Thursday, January 21, 2010

Incoming: Eminent Delivery, Part 1

::::::WARNING: Due to the graphic nature of some of the images and videos of, there is some medical and anatomical details that may be not appropriate for children.:::::::::::

Then again, if you're a medical crazy person like me than you wouldn't mind your children learning this kind of stuff. (Image taken from www.babybumpdiaries.com)

Alright, here we go. Get out your full body armor, because we're about to take on blood bath.

Actually, the process of birth can be a quite beautiful thing. This is where women come as close to what it feels like bring life into this world. It's the great blessing from the Lord that allows us a chance to take part in creation. I say epidurals are great blessings too, but that's just me.

The first thing you must remember is to: STAY CALM and DON'T PANIC!

You may think it's funny, but I've seen grown men faint at the thought of their wives going into labor. You wouldn't beleive how many unconscious fathers that I have had to scrape up off the hospital floor.

The next thing to do is to get a birthing area set up. The area has to be level and flat, with lots of light and warmth. Believe it or not, but the baby, just after being born, is bare-butt-naked and wet. It's kind of like being a nudist in Florida and immediately being transported to the arctic circle for the little tikes.

Don on barrier gloves (preferably sterile), goggles, and gown.

Next take the chuk from your birthing kit, and place it under the mother's pelvis with the cotton-side up. remember cotton-side up.

When the mother looks at you like you're insane and yells, "What the heck are you doing?!" (Note: women in labor are less likely to censor their words.)

You can calmly say, "Don't worry, mam; I know what I'm doing: I read a blog."

Now as for the positioning of the mother, I have provided a video clip of a vaginal birth for you to have an idea of how things should be during the delivery.

Graphic Childbirth video



The following steps are to be considered during heavy labor:

1. Breathing. Yes you should breathe, but actually it is important to breathe. Have the mother take deep breaths, concentrating on her breathing when she is inbetween contractions.

2. Crowning. The baby's head appearing at the vaginal opening is known as crowning. At this point during contractions, instruct the mother to push, while two assistants push her bent knees back at her chest. (Having assistants push the mother's knees back towards her, opens up the mother's pelvis making delivery easier.) The mother should NOT push in between contractions.

Instruct the mother to take a deep breath and hold it for at least ten seconds while she pushes. The idea of pushing is similar to that of bearing down to go to the bathroom... I know the guys can relate to this one. They have their newspaper and spend hours bearing down.

Warning: because the mother is pushing, most times the baby is not all that is 'delivered', so don't be surprised if a bowel movement precedes the baby's delivery. Just place another chuk or towel over the feces and continue with the birth.

3. Assist the head. Place your hand against the area below the vaginal opening and gently apply pressure during each contraction.

I had an OB preceptor that liked to used his knuckle here and dig in hard, because he could get his knuckle under the baby's chin through the perineal tissue. But since emergent deliveries are natural (non-epidural) deliveries, I highly suggest that you gently place your palm there... that is, if you want to live.

4. Appearance of entire head. As the baby's head is being delivered, gently support it with your hands. The baby's head, in most deliveries will appear chin down, then as the body turns to reconstitute, so that the shoulders can deliver, the baby's head will then turn to the side.

As soon as the head is out, tell the mother to stop pushing. Because at this point, you need to clean out the baby's nose and mouth.

5. Cleaning out the mouth and nose. The bulb syringe in your kit is essential for this step. Suction out the baby's mouth then nose. Use a clean towel if no syringe is available. (Images and videos taken from: Bookside press)

video

6. Nuchal Cord. If the umbilical cord is wrapped around the baby's neck, DO NOT attempt to cut the cord. Instead, place a finger under the cord to slip it off over the head.

If the cord will not slip over the baby's head, keep a couple fingers bracing it from tightening further around the baby's neck during delivery.

Normally, OBs cut and clamp the cord, but it takes experience to be able to effectively perform it. So I would highly suggest avoiding cutting the cord at this point in the delivery.

7. Head is delivered. The rest of the body should deliver with ease. Some baby's are with such ease that they literally slip out, others have broader shoulders and take some work.

The upper shoulder should present first, help it along by guiding the baby's head downward while the mother pushes. Once the top shoulder has delivered, then help guide the baby's head up when the mother pushes. (And I seriously mean guide, not pull on.) Then the bottom shoulder will deliver and then all baby's pop out at this point. So be prepared to catch.

8. Baby is out. Wrap the baby in a clean, dry and preferably warm towel or blanket. The baby should cry. Then place the baby on the mother's stomach.

If the baby doesn't cry or isn't breathing, keep the baby at the level of the mother's vagina. Place the baby's head lower than its feet. Stimulate the baby by rubbing its back. If still not breathing, give two quick gentle puffs of air into the infant's nose and mouth.

(Further resuscitation measures, should be left for a different discussion.)

Once baby is crying and breathing, place baby on mother's stomach. Skin to skin is the best.

DO NOT pull on the umbilical cord.

9. Cutting the cord. There should be two plastic, sterile clamps in your OB kit, or two kelly clamps. If you don't have either available then tie a clean shoelace or thick string, firmly around the umbilical cord, no closer than 4 inches from the baby's navel. (DO NOT use thread: it will cut through the cord.)

Tie another shoelace or thick string a few inches away from the first tie towards the mother's side of the umbilical cord. Make sure that both ties are secure, then using a sterile pair of scissors or scalpel cut the cord in between the ties.
video

10. Placenta. The placenta normally delivers itself. Usually a gentle kneading on the mother's belly helps the process, but I am going to leave the details of delivering the placenta to the following video. As for after the placenta is delivered, place it in an airtight container to take to the hospital with the mother.

video

11. Clean up. Gently (and I mean GENTLY!!!) wipe the blood off the mother with gentle soap and water. (Baby shampoo is a very good form of soap for wounds.) Fill a thick, feminine napkin pad with a little ice and place over the vagina.

12. Get to the Hospital. If you cannot get to medical help at all, then keep both mom and baby dry and warm. Keep the mom hydrated and watch the both of them closely for signs of shock.

13. Now you can Relax. Well, either that or pass out, because you just delivered a baby.



Since there is so much material concerning emergency births, I was unable to cover it all. Please refer to the following sources for more information on emergent deliveries:

ParasolEMT.com

Babypartner

Planbaby.com

Healthopedia.com

AHealthyme.com