In the cities, most babies are born in hospitals or other institutions where professional help from trained nurses and doctors is available. Even in villages, deliveries are conducted in primary health centers by professionals. However sometimes the women cannot get to a hospital and childbirth may take place at home, or on her way to the hospital in a bus, train, taxi, ambulance, or even unplanned on a plane or ship. The first-aider should be able to conduct this delivery properly so that at the end of it there is a healthy mother and a healthy baby. A first-aider may have to give help when a miscarriage occurs.
□ MISCARRIAGE
It occurs before 28th week of pregnancy, when the woman really does not except to deliver and hence is not ready for it. Then she is even less likely to be in a hospital than at term. She may be distressed and frightened and may be reluctant to confide in a stranger, particularly if that person is a man. Miscarriage is a dangerous event and needs prompt medical attention. It is often accompanied by vaginal bleeding which can be quite severe and sometimes life threatening. Features of a miscarriage are as follows.
1. Pain in lower abdomen and back.
2. Mucoid vaginal discharge.
3. Vaginal bleeding.
4. Loss of fluid vaginally.
First-aid
1. Reassure her.
2. Place her in a reclining position.
3. Give her privacy.
4. Monitor her vital parameters.
5. Keep any expelled material for showing to the doctor.
6. Treat shock.
7. Shift her to a hospital immediately.
□ CHILDBIRTH
Childbirth is a natural process and one does not have to do too much to see it to completion. But done improperly, there can be serious complications. Majority of births do not threaten the lives of both the mother and the baby. Labor usually lasts several hours, and there is normally adequate time to arrange for a transfer to a hospital. However sometimes a mother presents too late, or is trapped in a place due to natural disasters and cannot reach a hospital. Such a mother may be very anxious when she starts delivering in a place that is not the most ideal place for that purpose.
The stages of childbirth
Stage Features
First
It extends from the onset of labor to the full dilatation of the birth passage. It lasts for 12 to 14 hours.
The woman experiences periodic pains in the lower abdomen and back.
There is mucoid vaginal discharge, often mixed with a variable amount of blood.
The membranes rupture towards the end of this stage and there is expulsion of a lot of aminotic fluid vaginally.
Second
It extends from full dilatation of the birth passage to the expulsion of the baby. It lasts for up to 2 hours.
Third
It extends from the delivery of the baby to the delivery of the placenta and membranes. It lasts for 30 minutes.
Fourth
It is the 1-hour period after the third stage.
□ ARTICLES TO KEEP READY FOR A CHILDBIRTH
Minimum requirements
1. A lot of very clean clothes.
2. Alcohol.
3. An antiseptic soap.
4. Clean brush for scrubbing.
5. Clean cotton.
6. New razor blade to cut the umbilical cord.
7. Sterile gauze.
8. Two pieces of sterile, strong thread to tie the umbilical cord.
Additional desirable requirements
1. Antiseptic eye drops for the baby’s eyes.
2. Fetoscope or fetal stethoscope for listening to the new born baby’s feeble heart sounds.
3. Sterile needle and gut thread for sewing tears in the birth opening.
4. Sterile syringe and needles.
5. Suction bulb for sucking mucus out of the baby’s nose and mouth.
6. Two bowls — one for washing hands and the other for catching and examining.
7. Two clamps (hemostats) for clamping the umbilical cord.
□ INFECTION PREVENTION
When preparing for, and during the delivery it is extremely important to pay strict attention to asepsis and antisepsis because the placental bed is raw and there are a number of areas of injury in the birth passage. These can get infected very readily if microorganisms are allowed to enter it. Measures to prevent infection of the birth passage are as follows.
1. Ask everyone with a cold, cough, or septic spots on the hands to move away from the would-be mother.
2. Wear a face mask, if it is not available, tie a clean handkerchief in its place.
3. Scrub your hands and forearms thoroughly with soap and water for about five minutes.
4. After the delivery, wash your hands thoroughly again.