Thursday, February 11, 2016

Wilderness or Grid Down Medical Skills 4: Deliver A Baby

Medical training is serious and should be given by competent medical professionals. This article and the whole medical series is not medical advice. It is for informational purposes only. Find good medical training in your area before actually doing the procedures in this series.
This is a series designed to give you a basic medical knowledge of what I consider medical skills you should have if there is no help in sight. The skills are:
Broken bones
Establishing an airway
Deliver a baby
Know The Symptoms of a Heart Attack, Heat Exhaustion or a Stroke
Basic Wound Dressing Techniques

Delivering a baby
If you have a family member who is expecting a baby, it's important to be prepared in case the baby decides to come before anyone is ready. Delivering a baby is not hard, but it can be overwhelming.
It's important to remember that delivering your baby in a hospital is the safest way to go. Do not use the information presented here as a substitute for getting proper prenatal care and arranging for delivery at an appropriate facility.
It's up to the baby when the baby is ready to come. After that, kids rule your life. I’ve had several and they still take my time, money, and sweat.
1. Go to the hospital. As the uterus contracts to push the baby out of the birth canal, Mom should feel pain and pressure. When Mom feels labor progressing, especially if her water breaks, it's time to go to the hospital or call an ambulance. No matter how well this guide prepares you, it's better to deliver with the help of a professional.

If you're cutting it close, call 911. If not, then you may be able to take the car. Either way, get going toward the hospital or midwife as soon as possible. Having said this I realize this is a guide for delivery during a time when hospitals and health care may not be available.

2. Get comfortable. If you're not able to go to the hospital, then mom needs space. Get her some pillows and a spot on the floor or large bed. Put some clean sheets down so baby doesn't touch the dirty floor if on the floor. Mom will need at least one pillow under her hips. She can lay on her side until delivery. Prop up mom's back and support her during contractions.
Baby is going to be very slippery. Putting mom on the floor makes sure that baby doesn't fall very far if you don't keep a good grip on him or her!
3. Wash your hands. Baby will be born with very little immune system and is susceptible to infections. Follow universal precautions and wear personal protective equipment if you have it. Remember once you've washed your hands not to touch anything but mom, baby and the bedding.

4. Check for crowning. As the cervix dilates, the baby's head moves down the birth canal and becomes visible. If you can see baby's head, then birth is imminent.

You should be able to see the head clearly once it's visible. If it is obscured by a membrane stretched across it, then pinch the membrane and twist. The membrane is the amniotic sac, which should already have broken. If not, it will break easy when pinched and release the amniotic fluid. After that, things will move quickly!

5. Guide the baby. Put your hand in front of the baby's head and let it come out nice and slow. Don't try to hold the baby back, but don't let it explode from the vagina either.

The baby will slide out slowly in waves as mom's uterus contracts. As the baby comes out, it will turn to the side naturally. There is no need to try to force the baby or help it.

Putting some gentle pressure on the base of the vagina near the perineum will help baby's head pass.

6. STOP! Baby's head is out and Mom needs to stop pushing (easy for me to say). Clean baby's nose and mouth with a bulb syringe. If you don't have a bulb syringe, use a clean towel to wipe away fluid and membrane from baby's airway.

If you see the umbilical cord wrapped around the baby’s neck, try to slip the cord over the baby's head. This is important, but there is a possibility you will not be able to release the cord. If the cord won't go, deliver the baby anyway.

7. Guide the shoulders. Do NOT pull on the baby, but guide its shoulders out, starting with the top shoulder. If there is difficulty, you can put pressure on mom's abdomen just above the pubic bone to encourage the top shoulder to deliver.

Once the shoulders are out, baby is going to slip right through. Hold on tight; the baby is slippery and will probably wiggle.

8. Wrap baby up. Other than clearing the airway, the most important thing you can do for the baby is keeping it warm. Make sure to cover from head to toe, but leave the face open so the baby can breathe.

9. Deliver the placenta. After the baby is delivered, the placenta will come. Don't try to force it or pull on the umbilical cord. The placenta will naturally deliver in about ten or fifteen minutes.

10. Newborn babies don't have the ability to control their temperature well, so it's very important that they be kept warm and dry. If you've had a vaginal delivery and you and your baby are both in good condition, he should be placed directly onto your abdomen and dried off there. He'll be covered with a warm towel or blanket and given a cap to keep his head warm. Skin-to-skin contact will help keep your baby warm and let Mom start bonding as well.

11. Clamp the umbilical cord in two places and then cut between the two clamps. (Your partner can do the honors if he wants to!) Routinely the cord is cut almost immediately after birth. However, recent research shows that waiting a few minutes – so that extra blood flows from the placenta to the baby – lowers the risk of newborn anemia and iron deficiency in infancy.

12. Further suctioning of the baby’s nose and mouth may be done at this time. Also any further cleaning of the baby may be done now if it can be done with the baby in a warm place.

I have been present at many births (more than 7) and can tell you that it is always an amazing thing. But even though those births were in a hospital or birthing center I am confident that I could deliver a baby. My only anxiety would be with a complication. I would not know what to do without help and facilities. But in a situation where there is no choice I would have to mitigate whatever came up. This true for many different problems and scenarios. The reason for this very basic guide is to give basic information and some idea of what may be needed. As always, I am not a doctor and none of this should be considered medical advice.
Semper Paratus
Check 6