In this edition of What If?, we pose the question: What if...
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This article is meant to be a quick overview and not a detailed guide on obstetrics and child delivery. Consult a trained medical professional or accredited healthcare agency before even considering these techniques.
When you realize you’re going to have a child, it seems that the planning never ends. Selecting a name, shopping for clothes, and going to Lamaze classes are all part of preparing for the big day. But people often forget to plan for one outcome that happens a lot more often than you’d expect: delivering a baby before medical assistance can be reached.
We all hear about those stories on the news — the baby was in a hurry to get here or some complication prevented the mother from getting to the hospital and the delivery had to take place without a doctor or nurse. You may have heard about a woman who recently went into labor at a San Diego Padres game. The delivery came so quickly that it had to be performed at the stadium. Fortunately, the mother was lucky enough to be assisted by a nurse who happened to be there.
But what if she’d been somewhere remote, without the help of that experienced Petco Park staff nurse who happened to be a midwife as well?
Don’t think it can’t happen to you. If your car breaks down, you’re snowed in, or just happen to be somewhere isolated and you have to deliver a child on your own, you need to know what to do. Your child’s life may depend on it. Here at OG we believe in preparing for the when, not the if. Here we’ve put together some basic how-tos if you’re alone and have to self-deliver or help the mother deliver and may only have small household items at your disposal to aid in the process. It should be reiterated that we’re not advocating child delivery outside of a hospital setting; however, we know that emergencies do occur when medical help cannot be reached. We took the time to speak to some subject-matter experts to outline the steps to take should you be put in that situation.
First of all, it pays to be prepared. Don’t assume you’ll be able to reach the hospital in time — plan ahead, especially if you’re nearing the due date or know you’ll be in a location where reaching a hospital in a timely manner may be difficult. Certain airlines and cruise ships impose restrictions on traveling while pregnant and may require written permission by your doctor before allowing you to travel. These vary among companies and should be investigated well in advance. It’s best to consult with your doctor before taking any extended travel, especially during the third trimester. Your doctor may recommend against it, particularly if any irregularities have been detected during your pregnancy.
At the very least, whether traveling or staying home, plan out routes to nearby hospitals. If you’re traveling, are unfamiliar with the area, or will visit multiple locations, you should research hospital proximity for every stop you intend to make. The last thing you need is trying to figure out where to go and how to get there when labor has begun.
You’ll want to prepare a go-bag with spare clothes and any medication you’ll need to be on as directed by your doctor to safely continue during and after your pregnancy. Other essentials you should pack are diapers, baby clothes, spare food, baby bottle, and breast pump. Some people even forget that once they leave a hospital, they’ll need a car seat for the baby. Best to have one of those beforehand.
Commercial OB kits are great resources to have on hand in preparation for a possible unassisted childbirth. The contents are sterile, available for purchase at virtually any medical supply store or website, and are relatively inexpensive. Assembling your own kit is another option (see sidebar on page 40 for content recommendations). It’s advisable that you bring it with you or store some OB kits in places you may be staying. You can never be absolutely certain when the mother may go into labor, and you have to deliver at home, in the car, or in a location where no help is available.
It’s also recommended you take an infant CPR course. If you plan on becoming a new mother or father — check out CPR courses in your area so you can better prepare yourself should you need to perform this procedure after the delivery if your baby is having difficulty breathing.
Let’s say you are completely caught off-guard. An emergency forces you and your pregnant wife to leave home in a hurry, and her delivery date is quickly approaching. The next thing you know, you’re staying in a secluded place with only basic household items at your disposal. Then the labor process begins, and the likelihood of reaching a hospital or paramedics is low. It’s looking like you’ll have to deliver the child because you have no other option. What do you do?
First of all, don’t panic. Women have been successfully giving birth since long before hospitals and modern medicine existed. Stay calm and pretend you’re back in log cabin days when it was common for women to deliver at home. If you have a phone and can call 911, do so and follow the instructions of the dispatcher so they can walk you through the process, and you can report any problems. There are various complications that can occur during the birth process. We can’t cover every possibility, such as Caesarean sections, so the process detailed here is with the assumption that you are dealing with a normal baby delivery.
If you can’t call for help and the mother starts going into labor, see if you can quickly assemble the following items in preparation for the delivery:
“As labor gets underway, the mother will need to do what’s comfortable for her. She may want to walk around, and if it’s early enough, she can still eat and drink. Being hydrated and fed are important, especially if the labor is long,” says April Schwartz, a 10-year paramedic who has delivered four babies in the field. “Keep track of the contraction intervals. When they are consistently three to five minutes apart for about an hour, the delivery is imminent.”
Contractions occurring less than two minutes apart and the mother complaining of the urge to bear down are telltale indications that the delivery process is about to start. If you’re seeing these signs, have the mother lie down and get comfortable. Lying down is not imperative, but when she begins to push this will help you be in a better position to deliver the baby. Your role is basically to assist the baby’s birth. The process happens by itself and you’ll need to help guide the baby as best you can.
Begin by washing your hands thoroughly and wearing sterile gloves if possible. When you begin seeing the baby’s head “crown” (presence of baby’s head at the birth canal), the birth process is beginning.
“You never want to reach in and grab or pull,” says Schwartz. Check to see if the umbilical cord is wrapped around its neck. If the cord appears to be wrapped around the neck, this can be problematic and prevent the baby from breathing. “Place two fingers under the cord and guide it over the baby’s head so it’s not wrapped, taking care not to force the cord by pulling it,” says Joe Ferraro, a 15-year paramedic who has delivered three babies in the field and teaches EMS child delivery at a junior college in San Diego County. “You just want to loosen the cord as best you can and make space between the neck and cord as the delivery progresses.”
If you are still unable to free the cord after trying to guide it over the baby’s head, clamp the cord in two spots with clamps in the OB kit or by tying a couple lengths of string a few inches away from each other on the cord and cutting it in between the two clamps or ties. This will keep the cord from causing a constriction. If you have a sterile knife or scissors, they can be used to cut the cord. Usually the cord is not around the baby’s neck and, if that’s the case, the delivery will continue to progress normally.
If a shoulder begins to present, you want to apply a minimal amount of unilateral pressure so the other can come out. Tilt the head up slightly so one shoulder can be relieved, and then the other shoulder. Usually the baby is turned sideways during a normal delivery. You do not want to push on the top of the baby’s head — their cranial bones are very soft and pressure to the top of the head can cause brain injury. Just apply light pressure so it’s not an explosive delivery. Do not pull or push the baby, just guide it as the head is coming out while the mother pushes.
Once the shoulders are relieved, the baby will begin to expel rapidly. Help gently guide it out to keep it from falling. Once it’s out, you’ll want to quickly warm and dry the baby. “Stimulation from drying it lightly, but vigorously will encourage the baby to breathe,” Ferraro says. “Once it starts taking its first breaths, it will usually begin crying. The important step at this point is to keep the baby level with the vagina to keep blood flow regulated since the umbilical cord is still attached, unless you’ve already cut it to free it from the baby’s neck.”
The baby will appear somewhat bluish after the delivery, which is normal. Check the baby’s pulse — a newborn baby’s heart rate should be 120 to 160 beats per minute. “If the baby has a low pulse, appears sluggish, does not open its eyes, start crying, or breathing normally, they may need a few rescue breaths to see if they wake up and jostle,” says Schwartz. “You can also try gently smacking the bottom of the baby’s feet to encourage breathing.” Be sure you’re familiar with infant CPR before attempting this — like adult CPR, there is too much that can go wrong if you are inexperienced with the process. If there are respiratory difficulties, you can start CPR on the child or use the syringe bulb in the OB kit to suction the mouth and free it of any fluid or blockages. If the crying has a good strong tone and the baby is breathing normally, suctioning or CPR is not needed.
If everything appears to be proceeding normally, prepare to cut the cord. “Generally after the birth, the cord will pulsate for a couple minutes,” says Ferraro. “Once it stops, clamp or tie it off 6 to 8 inches from the child and then another clamp 2 to 3 inches from that toward the mother. Once it’s clamped, cut between the clamps.”
“If no means to cut the cord are available, you can go about a day without cutting it, as it will shrivel up on its own,” Schwartz says.
After ensuring the baby is healthy, breathing, and crying, it should be given to the mother for warmth and to begin breast-feeding. This process will stimulate the mother to stop contractions and bleeding, as well as feed the child. “The child will begin to develop passive immunities through the mother’s milk,” Ferraro says. The baby should be kept skin to skin with the mother as much as possible. The mother’s smell will help the baby start to perk up and breathe better. Cover the mother and newborn with a clean, warm blanket. Babies can easily lose heat since their body is not ready yet to regulate temperature. Keeping the baby’s head warm is important since they lose heat through their head. Softly applying a skull cap can help keep the baby warm, and these are usually found in an OB kit.
The placenta and afterbirth will deliver itself, and you don’t need to pull it out. Once it delivers, the bleeding should be minimal. Try to stop any bleeding with sterile dressing or a clean cloth by applying a minimal amount of direct pressure — don’t pack the vagina with any of these materials. Have the mother lay down and put her feet up to keep from fainting or excessive blood loss.
After the delivery is complete you should do whatever you can to reach a hospital, taking care to move the mother as little as possible since fluid loss will still be occurring.
If you are the mother, and have to deliver alone, you’ll need to basically do what’s been previously described as best you can. Put your hand down to guide the baby to make sure it doesn’t fall. Assuming the delivery happens without complications, try to rest, let the placenta expel, and keep the baby at your level. Cover the baby, keep it warm, and nurse as soon as possible. Women who are alone and forced to self-deliver may choose to do it sitting or squatting — this is not unusual in other parts of the world. After the delivery, try to seek medical attention immediately.
Aside from these steps, there is not much else you can do until medical help arrives. The best remedy for the situation is to be prepared and not put yourself in a position where you may have to deliver the child without trained assistance. The more you can do to avoid situations where you may be unable to reach help in time, the better off you and your child are. If you’re ultimately put in that position, best to stock up on the household items and medical training you might have to rely on. Better to have it and not need it than need it and not have it.
Certain Foods Induce Labor
Rumors still persist that things like drinking castor oil or eating spicy food can induce labor. There is no scientific evidence to prove this. It’s still unknown what exactly triggers the labor process to begin. Speculation still exists that having sex can induce labor, but this is still inconclusive.
Due Dates Are Accurate
Due dates can be inaccurate by weeks and even months. There is no guarantee that the delivery will occur nine months from the date of conception, give or take several days. This is, at best, an approximation. It’s hard to pinpoint the exact date, so assume it can happen at any time and plan accordingly.
Baby Gender Develops During Pregnancy
The male’s sperm determines the baby’s gender. The fetus is not neutral during the pregnancy process and nothing can influence the baby’s gender.
You can buy premade OB kits, but if you prepare your own you should at the very least include: