Emergency Childbirth An Urban Scenario
Intent: The purpose of the following childbirth scenario is to give instructions on 1) preparing a birthing bed, 2) dealing with a very tight cord around the neck, 3) drying the baby 4) suctioning the baby, if necessary, 5) keeping the mother dry and warm, and 6) being prepared with instruments and supplies to do these things.
Scenario: It’s a bitterly cold, snow-blown February morning in Michigan, and there has been a massive earth-quake the evening before. The Ready family’s home is intact, but there is no electricity, gas or water. Mom Ready, who is three weeks to her due date, some cramping during the night. When she gets up in the morning, her amniotic sac breaks, and there is a gush of water down her She definitely is going to have a baby. Little Lars is on his way, ready or not (pun quite by accident).
Dad Ready tries to call the hospital, but cannot get through. He suspects that hospital staff and emergency crews are overloaded with earth-quake related injuries and that there is no way his wife could be admitted. He also concludes that severe weather and broken-up roads could prevent them from the hospital, anyway. Nor does he want to risk his wife having a baby in the car when it is so cold. The Readys come to the conclusion that the safest thing to do is to have the baby at home.
Dad immediately runs down the street to ask a friend, who has had a home birth and is knowledgeable about herbs, to come help. The friend grabs her birthing supplies and goes to two other neighbors, a nurse and a doula (labor coach), to ask them to come and help. Fortunately, the Readys have a wood stove in the family room. As soon as ets back home he stokes the fire up and brings in a of wood. He moves a bed close to the fire and sets up an emergency toilet.
Observation: Supportive and knowledgeable people are important to make up the birth team. A crucial need is warmth. The mother needs to be warm to have effective contractions. The baby has to be warm to sustain respiratory function.
Scenario continued: The birth team arrives. The doula helps make the Mom comfortable. The friend and nurse immediately go to work setting up for the birth. They look through the emergency birthing kit and supplies that the Readys have and then they begin collecting additional things from around the house. The Dad shows them where the emergency water supply is and other things that they might need.
The helpers put a plastic drop cloth over the bottom sheet of the bed, adjust a clean old sheet on top of it and pin the corners through to the mattress to avoid slipping. On top of that they place several underpads which they in the birth take down the shower curtain in the bathroom and secure it to the floor by the bed with a little duct tape.
Supplies to Prepare the Bed: 1) Plastic to cover the birthing area is important. It can be a plastic drop cloth (thicker is far better), a shower curtain, or plastic bags. 2) Diaper pins are better than large safety pins, because the safety pins often and are not strong enough. 3) Underpads provide a clean and semi sterile field for the baby, to be born onto. 4) Duct tape. 5)Two or three old sheets.
Scenario continued: The Mom is propped up on the bed with pillows behind her. She has a strong urge to push, and the starts to come down the birth canal. After several contractions the head emerges. The doula helps the mother to stop pushing and helps her blow through the next contraction. The nurse puts her fingers over the neck as far as she can, feeling for a cord. There is a cord around the neck, so she pulls on it to loosen it up. She jiggles it to one side and then the other, and actually puts some force on it, but it does not loosen. She quickly takes two sterile cord clamps and clamps them two inches apart from each other on the cord. Then she takes the sterile disposable scalpel and cuts the cord between the two clamps.
Observations: Usually, the baby is born and the placenta delivered before the cord is clamped and cut. Normally, this is the case even when the cord is around the neck, because it usually can be loosened enough or pulled over the head so the baby can be born. However, occasionally, the cord is short or entangled, preventing the body from coming out. You never know when this will happen, so you must ALWAYS be prepared with the proper equipment. In those cases, the reason for clamping twice is to cut off the blood flow from the baby and from the placenta which is attached to the mother’s uterus. Both the baby and the mother need to be protected from hemorrhage. Remember, anything that touches the cord needs to be sterile. Placing instruments and umbilical tapes in boiling water for 15 minutes is an easy way to sterilize them.
Supplies to Clamp the Cord:
Best – Two 7 or 8 inch Rochester Pean Hemostats.
The most efficient way to clamp off the cord is to use hemostats. It is important to do it fast, because as soon as the cord is clamped, the oxygen supply from the placenta is cut off to the baby. While hemostats are your most expensive option up front, they can be sterilized and used over and over again. If you are buying hemostats, get the best quality you can. I like German instruments. When I first started my midwifery practice, I got a set of middle quality hemostats. After just a few births, one of them broke as I was using it, causing some bleeding. I came to the conclusion right then that saving a few bucks on cheaper instruments is not worth the risk. Besides, why not invest in something you can use during your entire lifetime and even pass down to the next generation? Be sure to get a 7 or 8 inch Rochester Pean hemostat, because shorter ones do not work well on very fat umbilical cords. Hemostats come in straight and curved tips. Either is fine. It may be advantageous to get one straight and one curved.
Next Best – Two or Three Plastic Cord Clamps (as is illustrated in the scenario).
Two or three plastic cord clamps are the next best option to use, if you don’t have hemostats. Our scenario shows why it is necessary to have at least two cord clamps included in each birthing kit. Cord clamps are often hard to close, so, if the cord is still pulsing like in this scenario, then a lot of pressure needs to be put on the clamp to get it to close completely. Later, another clamp can be an inch or two out from the baby’s umbilicus and the extra cord extending out from there cut off.
Least Best –Two or Three Umbilical Cord Tapes.
Umbilical cord tapes work, but you have to tie a square knot with both tapes. That takes time, and time is of the essence in scenarios like this one. So, if you’re using cord tapes, it is best to have two people tying off the chord, so it can be done twice as fast. Some families have a tradition off the cord with cord tape. These families should still have on hand 2 hemostats or 2 plastic cord clamps to expedite clamping off the cord in emergency situations. Because cord tape is 1/8 inch thick and is like a cotton twill tape, it is much easier and safer to use than shoelaces. Laces are frequently too thick to cut the blood flow off completely. If you do use a shoelace, make sure it is made of cotton and is thinner than a regular lace. You also can use cotton string. Avoid using dental floss, because it has a tendency to cut through the cord.
Umbilical Clamp Cutter. If you use a plastic umbilical cord clamp, you need something to cut it off with. Although the clamp can stay attached until the stump falls the clamp sometimes starts to pull on the belly button a little. 24 to 48 hours, the clamp does not need to remain on the cord. The clamp can be released by cutting through the circle at one end. In my experience, metal clamp cutters are much more dependable to use than flimsy plastic cutters, which very easily. A cheap and very adequate alternative is a small wire cutter that you can buy from any hardware store.
Supplies to Cut the Cord: 1) Sterile Disposable Scalpel the cheapest and most practical way to cut the Pin an emergency. One should be included in every birth kit. 2) Scissors. To cut the umbilical cord, you can use a pair of very sharp household scissors or a knife that you have sterilized. However because the umbilical cord is tough and hard to cut with regular scissors consider purchasing special umbilical scissors or cheaper, a large pair of bandage scissors, which works very well. You can also use operating scissors (blunt/ sharp edge) for cutting the cord, as well as to do a rarely needed episiotomy.
Scenario continued: The doula instructs the Mom to push again. Little Lars comes out all wet and slimy and is placed skin-to-skin on his mother’s abdomen. The neighbor puts a towel (warmed by the fire) over the baby and vigorously dries him. Lars cries. The wet towel is quickly replaced by a warm dry towel.
Observations: When you hear the baby cry, you know he is breathing. This sounds like a given, but deep breathing at the outset helps stabilize the baby. Getting and keeping the baby dry and warm is important. If the baby loses heat because of wetness, he may start having breathing problems.
Supplies to Dry Off the Baby: 1) Two or Three Towels. Actually a stack of old, clean towels is great, but at least 2 or 3 for the baby. A towel is better than a receiving blanket, because it soaks up the moisture faster and is rough, stimulating the baby.
Scenario continued: Bubbles are beginning to come out of Lars’ mouth, and he is choking a little on some fluid. The neighbor shows Mom how to suction the baby by pushing the air out of the bulb syringe, inserting it into the side of the baby’s mouth, and then letting go of the syringe. After taking the syringe out of the mouth the neighbor squeezes the syringe again and forces the liquid in it onto a towel. The baby stops choking. The neighbor puts the syringe where the mother can reach it.
Observations: Although most babies do not need to be suctioned, some babies are born with a lot of fluid and mucous in their mouths, and they struggle with it. Keep a good bulb syringe close at hand, and use it when necessary. If you need to suction both the nose and the mouth, suction the mouth first. If you don’t have a syringe, you can sweep the baby’s mouth with a wash cloth.
Supplies to Suction the Baby: 1) 3 oz. Bulb Syringe. A 3 oz. syringe does a lot better job at suctioning than a 2 oz. syringe. 2) A DeLee mucous trap can be used to suction deeper. 3) Wash clothes.
Scenario continued: All of a sudden, the Mom has about a cup of blood come out of her vagina. Then the bleeding stops. Next she has some cramps and she pushes the placenta out. The nurse puts the placenta in a plastic bag and checks the Mom’s uterus to see that it is firm. The neighbor gives Mom some Shepherd’s Purse tincture to prevent excessive bleeding
Observations: The gush of blood is a sign that the placenta has detached and it’s time for the mother to push the placenta out.
Supplies for the Placenta and Bleeding: 1) Plastic Sack. Often a plastic sack is put over a salad bowl that can be put under the mother to help catch the placenta. 2) Shepherd’s Purse tincture or other herbal anti-bleed tinctures are helpful to cut down bleeding.
Scenario continued: The Mom starts to shake a little, and the neighbor gives her a dropper of an herbal formula tincture that stops the shaking and warms up the mother from the inside out, followed by some juice. The helpers clean up the underpads and get the area under the mother dry and protected. They help her put on a dry T shirt and put some warm blankets over her. The mother to warm up and begins to nurse her baby.
Observations: Its very common for a mother to shake after having a baby. I consider it to be a mild form of shock. Check to ensure that the mother is dry and warm externally and internally. Nursing the baby as soon as possible actually makes it easier for the baby to get the hang of it. It also helps the mother, because it stimulates cramping of the uterus.
Supplies to Warm up the Mother: 1) Rescue Tincture (in an alcohol menstruum for quick absorption) is an herbal formula on the market for shock, heart attack, seizures, and any time the body systems need to be stimulated. Another simple formula, which you can prepare yourself, that is helpful for stimulating the mother is 3 Tablespoons apple cider vinegar or lemon juice mixed with 3 Tablespoons honey in a half a cup of water. 2) Blankets and/or Heavy Towels. It’s nice to warm these up for the mother. If you have electricity, you can put them in the clothes dryer.
Scenario continued: Lars is safely here. Everyone is thankful and happy that they were prepared enough to deal with the birth. The Readys give each member of the birth team some emergency candles and a jug of water that they can use in their own homes. They’re all glad they had some emergency supplies. The three helpers are now inspired to get some good instruments and equipment for emergency birthing. No doubt, when the word gets out in the neighborhood, their services will be called on again.