Wednesday, July 2, 2014

Advance Learning for Emergency Childbirth


(Photo:  )

    This is Part Two in a series I am calling "Preparedness and the Childbearing Family".

This is the link to the first post in the series:

 In the prior post I discussed at some length, emergency supplies each potential childbearing family should have, and if you, as a principle preparedness person (the place where the adult children and wives and grands travel) should have in your emergency supplies.  This of course is in addition to the normal medical supplies I have mentioned with regard to Medical Evacuation Kit, and Family Medical Kit designed to remain in your home.

These are links for supplies for the basic kits your family should amass for "shelter in place" events and for medical kit for family evacuation.   Please also see the link above, as it has essential information.

   Getting the supplies in your home and knowing what they are, is key.  It is possible that in an emergency, you would not be the one using them.  A squad member, police officer or EMT who lives down your street, a nurse, a midwife, or even a physician might be helping you in an emergency.

    However, sometimes we just aren't that lucky, and so this is the learning component designed to accompany all those supplies I indicated you should have.

      This is NOT a blog post on how to deliver your newest family member without the aid of physicians, midwives or professionals. Entire libraries are written on this subject. It's a vast field.  Physicians who complete medical school, and a year of internship, then spend three to four years in residency learning all of the aspects of this, and then may actually complete an additional two to three years of fellowship in a related sub-specialty.  Certified Nurse Midwives are Registered Nurses who completed a Master's degree in a program for Nurse Midwifery.
      This post is a beginning point where the public can begin to gather basic information as a foundation, which can be added to later.  The information contained here is so important that it may save a life, and this is the spirit in which it is being given.

      Suppose an emergency has taken place and your married son and daughter and their one year old son are staying with you. It's Summer and they have been busy helping you plant more vegetables, weeding the vegetable beds, and harvesting some things periodically.   Your distant neighbor and trading partner Jeff has his daughter Chloe and her husband staying with them.  Chloe is about eight months pregnant. Her pregnancy has been normal and uneventful, and Jeff has been hoping that the emergency ends allowing his daughter to return to nearer the city where the possibility of a hospital birth exists.  His house and yours are seventy miles from any hospital and the hospitals are presently diverting people because they are full following the emergency.  You have your emergency childbirth kit from the last blog post.  One day when you are working outside, breathless Jeff comes to you and tells you that Chloe is in labor and he needs help.

       Although each birth can be said to be unique, even for the same woman, there are sufficient commonalities that we can train people to expect and manage what is essentially a normal birth. Then, we can hope for the best.   There is no guarantee that a non-medical birth will result in a healthy baby and a healthy mother afterward, there is much that we can do toward that end.  Although it is true that women have been having babies for all time, it is also true that one hundred years ago, most children under five, died.  Of thirteen children, families often lost multiple sons and daughters, and stillbirths and maternal deaths were fairly common. These are the things we can do in order to make this journey as safe as possible given the circumstances above.

        If you find yourself in an emergency, then these are basic directions for managing emergency childbirth.
You will need the emergency birth kit I mentioned you should have in the last post.

1. If during an emergency,  (impending hurricane, war, civil unrest, terrorist attack, earthquake etc.) you should try to transport the mother to an operational medical facility.  This is not always possible, and this is the purpose of this post. In this event, you should make every attempt to activate the emergency medical system, if it is accessible as labor begins.    In an emergency, you may need ambulance transport if possible, or even just an EMT who might walk to your location, if the emergency of the day has tied up emergency transport.

2. Prepare a location for emergency childbirth.   If at your home, or her own, place her in a single bed, if possible, with multiple pillows.  Position the pillows to permit a sitting posture in the bed, because at times, this will be best.   Prepare the bed by placing a folded new shower curtain plastic liner in the middle of the bed and tucking it in on both sides. Place chux on top of that.  Then above that place a flat sheet folded in half, and ironed (to kill any germs)   Place that also in the middle of the bed to cover the shower curtain liner and chux (this is one brand of disposable plastic lined padding) and firmly tuck it in on both sides of the bed.

3. Early in the labor if she is not nauseated, she may drink clear fluids.  Make sure she urinates about once an hour She may leave the bed to use the bathroom early in labor, but later, you must escort her.

4. These people are depending upon you to be as calm as possible, regardless of the outcome here.  This woman's outlook and emotional reserve are essential.  Stay positive and encouraging.  Even though they can certainly be a support, there are to be no pets in the room with the laboring woman.  Part of this is that this needs to be as clean a room as possible, and in addition, this can be a confusing time for pets as well as for people.  Sometimes a pet who is normally gentle will misunderstand what is going on during an intense part of the delivery and can attack someone.  You don't need additional patients !       Lastly, keep the room calm.



lotta joy said...

If I was going to give birth, I can think of NO ONE I'd rather have with me than you. I'd trust you even if you started beating me with sticks.

JaneofVirginia said...

Fortunately, most of us have access to genuine physicians and/or certified nurse midwives. However, once in awhile, a person who has done some background work can do an excellent job in an absolute emergency. Emergencies are what we are planning for ! Thanks for the vote of confidence.

Linda said...

I had three deliveries and one early miscarriage. Each delivery was so different--3 hour labor for first, 12-hour for second, and 30-hour breach, toes-first breach for the third birth.

My great-grandmother was the second wife of man whose wife died in childbirth. Childbirth once was a dangerous ordeal for women. (yeah, you said that) Men with twenty children often went through four or five wives. I very much dislike the statement that women have been having babies without doctors for hundreds of years. Yes, and just a short time ago, doctors went from horrendous infections straight to delivery without washing their hands. Nurses objected to the filth of hospitals and doctors lack of hand washing. Science finally convinced them. I remember hearing that women feared going to hospitals before and after sanitary conditions existed. They figured out that the number of women who survived hospital births was much smaller than maternal survivors who delivered at home.

Unless extraordinary circumstances existed in a birth, I imagine that sanitary conditions are the most important thing to consider and prepare for. I could be wrong. I have no training at all, but I believe I could deliver a baby without going to pieces. In medical emergencies, I have been extremely focused and competent, even when I was seven and Mama stood in shock, watching my 3-yr-old sister bleeding profusely as I demanded and begged mama to do something. Finally, I got a CLEAN dishtowel and put it on my sister's six-inch gash from above and below her elbow. Somehow, I knew it must be clean, not just anything to put on the gash.

JaneofVirginia said...

Although I suppose it IS true that "women have been having babies for milennia" we do need to recognize that in those pre-enlightened days, many of the babies and a fair measure of the mothers did indeed die. This series is not about choices for childbirth, because a trained physician or degreed certified midwife should deliver everyone in order to provide the best margin for safety. Many women can safely deliver in a supervised home birth, however, those women are handpicked using protocols agreed upon by obstetricians and midwives. The rest of women are safest delivering at a reputable licensed hospital with a maternity center. This series is about being prepared for potential childbirth when some type of external issue, flood, earthquake, war or anything else makes an early labor trip to a hospital an impossibility.

Gisele Lohan said...

Very nice post you have posted. i like this post because it would be too useful for many people at the emergency time. You have done brilliant and hard work to write this good blog.

disaster preparedness

JaneofVirginia said...

Thank you, Gisele.