,u ,,emergency ,,childbirth ,a ,,reference ,,guide ,,for ,,students ,,of ,,the ,,medical ,,self-,,help ,,training ,,course ,,lesson ,,no4 #aa ,,acknowledgment ,we wish to acknowledge with grateful appreciation the many services provided by the ,american ,medical ,association1 through the ,committee on ,disaster ,medical ,care1 ,council on ,national ,security1 ,board of ,trustees and staff1 in the preparation of this handbook4 ,from the inception of studies to determine emergency health techniques and procedures1 the ,association gave valuable assistance and support4 ,the ,committee on ,disaster ,medical ,care of the ,council on ,national ,security1 ,,ama1 reviewed the material in its various stages of production1 and made significant contributions to the content of the handbook4 ,a joint publication of the ,u4,s4 ,,department ,,of ,,defense ,office of ,civil ,defense and the ,u4 ,s4 ,,department ,,of ,,health1 ,,education1 ,,and ,,welfare ,public ,health ,service ,health ,services and ,mental ,health ,administration ,division of ,emergency ,health ,services #efjj ,fishers ,lane1 ,rockville1 ,maryland #bjheb ,reprinted ,december #aigj ,,emergency ,,childbirth ,what ,to ,do #a4 ,let nature be your best helper4 ,childbirth is a very natural act4 #b4 ,at first signs of labor assign the best qualified person to remain with mother4 #c4 ,be calm2 reassure mother4 #d4 ,place mother and attendant in the most protected place in the shelter4 #e4 ,keep children and others away4 #f4 ,have hands as clean as possible4 #g4 ,keep hands away from birth canal4 #h4 ,see that baby breathes well4 #i4 ,place baby face down across mother's abdomen4 #aj4 ,keep baby warm4 #aa4 ,wrap afterbirth with baby4 #ab4 ,keep baby with mother constantly4 #ac4 ,make mother as comfortable as possible4 #ad4 ,identify baby4 ,what ,not ,to ,do #a4 ,,do ,,not hurry4 #b4 ,,do ,,not pull on baby1 let baby be born naturally4 #c4 ,,do ,,not pull on cord1 let the placenta 7afterbirth7 come naturally4 #d4 ,,do ,,not cut and tie the cord until baby ,,and afterbirth have been delivered4 #e4 ,,do ,,not give medication4 ,,do ,,not ,,hurry--,,let ,,nature ,,take ,,her ,,course4 ,if it becomes necessary for families to take refuge in fallout shelters there will undoubtedly be a number of babies born under difficult conditions and without medical assistance4 ,every expectant mother and the members of her family should do all they can to prepare for emergency births4 ,they will need to know what to do and what to have ready4 7,see ,expectant ,mother's ,emergency ,kit47 ,,special ,,safeguards ,a pregnant woman should be especially careful to protect herself from radiation exposure4 ,she should have the most protected corner of the shelter and not be allowed to risk outside exposure4 ,she should not lift heavy objects or push heavy furniture4 ,if food shortages exist1 she should be given some preference4 ,fear and possible exertion involved during an atomic attack will probably increase the number of premature births and of miscarriages4 ,,preparations ,usually there is plenty of time after the beginning of first labor pains to get ready for the delivery4 ,signs of labor are low backache1 bloody-tinged mucous strings passing from the birth canal1 or a gush of water from the birth canal4 ,the mother will need a clean surface to lie on4 ,her bed should be so arranged that the mattress is well protected by waterproof sheeting or pads made from several thicknesses of paper covered with cloth4 ,cover these protective materials with a regular bedsheet4 ,a warm bed should be made ready in advance for the baby4 ,it may be a clothes basket1 a box lined with a blanket1 or a bureau drawer placed on firm chairs or on a table4 ,if possible1 warm the baby's blanket1 shirt1 and diapers with a hot water bottle4 ,warm bricks or a bag of table salt that has been heated can be used if a hot water bottle is not available4 ,a knife1 a pair of scissors1 or a razor should be thoroughly cleansed and sterilized in preparation for cutting the umbilical cord4 ,if there is no way to boil water to sterilize them 7the preferred method of sterilization71 sterilize them by submersion in #gj percent isopropyl alcohol solution for at least #bj minutes or up to #c hours1 if possible4 ,sterile tapes for tying the umbilical cord will be needed4 7,do not remove them from their sterile wrappings until you are ready to use them47 ,if no tapes are available1 a clean shoestring or a strip of sheeting 7folded into a narrow tie7 can be boiled and used wet as a cord tie substitute4 ,,stages ,,of ,,labor ,labor is the term used to describe the process of childbirth4 ,it consists of the contractions of the wall of the womb 7uterus7 which force the baby and1 later1 the afterbirth 7placenta7 into the outside world4 ,labor is divided into three stages4 ,its duration varies greatly in different persons and under different circumstances4 ,during the first and longest stage1 the small opening at the lower end of the womb gradually stretches until it is large enough to let the baby pass through4 ,the contractions 7tightening7 of the uterus1 which bring about this stretching and move the baby along into the birth canal1 cause pains known as labor pains4 ,these pains1 usually beginning as an aching sensation in the small of the back1 turn in a short time into regularly recurring cramplike pains in the lower abdomen4 ,by placing your hand on the mother's abdomen just above the navel1 you can feel each tightening of the uterus as an increasing firmness or hardness4 ,it lasts for #cj to #fj seconds4 ,the pains disappear each time the uterus relaxes4 ,at first these pains occur from #aj to #bj minutes apart and are not very severe4 ,they may even stop completely for a while and then start up again4 ,the mother should rest when she is tired but need not be lying down continuously4 ,she may sleep between tightenings if she can4 ,she can take a little water or perhaps tea during the entire labor process4 ,she should urinate frequently during labor so the bladder will be as empty as possible at the time of birth4 ,the skin in the vaginal area of the mother should be sponged occasionally with soapy water4 ,special attention should be given to cleaning the inner sides of the thighs and the rectal area with heavy lather4 ,soap or water should not be allowed to enter the vagina4 ,a slight1 watery1 bloodstained discharge from the vagina normally accompanies labor pains or occurs before the pains begin4 ,for first babies1 this stage of labor may continue for as long as #ah hours or more4 ,for women who have had a previous baby1 it may last only #b or #c hours4 ,the end of this first stage is usually signaled by the sudden pressing of a large gush of water 7a pint or so71 caused by the normal breaking of the bag of waters which surrounds the baby in the mother's womb4 ,for some women1 the bag of waters breaks before labor begins or perhaps as the first sign of its beginning4 ,this should not cause the mother or those helping her any concerns4 ,it usually does not seriously affect the birth4 ,through this first stage of labor1 the mother does not have to work to help the baby be born4 ,she should not try to push the baby down1 but should try to relax her muscles4 ,she can help do this by taking deep breaths with her mouth open during each tightening4 ,illustration3 ,a4 ,at full term1 or after #dj weeks of pregnancy1 the baby is ready to be born4 ,the cervix through which baby must leave the uterus is shown clearly here1 still closed4 ,the contractions of the muscles of the uterus will open the cervix1 and force the baby down through the vagina1 or birth canal1 to the outside4 ,illustration3 ,b4 ,at the end of the first stage of labor the cervix is completely open and the baby's head is beginning to come down through the vagina4 ,contractions begin in the lower back and later are felt in the lower abdomen4 ,at the time shown here contractions are probably coming every #b minutes1 lasting #dj-fj seconds and very strong4 ,illustration3 ,c4 ,the first stage of labor usually lasts several hours and is hard work4 ,the mother needs to relax1 rest1 and be reassured4 ,give her water and fruit juices4 ,in this picture the second stage of labor is well along4 ,it is shorter than the first stage and the mother will now be pushing down with each contraction1 helping to force the baby into the world4 ,illustration3 ,d4 ,the head of the baby has been partially born4 ,this shows the usual position with the face down and the back of the head up4 ,the bag of waters in which the baby is enclosed throughout the pregnancy may have broken at the beginning of labor1 before or during the first stage4 ,it may break now1 or have to be torn with the fingers4 ,illustration3 ,e4 ,here you see the baby's head turned to the right as is usual4 ,the shoulders are about to be born4 ,the head must turn so that the baby's body can fit into the birth canal and come through more easily4 ,after the birth of the baby there will be further uterine contractions and the placenta will be separated from the uterine wall and expelled4 ,,change ,,of ,,feeling ,gradually the time between the labour pains grows shorter and the pains increase in severity until they are coming every #b to #c minutes4 ,it will not be long now before the baby is born4 ,at this stage the mother will notice a change4 ,instead of the tightness in the lower abdomen and pain across the back1 she will feel a bearing down sensation almost as if she were having a bowel movement4 ,this means the baby is moving down4 ,when this happens1 she should lie down and get ready for the birth of the child4 ,the tightening and bearing down feelings will come more frequently and be harder4 ,she will have an uncontrollable urge to push down1 which she may do4 ,but she should not work too hard at it because the baby will be brought down without her straining too hard4 ,there will probably be more blood showing at this point4 ,the person attending the delivery should thoroughly scrub hands with soap and water4 ,never touch the vagina or put fingers inside for any reason4 ,the mother also should keep her hands away from the vagina4 ,as soon as a bulge begins to appear in the vaginal area and part of the baby is visible1 the mother should stop pushing down4 ,she should try to breathe like a panting dog with her mouth open in order not to push the baby out too rapidly with consequent tearing of her tissue4 ,she should keep her knees up and legs separated so that the person helping her can get at the baby more easily4 ,,moment ,,of ,,birth ,the person helping the mother should always let the baby be born by itself4 ,no attempt should be made to pull the baby out in any way4 ,usually the baby's head appears first1 the top of the head presenting and the face downward4 ,infrequently the baby will be born in a different position1 sometimes buttocks first1 occasionally foot or arm first4 ,in these infrequent situations1 patience without interference in the birth process is most important4 ,the natural process of delivery1 although sometimes slower1 will give the child and the mother the best chance of a safe and successful birth4 ,the baby does not need to be born in a hurry1 but usually about a minute after the head appears the mother will have another bearing down feeling and push the shoulders and the rest of the baby out4 ,as the baby is being expelled1 the person helping the mother should support the baby on her hands and arms so that the baby will avoid contact with any blood or waste material on the bed4 ,if there is still a membrane from the water sac over the baby's head and face at delivery1 it should immediately be taken between the fingers and torn so that the water inside will run out and the baby can breathe4 ,if1 as sometimes happens1 the cord1 which attaches the child from its navel to the placenta in the mother's womb1 should be wrapped around the baby's neck when his head and neck appear1 try to slip it quickly over his head so that he will not strangle4 ,after the baby is born1 wrap a fold of towel around his ankles to prevent slipping and hold him up by the heels with one hand1 taking care that the cord is slack4 ,to get a good safe grip1 insert one finger between the baby's ankles4 ,do not swing or spank the baby4 ,hold him over the bed so that he cannot fall far if he should slip from your grasp4 ,the baby's body will be very slippery4 ,place your other hand under the baby's forehead and bend its head back slightly so that the fluid and mucus can run out of its mouth4 ,when the baby begins to cry1 lay him on his side on the bed close enough to the mother to keep the cord slack4 ,the baby will usually cry within the first minute4 ,if he does not cry or breathe within #b or #c minutes1 use mouth-to-mouth artificial respiration4 ,very little force should be used in blowing air into the baby's mouth4 ,a short puff of breath about every #e seconds is enough4 ,as soon as the baby starts to breathe or cry1 mouth-to-mouth breathing should be stopped4 ,,cutting ,,the ,,cord ,there should be no hurry to cut the cord4 ,take as much time as necessary to prepare the ties and sharp instruments4 ,you will need two pieces of sterile white cotton tape or two pieces of #a-;inch-wide sterile gauze bandage about #i inches long to use to tie the cord4 7,if you do not have sterile material for tying the cord but do have facilities for boiling water1 strips of sheeting--boiled for #ae to #bj minutes to make them sterile--can be used47 ,tie the umbilical cord with the sterile tape in two places1 one about #d inches from the baby and the other #b inches farther along the cord toward the mother1 making two or more simple knots at each place4 ,cut the cord between these two ties with a clean sharp instrument such as a knife1 razor blade1 or scissors4 ,a sterile dressing about #d inches square should be placed over the cut end of the cord at the baby's navel and should be held in place by wrapping a bellyband or folded diaper around the baby4 ,if a sterile dressing is not available1 no dressing or bellyband should be used4 ,regardless of whether a dressing is applied or not1 no powder1 solution1 or disinfectant of any kind should be put on the cord or navel4 ,if the afterbirth has not yet been expelled1 cover the end of the umbilical cord attached to it 7and now protruding from the vagina7 with a sterile dressing and tie it in place4 ,illustration3 ,cut between the square knot by bringing the left tape over right tape for first loop and right tape over left for second loop4 ,tighten each loop firmly as tied4 ,use scissors or a razor blade to cut cord4 ,,third ,,stage ,,of ,,labor ,usually a few minutes after the baby is born 7although sometimes an hour or more will elapse7 the mother will feel a brief return of the labor pains which had ceased with the birth4 ,these are due to contractions of the uterus as it seeks to expel the afterbirth4 ,do not pull on the cord to hurry this process4 ,some bleeding is to be expected at this stage4 ,if there is a lot of bleeding before the afterbirth is expelled1 the attendant should gently massage the mother's abdomen1 just above the navel4 ,this will help the uterus to tighten1 help the afterbirth come out1 and reduce bleeding4 ,it may be desirable to put the baby almost immediately to the mother's breast for a minute or two on each side even though the mother will have no milk as yet4 ,this helps the uterus contract1 and reduces the bleeding4 ,someone should stand by the mother and occasionally massage her abdomen gently for about an hour after the afterbirth is expelled4 ,after that the mother should feel the rounded surface of the uterus through the abdomen and squeeze firmly but gently with her fingers4 ,the bedding should be cleansed and the mother sponged4 ,washing and wiping of the vaginal area should always be done from the front to the back in order to avoid contamination4 ,a sanitary napkin should be applied4 ,keep the mother warm with blankets4 ,she may have a slight chill4 ,give her a warm 7not hot7 drink of sweetened tea1 milk1 or boullion4 ,wipe her hands and face with a damp towel4 ,she may drop off to sleep4 ,the mother's diet after delivery may include any available foods she wishes4 ,she may eat or drink as soon as she wants to1 and she should be encouraged to drink plenty of fluids1 especially milk4 ,canned milk can be used and made more palatable by diluting with equal parts of water and adding sugar1 eggs1 chocolate1 or other flavoring4 ,for the first #bd or #dh hours after delivery1 the mother will continue to have some cramping pains in the lower abdomen which may cause a great deal of discomfort4 ,aspirin may help relieve these afterpains4 ,she should empty her bladder every few hours for #b days following the birth4 ,if her bowels do not move within #c days after delivery she should be given an enema4 ,,miscarriage ,if a pregnant woman shows evidence of bleeding1 she should restrict her activities and rest in bed in an effort to prevent possible loss of the baby4 ,if a miscarriage does occur1 keep the patient flat with the foot of the bed elevated from #ab to #ah inches to retard vaginal bleeding4 ,keep her warm and quiet1 and give her fluids4 ,,expectant ,,mother',s ,,emergency ,,childbirth ,,kit ,the public health and civil defense agencies of one ,state have planned a #a #a_/b-pound emergency childbirth kit made up of basic supplies that can be carried in a #a-yard-square receiving blanket4 ,the kit consists of the following3 ,one-yard square of outing flannel1 hemmed 7receiving blanket74 ,plastic 7polyethylene flexible film7 for outer wrapping of the kit if desired4 7,do not wrap the baby in this plastic film47 ,one or two diapers4 ,four sanitary napkins 7wrapped74 ,adhesive tape identification strips for mother and baby4 ,short pencil4 ,soap4 ,sterile package containing3 ,small pair of blunt-end scissors 7cheapest scissors will do71 or a safety razor blade with a guard on one side4 ,four pieces of white cotton tape1 #a_/b inch wide and #i inches long4#a ,four cotton balls4 ,roll of #c-;inch gauze bandage4 ,six #d-;inch squares of gauze4#a ,two or more safety pins4 #a ,you will actually use only two tapes for tying the umbilical cord4 ,the two extras are included as a safeguard in case one or two should be dropped or soiled4 ,extra #d-;inch squares of gauze also are included4 ,illustration3 ,emergency childbirth kit ,instructions such as those contained in this chapter also should be considered a part of the emergency childbirth kit4 ,to make the kit ready to carry1 lay the plastic 7if used7 out flat1 and lay receiving blanket out flat on top of the plastic4 ,place the diapers1 sterile package1 soap1 sanitary napkins1 identification tapes1 pencil and instructions in the center4 ,pull two opposite corners of the receiving blanket and plastic together and tie4 ,do the same with the other opposite corners1 pulling each side together well so that nothing will fall out4 ,then tightly knot the loose ends together in the same way1 leaving an opening so that the kit can be slipped over the arm for carrying the kit while leaving the hands free4 ,such an emergency delivery kit will weigh about #a #a_/b pounds4 ,the contents suggested are basic essentials only1 for extreme emergency4 ,much more could be added1 but the extra weight might mean leaving behind some other items needed for survival4 ,additional supplies could be stored in your home shelter to be ready in the event the birth takes place there4 ,in the case there is no need for an emergency delivery1 either in the home1 shelter or in some evacuation situation1 the supplies in the kit can be used in home care of the baby4 ,,identification ,,tapes ,in emergency situations1 identification will be particularly important1 especially if the birth should take place in a group shelter rather than a family shelter1 or in an evacuation situation4 ,two wide strips of adhesive tape will be needed--one long enough to go around the mother's wrist1 and the other long enough to go around the baby's ankle4 ,information should be written on these strips as shown below4 ,illustration3 ,for mother--,write parents' names1 blood types1 and mother's ,rh factor1 street address1 and whether it is a first or later child4 ,illustration3 ,for baby--,write date and hour of birth and parents' names and address4