How to Survive the End of the World as We Know It - James Wesley Rawles [71]
Unreduced nuchal cords (umbilical cords wrapped around the neck) are a major cause of death or brain damage in “normal” deliveries due to strangulation as they tighten. Don’t forget to check for the cord around the neck! Finally the face will be out, and the child will normally stick at the shoulders, as this is the widest point on the child. Take this time to suction the baby ’s nose and mouth thoroughly. I would highly recommend getting several blue bulb syringes over-the-counter now for just such a situation. If you note a greenish slime (meconium) on the baby or in his mouth, this means he has had a bowel movement due to the stress of labor, or because of the above mentioned nuchal cord. It is very important to get this out of the throat and nose now, because once he comes out the rest of the way and takes his first breath, he will suck this junk down into his lungs. A small amount of previously boiled water may help to make the meconium runnier and easier to suction. The meconium itself is sterile, and is no cause for alarm, other than the risk of aspirating it.
Passing the shoulder is a little more difficult. Most of the time you can reach up and grasp the shoulders, pushing the trunk down to deliver the forward-most shoulder, then up to deliver the trailing one. Sometimes an assistant can put pressure over the mother’s bladder while flexing her leg up into the air to help push the baby’s shoulder down to get it to pass under the pelvic bone. You can do a Google search for “McRoberts maneuver” for a more detailed and complex explanation. Do not tug down on the head itself, as it can tear the nerves going into the arm from the neck. Also, do not push down on the top of the uterus, as this can cause some serious problems as well. In a truly desperate situation, the baby’s collarbone can be broken to cause the shoulder to collapse some. While it sounds horrible, the bone heals fairly readily, and it’s something I’ve had to do even in the hospital setting once or twice. You put one palm over the breastbone of the baby and the other behind the shoulder of the collarbone to break, then press with both thumbs in the center of the clavicle with a force slightly greater than that used to break a turkey wishbone. You will definitely feel the “pop.” It is important to note that after the first shoulder delivers, the baby pretty much wants to pop right out. Try to get the mom to breathe through her nose and stop pushing while you apply pressure back in, so that the baby slides out in a controlled fashion. Letting it slide out uncontrolled will greatly increase the risk of a tear to the mom.
After the baby passes, lower him below the level of the birth canal to help his blood flow out of the placenta and back into his body. After about thirty seconds, clamp the cord with whatever you have, such as boiled clothespins. Clamp above and below where you intend to cut, which is usually about one-and-a-half inches from the baby’s belly. Cut with a sterilized blade, as this is a major source of infection in the Third World. Keep the clamp on the baby for a day or two, until the vessels scarify.
Clean the baby with a dry cloth to remove all the slime, and immediately wrap him in a warm blanket, as babies have a hard time controlling their body temperatures initially. You can stimulate the baby if he isn’t crying by rubbing his breastbone with your knuckle using moderate force, or by a light pinch. Try to get the baby to breast-feed right away, as it will help the mom’s uterus collapse down and minimize bleeding.
Massage the mother’s belly, pressing down on her uterus with moderate force (enough to be somewhat uncomfortable). After the uterus has contracted, the placenta will separate from it. After separation, apply gentle traction to the end of the placenta to get it to