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a hurry, but usually about a minute after the head appears the mother will have another bearing down feeling and push the shoulders and the rest of the baby out.

As the baby is being expelled, the person helping the mother should support the baby on her hands and arms so that the baby will avoid contact with any blood or waste material on the bed.

If there is still a membrane from the water sac over the baby's head and face at delivery, it should immediately be taken between the fingers and torn so that the water inside will run out and the baby can breathe.

If, as sometimes happens, the cord, which attaches the child from its navel to the placenta in the mother's womb, should be wrapped around the baby's neck when his head and neck appear, try to slip it quickly over his head so that he will not strangle.

After the baby is born, wrap a fold of towel around his ankles to prevent slipping and hold him up by the heels with one hand, taking care that the cord is slack. To get a good safe grip, insert one finger between the baby's ankles. Do not swing or spank the baby. Hold him over the bed so that he cannot fall far if he should slip from your grasp. The baby's body will be very slippery. Place your other hand under the baby's forehead and bend its head back slightly so that the fluid and mucus can run out of its mouth. When the baby begins to cry, lay him on his side on the bed close enough to the mother to keep the cord slack.

The baby will usually cry within the first minute. If he does not cry or breathe within 2 or 3 minutes, use mouth-to-mouth artificial respiration.

Very little force should be used in blowing air into the baby's mouth. A short puff of breath about every 5 seconds is enough. As soon as the baby starts to breathe or cry, mouth-to-mouth breathing should be stopped.




CUTTING THE CORD

There should be no hurry to cut the cord. Take as much time as necessary to prepare the ties and sharp instruments.

You will need two pieces of sterile white cotton tape or two pieces of 1-inch-wide sterile gauze bandage about 9 inches long to use to tie the cord. (If you do not have sterile material for tying the cord but do have facilities for boiling water, strips of sheeting—boiled for 15 to 20 minutes to make them sterile—can be used.) Tie the umbilical cord with the sterile tape in two places, one about 4 inches from the baby and the other 2 inches farther along the cord toward the mother, making two or more simple knots at each place. Cut the cord between these two ties with a clean sharp instrument such as a knife, razor blade, or scissors.

A sterile dressing about 4 inches square should be placed over the cut end of the cord at the baby's navel and should be held in place by wrapping a "bellyband" or folded diaper around the baby. If a sterile dressing is not available, no dressing or bellyband should be used. Regardless of whether a dressing is applied or not, no powder, solution, or disinfectant of any kind should be put on the cord or navel.

If the afterbirth has not yet been expelled, cover the end of the umbilical cord attached to it (and now protruding from the vagina) with a sterile dressing and tie it in place.

Figure 7

[Illustration: Cut between the square knot by bringing the left tape over right tape for first loop and right tape over left for second loop. Tighten each loop firmly as tied. Use scissors or a razor blade to cut cord.]




THIRD STAGE OF LABOR

Usually a few minutes after the baby is born (although sometimes an hour or more will elapse) the mother will feel a brief return of the labor pains which had ceased with the birth. These are due to contractions of the uterus as it seeks to expel the afterbirth. Do not pull on the cord to hurry this process.

Some bleeding is to be expected at this stage. If there is a lot of bleeding before the afterbirth is expelled, the attendant should gently massage the mother's abdomen, just above the navel. This will help the uterus to tighten, help the afterbirth come out, and reduce bleeding.

It may be desirable to put the baby almost immediately to the mother's breast for a minute or two on each side even though the mother will have no milk as yet. This helps the uterus contract, and reduces the bleeding.

Someone should stand by the mother and occasionally massage her abdomen gently for about an hour after the afterbirth is expelled. After that the mother should feel the rounded surface of the uterus through the abdomen and squeeze firmly but gently with her fingers. The bedding should be cleansed and the mother sponged. Washing and wiping of the vaginal area should always be done from the front to the back in order to avoid contamination. A sanitary napkin should be applied.

Keep the mother warm with blankets. She may have a slight chill. Give her a warm (not hot) drink of sweetened tea, milk, or boullion. Wipe her hands and face with a damp towel. She may drop off to sleep.

The mother's diet after delivery may include any available foods she wishes. She may eat or drink as soon as she wants to, and she should be encouraged to drink plenty of fluids, especially milk. Canned milk can be used and made more palatable by diluting with equal parts of water and adding sugar, eggs, chocolate, or other flavoring.

For the first 24 or 48 hours after delivery, the mother will continue to have some cramping pains in the lower abdomen which may cause a great deal of discomfort. Aspirin may help relieve these afterpains. She should empty her bladder every few hours for 2 days following the birth. If her bowels do not move within 3 days after delivery she should be given an enema.




MISCARRIAGE

If a pregnant woman shows evidence of bleeding, she should restrict her activities and rest in bed in an effort to prevent possible loss of the baby. If a miscarriage does occur, keep the patient flat with the foot of the bed elevated from 12 to 18 inches to retard vaginal bleeding. Keep her warm and quiet, and give her fluids.




EXPECTANT MOTHER'S EMERGENCY CHILDBIRTH KIT

The public health and civil defense agencies of one State have planned a 1 1/2-pound emergency childbirth kit made up of basic supplies that can be carried in a 1-yard-square receiving blanket.

The kit consists of the following:

One-yard square of outing flannel, hemmed (receiving blanket).
Plastic (polyethylene flexible film) for outer wrapping of the kit if desired. (Do not wrap the baby in this plastic film.)
One or two diapers.
Four sanitary napkins (wrapped).
Adhesive tape identification strips for mother and baby.
Short pencil.
Soap.
Sterile package containing:
    Small pair of blunt-end scissors (cheapest scissors will do), or a safety razor blade with a guard on one side.
    Four pieces of white cotton tape, 1/2 inch wide and 9 inches long.[1]
    Four cotton balls.
    Roll of 3-inch gauze bandage.
    Six 4-inch squares of gauze.[1]
    Two or more safety pins.

[1] You will actually use only two tapes for tying the umbilical cord. The two extras are included as a safeguard in case one or two should be dropped or soiled. Extra 4-inch squares of gauze also are included.

Emergency childbirth kit Emergency childbirth kit

Instructions such as those contained in this chapter also should be considered a part of the emergency childbirth kit.

To make the kit ready to carry, lay the plastic (if used) out flat, and lay receiving blanket out flat on top of the plastic. Place the diapers, sterile package, soap, sanitary napkins, identification tapes, pencil and instructions in the center. Pull two opposite corners of the receiving blanket and plastic together and tie. Do the same with the other opposite corners, pulling each side together well so that nothing will fall out. Then tightly knot the loose ends together in the same way, leaving an opening so that the kit can be slipped over the arm for carrying the kit while leaving the hands free.

Such an emergency delivery kit will weigh about 1 1/2 pounds. The contents suggested are basic essentials only, for extreme emergency. Much more could be added, but the extra weight might mean leaving behind some other items needed for survival. Additional supplies could be stored in your home shelter to be ready in the event the birth takes place there. In the case there is no need for an emergency delivery, either in the home, shelter or in some evacuation situation, the supplies in the kit can be used in home care of the baby.




IDENTIFICATION TAPES

In emergency situations, identification will be particularly important, especially if the birth should take place in a group shelter rather than a family shelter, or in an evacuation situation.

Two wide strips of adhesive tape will be needed—one long enough to go around the mother's wrist, and the other long enough to go around the baby's ankle. Information should be written on these strips as shown below.

Identification tape—for mother Identification tape—for mother

[Illustration: For mother—Write parents' names, blood types, and mother's Rh factor, street address, and whether it is a first or later child.]

Identification tape—for baby Identification tape—for baby

[Illustration: For baby—Write date and hour of birth and parents' names and address.]










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