Remember do not pull the umbilical cord. The most ideal position is for the baby to be face down as it passes thru the birth canal , this means the face of the baby will be facing the mothers spine . Remember also to carefully support the baby’s head , since its neck is not yet strong enough to support its head.
After the head presents , it usually rotates to one side or the other, this is a signal that the baby’s body is about to emerge . If it does not rotate then ask the mother to give another gentle push , usually one shoulder emerges first and then the other. At this point keep supporting the head and lift the baby towards the mothers stomach , the body will be very slippery , be careful not to drop the baby.
If the baby’s body does not come out after the head , then have the mother lie on her back and grab her legs and pull them towards her head and have her push hard with each contraction ,this is a very effective position to help the passage of the baby thru the birth canal. You should never push on the mothers abdomen , this does nothing and potentially could injure the baby.
If the baby is a breech delivery ( feet first instead of the head ), then have her assume the same position as described above , pulling her legs back , have her sit on the end of the bed. Do not touch the baby’s body , this could make the baby gasp for air while it is still submerged in amniotic fluid and aspirate or choke on the fluid. If possible make sure the room is warm , if it is cold the baby could also be stimulated to gasp .
Once the baby emerges completely hold it with both hands with the head down at a 45 degree angle , this allows fluids to drain from the mouth and the nose . You can also gently rub your fingers down both sides of the baby’s nose , this will also allow any fluid to escape the nose. Now put the baby on the mothers chest , with full skin to skin contact between the mother and baby. Cover them both with warm towels if possible . This skin to skin contact causes a hormone called oxytocin to be released which will cause the uterus to contract and deliver the placenta.
Now , make sure the baby is breathing . If it is crying slightly then it is breathing and this is normal. If it is not breathing then you must act quickly to ensure the safety of the baby. The latest thoughts are not to slap the baby like we all saw in countless movies. Instead while the baby is still lying on mothers chest rub its back with a towel , if this does not work then put the baby on its back with its head facing the ceiling and its back on the mothers chest, tilt its head back this will straighten the airway and allow the baby to breathe. If the baby starts to turn blue then it is not breathing , usually this is a mechanical obstruction from fluid . Immediately wipe any fluid out of the baby’s mouth and nose. If this fails , then you need to use a bulb syringe ( like a turkey baster ) and flatten the air out of it and insert the tip in either nostril and the mouth and suck out the fluid , this can also be done with a straw with you gently sucking on one end. If this fails then flick your fingers on the baby’s feet or gently swat its butt. Do not slap the baby hard .
The next stage is delivering the placenta or after birth. The placenta is the sac around the baby that acts as an interface between the mothers body and the baby’s. The baby is attached to the placenta by the umbilical cord ( at its belly button or umbilicus ). The delivery of the placenta is the third and final stage of the birthing process. Usually the placenta arrives from a few minutes to an hour after the delivery of the baby . Right before the placenta is passed the umbilical cord will grow longer and the mother will start to bleed thru her vagina . Have the mother push and you can assist her by firmly rubbing the mothers stomach from her belly button down towards her vagina , this will also help slow the bleeding from the mother.
Now , if the baby can reach the mothers breasts without stretching the umbilical cord too tightly , then allow it to breast feed. Breast feeding is very healthy for the baby and will help stimulate the uterus to expel the placenta more easily. Whatever you do , DO NOT PULL ON THE UMBILICAL CORD TO HELP THE PLACENTA EMERGE, THIS WILL INJURE THE MOTHER.
Now you need to cut the cord . First you need to feel the umbilical cord for a pulse , do not cut it until the pulse stops. After about ten minutes the pulse will stop , this is the sign that the placenta has separated from it , do not cut the cord until there is no pulse remaining. Be careful the cord is slippery , but the good news is that it does not have nerve endings in it , so cutting it will not be felt by either the mother or the baby . Now take those two pieces of cord or string that you have and tie a double knot about three inches from the baby’s belly button and another double knot about two more inches away from the baby. Use a sterile knife or scissors and cut between the two knots. You can sterilize your instruments by either boiling them in water for twenty minutes or wiping tem down with alcohol or hydrogen peroxide.
Keep the baby warm and comfortable as well as the mother . The mother can now take Tylenol for pain or ibuprofen etc. Ice packs on the mothers abdomen can also help her pain . You can give the mother something light to eat or drink , but nothing too sweet , which may cause her to vomit , this is perfectly normal.
In case the mother is bleeding , which occurs in about a fifth of deliveries , then you should massage her uterus thru her abdomen, this means massaging her abdomen firmly below her navel or belly button. Another method to slow bleeding is to place a clean hand inside her vagina, put your other hand on the abdomen and push up with the hand inside and down with the hand outside, this will help to control bleeding. Do not give aspirin which causes more bleeding to occur.
Following the above instructions will allow little Ralphie or in the case of a girl little Ralphina to be delivered safely and healthily in a survival situation.
-Dr. Ralph La Guardia M.D.
Have Medical Questions? Ralph La Guardia M.D., author of The Doomsday Book of Medicine, will answer them! Send your questions to Administrator@planpreparesurvive.com or use our contact page.
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