Remote Primary Health Care Manuals

Quick guide to helping with a birth

 

If in strong labour with very painful contractions close together — woman may be about to have her baby

Get ready for birth quickly if

  • Woman distressed, restless, irritable, feels like 'pushing' or going to toilet to pass faeces
  • Woman says baby is coming

Do first

  • Call for help — get midwife/doctor/obstetrician on speaker phone, if none locally
  • If woman having contractions but doesn't have 'urge to push' — medical consult and see Labour and birth
  • Find support people — if possible female ATSIHP or older women familiar with birthing
  • Reassure woman, explain what is happening and have someone stay with her for support
Ask helper to get equipment
  • Birth box and birth/obstetric medicine kit from clinic fridge. Should include
    • 2 sterile metal cord clamps, sterile blunt-ended scissors for cutting cord, 2 plastic cord clamps
    • Oxytocin box of 5 (from fridge) — 1 ampoule (10 international units/mL) — needed for delivery of placenta. Other 4 are needed if she bleeds after birth
    • Resuscitation equipment for mother (eg oxygen, mask, bag-valve-mask, suction equipment with adult yankauer sucker)
    • 2 large bore IV cannula
  • For baby
    • Warm towels
    • Oxygen​ with flow meter (flow rates up to 10L/min)
    • Infant face mask, oxygen tubing
    • Bag-valve-mask — sizes 0 and 00
    • Mechanical suction (low pressure if possible), tubing
    • Suction catheters, sizes 8–12F

Check

  • Look at vulva — can you see part of baby (usually the head)
    • If you can’t see baby but there is bulging of perineum or anus — birth is likely to be close
    • If you can't see baby and perineum not bulging — medical consult — see Labour and birth

If time

  • Ask helper to get woman’s pregnancy record. Check
    • Gestation (how many weeks pregnant)
    • Medical complications (eg diabetes​, anaemia) ​​
    • Vaginal swab results for Group B streptococcus (GBS)
  • If membranes ruptured ​(waters broken) ask when — look at colour of liquor (waters)
    • Clear, pink or clear with blood mixed in is normal
    • Meconium ​(brown/green) means baby has passed faeces
  • Put in IV cannula — largest possible, insert 2 if time
  • Ask helper to do medical consult

Do — if head seen or perineum bulging

  • Put on goggles and sterile gloves
  • Support woman to get into a position that feels comfortable — upright position or kneeling on all fours or semi-sitting propped up on pillows. Do not let her lie flat on her back
  • Let birth of head happen slowly on its own
    • Let woman push as she feels like it
    • When perineum is stretched thin and labia is wide apart as head is being born — ask woman to 'pant' or puff through contractions — helps baby’s head to be born as slowly as possible and may help to stop perineum from tearing
    • Wait for baby’s head to turn and face inside of woman’s leg — you don't need to help this

Birth of shoulders

  • Baby usually born with next contraction
    • After shoulders come out the rest of baby’s body will usually follow
    • Support baby as it births — it will be slippery so use gentle but firm grip. Can use warm towel
  • If not born with next contraction
    • Put palms of your hands on each side of baby’s head, over ears and temples
    • Gently ease baby’s head toward woman’s anus as she pushes anterior shoulder out from underneath pubic bone
    • Once anterior (front) shoulder born gently ease baby’s head toward woman’s abdomen as she pushes out posterior (back) shoulder
  • If shoulders do not come out — they could be stuck. This is an emergency — see Shoulder dystocia (stuck shoulder) straight away
  • After the birth — Give oxytocin IM — 10 international units in woman's thigh

Immediate care of baby

  • Put baby skin-to-skin on mother’s chest or abdomen
    • If mother doesn't want baby on her — put baby between her legs, away from blood and mess
  • Do not clamp cord immediately — leave for at least 1 minute and until stops pulsating if possible
  • Dry baby very well, remove wet towel and cover baby with clean warm towel — make sure head is covered
  • Do 'rapid assessment' of baby’s condition
    • Breathing or crying
    • Heart rate more than 100 beats/min — listen with stethoscope
    • Good muscle tone
  • If baby pale, floppy and/or not breathing properly and/or heart rate less than 100 beats/min — see Newborn resuscitation  straight away
  • If baby breathing, good muscle tone and becoming pink — see Labour and birth Immediate care of baby
  • Important to also follow the rest of the steps for care of mother and baby — see Labour and birth Third stage of labour
  • See Care of mother — first 24 hours after birth