Emergency Childbirth

It is very unlikely that you will have to deliver a child in an unplanned-for situation. Even the second stage of labour can allow enough time for an ambulance or midwife to arrive. However, if you are called upon to help with an emergency birth, take comfort from the fact that there is little that you can do to affect the birth process. Your key role is to support the mother, to ensure that medical help has been called and to care for the mother and baby after the birth.

Signs that the birth may be imminent

• Contractions less than 2 minutes apart
• Strong urge to push
• Bulging vaginal opening
• Baby's head visible

If the urge to bear down comes on the way to hospital, the mother can try using breathing techniques to avoid pushing.

What can you do to help?

1. Ensure that the midwife or doctor has been called. If labour is in the early stages, ask the mother where she wants to be and make arrangements for transport.
2. If at any time there is severe bleeding or signs and symptoms of shock, call an ambulance.
3. Support the mother in her most comfortable position. This will usually be standing or squatting as gravity helps the delivery process. Ask her what she would like you to do to help with the pain. Potential options include a warm bath, rubbing the small of her back and frequent sips of water. Encourage her to breathe out as breath-holding makes pain worse by increasing muscle tension. Most pregnant women will have a pregnancy record. Help her to find this as it contains useful information for both you and the medical staff.
4. If labour has progressed to the second stage and birth is imminent, ensure that:
   • The woman has removed the clothes from her lower bodyn
   • The ambulance is on the way-the ambulance control or midwife may give you instructions over the phone.
   • You and the environment are as clean as they can be.
   • You have a warm covering for the baby and mother.
5. Help the mother into a position she finds comfortable.
6. Support the mother while she pushes out the baby as it descends.
7. Support the head and shoulders as the baby appears - this will happen naturally and quickly. Do not pull the baby. lf the cord is wrapped around the neck, check that it is loose and gently pull it over the head.
8. Gently lift the baby and place on the mother's stomach. There is no need to cut the cord. If the baby does not show any signs of movement, check its airway and breathing and be prepared to resuscitate if necessary.
9. Keep mother and baby warm while waiting for the ambulance. The placenta and cord will follow shortly - keep these for the medical staff to check. Gently massaging below the belly button may help stop bleeding.

If the baby is breech (Not head first)

The concern with a breech birth is that the largest part of the baby (the head) may not be easily delivered. If the baby is breech a foot, knee or buttock may come out first. If this happens:

1. Ensure that medical help has been called.
2. Allow the birth to continue - do not try to stop the baby coming out.
3. Support the baby's body as it is delivered.
4. If the head is not delivered within 3 minures of the shoulders, gently raise the baby's legs to the ceiling until you can see the face (do not pull the baby from the mother). Wipe the face clear and encourage the mother to keep pushing until the head is delivered.