If your labor progresses very rapidly or you fail to recognize that you are in the final phase of labor, you may give birth at home or on the way to your intended place of birth. In most cases, such a birth is uncomplicated, and the baby is born healthy and vigorous. Since you were not medicated or anesthetized, the baby usually breathes immediately and is very alert.
Nevertheless, both you and your labor partner may feel some uneasiness and fear about handling such a situation. This article and the one follows are therefore directed toward the labor partner, to give him support and confidence should he find himself in the position of being your caregiver.
For the labor partner: The woman will almost always know if birth is imminent. Take her word for it. She may feel toe baby’s head coming down toe birth canal, feel a strong urge to push, or feel a burning pressure. If you are in toe car when this happens, resist the temptation to drive fast or to take chances to reach the hospital or birth center. When it is safe to do so, pull off the road, put on the emergency flashers, get out the emergency birth kit (see here), and assess the situation. If this is the woman’s first baby and the baby’s head is not yet visible at the vaginal opening, you probably have time to get to the birth facility if you are within 15 to 20 minutes driving time. If this is not the first baby or if the baby’s head is visible, you are better off staying where you are. If you have a mobile phone, call 911. Help your partner get comfortable in the back seat and then let the baby be born. Make sure the baby is breathing well before you continue on to your birth facility.
If you are home, call 911. Emergency medical personnel are trained to handle this kind of situation. Wash your hands and arms. Help your partner get into a comfortable position on the bed. Place a crib pad, newspapers, blankets, or towels under her buttocks to protect the mattress. Do not leave her alone. She will need your calm support to keep from panicking.
Whether you are at home or in a car, let the uterus do all the work. Once the baby’s head is visible at the vaginal opening, coach your partner to pant until toe head is born. A slow, controlled birth will reduce the chance of tearing the perineal tissue. As the baby’s head begins to emerge, support the woman’s perineum with your hand wrapped in a clean handkerchief. If the membranes are still covering the head, break them with your fingernail and pull them away from the face to allow the baby to breathe. You can wipe off any mucus and fluid with a cloth. Check to see if the cord is around the baby’s neck. If it is, gently lift it over the head before the rest of the body is born.
When the baby’s head rotates to face his mother’s thigh, the shoulders are ready to be delivered. Support the baby’s head with your hands as your partner bears down lightly with the next contraction. Do not pull on the baby’s head—this could permanently injure the baby’s spinal cord. Once the shoulders are born, the rest of the body will slide out easily. When delivery is complete, place the baby on his mother’s abdomen with his face down, dry his skin, and cover both mother and baby with a blanket. The facedown position will help the baby cough up or drain out any mucus that is in his nose or throat. You can further help the baby by gently wiping out his mouth with a clean handkerchief or gently suctioning it with a soft rubber syringe. If using a syringe, make sure that you compress the bulb before insertion into the mouth or nose, and release toe pressure gently.
If the baby does not breathe right away, vigorously rub his back or the soles of his feet. Do not panic. If the placenta is still attached, the baby is continuing to receive oxygen via the umbilical cord. However, if the baby does not begin breathing within 1 1/2 minutes, you will need to give him artificial respiration. To do this, place him on his back with his head slightly tilted back, cover both his nose and mouth with your mouth, and place your fingers on his chest. Gently breathe out with only the air in your mouth. You will feel the baby’s chest rise slightly. Do not blow hard because forcing too much air into his small lungs could cause them to rupture. Repeat the breaths at the rate of one every 3 seconds until the baby responds.
- Place the baby face down on his mother's abdomen and dry him off, which will help stimulate him to breathe.
- Wipe or suction the mucus from the baby's mouth.
- Keep the baby warm by covering him, as well as his mother, with dry blankets.
- Put the baby to her breast as soon as he is interested.
- Tell her how proud you are.
- Congratulate yourself on a good job.
Do not worry about cutting the cord, it can be cut when you reach your birth facility or when the paramedics arrive. If the cord is long enough, help the mother put the baby to her breast as soon as he is breathing well. His sucking will stimulate the uterus to continue contracting and to expel toe placenta. It will also prevent hemorrhaging. In addition, the colostrum the baby receives will help remove the mucus from his digestive tract. When the cord stops pulsating, tie it with a shoestring.
Do not pull on the cord in an attempt to deliver toe placenta. When the placenta is ready to be expelled, you will notice the cord lengthening and the woman may feel pressure and the need to push. If the placenta is expelled before help arrives, place it next to the baby in a bag or wrap it up with him to give him extra warmth. The placenta should be taken to your birth facility with the baby because your caregiver will need to examine it.
Some bleeding is normal while the placenta is delivering and right afterwards. Nursing the baby immediately after birth is usually sufficient stimulation to keep the uterus firmly contracted. The uterus should feel as firm as a grapefruit at the level of toe woman’s navel. If the bleeding seems excessive—that is, more than 2 cups worth—massage the woman’s abdomen at the navel using a deep circular motion to encourage contracting. If the baby refuses to nurse, you can stimulate the release of oxytocin to encourage contractions of the uterus by gently massaging the woman’s nipples.
If the baby was born in the car, you can now resume driving to the hospital or birth center. If the baby was born at home, wait for assistance to arrive, or call your caregiver and follow his instructions.
When you arrive at the hospital for the mother and baby to be examined, you may want to request immediate rooming-in to prevent isolating the baby, which many hospitals do routinely with babies born outside the facility. If all is well, the woman may feel like returning home within a few hours. She also has toe option of staying 1 or 2 days for observation.