What to do during labor in an emergency environment

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Hurricanes, cyclones, earthquakes, and other calamities are a terrifying reminder of the little control we have over our own life. But while we might be more used to contemplating our powerlessness in the context of mortality, we are just as helpless in the opposite situation: Birth.

Labor does not stop if the time, place, or conditions are inconvenient, which means women go through childbirth even in the most dangerous circumstances—including, currently, through hurricane Ian.

While terrifying, there are a few steps pregnant women and their support networks can take to help make delivery as safe as possible, even under precarious circumstances, and with limited resources.

Midwife and safe childbirth advocate Jennie Joseph has been working for many years to reduce the burden of maternal morbidity and mortality in the US through her organization, Commonsense Childbirth. She developed “a guide for pregnant parents, families, supporters, first responders, and good Samaritans,” to help navigate something as delicate as labor and delivery in distressing circumstances.

What to do during labor in an emergency environment

1. Make sure it’s really labor. Hydrate the mother and help her drink at least 16 oz, or half a liter of water, and get as comfortable as possible to see if contractions ease.

2. Time the contractions to see whether they become closer and stronger.

3. Find a space that is as safe as possible for the mother to deliver—somewhere protected and ideally private. Put down blankets and towels if there are any to be found or any kind of clean cloth.

4. Support the mother, help her breathe and relax, and keep a calm and positive attitude.

5. Be patient. Labor can take many hours and even more than a day. Keep the mother fed and hydrated, help her use the bathroom, and let her sleep on and off if she feels like it.

6. Listen to the mother. When she feels the urge to push, it means the delivery stage has begun. Put her in whichever position she finds most comfortable—on hands and knees, squatting, lying on her side. Trust her body.

7. Pushing may take a few minutes to a few hours. Encourage the mother gently. No yelling. There is no need to touch the woman unless she asks to be touched. Don’t hold the baby’s head as it emerges (it’s best to limit exposure to anything potentially unhygienic).

What to do as soon as the baby is delivered

8. Once the head is born, the rest should follow quickly. Shoulders and body shouldn’t take more than a couple of additional contractions, and if they take longer, help the mother onto her hands and knees so she can continue pushing. When the baby has emerged gently guide it up the mother’s chest or belly and cover them both quickly with a blanket so the baby can stay warm.

9. Maintain skin-to-skin contact between the baby and the mother.

10. Don’t cut the umbilical cord, which continues to provide nutrients and oxygen from the placenta.

11. Gently rub the baby’s back, talk to the baby, and make sure their breathing and color improve. Guide it to breastfeeding.

What about the placenta?

12. Soon, the mother will start cramping, which means the placenta is ready to be expelled. If she wants to change positions help the woman squat or get comfortable. There is no need to touch or pull the placenta to help it out. Once it’s all been expelled, wrap it in a towel and put it in a bowl near the mom, as it’s still attached to the umbilical cord.

Help with breastfeeding

13. The baby will instinctively move up to the breast and try to find the nipple. They will lick their lips, bob their head, and push up against their abdomen with their feet. You can gently help it up and onto the nipple.

14. Once the baby has latched onto the nipple (this might take a little time), let them be quiet and free to feed undisturbed.

What to do if the mom is bleeding

15. If the flow from the mom is heavier than a period, press below the mother’s belly button, and rub hard. This helps reduce the size of the uterus, which should be about the size of a grapefruit, and firm. You should be able to feel the contour of the uterus underneath the flesh while pressing the belly, which will still appear quite enlarged. Continue rubbing to reduce bleeding.

16. Keep the baby breastfeeding, which helps tighten the uterus and reduce bleeding.

17. Feed the mom small amounts of food, ideally protein, and keep her hydrated.

What aftercare to adopt

18. Keep a close eye on the mom and the baby. Encourage them both to eat, and keep the mom hydrated. Do not separate the skin-to-skin contact unless necessary, or move the baby away from the mother.

19. Do not cut the umbilical cord unless you have sterile clamps and instruments, as it could lead to infection.

20. Get medical help as soon as possible.