How to deliver a woman: step-by-step instructions

The situation when labor begins quickly, and the ambulance team is still on the way, is critical and requires the immediate mobilization of all the resources of those present. Fear and panic are the body’s natural reaction to stress, but it is at these moments that the well-being of the mother and child depends on the composure of others. Emergency birth outside the walls of a maternity hospital do not happen as rarely as is commonly thought, and knowledge of basic action algorithms can save lives.

The main task of a person who finds himself next to a woman giving birth is not to replace a professional obstetrician, but to ensure the safe passage of the fetus through the birth canal and prevent complications in the first minutes of the baby’s life. It is necessary to clearly understand that the birth process is a natural physiological mechanism that, in its normal course, does not require complex medical intervention. However, monitoring the condition of the woman in labor and willingness to act according to instructions are vital.

In this article we will analyze a step-by-step algorithm of actions that will allow you to competently organize the process, prepare the place and correctly receive the newborn. Remember that time in childbirth is measured by contractions, and every minute of delay or, conversely, unnecessary fuss can affect the outcome. Calmness, confidence and strict adherence to recommendations are your main tool of help.

Assessing the situation and calling emergency services

The first and most important step is to objectively assess the condition of the woman in labor and immediately call a specialized team. The rescue operator must be informed not only of the address, but also of key parameters: the number of pregnancies, the expected period, the presence of amniotic fluid and its color, as well as the frequency and duration of contractions. Dispatcher may give additional instructions that should be followed in parallel with site preparation.

It is necessary to determine whether the woman has the urge to defecate or the feeling that the baby is “already coming.” This is a sure sign that the fetal head has descended into the pelvis and the process has entered the second stage. If contractions last less than a minute and repeat every 2-3 minutes, and the intervals between them are reduced, there is no time to get ready for the hospital.

⚠️ Attention: If the amniotic fluid is green, brown or black, this is a sign of fetal hypoxia. Notify the dispatcher immediately as the baby may require resuscitation immediately after birth.

In parallel with calling doctors, it is necessary to organize a meeting of the team, since in a stressful situation, doctors may lose time searching for an entrance or apartment. Coordination of actions between the person meeting and receiving the birth is critically important. While one person prepares the place and supports the woman, the second ensures unhindered access for doctors to the patient.

Preparing the site and hygienic conditions

Organizing a birthing space requires speed and adherence to basic aseptic rules, as far as possible at home. The ideal option would be to cover a hard surface (a bed, a sofa, or even the floor if there is no other option) with a clean oilcloth, on top of which you need to place several layers of sheets or large towels. Hygiene in this context, it means minimizing the risk of infection in the open birth canal.

The person who will directly receive the child must wash their hands thoroughly with soap, treat them with an antiseptic (alcohol, chlorhexidine) and, if possible, wear medical gloves. If you don't have gloves, keeping your hands clean is the only protection against bacteria. You should also have a sterile diaper or clean, ironed cloth ready to receive your baby.

• 🧼 Wash your hands thoroughly with soap and treat with antiseptic up to your elbows.
• 🛏️ Cover the surface with clean oilcloth and several layers of cotton sheets.
• 💡 Provide bright lighting to see the color of the child’s skin and the nature of the discharge.
• 🌡️ Prepare a warm blanket and swaddles to warm your newborn immediately after birth.

It is important to create a comfortable temperature in the room, as newborns instantly lose heat. Drafts are unacceptable, but stuffy air is also harmful. Ventilation It's better to do it in advance. You should have scissors (boiled or treated with alcohol) and a clean thread or cord clamp on hand in case you need to cut the umbilical cord, although ideally this should not be done until doctors arrive.

Positioning the woman in labor and supporting contractions

Choosing the right position for a woman can greatly facilitate labor and reduce the risk of rupture. The classic horizontal position on the back with legs apart and bent at the knees is the most comfortable for the person delivering the baby, but not always the most physiological for the woman in labor. If a woman feels better upright or on her side, you should not force her to lie down unless there is a direct risk of falling.

During a fight, it is necessary to support the woman mentally and physically. You can hold her hand, massage her lower back with circular movements, and prompt her breathing rhythm. Breathing control helps reduce pain and ensure the flow of oxygen to the fetus. It is important to ensure that the woman does not scream, but exhales air, since screaming leads to muscle spasm and slows down the process.

When the period of pushing begins, a woman instinctively pushes, as if she is having a bowel movement. At this moment, she should take a deep breath, hold her breath and push down into the perineum. Between attempts it is necessary to relax and restore strength as much as possible. Your job is to encourage and monitor so that efforts are directed correctly.

If you see that the baby’s head has already appeared, you should not allow the woman to push at this moment - you need to breathe frequently and shallowly (“doggy”) so that the head comes out smoothly and the perineum does not rupture. Speed control exit of the head is a key point for maintaining tissue integrity.

Moment of birth: reception of the fetus and suction of mucus

The most crucial moment is the appearance of the baby’s head and shoulders. The head is usually born face down, then turns around and the shoulders are born. You need to accept the baby with clean, warm hands, gently supporting the head, but under no circumstances pull on it. Natural course childbirth requires no effort on your part, except for fall insurance.

As soon as the baby is born, it should be immediately placed on the mother's stomach or chest, if possible, or on a prepared clean diaper. The baby's head should be tilted down slightly to allow amniotic fluid and mucus to drain from the mouth. If the child does not scream immediately, you need to carefully clear his mouth and nose of mucus with a finger wrapped in a clean cloth, or with a special aspirator, if you have one.

⚠️ Attention: It is strictly forbidden to shake a child or spank him on the back. To stimulate breathing, it is enough to vigorously rub the back and chest with a dry, warm diaper.

After birth, the baby should make a loud cry, which indicates the expansion of the lungs. If the baby's skin is bluish, but he is breathing and screaming, this is normal, the color will soon be restored. If the baby is lethargic, not breathing and has a pale or bluish skin color, immediate resuscitation is required, which will be discussed below. Time in this case it goes for seconds.

Umbilical cord care and placenta exit

After the baby is born, the umbilical cord continues to pulsate, transferring remaining blood and oxygen from the placenta to the baby. In a hospital setting, the umbilical cord is clamped after 1-3 minutes, but in an emergency it is better to wait until the pulsation stops or the doctors arrive if the child’s condition is stable. If it is necessary to cut the umbilical cord (for example, to begin resuscitation), this is done strictly according to the rules.

It is necessary to apply two clamps or tie the umbilical cord with a sterile thread: one clamp (or knot) at a distance of 2-3 cm from the baby’s umbilical ring, the second - 5-7 cm further. The umbilical cord must be cut between these points with sterile scissors or a blade. The umbilical cord stump should be treated with an antiseptic (iodine, alcohol, chlorhexidine).

After the baby is born, the uterus continues to contract to release and deliver the placenta (afterbirth). This process can take from 10 minutes to an hour. Placenta comes out painlessly, often with little blood loss. Pulling on the umbilical cord to speed up the release of the placenta is strictly forbidden - this can cause uterine inversion and severe bleeding.

After the placenta comes out on the woman’s lower abdomen (uterine area), you need to put cold (ice, wrapped in a towel) for 20-30 minutes. This helps the uterus contract and stop bleeding. The woman should be given plenty of warm fluids and rest.

Primary toileting of the newborn and warming

Immediately after birth, the baby's thermoregulation is disrupted and he quickly loses heat. Therefore, the next task is to wipe the baby dry with a warm diaper, paying special attention to the folds, and wrap him in a dry blanket. Be sure to put a cap on your head, since the main heat transfer occurs through it.

The newborn's eyes are wiped with a sterile cotton swab dipped in boiled water or saline, moving from the outer corner to the inner. A separate swab is used for each eye to avoid infection. If possible, you can use special drops, but in an emergency, clean water is sufficient.

It is important to constantly monitor the child's body temperature. If he trembles or his skin turns pale, skin-to-skin contact with the mother (if condition allows) or father is necessary. Heat transfer between an adult and a child is the most effective way to keep a baby warm. Do not use heating pads with boiling water, as there is a high risk of burning delicate skin.

If the baby was born in amniotic fluid with meconium (green) and is not breathing, it is necessary immediately after birth, without cutting the umbilical cord, to suck out the mucus from the mouth and nose and begin stimulating breathing. In severe cases, artificial mouth-to-mouth and nose-to-mouth respiration is required, but this requires special skills.

Actions in case of complications and resuscitation

Complications during childbirth can occur suddenly, and the speed of reaction is important here. Heavy bleeding (more than 500 ml) after childbirth requires massage of the uterus through the anterior abdominal wall in a circular motion until it thickens. Uterus should become hard as a rock. At the same time, coldness is applied to the lower abdomen.

If the child does not cry, there is no breathing or heartbeat, resuscitation measures must be started immediately. The child is placed on a hard surface, the head is slightly tilted back, the airways are cleared and 5 careful breaths are taken “mouth to mouth and nose”, pinching the nose with the fingers. This is followed by 15 pressures on the sternum (lower third) with two fingers.

⚠️ Attention: The force of pressure when massaging the heart of a newborn should be minimal so as not to break the ribs. The depth of compression is about 1/3 of the thickness of the chest (approximately 1.5-2 cm).

The cycle “2 breaths - 15 pressures” is repeated until a scream appears, the skin turns pink, or the doctors arrive. Do not stop resuscitation if you see even the slightest signs of life. Even in extreme conditions survival rate with proper resuscitation is quite high.

Remember that your task is to gain time before the professionals arrive. Don’t be afraid to do something wrong, it won’t get any worse if you act according to instructions and with the goal of saving a life. Calmness, confidence and clear actions are the key to success in an emergency situation.