What to Do When the Midwife Doesn’t Make It

Assisting a woman in childbirth is not necessarily difficult. A woman who goes into labor early and progresses quickly is not very likely to need medical help. So take a deep breath and have some faith! That being said, if you have engaged a midwife or a doctor and your caregiver doesn’t make it, you want to know what to do. The following list is an abbreviated cheat sheet that is designed to help you figure out what to do and when. When in doubt, you should let events take their course as childbirth tends to proceed best when it’s not interfered with. That being said you can certainly call 911 at any time, and you should do so if there are any indications of complications that you cannot handle on your own.

How to Assist During Labor

  1. Remind the laboring woman to go to the bathroom at least once every 30 minutes.
  2. Offer the laboring woman water to drink. Since she’ll probably just take a sip at a time, keep offering it to her every ten minutes or so. It helps if the cup has a straw so you can hold it for her.
  3. If the woman wants to give up, offer her gentle encouragement.
  4. If the woman has a really hard time, you can offer to get her in the tub or the shower. Make sure that the tub is not slippery. If it is, help her sit down.
  5. You can talk to the laboring woman, but if she asks you to be quiet, you need to abide by her wishes.
  6. If you’re comfortable with it, you can offer a massage or other physical contact. Some women really crave it, while others prefer to be left alone.

How to Assist During the Birth

  1. Encourage the woman to be in a favorable position. Don’t let her lie on her back.
  2. Don’t pull on the cord.
  3. Let her scream if she feels like it (some women are screamers, some aren’t). Don’t worry about the neighbors. However, in order to avoid perineal tearing, it’s better for the laboring woman to make low-pitched moaning sounds than to give in to high-pitch screaming.
  4. Make sure you have warm towels ready if she is actively pushing.
  5. Make sure the baby is either caught or lands safely upon delivery.
  6. Help her hold her baby to keep them both warm.

How to Evaluate the Baby

  1. The baby needs to breathe within the first minute of being born. Encourage this by gently wiping mucous of the baby’s face and rubbing his back. Suctioning nose and mouth is not necessary in all cases, but be prepared to do so.
  2. Slightly elevating the baby’s body and rubbing baby’s back and flicking his feet may also help him start breathing on his own. The baby should be laid on his tummy with his head to the side to allow the mucus to drain.  As a last resort, mouth-to-mouth resuscitation should be tried.
  3. The baby should turn from red to rosy within a few minutes.
  4. The baby doesn’t need anything except to be held and loved, at least for the first little while.

Evaluate the Mother

  1. It’s important to keep an eye on the mother after birth. If she shows signs of dizziness, shock, extreme blood loss or any other problems, you might need to call 911.
  2. After the baby is born, the mother won’t feel any pain at all. She will most likely feel relieved, elated, and emotional. Let her hold her baby. She needs it as much as the baby does.

The Cord and the Placenta

  1. There is no rush the cord. Don’t cut it until it stops pulsating.
  2. There is no immediate rush to deliver the placenta. Allow mother and baby to bond and nurse, and it will happen.
  3. If the placenta has not been delivered after an hour or more, you can encourage the woman to try to switch positions. She can try to push it out, but don’t ever pull on the cord. If that doesn’t work, you can try to massage the uterus. Nursing can also help her expel the placenta, because it encourages oxytocin release.
  4. The placenta shouldn’t be put in the regular trash, because it might invite unnecessary attention. It’s also wasteful. If you don’t want to encapsulate it, bury it outside.
  5. Tie off the cord with shoestring within 6 inches off your baby’s belly. Tie it off again another inch or two from there, and then use scissors to cut in the middle. Later, after your baby has nursed, when you are ready to weigh him, you can use the clamp to shorten the umbilical cord attached to his belly.
  6. The placenta should be in one piece without any torn parts. You should be able to locate three twists in the placenta (three arteries and one vein).

The First Few Days after Birth

  1. It’s important to make sure that the baby is nursing regularly. Even before the milk comes in, the baby will get plenty of nutrients from the colostrum. You can also make sure the baby is feeding okay by verifying output. What goes in must come out. If you’re changing diapers a lot, you probably don’t have anything to worry about.
  2. The mother may experience severe cramping after birth. This is natural. The uterus is shrinking back down to original size, and it can be painful, especially after second and subsequent births. She can try a hot pillow, massage, switching positions, and over-the-counter Ibuprofen. The afterpains will be worse during nursing sessions.
  3. If you haven’t done the research already, you might want to figure out how to get a birth certificate for your baby at this time.

How to Assist a Woman in Childbirth

Generally, a laboring woman needs very little physical assistance. Her body is meant to give birth, and it will do so regardless of your involvement. If you are dealing with a first-time mother, then you may need to give extra reassurance in the form of soothing encouragement. Of course, you should pay attention to the individual needs of the laboring woman. If she asks you to leave her alone, then you should honor her wish. However, you should remain nearby in order to assist her when necessary.

Keep Her Hydrated

The two main things that you can do during labor are to make sure that the laboring woman is drinking and urinating regularly. During the early stages of labor, she may even be hungry. You should take her cues, but periodically offering her water to drink is easier than for her to have to ask you for it.

It’s very important to make sure that the laboring woman empties her bladder regularly, at least once every hour. A full bladder can actually impede the progress of labor. Plus, emptying the bladder also has the physical side-effect of relaxing the muscles that are relevant during childbirth. However, during the end of the first stage of labor, it may feel very uncomfortable for the woman to sit on the toilet during a contraction.

Get Supplies Ready

Whether you are waiting for birth attendants or planning on going through with this on your own, as the birth assistant, it’s your job to get the supplies ready. While you can easily find a long list of necessary supplies, you can cut it down to bare essentials if necessary. Especially for an unplanned, unassisted birth, you may not have everything ready. You should find towels or sheets to wrap the baby in first. At home, you can warm towels up in the dryer to help baby stay warm.

If you have the time, you might want to work on protecting your flooring. Old tarps, mattress protectors, or even trash bags work can be used under blankets and bedding to prevent stains on your carpet or hardwood floors. If it’s possible, encourage the laboring woman to give birth near the bathroom. The shorter distance from the site of the birth to the bathroom, the less you’ll have to worry about blood dripping everywhere. You could also put towels or blankets on the floor to create a path to the bathroom.

Finally, you need to find something to cut the cord with. Cutting the cord doesn’t have to get done quickly. In fact, some people choose not to do it at all (it’s called a Lotus birth). Therefore, you can take your time and sterilize those scissors properly. If you don’t have scissors, a knife would work, too. But it’s really important to sterilize it first. All you need to do is put it in boiling water for a minute or two.

Evaluate Baby and Mother

When the baby is born, you can help by evaluating both baby and mother. If the baby is not breathing on her own, you need to clear her nose and mouth. It also helps to rub the baby’s back to get her going. If you don’t have a suction bulb, you can use your mouth to suction baby’s airways. This should not be necessary at every birth, but if the baby is turning blue, then you have to act fast.

Both baby and mother will do better if they can just be together. Leaving the baby in mother’s arms will help the newborn regulate his temperature. It will also encourage breastfeeding, and most babies will be ready to latch on within the first hour. Instead of worrying too much about cleanup right away, you also need to keep an eye on the mother. If she feels dizzy or is losing a lot of blood, you need to take it seriously.

For the most part, labor will progress on its own without your help. In fact, most of the time, it’s better not to interfere. As the attendant, it’s your job to get medical help if necessary and provide the basic supplies when needed. But for the mother, the benefits of having a birth attendant who cares will be very valuable indeed.