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or shower curtain underneath if possible). If a bed is not available, place clean clothing or newspapers under the woman or at least under her hips and thighs. If you can, gather clean blankets or towels (to wrap the baby); clean string, shoelaces, cord, or strips of cloth (to tie the umbilical cord); scissors or a knife (to cut the umbilical cord); a large plastic bag or other container (in which to place the afterbirth, or placenta, so a doctor can examine it later); and sanitary napkins or a clean cloth (to place over the woman’s vagina after the birth).

2. Make the woman as comfortable as possible.

3. Wash your hands with soap and water. Sterilize the scissors or knife with rubbing alcohol, or place them in boiling water for at least 5 minutes or over an open flame for 30 seconds and cool them before using them.

4. Have the woman lie on her back with her knees bent, feet flat, and knees and thighs wide apart.

5. Do not place your hands or any objects in the vagina, interfere with the delivery in any way, or touch the baby until the head is completely out of the vagina. Once the baby’s head is visible, support the baby’s head but don’t pull. If the baby’s head is inside a fluid-filled bag (the placenta), carefully puncture the bag with the sterile scissors or your finger and remove the membranes from the baby’s face.

Support the baby’s head as it emerges

6. Once the head has emerged, if you can feel or see that the umbilical cord is around the baby’s neck, quickly but gently slip the cord over the baby’s head. If the cord is wrapped around the neck too tightly, cut the cord immediately and tie off the ends (see step 14). If the cord is not wrapped around the neck, do not cut it at this time.

7. Continue to support the head as the shoulders emerge, but don’t pull the baby out (even by the armpits). Carefully hold the baby as the rest of his or her body comes out.

8. After delivery, if you can, note the time.

9. Support the baby’s head and body with one hand while grasping the baby’s legs and ankles with the other (get a firm grip because the baby will be very slippery). Position the baby so that his or her head is lower than the feet to allow any membranes or fluid to drain from the baby’s lungs, mouth, and nose. Do not hold the baby completely upside down by the ankles or slap or hit him or her.

10. Gently wipe any fluid or membranes out of the baby’s mouth and nose (preferably with a sterile gauze or clean cloth).

Wipe fluid or membranes from the mouth and nose

11. If the baby has not cried or is not breathing, gently rub his or her chest, or tap the bottoms of the feet. If the baby still is not breathing, perform artificial respiration (see page 156).

12. Once the baby has started breathing, wrap him or her up snugly (including the top of the head). Do not clean the cheesy white coating from the baby’s skin, eyes, or ears (it is a protective covering).

13. If the woman can be taken to a hospital immediately after the delivery of the placenta (which occurs about 5 to 20 minutes after delivery), the baby can be left attached to the cord and placenta.

14. If you must cut the umbilical cord, do not cut or tie it until it has stopped pulsating. Using a string, shoelace, cord, or cloth, tie a tight knot in the umbilical cord at least 4 inches from the baby’s navel and then tie another knot 6 to 8 inches away from the baby. Cut the cord between the two knots with the sterile scissors or knife. (At the hospital, a doctor will clamp the umbilical cord at the baby’s abdomen in the usual way.)

15. Within 20 minutes, the placenta (which is attached to the umbilical cord) will emerge.

Tie a knot in the umbilical cord 4 inches away from the baby and another one 6 to 8 inches away from the baby

The woman’s contractions will eventually push out the placenta. Do not pull on the umbilical cord. Pulling on the umbilical cord may pull off a section of the placenta from the wall of the uterus and cause severe or continuous bleeding. Gently but firmly massage the woman’s lower abdomen