Delivery of a Baby

Occasionally circumstances prevent the attendance of a physician at the delivery of a baby. In this emergency someone must help the mother through the childbirth and take care of her and the baby until a physician arrives or until mother and baby can be placed in a hospital. When circumstances permit, the following items should be made ready before the birth:
1. A basket or bassinet lined with soft blankets.
2.  A piece of rubber sheeting about four feet (1.2 meters) square to protect the bed on which the mother lies.
3. One or two clean sheets.
4. One or two medium-sized towel, freshly ironed with a very hot iron and folded so their inner surfaces have not been touched by hands.
5. A small supply of sanitary napkins, kept clean in their original package.
6. Three or four strips of cloth tape about one-half inch (1 cm.) width {and at least ten inches (25 cm.) long. The cotton binding tape a seamstress uses is satisfactory, or strips torn from a sheet or handkerchief.
7. A pair of scissors for cutting the umbilical cord.
8. A basin measuring at least ten inches (25 cm.) in diameter.
Getting the Patient Ready. The expectant mother should lie on her back near the edge of the bed in such a position that the person who cares for her at this time can lean over her as the baby is being born. Her knees should be raised, and some provision should be made for her to brace her feet to enable her to "bear down" at the time of each labor pain.

If time permits, the rubber sheet should be placed beneath the cloth sheet and under the patient's hips. The patient's genital area should be washed with soap and hot water. To avoid contaminating the birth canal, the washing should be away from the vulva and downward toward the rectum.

CAUTION
Do not try to keep the baby from being born even though the doctor has not arrived or the mother is still en route to the hospital. Delaying the birth by holding a towel against the baby's head or by having the mother cross her legs may injure the baby or mother.

The Baby's Birth. Usually, it is the crown of the baby's head that is seen first as the baby is pushed through the birth canal. With the mother lying as described above, the baby's face is toward the bed. As the baby's head comes through the mother's vulva, it stretches to their limit the tissues that form the outlet of the birth canal, sometimes causing them to tear. When this occurs, the tear is toward the mother's anus. Sometimes the attendant can prevent this tearing by covering his hand with a freshly laundered towel and gently working the tissues of the vulva past the baby's head.

 Once the baby's head has been born, the most difficult part is over. The baby's head can be supported slightly by the attendant's hand while the shoulders and body complete their passage through the birth canal. Mucus should be wiped away gently from the baby's nose and mouth.
Baby's First Cry. At this point, the baby is still attached to its mother by the umbilical cord, which extends from within, connected still to the placenta (afterbirth). The umbilical cord is normally long enough so that the baby can be moved easily in the immediate vicinity.

It is now important for the baby to take its first breath. The baby should be held upside down, suspended from its ankles which are held securely between the attendant's fingers. The baby's skin is slippery, and great caution should be taken lest the attendant lose his hold. With the baby thus suspended, the attendant's other hand should be used to wipe away remaining mucus from the baby's nose and mouth (using a clean towel or freshly laundered handkerchief). Then rub the baby briskly up and down his back. This normally causes the
baby to cry and thus to take its first breath.

Tying the Umbilical Cord. Once the baby has cried, a clean towel should be placed across the mother's abdomen and the baby laid on the towel, crosswise to its mother's body. Now is the time to tie the umbilical cord, using the pieces of cotton tape or narrow strips of cotton cloth. Never use string for this, as it tends to cut the tissues of the umbilical cord. Place one of the tapes around the umbilical cord at a point about three inches (7 cm.) from the attachment of the umbilical cord to the baby's body. As the first tie is drawn tightly, the soft tissues of the umbilical cord will move aside slightly so that the tape will actually compress the blood vessels within the cord. Be deliberate in making this tie. As a precautionary measure, place another tape next to and below the first one.

Place a third tape around the cord about two inches (5 cm.) farther away from the baby and tie this one also.
Using the scissors, cut the cord between the outer two tapes. A small amount of blood will ooze from the cut ends of the umbilical cord. If more than a small amount escapes from the baby's end of the cord, another tape should be tied around the stump of the cord.
The baby is now completely separated from its mother and can be wrapped in a soft blanket and placed by the mother or in the basket or crib.
The Afterbirth. The attendant's attention is now directed to the afterbirth (placenta), which usually passes through the birth canal about fifteen minutes after the baby has been born. The afterbirth can be guided by taking hold of the end of the umbilical cord; but the umbilical cord should not be used to pull on the afterbirth. As it passes through the vulva, there is usually a small gush of blood. The afterbirth should be placed in a basin and set aside for the doctor to examine.

Preventing Hemorrhage. The power for the delivery of a baby is derived from the forceful contraction of the muscle in the wall of the mother's uterus. Now that delivery is completed, the muscle of the uterus may relax as a consequence of fatigue. Normally, it should remain firm in order to prevent the further loss of blood. Immediately after the passing of the afterbirth, the attendant should place his hand on the mother's abdomen just below her umbilicus. Here he can feel a large mass. This is the uterus, much larger now than it will be a few days later. By massage through the abdominal wall, the uterus can be made to contract firmly. Frequent examination through the abdominal wall to determine the condition of the uterus should continue for about an hour after the delivery of the placenta. If it begins to relax and permit further bleeding (becoming larger and softer), massaging should be resumed. Have the mother hold her hand over the uterus and report if it is relaxing
Continuing Care. After the afterbirth has been expelled, two or three sanitary napkins, fresh from their container, should be used to cover the mother's genital area. These should be covered by a folded towel. These do not need to be fastened in place other than by pressure of the patient's thighs. She should be allowed to rest now, but she must remain warm. If she tends to chill, a hot-water bag can be used. Early care of the baby should be under a doctor's direction. The baby should be permitted to nurse relatively soon.

Source
Modern Medical Guide
Harold Shryock, M.D