Stay calm! The imminent birth of a baby without professional attendance can be a scary situation but serious complications are rare. A little knowledge will give both you and the mother some needed confidence.
Make the Mother Comfortable
This usually does not mean lying down. Most mothers will instinctively want to squat or get on hands and knees. A few will want to kneel or stand, leaning on another person. If delivery takes place on a bed, turn the mother on her left side if possible and help her hold up her right knee. These positions widen the pelvis and allow the most room for baby to come through. Tell her (as often as you can) that she’s doing great and looks beautiful!
Encourage the Mother to do What Comes Naturally
She should push in whatever way feels best to her. Remind her to relax and take deep breaths between contractions. Tell her when you can see the baby’s head and let her touch it if she wants to, or provide a mirror. She’ll feel better knowing she’s making progress!
Support Her Stretching Skin
If you have time use warm compresses to improve circulation and oil to massage and lubricate the perineum, the skin between vagina and anus that is most likely to tear. Do this as the baby’s head is emerging, and ask mom to give tiny little pushes very slowly. Since control is difficult for the mother at this stage, use your hands or warm compresses to provide counter pressure but do not hold the baby in or push it back! Once the head is born, feel for the umbilical cord around the neck. If it is there, you can probably stretch it gently over the baby's head or push it back as the shoulders come through. A cord that must be cut should be clamped or tied in two places, then severed between them. The baby may need rescue breathing if the cord is cut prematurely, so do not do it unless you have to!
Deliver the Shoulders
After the head is born the mother can take a short break. The baby will turn it's head all by itself. The next contraction will squeeze out the shoulder in front, so tug gently toward the mother's back to assist, then forward to deliver the rear shoulder. If the mother is on her hands and knees this will be reversed. If contractions are good and the shoulders seem to be stuck, moving the mother onto her hands and knees will probably dislodge them. Or, wiggle the baby back and forth using two fingers on the collarbone and two on the opposite shoulderblade, alternating positions until one side comes free. (Do not pull under the baby's armpit as this can cause permanent nerve damage.) Hang on, babies are slippery!
Hand the Baby to the Mother
The umbilical cord will be long enough to place the baby's head between the mother's breasts. Dry the baby off with towels and warm covers. Mother and baby should be skin-to-skin, nothing should be between them. The mother's body will warm the baby. Her touch will help the baby breathe. A strong pulse should be felt in the umbilical cord. A healthy baby grimaces, opens its eyes and moves its hands. Gradually, the baby's blue body will become pink. The cord can be left intact indefinitely. Encourage the mom to drink fluids. Breastfeeding can take place whenever mother and baby are ready.
If the pulse is slow and the baby doesn't move, tip the chin up gently and give a slow, strong, rescue breath as if you are inflating a new balloon. Subsequent breaths, if needed, should be softer.
Deliver the Placenta
Watch for a gush of blood and lengthening of the cord that signals the afterbirth is detached and ready to deliver. This usually happens within an hour after the baby's birth. Mom may want to squat or stand; she may complain of more contractions. Do not pull on the cord unless you can see the placenta and just need to lift it out. Place the placenta in a bowl and keep it near the baby. Gently rub the mother's tummy to make sure her uterus is firm. It will feel like a grapefruit. Brace the bottom and massage the top and sides briefly, or the mother can do it herself.
Stay Close
Activate Emergency Medical Services (911) if the mother is bleeding excessively or if the baby has difficulty breathing. The mother should have help to get up to the bathroom at first because she may become dizzy. A small ice pack on her perineum will reduce swelling and pain. Clean up the surroundings, get her something nutritious to eat, and tell her what a great job she did. Congratulations!
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