What to do when a woman delivers unexpectedly

YOU are in a matatu and suddenly the pregnant woman sitting next to you goes into labour. What do you do?

Dr David Kiragu gives the run-down of how to handle such or similar situations.

The most important measure to prevent maternal death during delivery is the availability of trained medical personnel at the time of delivery. Alternative approaches such as self delivery or delivery by an untrained person must be discouraged as much as possible. If the expulsion of the baby is imminent, and there is no way of getting to a health facility, you can engage in First Aid measures to assist the mother deliver – but only as a last resort. Provide as much privacy as possible.

The First Option
The first option is to transfer the lady to a medical facility as soon as possible.

It is also extremely important to emphasise to expectant women the need to have a birth plan: What will I do when labour starts? Where will I deliver? How will I access that institution? These are some of the questions that every expectant mother must bear in mind. It is very important for a woman to have a birth plan during the antenatal period. That being the case, at the onset of labour proceed to the hospital that the lady has decided on beforehand. Of course, in the absence of a birth plan, look for ways and means to access the nearest health facility. The nearest facility should also be approached if the one in the birth plan can’t be reached in time for various reasons.

Ask her where she had planned to have the baby. If the place is accessible, then head there immediately. If not, the nearest medical facility will do. Delivery in a medical facility or with trained medical personnel present has very direct effects on survival of both mother and child.

What Happens If Her Water Breaks?
Water breaking does not necessarily mean that the baby is about to come out. Labour can either start by the pains or breakage of waters; either of which would necessitate that the lady proceeds to hospital. Waters can break before labour pains begin. If you observe breakage of water, go to a health facility immediately. Sometimes waters can break when baby is not fully mature. This portends certain maternal and foetal risks which require that the lady be admitted to a health facility.

Labour is a natural process whose actual trigger has not yet exactly been established. Physical activity is not key to initiation of labour.

What NOT TO DO

As an assistant, you must understand the risk of contracting transmissible infections if you do not wear protective gloves.

Avoid using dirty materials and utilities during the delivery process. Do not just get any knife, cloth or string. You, the baby and the mother could be exposed to all manner of bacterial infections. A wide variety of bacterial infections can be contracted through unhygienic delivery.

Avoid forceful extraction of the baby, like pulling baby or even pressing the mother’s belly to evacuate the foetus. Such measures may lead to rupture of maternal organs like the uterus.

Avoid trying to forcefully pull out the placenta. It will come out on its own probably as you proceed to the health facility.

Conditions under which an Emergency Delivery can best be conducted:

Emergency delivery is largely applicable for rural areas. It is essential that expectant women carry with them what we refer to as an emergency kit. The kit should contain two pairs of (sterile) gloves, a sterile blade and a clean piece of string because these are the tools you would need in an emergency delivery.

The assistant should wear gloves and have a sterile blade for cutting the umbilical cord. Secondly, this delivery can only be performed if the expulsion of the baby is imminent and there really is no time to get to a health facility.

If it is obvious that the baby is coming out, then assist. Mothers are very perceptive; they can tell when the baby is about to come out. So take her cue.

What To Do

o Respect the lady’s privacy. In as much as you want to assist, it is good to respect the lady’s privacy in whatever you do. Don’t have people jumping into the fray just for their amusement or to satisfy their curiosity. Put a barricade around her if possible or move her to a more concealed place like an alley.

o It is best that individuals who have some sort of experience, like a mother who has gone through delivery be given the opportunity to assist. Such a person is relatively more knowledgeable and better placed to offer real help,
o Have the mother lie on her back with her thighs wide apart; that is the safest position.
o As the baby’s head emerges, the assistant should gently support the baby’s head and apply a little downward traction (push head gently downward towards the mothers bowls) until baby exits the birth canal. While doing this support the mothers external birth canal to avoid tearing.
o Wipe off the baby’s nose and mouth any secretions that may be there. Use a clean cloth for that purpose,
o At this stage, the baby is still connected to the placenta by the umbilical cord. Grasp the umbilical com about 6 inches (which should be about the length of our hand) from baby’s abdomen and tie it with a clean piece of string. Make a second tie on the side of the placenta, an inch above the first tie; then cut between the two to release baby. Cover the baby with clean warm clothes,
o Leave the placenta in place as you proceed to the hospital for further assistance. Medical personnel will deliver the placenta and undertake whatever resuscitative measures necessary for the baby and mother. For you at the First Aid level, your principal role is to assist the mother to deliver the baby. Any aftercare should be left to qualified medical personnel. The mother and baby should be rushed to the hospital quickly before any further catastrophy.

Risks of such deliveries
o Severe bleeding by the mother, if this occurs, there will be no drugs to deal with bleeding and may lead to complications and death.
o Because it is impossible to have perfect sterility, infections to a mother’s reproductive organs and to the newborn (bacterial infections in particular) are common. When a mother who has delivered in this mode is taken to the hospital, clinicians normally administer antibiotics to both mother and baby to fight any infections.
o Maternal injury is likely to occur. This is because the delivery may be conducted by somebody who lacks the professional skills. Midwives have a professional management method which minimises injury.
o Absence of resuscitative facilities for the newborn can lead to preventable complications like pneumonia or even foetal death. For example if a baby inhales maternal secretions while in a health facility medical personnel will suck them out immediately. This is however not possible in an emergency setting.

It makes sense for a pregnant woman within context of a poor infrastructure/access to health facilities to carry with them an emergency kit containing gloves (two pairs) a sterile blade and a clean piece of string.

The stated risks should be enough to deter someone from casually deciding to deliver a baby outside a health facility.

END: PG8/45-46