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It is plainly important for all expectant women to understand the normal course of unhindered labor and childbirth. The laboring woman and anyone she chooses to have accompany her can best foster the safest, easiest birth possible in any situation with a basic understanding of what is happening and exactly which actions, if any, are needed. The following descriptions and suggestions were extracted and compiled from numerous "Emergency Childbirth" articles and manuals in an attempt to bring together the most straightforward, useful information for an unattended birth, whether intentional or accidental. This is not intended to be a comprehensive guide for childbirth, but rather an outline of some of the more useful details. None of the following is meant to be taken as medical advice, because labor and birth are not medical conditions. First and foremost, birth is a natural, normal event, which, like most other bodily functions, proceeds best without outside interference.

Labor is sometimes described as consisting of three stages. In the first stage, muscles of the uterus (or "womb") contract to expand its opening - the cervix - and push the baby down into the vagina (or "birth canal"). During the second stage, these contractions (also called "hugs, "rushes," or "expansions") push the baby through the vagina and out into the world. This is sometimes accompanied by involuntary and/or voluntary pushing (or "bearing down") by the mother. Finally, in the third stage the placenta (or "afterbirth") comes out.

The first stage

During the first stage, the widening and thinning of the cervix may be noticeable only to the mother or may not be felt at all. This "dilation" and "effacement" can feel like stretching or pinching sensations, low backache, irregular muscular contractions or cramps in the lower abdomen. Other signs of this process may include the appearance of a slippery pink, red, yellow, or brown colored discharge from the vagina. The protective amniotic sac (or "bag of waters") may break or begin to leak on its own at this point, too, though it is perfectly normal for this to occur at any time from between the last few weeks of pregnancy; to entirely after the birth.

Some mothers may like to time their contractions. This is not a precise measurement by any means, but can give a general idea as to how far into labor mother is and how much time remains until the baby comes. To do this, place a hand on the abdomen just above the navel. If a companion is doing this s/he should first get the mother's permission. As contractions begin, the uterus will harden. Timing the interval from the moment the uterus begins to harden until it completely relaxes will tell you how long the contraction is lasting. As labor progresses, this time will usually increase.

Timing the intervals in between the start of one contraction and the start of the next contraction will tell you how often they are occurring. A simpler method is to count the number of contractions in any given amount of time - say half an hour - and divide the time by the number. As labor progresses, this time will usually decrease. As labor progresses, contractions may increase in intensity, frequency, and regularity. Sometimes - but not necessarily always - they may become painful or more so. If the contractions recur every 3-4 minutes and last around 50-60 seconds, the mother is probably in the latter part of the first stage. There will likely be an accompanying sensation of pressure in the pelvis as the baby moves downward.

Some general suggestions for the first stage of labor:

1. In the early part of labor it is healthy for the mother to stay active as long as she does not get uncomfortably tired, and rest whenever she feels like it. She and her companions, if any, should remain especially patient and calm at this time. This stage can continue for minutes or days, and pressure to perform can seriously undermine mother's morale. Mother can do as she pleases as the contractions come and go, and may breathe normally through them. Walking, standing, dancing, and most any moderate everyday activity can aid labor, so if that feels good to the mother she should do so. Eating, drinking, emptying the bowels, and urination as needed are very important to maintaining mother's energy and comfort levels. Be aware that rapid delivery can feel like an impending bowel movement, so take precautions to ensure that the baby is not accidentally born into the toilet. Vomiting is not abnormal during labor, so small portions of food and drink may be easiest to keep down. Besides plain water, broth, fruit juices, sports drinks, and ice chips are popular for quenching thirst during labor. Consensual intimacy with a partner is also extremely beneficial.

2. While the mother and infant are usually not endangered by the germs native to their family environment, it is wise to keep foreign objects and strangers' hands completely away from the mother's genitals, as they may introduce infection to the mother and baby.

3. Anyone allowed to be present at the labor and birth should respect all wishes of the mother, including whether she wants to be accompanied or left alone. Everyone present should remain pleasant and calm at all times. Nervous companions - even those not obviously so - can inhibit the woman's labor. Any comments on how long the labor is lasting, how the woman looks, and the like, can slow the birth process dangerously. Even eye contact or positive and quiet talk may obstruct the birth because labor contractions often require intense focus like that required to complete an orgasm. The mother's privacy and modesty should always be respected.

4. Relaxation is very advantageous. Trying to go limp like a "rag doll" and breathing deeply, consciously making your tummy rise and fall, can loosen muscle tension. Simulate the kind of breathing you do when you are nearly asleep. This abdominal breathing can help keep the tissues of both mom and baby well oxygenated. If the mother is open to conversation, companions may suggest that she relax her hands, face, legs, etc. if they look tense. Body tension may work against the contractions and create or intensify any sensations of "pain." Intentional relaxation can help a laboring woman to handle the contractions more easily and have a faster, safer labor.

5. If the laboring woman finds herself with tingling sensations in her hands and feet, she may be breathing too fast and may want to slow down. She may find it helpful to follow a companion's breathing until the tingling goes away.

6. Firm hand pressure on the mother's lower back by those attending may help to relieve any backache. Alternately, the mother may prefer to lean her back against a firm surface. Frequent changing of positions, rhythmic movement, massage, bathing, and masturbation may help to relieve any annoying sensations, too. Encouraging perspective can be gained by keeping in mind that in 24 hours of labor there are usually only about 3 1/2 hours of actual contractions, with periods of rest liberally interspersed. Some labors are longer than 24 hours, but many labors are far shorter.

7. When she feels the baby is on the way, mother should choose a place to have her baby that will be reasonably clean and peaceful. Optimally, her environment will support her to comfortably recline, squat, stand, move about or rest on hands and knees as she wishes. It may be desirable to have towels, pillows or blankets assembled for a soft landing place for baby and to absorb birth fluids.

At the end of the first stage, the mother may feel exhausted, discouraged or otherwise intensely emotional. This is often referred to as "transition" and can be the most intense or difficult part of labor. Such feelings are perfectly normal. The mother may have a backache, may vomit, may feel either hot or cold (or both at the same time). She may tremble, feel panicky or scared, cry or be easily upset by onlookers. She may feel that she cannot go on and may even announce that she has changed her mind and is not going through with the birth. At this time she should only be encouraged and assured that labor is proceeding well and her feelings are normal.

The second stage

The contractions of the second stage are often different from earlier ones. Some women even experience a long rest before second stage contractions begin. These may be easier to cope with, coming further apart, and the mother may feel inclined to bear down (push) with them. If she gets this feeling, she can take a deep breath as each contraction comes, hold her breath and gently push however she feels most comfortable. There is no hurry, and even if there is no urge to push voluntarily, the uterus will still move the baby down and out on its own. The mother need not exert great force as she pushes, if she does. She will often make deep, grunting moans with each contraction and may feel great relief from freely made vocalizations. She may want to push with several breaths during each contraction. After they pass, a deep sigh can help her recover her breath. She may then rest until the next contraction. She might even sleep between contractions.

More general suggestions for the second stage of labor:

1. Companions should remain calm. Be comforting but not condescending to the mother and help her prepare to catch her baby in whatever way she wishes. Support and defend her preferences however she directs you to. Discourage anyone allowed to view the birth from crowding around the mother or distracting her in any way. In order to avoid infecting mother and baby and inhibiting labor, continue to prevent strangers from touching the mother's genitals. Assist the mother in finding her most comfortable position possible. Help her remove or pull any constricting clothing above her waist.

2. Use the cleanest materials available for mother and baby. Clean towels or parts of the mother's own clothing can be used. In an emergency situation save something dry and clean to keep mother and baby warm after the birth. If mother wants to lie on the ground, she may want a blanket or other soft item under her. Newspaper or leaves can absorb birth fluids and soften the floor if nothing else is available. It is normal for mother to urinate or have a bowel movement occasionally while pushing, but it is good to try to keep these wiped away from the vaginal opening if possible.

3. At first, when the leading part of the baby's body reaches the outlet of the vagina, it will usually be seen only during contractions - retreating some in between - and will become constantly visible after a while. Whatever body part appears first may seem unusual in texture, shape and color.

4. The mother may feel a stretching, burning sensation at this point. To allow the baby's head to slide gently and painlessly out of the vagina, she may wish to stop any deliberate pushing if possible. This will help prevent the mother's skin from tearing and will minimize bruising of the baby's head and face. In this case the mother may want to pant like a dog until both of the baby's shoulders have emerged on their own.

5. Avoid thinking about labor in superficial, mechanical terms (e.g. what color this is, what size that is, how much of that came out, what number of those there are...). Instead mothers, pay attention to your overall well being and that of your baby. Focusing on external "danger signs" can distract mother from receiving important inner cues like an urge to find a more comfortable position. Birthing mothers carry everything they need within them, whether it is the wisdom and power to seek out necessary help or to give birth completely alone. While in labor, mothers don't need to be searching for problems, but instead remaining receptive to messages their bodies give them. Open. That's how the baby comes out.

The birth

1. As the baby is coming out of the vagina, the mother's skin around the baby's emerging body part will ordinarily be red or pink. Any place that turns white may be prone to tear more easily, so gentle massage or pressure with the fingertips may be beneficial there. Olive oil can be used for massage, or warm washcloths applied, paying special attention to the area closest to mother's anus, which is the most common place to tear. If she desires, you can support the mother's tissues with your hand or a washcloth. Do not hold the opening closed; just support the skin so the baby can ease out. The unhindered birth of the baby is more important than the avoidance of tears.

2. If the baby's body does not follow within the next few contractions, check around its neck for the umbilical cord (see third stage section below). If you feel the cord and it is loosely wrapped, you can gently hook it with your finger and pull it over the baby's head. Sometimes the cord is wrapped more than once. If the cord is so tight that it cannot be slipped over the baby's head, wait until the baby's body is born to unwrap it, keeping the baby's head close to mother's bottom as its body emerges. Most cords that are long enough for the head to be born are long enough to permit this. If the cord really seems to be too short to permit the baby to be born, it can be carefully cut and tied off and the baby pushed out rapidly. In this situation the baby may become distressed or injured because his oxygen supply will be cut off prematurely. (See point # 11 below for information on how to encourage breathing).

3. After the baby's mouth and nose are visible, ensure that the face does not sit in a puddle of amniotic fluid. Mucous will come out of the baby's mouth and nose naturally, as his body is gently hugged by his mother's on the way down and out. Birth products can be wiped off the face gently, with a clean cloth. As the baby's head emerges -- if it comes first -- it is usually face down. Often it will then turn spontaneously, so that the nose is pointed towards the mother's thigh. No assistance or interference with this process is needed. Support the baby's head or body by cradling it in your hands or resting it on the (padded and covered) floor. Do not pull or exert any pressure on it.

4. After the birth of the head, usually within the next few contractions, one or both of the shoulders comes and then the whole body usually slips quickly out. A baby in the breech position's buttocks or feet will come first and there may be a pause before the head comes out. If several contractions pass without the whole baby emerging, it may help for mother to change positions, from reclining to all fours, or from all fours to a squat, from a squat to standing, etc. Always keep in mind that even though the baby may not be breathing yet, in all but the rare exceptions he is still recieving oxygen from his mother just as he did in utero.

5. If a shoulder does not come out after position changes with a headfirst (or "vertex") baby, you may want to try to find his armpit by inserting two fingers into the vagina. With one or two fingers hooked under the armpit, try to rotate the shoulder counterclockwise while pulling out. Allow the shoulders to come out with the head supported underneath. Remain calm and be patient at all times.

6. As the wider parts of the baby emerge, be prepared for the rest of the body to come out quickly. Be very careful, as newborn babies are very slippery. With one hand, you can support the shoulders with your thumb and middle finger around the baby's neck and your forefinger on the head (support but do not choke), and with the other hand support the baby's back and buttocks, holding its thigh for control.

7. Do not pull on the umbilical cord when picking the baby up. Place the baby immediately onto mother's bare skin. Her tummy and chest are usually the most convenient places. It is most desirable for mother to hold the baby continuously with her bare skin next to her baby's bare skin. If the umbilical cord is long enough, she will be able to hold the baby in her arms. If the cord is short, the mother may need to rest the baby on her lower abdomen and she may appreciate help holding it there. If these options are not possible for some reason, the mother's companions should touch the baby gently, keep him warm, and talk to him calmly until he is breathing well on his own.

8. Someone may place any of the cleanest items available over mother and baby if desired. It is important to keep mother and baby comfortably warm at all times. An infant hat can also help the baby to retain body heat.

9. Keep the baby's body slightly higher than the head until mucous and other fluids are drained from its nose and mouth. The baby will probably breathe almost immediately, but a happy baby may not cry and should not be handled roughly or otherwise encouraged to do so. Unnecessary crying is stressful to baby and uses up precious energy. A crying newborn should be soothed and offered the breast. If all is well you may want to make a record of the time and approximate location of the birth of the baby at this point.

10. The baby may appear bluish or purple in color at first, and may have blood, mucous (like uncooked egg whites in appearance), a creamy white protective substance called vernix, and/or possibly even stool on its skin. His head may be somewhat misshapen, becoming more rounded over the next day or so. These are all normal. The appearance of thick (pea soup consistency or thicker) meconium (baby's sticky, green or black first bowel movement) can indicate that the infant was in distress and may require medical intervention to survive. Some coughing and gurgling is normal as the newborn clears mucous from his lungs, but seek out appropriate emergency assistance - if available - at signs of serious difficulty in breathing, such as a sunken chest.

11. As the baby begins to breathe on his own, his body will change to a healthy pink or red color beginning at the chest and radiating out to the limbs. If the baby does not breathe spontaneously, very gently clear any mucous from the mouth with your mouth or finger. Encourage breathing by gently rubbing the baby's back, tickling his/her feet, and speaking encouraging words calmly and lovingly to him/her. Never shake a baby, as this can easily cause serious brain damage or death. If all else fails, give extremely gentle mouth-to-mouth resuscitation. Lay the baby flat on his back. Tilt his head back slightly by lifting the chin. Cover the baby's mouth and nose completely with your mouth and breathe two small puffs of air slowly into the baby's lungs. Be sure the baby's chest gently rises with each puff.

If the baby is still not breathing, check his pulse by placing your index and middle fingers on the inside of his upper arm between the shoulder and elbow and pressing while feeling carefully for 5-10 seconds. If you feel a pulse, continue with resuscitation until breathing begins unaided. Recheck pulse every minute. If there is no pulse, put your index and middle fingertips on the center of baby's chest, directly between the nipples. Push down slightly, between ½ - 1 inch. Do this five times rapidly. Then tilt baby's head back by lifting the chin. Cover the baby's mouth and nose completely with your mouth and give one small puff of air slowly. Be sure the baby's chest gently rises with each puff. Then, rapidly pump chest five more times, then give one more small, slow puff of air. Keep doing this. Count: 1,2,3,4,5, Puff,1,2,3,4,5, Puff until baby is revived or medical assistance can be obtained.

The third stage

The umbilical cord is a fleshy, bluish tube - about a pinky in finger thickness - protruding from the infant's belly and connected to the placenta which may still be inside the uterus or vagina immediately after birth see paragraph below. This should not be cut until it has become cold and white, having finished pulsating with oxygen-rich blood, and after the placenta has completely emerged. It is of great benefit to both the baby and mother, if the baby can be allowed to suckle at the breast as soon as it is born. However, it is most important that the baby is breathing well on its own before the cord is cut. If the infant does not nurse within the first half-hour or so, he may naturally not show interest again for another 24 hours. This is not generally cause for concern, but breastfeeding should be encouraged to begin as soon as possible so that baby can receive the essential nutrients and immunities only found in the deceptively thin first milk, called colostrum.

The placenta is a round, red organ, sized and shaped approximately like an one inch thick dinner plate, which is spontaneously expelled by the uterus in a period of a few minutes to several hours after the baby is born. The mother may feel contractions similar to those during labor that will push out the placenta, and she may want to bear down again.

Some general suggestions for the third stage of labor

1. No attempt should be made to pull the placenta out using the cord, nor should anyone attempt to force it out by pressing on the mother's abdomen. Immediately following the birth of the placenta, there may be additional bleeding and a few blood clots. The womb will continue to contract and may feel like a firm grapefruit just below the mother's navel afterwards. If it is soft or there seems to be excessive blood, the baby should be encouraged to nurse. If this is not possible, mother's nipples can be stimulated by hand or mouth, and the mother may gently massage her own abdomen. These actions can help reduce the
mother's chances of bleeding too much. While some mothers consider the thought distasteful, chewing a bit of the placenta is reported to reduce bleeding and may be worth trying in an emergency. While this claim is not proven, consuming placenta is certainly harmless, common among mammals, and can provide valuable nutrients.

2. Be alert for excessive blood loss and shock in the mother. Symptoms of shock are vacant eyes, dilated pupils, pale and cold or clammy skin, faint and rapid pulse, shallow and irregular breathing, dizziness and vomiting. If you notice these symptoms, keep the woman warm and still, slightly elevate her feet and legs, use soft lights, talk softly and calmly to her, and seek out acceptable emergency assistance if it is available.

3. The baby will have an easy route of entry for infection through a cut cord, so if possible it should not be cut until a sterile or home environment and instruments are available. If necessary or desired, the cord and placenta can safely be left attached for a few days when the cord will become stiff and dry and break off naturally. If you will not be cutting the cord for a length of time, you may want to keep the placenta in a drain-able, waterproof container or replaceable absorbent wrapping, as blood will likely continue to trickle from it for a while and it may acquire a strong odor. Keep this container close to the baby and avoid pulling on the cord by moving them together when necessary. If you do wish to cut the cord, wait until the placenta is out, or at least until the cord is whitened, empty of blood, and no longer pulsating so that the baby can still receive oxygen from his mother before he absolutely has to breathe on his own.

4. To prevent oozing from either end of the cord, clamps or ties may be used. Non-slip knots can be made no closer to baby's tummy than one inch with a sterile cord, shoelace, dental floss or flexible cloth. Cord clamps must be pre-ordered from specialty stores and should be applied according to the manufacturer's instructions. If cord cutting is delayed long enough there should be no mess, but if the cord must be cut early, tie it in two places and cut between them to keep blood from leaking out of either side. The placenta and attached membranes can be inspected to make sure that no pieces are left inside the uterus. The placenta will have one bumpy side and one shiny smooth one. The outer edge should be fairly even and circular in shape without any obvious holes or chunks missing. When the placenta is held like a bowl, the bumps on the inside surface should come together neatly like puzzle pieces.

After the birth

1. Continue to check the baby's breathing and overall body color. The baby should not appear blue at all or yellowish early on. If the baby appears to stop breathing or turns blue, continue previously listed stimulation. If the baby has yellowish skin and eyes at birth, is lethargic at any time, and/or does not nurse, wet, or poop frequently in the first few weeks, appropriate emergency help may be needed.

2. Keep mother and baby comfortably warm, but do not allow them to overheat. The mother will probably need to eat, drink, and go to the bathroom and may wish to bathe, rest, nurse, and bond with her baby. She should continue to keep foreign objects and strangers' hands away from her genital area to avoid infection.

3. The mother can expect some vaginal discharge for several days. This is usually red to reddish brown for the first day or so, and may occasionally have egg sized or smaller lumps, but lightens and becomes less abundant within a few days. It normally has a strong, but not foul, odor. A resumption or increase of bleeding after a few days - especially when bright red - may indicate too much activity undertaken too soon.

4. Companions should support the mother and help her relax and savor the precious, irreplaceable time with her newborn following the birth. Newborns should be held and touched as much as possible and never left unsupervised. Experienced, friendly support in breastfeeding from an organization such as La Leche League (1-800-La-Leche) can be essential to the success of the early nursing relationship, which is vital to the health of both mother and infant.

Remember that birth is a normal, natural function of the female body. Relax and enjoy!

Copyright Laurie Annis Morgan December 1999

Medically oriented emergency childbirth resources

Emergency Childbirth: A Manual by Dr. Gregory White
http://www.amazon.com/exec/obidos/ASIN/0934426570/laurieshumblehom

Help, She's Having a Baby : Emergency Childbirth : A Practical Guide to Help You Know What to Do When It's Up to You by Nancy Crowley
http://www.amazon.com/exec/obidos/ASIN/0964035812/laurieshumblehom

Special Delivery : The Complete Guide to Informed Birth by Rahima, Baldwin http://www.amazon.com/exec/obidos/ASIN/0890879346/laurieshumblehom

State of New Jersey Emergency Medical Dispatch Guidecards online http://www.state.nj.us/health/ems/guidecard.htm

John Hunter Hospital - Emergency Childbirth online http://www.clininfo.health.nsw.gov.au/hospolic/jhec/httoc.htm

How-To Survival Library's Emergency Childbirth online page http://forums.cosmoaccess.net/forum/survival/prep/ebirth.htm

First Aid Childbirth: Emergency Delivery http://firstaid.eire.org/Childbirth.htm

Emergency Childbirth by Robin Elise Weiss
http://pregnancy.about.com/health/pregnancy/library/weekly/aa071199.htm

Childbirth: Emergency Delivery on Dr. Koop.com
http://www.drkoop.com/conditions/encyclopedia/articles/003000a/003000194.html

Emergency Childbirth by OnHealth
http://www.onhealth.com/ch1/resource/firstaid/item,38009.asp

Emergency childbirth: What you need to know Answered by Peg Plumbo, CNM at Parent'sPlace.com http://www.parentsplace.com/pregnancy/labor/qa/0,3105,14064,00.html