,u ,,em]g5cy ,,*ildbir? ,a ,,ref]5ce ,,guide ,,= ,,/ud5ts ,,( ,,! ,,m$ical ,,self-,,help ,,tra9+ ,,c\rse ,,lesson ,,no4 #aa ,,ackn[l$gm5t ,we wi% to ackn[l$ge ) grateful appreciation ! _m s]vices provid$ by ! ,am]ican ,m$ical ,association1 ?r\gh ! ,committee on ,disa/] ,m$ical ,c>e1 ,c\ncil on ,national ,security1 ,bo>d ( ,tru/ees & /aff1 9 ! prep>ation ( ?is h&book4 ,f ! inception ( /udies to det]m9e em]g5cy heal? te*niques & proc$ures1 ! ,association gave valuable assi/ance & support4 ,! ,committee on ,disa/] ,m$ical ,c>e ( ! ,c\ncil on ,national ,security1 ,,ama1 review$ ! mat]ial 9 its v>i\s /ages ( production1 & made significant contributions to ! cont5t ( ! h&book4 ,a jo9t publication ( ! ,u4,s4 ,,dep>tm5t ,,( ,,def5se ,(fice ( ,civil ,def5se & ! ,u4 ,s4 ,,dep>tm5t ,,( ,,heal?1 ,,education1 ,,& ,,welf>e ,public ,heal? ,s]vice ,heal? ,s]vices & ,m5tal ,heal? ,adm9i/ration ,division ( ,em]g5cy ,heal? ,s]vices #efjj ,fi%]s ,lane1 ,rockville1 ,m>yl& #bjheb ,repr9t$ ,decemb] #aigj ,,em]g5cy ,,*ildbir? ,:at ,to ,d #a4 ,let nature be y\r be/ help]4 ,*ildbir? is a v natural act4 #b4 ,at fir/ signs ( labor assign ! be/ qualifi$ p]son to rema9 ) "m4 #c4 ,be calm2 reassure "m4 #d4 ,place "m & att5dant 9 ! mo/ protect$ place 9 ! %elt]4 #e4 ,keep *ildr5 & o!rs away4 #f4 ,h h&s z clean z possible4 #g4 ,keep h&s away f bir? canal4 #h4 ,see t baby brea!s well4 #i4 ,place baby face d[n across "m's abdom54 #aj4 ,keep baby w>m4 #aa4 ,wrap aft]bir? ) baby4 #ab4 ,keep baby ) "m con/antly4 #ac4 ,make "m z com=table z possible4 #ad4 ,id5tify baby4 ,:at ,n ,to ,d #a4 ,,d ,,n hurry4 #b4 ,,d ,,n pull on baby1 let baby be born naturally4 #c4 ,,d ,,n pull on cord1 let ! plac5ta 7aft]bir?7 come naturally4 #d4 ,,d ,,n cut & tie ! cord until baby ,,& aft]bir? h be5 deliv]$4 #e4 ,,d ,,n give m$ication4 ,,d ,,n ,,hurry--,,let ,,nature ,,take ,,h] ,,c\rse4 ,if x becomes necess>y = families to take refuge 9 fall\t %elt]s !re w und\bt$ly be a numb] ( babies born "u difficult conditions & )\t m$ical assi/ance4 ,e expectant "m & ! memb]s ( h] family %\ld d all !y c to prep>e = em]g5cy bir?s4 ,!y w ne$ to "k :at to d & :at to h ready4 7,see ,expectant ,"m's ,em]g5cy ,kit47 ,,special ,,safegu>ds ,a pregnant woman %\ld be especially c>eful to protect h]self f radiation exposure4 ,%e %\ld h ! mo/ protect$ corn] ( ! %elt] & n be all[$ to risk outside exposure4 ,%e %\ld n lift heavy objects or pu% heavy furniture4 ,if food %ortages exi/1 %e %\ld be giv5 "s pref]5ce4 ,fe> & possible ex]tion involv$ dur+ an atomic attack w probably increase ! numb] ( premature bir?s & ( misc>riages4 ,,prep>ations ,usually !re is pl5ty ( "t aft] ! beg9n+ ( fir/ labor pa9s to get ready = ! deliv]y4 ,signs ( labor are l[ backa*e1 bloody-t+$ muc\s /r+s pass+ f ! bir? canal1 or a gu% ( wat] f ! bir? canal4 ,! "m w ne$ a clean surface to lie on4 ,h] b$ %\ld be s arrang$ t ! mattress is well protect$ by wat]pro( %eet+ or pads made f sev]al ?icknesses ( pap] cov]$ ) clo?4 ,cov] ^! protective mat]ials ) a regul> b$%eet4 ,a w>m b$ %\ld be made ready 9 advance = ! baby4 ,x may be a clo!s basket1 a box l9$ ) a blanket1 or a bureau draw] plac$ on firm *airs or on a table4 ,if possible1 w>m ! baby's blanket1 %irt1 & diap]s ) a hot wat] bottle4 ,w>m bricks or a bag ( table salt t has be5 heat$ c be us$ if a hot wat] bottle is n available4 ,a knife1 a pair ( scissors1 or a razor %\ld be ?or\ghly cleans$ & /]iliz$ 9 prep>ation = cutt+ ! umbilical cord4 ,if !re is no way to boil wat] to /]ilize !m 7! pref]r$ me?od ( /]ilization71 /]ilize !m by subm]sion 9 #gj p]c5t isopropyl alcohol solution = at lea/ #bj m9utes or up to #c h\rs1 if possible4 ,/]ile tapes = ty+ ! umbilical cord w be ne$$4 7,d n remove !m f _! /]ile wrapp+s until y are ready to use !m47 ,if no tapes are available1 a clean %oe/r+ or a /rip ( %eet+ 7fold$ into a n>r[ tie7 c be boil$ & us$ wet z a cord tie sub/itute4 ,,/ages ,,( ,,labor ,labor is ! t]m us$ to describe ! process ( *ildbir?4 ,x consi/s ( ! contractions ( ! wall ( ! womb 7ut]us7 :i* =ce ! baby &1 lat]1 ! aft]bir? 7plac5ta7 into ! outside _w4 ,labor is divid$ into ?ree /ages4 ,its duration v>ies greatly 9 diff]5t p]sons & "u diff]5t circum/ances4 ,dur+ ! fir/ & longe/ /age1 ! small op5+ at ! l[] end ( ! womb gradually /ret*es until x is l>ge en\gh to let ! baby pass ?r\gh4 ,! contractions 7tight5+7 ( ! ut]us1 :i* br+ ab\t ?is /ret*+ & move ! baby along into ! bir? canal1 cause pa9s kn[n z labor pa9s4 ,^! pa9s1 usually beg9n+ z an a*+ s5sation 9 ! small ( ! back1 turn 9 a %ort "t into regul>ly recurr+ cramplike pa9s 9 ! l[] abdom54 ,by plac+ y\r h& on ! "m's abdom5 j above ! navel1 y c feel ea* tight5+ ( ! ut]us z an increas+ firmness or h>dness4 ,x la/s = #cj to #fj seconds4 ,! pa9s disappe> ea* "t ! ut]us relaxes4 ,at fir/ ^! pa9s occur f #aj to #bj m9utes ap>t & are n v sev]e4 ,!y may ev5 /op completely = a :ile & !n />t up aga94 ,! "m %\ld re/ :5 %e is tir$ b ne$ n be ly+ d[n cont9u\sly4 ,%e may sleep betwe5 tight5+s if %e c4 ,%e c take a little wat] or p]haps tea dur+ ! entire labor process4 ,%e %\ld ur9ate frequ5tly dur+ labor s ! bladd] w be z empty z possible at ! "t ( bir?4 ,! sk9 9 ! vag9al area ( ! "m %\ld be spong$ occasionally ) soapy wat]4 ,special att5tion %\ld be giv5 to clean+ ! inn] sides ( ! ?ighs & ! rectal area ) heavy la!r4 ,soap or wat] %\ld n be all[$ to ent] ! vag9a4 ,a slight1 wat]y1 blood/a9$ dis*>ge f ! vag9a normally accompanies labor pa9s or occurs be=e ! pa9s beg94 ,= fir/ babies1 ?is /age ( labor may cont9ue = z long z #ah h\rs or m4 ,= wom5 :o h _h a previ\s baby1 x may la/ only #b or #c h\rs4 ,! end ( ?is fir/ /age is usually signal$ by ! sudd5 press+ ( a l>ge gu% ( wat] 7a p9t or s71 caus$ by ! normal break+ ( ! bag ( wat]s :i* surr\nds ! baby 9 ! "m's womb4 ,= "s wom51 ! bag ( wat]s breaks be=e labor beg9s or p]haps z ! fir/ sign ( its beg9n+4 ,?is %\ld n cause ! "m or ^? help+ h] any conc]ns4 ,x usually does n s]i\sly affect ! bir?4 ,?r\gh ?is fir/ /age ( labor1 ! "m does n h to "w to help ! baby be born4 ,%e %\ld n try to pu% ! baby d[n1 b %\ld try to relax h] muscles4 ,%e c help d ?is by tak+ deep brea?s ) h] m\? op5 dur+ ea* tight5+4 ,illu/ration3 ,a4 ,at full t]m1 or aft] #dj weeks ( pregnancy1 ! baby is ready to be born4 ,! c]vix ?r\gh :i* baby mu/ leave ! ut]us is %[n cle>ly "h1 /ill clos$4 ,! contractions ( ! muscles ( ! ut]us w op5 ! c]vix1 & =ce ! baby d[n ?r\gh ! vag9a1 or bir? canal1 to ! outside4 ,illu/ration3 ,b4 ,at ! end ( ! fir/ /age ( labor ! c]vix is completely op5 & ! baby's head is beg9n+ to come d[n ?r\gh ! vag9a4 ,contractions beg9 9 ! l[] back & lat] are felt 9 ! l[] abdom54 ,at ! "t %[n "h contractions are probably com+ e #b m9utes1 la/+ #dj-fj seconds & v /rong4 ,illu/ration3 ,c4 ,! fir/ /age ( labor usually la/s sev]al h\rs & is h>d "w4 ,! "m ne$s to relax1 re/1 & be reassur$4 ,give h] wat] & fruit juices4 ,9 ?is picture ! second /age ( labor is well along4 ,x is %ort] ?an ! fir/ /age & ! "m w n[ be pu%+ d[n ) ea* contraction1 help+ to =ce ! baby into ! _w4 ,illu/ration3 ,d4 ,! head ( ! baby has be5 p>tially born4 ,?is %[s ! usual position ) ! face d[n & ! back ( ! head up4 ,! bag ( wat]s 9 :i* ! baby is enclos$ ?r\gh\t ! pregnancy may h brok5 at ! beg9n+ ( labor1 be=e or dur+ ! fir/ /age4 ,x may break n[1 or h to be torn ) ! f+]s4 ,illu/ration3 ,e4 ,"h y see ! baby's head turn$ to ! "r z is usual4 ,! %\ld]s are ab\t to be born4 ,! head mu/ turn s t ! baby's body c fit into ! bir? canal & come ?r\gh m easily4 ,aft] ! bir? ( ! baby !re w be fur!r ut]9e contractions & ! plac5ta w be sep>at$ f ! ut]9e wall & expell$4 ,,*ange ,,( ,,feel+ ,gradually ! "t betwe5 ! lab\r pa9s gr[s %ort] & ! pa9s increase 9 sev]ity until !y are com+ e #b to #c m9utes4 ,x w n be long n[ be=e ! baby is born4 ,at ?is /age ! "m w notice a *ange4 ,in/ead ( ! tightness 9 ! l[] abdom5 & pa9 across ! back1 %e w feel a be>+ d[n s5sation almo/ z if %e 7 hav+ a b[el movem5t4 ,?is means ! baby is mov+ d[n4 ,:5 ?is happ5s1 %e %\ld lie d[n & get ready = ! bir? ( ! *ild4 ,! tight5+ & be>+ d[n feel+s w come m frequ5tly & be h>d]4 ,%e w h an uncontrollable urge to pu% d[n1 :i* %e may d4 ,b %e %\ld n "w too h>d at x because ! baby w be br\ght d[n )\t h] /ra9+ too h>d4 ,!re w probably be m blood %[+ at ?is po9t4 ,! p]son att5d+ ! deliv]y %\ld ?or\ghly scrub h&s ) soap & wat]4 ,nev] t\* ! vag9a or put f+]s inside = any reason4 ,! "m also %\ld keep h] h&s away f ! vag9a4 ,z soon z a bulge beg9s to appe> 9 ! vag9al area & "p ( ! baby is visible1 ! "m %\ld /op pu%+ d[n4 ,%e %\ld try to brea! l a pant+ dog ) h] m\? op5 9 ord] n to pu% ! baby out too rapidly ) consequ5t te>+ ( h] tissue4 ,%e %\ld keep h] knees up & legs sep>at$ s t ! p]son help+ h] c get at ! baby m easily4 ,,mom5t ,,( ,,bir? ,! p]son help+ ! "m %\ld always let ! baby be born by itself4 ,no attempt %\ld be made to pull ! baby out 9 any way4 ,usually ! baby's head appe>s fir/1 ! top ( ! head pres5t+ & ! face d[nw>d4 ,infrequ5tly ! baby w be born 9 a diff]5t position1 sometimes buttocks fir/1 occasionally foot or arm fir/4 ,9 ^! infrequ5t situations1 pati5ce )\t int]f]5ce 9 ! bir? process is mo/ important4 ,! natural process ( deliv]y1 al?\gh sometimes sl[]1 w give ! *ild & ! "m ! be/ *ance ( a safe & successful bir?4 ,! baby does n ne$ to be born 9 a hurry1 b usually ab\t a m9ute aft] ! head appe>s ! "m w h ano!r be>+ d[n feel+ & pu% ! %\ld]s & ! re/ ( ! baby out4 ,z ! baby is be+ expell$1 ! p]son help+ ! "m %\ld support ! baby on h] h&s & arms s t ! baby w avoid contact ) any blood or wa/e mat]ial on ! b$4 ,if !re is /ill a membrane f ! wat] sac ov] ! baby's head & face at deliv]y1 x %\ld imm$iately be tak5 betwe5 ! f+]s & torn s t ! wat] inside w run out & ! baby c brea!4 ,if1 z sometimes happ5s1 ! cord1 :i* atta*es ! *ild f its navel to ! plac5ta 9 ! "m's womb1 %\ld be wrapp$ ar\nd ! baby's neck :5 8 head & neck appe>1 try to slip x quickly ov] 8 head s t he w n /rangle4 ,aft] ! baby is born1 wrap a fold ( t[el ar\nd 8 ankles to prev5t slipp+ & hold him up by ! heels ) "o h&1 tak+ c>e t ! cord is slack4 ,to get a good safe grip1 ins]t "o f+] betwe5 ! baby's ankles4 ,d n sw+ or spank ! baby4 ,hold him ov] ! b$ s t he _c fall f> if he %\ld slip f y\r grasp4 ,! baby's body w be v slipp]y4 ,place y\r o!r h& "u ! baby's =ehead & b5d its head back slightly s t ! fluid & mucus c run out ( its m\?4 ,:5 ! baby beg9s to cry1 lay him on 8 side on ! b$ close en\gh to ! "m to keep ! cord slack4 ,! baby w usually cry )9 ! fir/ m9ute4 ,if he does n cry or brea! )9 #b or #c m9utes1 use m\?-to-m\? artificial respiration4 ,v little =ce %\ld be us$ 9 bl[+ air into ! baby's m\?4 ,a %ort puff ( brea? ab\t e #e seconds is en\gh4 ,z soon z ! baby />ts to brea! or cry1 m\?-to-m\? brea?+ %\ld be /opp$4 ,,cutt+ ,,! ,,cord ,!re %\ld be no hurry to cut ! cord4 ,take z mu* "t z necess>y to prep>e ! ties & %>p in/rum5ts4 ,y w ne$ two pieces ( /]ile :ite cotton tape or two pieces ( #a-;in*-wide /]ile gauze b&age ab\t #i in*es long to use to tie ! cord4 7,if y d n h /]ile mat]ial = ty+ ! cord b d h facilities = boil+ wat]1 /rips ( %eet+--boil$ = #ae to #bj m9utes to make !m /]ile--c be us$47 ,tie ! umbilical cord ) ! /]ile tape 9 two places1 "o ab\t #d in*es f ! baby & ! o!r #b in*es f>!r along ! cord t[>d ! "m1 mak+ two or m simple knots at ea* place4 ,cut ! cord betwe5 ^! two ties ) a clean %>p in/rum5t su* z a knife1 razor blade1 or scissors4 ,a /]ile dress+ ab\t #d in*es squ>e %\ld be plac$ ov] ! cut end ( ! cord at ! baby's navel & %\ld be held 9 place by wrapp+ a bellyb& or fold$ diap] ar\nd ! baby4 ,if a /]ile dress+ is n available1 no dress+ or bellyb& %\ld be us$4 ,reg>dless ( :e!r a dress+ is appli$ or n1 no p[d]1 solution1 or dis9fectant ( any k9d %\ld be put on ! cord or navel4 ,if ! aft]bir? has n yet be5 expell$1 cov] ! end ( ! umbilical cord atta*$ to x 7& n[ protrud+ f ! vag9a7 ) a /]ile dress+ & tie x 9 place4 ,illu/ration3 ,cut betwe5 ! squ>e knot by br++ ! left tape ov] "r tape = fir/ loop & "r tape ov] left = second loop4 ,tight5 ea* loop firmly z ti$4 ,use scissors or a razor blade to cut cord4 ,,?ird ,,/age ,,( ,,labor ,usually a few m9utes aft] ! baby is born 7al?\gh sometimes an h\r or m w elapse7 ! "m w feel a brief return ( ! labor pa9s :i* _h ceas$ ) ! bir?4 ,^! are due to contractions ( ! ut]us z x seeks to expel ! aft]bir?4 ,d n pull on ! cord to hurry ?is process4 ,"s ble$+ is to be expect$ at ?is /age4 ,if !re is a lot ( ble$+ be=e ! aft]bir? is expell$1 ! att5dant %\ld g5tly massage ! "m's abdom51 j above ! navel4 ,?is w help ! ut]us to tight51 help ! aft]bir? come out1 & r$uce ble$+4 ,x may be desirable to put ! baby almo/ imm$iately to ! "m's brea/ = a m9ute or two on ea* side ev5 ?\gh ! "m w h no milk z yet4 ,?is helps ! ut]us contract1 & r$uces ! ble$+4 ,someone %\ld /& by ! "m & occasionally massage h] abdom5 g5tly = ab\t an h\r aft] ! aft]bir? is expell$4 ,aft] t ! "m %\ld feel ! r\nd$ surface ( ! ut]us ?r\gh ! abdom5 & squeeze firmly b g5tly ) h] f+]s4 ,! b$d+ %\ld be cleans$ & ! "m spong$4 ,wa%+ & wip+ ( ! vag9al area %\ld always be done f ! front to ! back 9 ord] to avoid contam9ation4 ,a sanit>y napk9 %\ld be appli$4 ,keep ! "m w>m ) blankets4 ,%e may h a slight *ill4 ,give h] a w>m 7n hot7 dr9k ( sweet5$ tea1 milk1 or b\llion4 ,wipe h] h&s & face ) a damp t[el4 ,%e may drop (f to sleep4 ,! "m's diet aft] deliv]y may include any available foods %e wi%es4 ,%e may eat or dr9k z soon z %e wants to1 & %e %\ld be enc\rag$ to dr9k pl5ty ( fluids1 especially milk4 ,cann$ milk c be us$ & made m palatable by dilut+ ) equal p>ts ( wat] & add+ sug>1 eggs1 *ocolate1 or o!r flavor+4 ,= ! fir/ #bd or #dh h\rs aft] deliv]y1 ! "m w cont9ue to h "s cramp+ pa9s 9 ! l[] abdom5 :i* may cause a great deal ( discom=t4 ,aspir9 may help relieve ^! aft]pa9s4 ,%e %\ld empty h] bladd] e few h\rs = #b days foll[+ ! bir?4 ,if h] b[els d n move )9 #c days aft] deliv]y %e %\ld be giv5 an enema4 ,,misc>riage ,if a pregnant woman %[s evid5ce ( ble$+1 %e %\ld re/rict h] activities & re/ 9 b$ 9 an ef=t to prev5t possible loss ( ! baby4 ,if a misc>riage does occur1 keep ! pati5t flat ) ! foot ( ! b$ elevat$ f #ab to #ah in*es to ret>d vag9al ble$+4 ,keep h] w>m & quiet1 & give h] fluids4 ,,expectant ,,"m',s ,,em]g5cy ,,*ildbir? ,,kit ,! public heal? & civil def5se ag5cies ( "o ,/ate h plann$ a #a #a_/b-p\nd em]g5cy *ildbir? kit made up ( basic supplies t c be c>ri$ 9 a #a-y>d-squ>e receiv+ blanket4 ,! kit consi/s ( ! foll[+3 ,"o-y>d squ>e ( out+ flannel1 hemm$ 7receiv+ blanket74 ,pla/ic 7polye?yl5e flexible film7 = out] wrapp+ ( ! kit if desir$4 7,d n wrap ! baby 9 ?is pla/ic film47 ,"o or two diap]s4 ,f\r sanit>y napk9s 7wrapp$74 ,adhesive tape id5tification /rips = "m & baby4 ,%ort p5cil4 ,soap4 ,/]ile package conta9+3 ,small pair ( blunt-end scissors 7*eape/ scissors w d71 or a safety razor blade ) a gu>d on "o side4 ,f\r pieces ( :ite cotton tape1 #a_/b in* wide & #i in*es long4#a ,f\r cotton balls4 ,roll ( #c-;in* gauze b&age4 ,six #d-;in* squ>es ( gauze4#a ,two or m safety p9s4 #a ,y w actually use only two tapes = ty+ ! umbilical cord4 ,! two extras are includ$ z a safegu>d 9 case "o or two %\ld be dropp$ or soil$4 ,extra #d-;in* squ>es ( gauze also are includ$4 ,illu/ration3 ,em]g5cy *ildbir? kit ,in/ructions su* z ^? conta9$ 9 ?is *apt] also %\ld be consid]$ a "p ( ! em]g5cy *ildbir? kit4 ,to make ! kit ready to c>ry1 lay ! pla/ic 7if us$7 out flat1 & lay receiv+ blanket out flat on top ( ! pla/ic4 ,place ! diap]s1 /]ile package1 soap1 sanit>y napk9s1 id5tification tapes1 p5cil & in/ructions 9 ! c5t]4 ,pull two opposite corn]s ( ! receiv+ blanket & pla/ic toge!r & tie4 ,d ! same ) ! o!r opposite corn]s1 pull+ ea* side toge!r well s t no?+ w fall out4 ,!n tightly knot ! loose ends toge!r 9 ! same way1 leav+ an op5+ s t ! kit c be slipp$ ov] ! arm = c>ry+ ! kit :ile leav+ ! h&s free4 ,su* an em]g5cy deliv]y kit w weigh ab\t #a #a_/b p\nds4 ,! cont5ts sugge/$ are basic ess5tials only1 = extreme em]g5cy4 ,mu* m c\ld be add$1 b ! extra weight might mean leav+ beh9d "s o!r items ne$$ = survival4 ,additional supplies c\ld be /or$ 9 y\r home %elt] to be ready 9 ! ev5t ! bir? takes place !re4 ,9 ! case !re is no ne$ = an em]g5cy deliv]y1 ei!r 9 ! home1 %elt] or 9 "s evacuation situation1 ! supplies 9 ! kit c be us$ 9 home c>e ( ! baby4 ,,id5tification ,,tapes ,9 em]g5cy situations1 id5tification w be p>ticul>ly important1 especially if ! bir? %\ld take place 9 a gr\p %elt] r ?an a family %elt]1 or 9 an evacuation situation4 ,two wide /rips ( adhesive tape w be ne$$--"o long en\gh to g ar\nd ! "m's wri/1 & ! o!r long en\gh to g ar\nd ! baby's ankle4 ,in=mation %\ld be writt5 on ^! /rips z %[n bel[4 ,illu/ration3 ,= "m--,write p>5ts' names1 blood types1 & "m's ,rh factor1 /reet address1 & :e!r x is a fir/ or lat] *ild4 ,illu/ration3 ,= baby--,write date & h\r ( bir? & p>5ts' names & address4