For some, the idea of going through a pregnancy, giving birth and caring for a newborn without the benefit of doctors and hospitals is terrifying. Though pregnancy and childbirth are very natural, there are certain things people aren’t aware of and situations that could occur. In today’s society, we trust our obstetricians and pediatricians with our medical needs, and the needs of our children during this time, but what will happen during the inevitable baby boom after some type of disaster? Doctors may be in short supply and hospitals may be overcrowded. We, as survivalists need to know all we can about pregnancy, childbirth, and care for the newborn if the help we rely on today is gone tomorrow. This article is for information purposes only! Do not use it to replace the professional medical care available in current times.
In this article we will discuss pregnancy, including the different stages and what to expect, as well as some complications that could arise. We will discuss the birth process from the first contraction, the rupture of the amniotic sac (the water breaking), the actual delivery of the infant, and post-partum care. Finally care of the newborn and how to make sure that infant thrives in what could be very difficult times. For some this is an uncomfortable or even embarrassing subject…try to think of this for what it is, the most natural act that two humans can share…the making of a new life. With most medical situations, especially those in the emergency medical service arena, there are very few instances of immediate gratification…delivering a baby into this world is one of them. Seeing the immeasurable joy on the faces of the parents and hearing that baby’s first cry are things you will remember all of your life. Being as knowledgeable and prepared for this blessed event will make it even more memorable.
Another note, this article is written in a sort of editorialized style, coming from someone (namely me) who has been there! Done that! It’s been my experience to note that some men, namely first time fathers are mystified by the quantity and quality of emotions displayed by a pregnant woman, hence some of the insight and thoughts added in this article. The medical information given here is accurate, the feelings and thoughts of the pregnant mother are completely opined by me as a general consensus of how MOST (but not all) pregnant women feel and think.
We all know how pregnancy occurs, so this doesn’t need to become a mini sex education course. Starting at the moment of conception, the single cell that has been created from the mother’s egg and the father’s sperm is called a zygote. The genetic make up and the sex are determined at this point. Some of you may know how chromosomes determine the sex of a fetus, but incase some of you don’t, I’ll explain. Females have a double X chromosome that makes them females. Males have an XY chromosome that makes them males. The mother will contribute one of her X-chromosomes and the father will contribute either an X or a Y. Depending on which he contributes determines the sex of the baby. If he give the X, the fetus will be female, if he gives the Y, the fetus will be a male. So, it is the father’s chromosomes that determine the sex of the baby, not the mother’s. The cells of this zygote begin to multiply and divide and grow very rapidly for four weeks. Usually around four to six weeks this zygote develops a heartbeat and from then on it is called a fetus. This fetus will grow and develop for and additional 38 weeks within the mother’s uterus. As it grows, the mother’s stomach will obviously grow, alerting the world of her impending event! The gestation period for humans is 40 weeks. Now some of you are saying, but 40 weeks is 10 months and pregnancy only lasts nine months!! When counting the months, the first four weeks aren’t included, because during this period the zygote is still forming and hasn’t become a fetus yet. Most women don’t realize they are pregnant until they have missed one or two periods, and by then they are 10 to 12 weeks pregnant, which would be considered about two months along.
This 40 week period is divided into three segments called trimesters. The first trimester is from 1-14 weeks. It is during this first trimester when the critical development of the body’s organs and other systems takes place. Women should be very alert to their bodies, and if they are within child bearing age and sexually active, keep track of their menses and any unusual changes in their bodies. Being aware of these things will clue them in to the possibility of being pregnant and the need to take care with their bodies and their diet. Some clues to look for are missing periods, sore breasts, fatigue, changes in appetite (can be increase or a decrease), “morning sickness” which for any women out there who have been pregnant know, that it can be all-of-the-time-sickness, and moodiness. All of those things can happen with stress or illness, but usually alleviate themselves quickly. With pregnancy, it sometimes appears as a flu that lasts several weeks. For most women, the nausea and vomiting, coined morning sickness, usually disappear by week 14, however in some cases, these symptoms can be less or last longer, sometimes through the entire pregnancy. When a pregnant woman has this sickness longer than half of the pregnancy, it is called Hyperemesis gravidum….meaning lots of vomiting during pregnancy!! These women are in danger of becoming dehydrated, and usually need IV rehydration several times throughout the pregnancy. Many do not gain adequate weight and feel poorly the entire time. Speaking from experience, the baby is usually not in jeopardy…as it was put to me, “The baby is a parasite, so to speak, and will take what is necessary from you to thrive…you’ll just feel like crap the whole time.” Some women are given shots of antiemetic drugs like Phenergan or Visteril to control the nausea and vomiting.
It is also during this first trimester that the risk of spontaneous abortion, commonly called miscarriage, is the greatest. Some minor spotting can be normal, but heavier bleeding or clotting and cramping may be a sign of miscarriage and the patient should be monitored closely.
In current times, the baby’s heartbeat can be heard on a transvaginal ultrasound at as early as four weeks. It can usually be heard by doppler at 10 to 12 weeks. The mother will not be able to feel the baby move or kick this early, but on ultrasound will be able to see it.
The second trimester is from week 15 to week 28. Most of the baby’s vital systems have developed and during this time the fetus transforms from this tadpole-like shape into that of a baby. It is during the second trimester that the pregnant mother will be extremely energetic, and will take on that “radiance” or “glow” that people speak of. In most cases the fatigue and nausea have disappeared and the mother is anxious for her secret to begin to swell out in front of her. During the second trimester she wants everyone to know she is pregnant and comment on it. She will also feel the baby move for the first of many times somewhere around week 18, which is 4 ½ months. At this same time her tummy will take on the inevitable “pooch” and regular pants will be fitting very snugly if at all. At 20-24 weeks, which is month five, she will definitely need maternity clothes, and it will appear she has a small cantaloupe under her shirt. Weight gain is still minimal, though appetite begins to increase and the proverbial cravings will begin.
Week 20 marks a defining point in pregnancy during current times. This is the cut off point for a fetus that is born prematurely to be viable, meaning to have a chance to survive. If the woman’s body tries to go into premature labor at this point, everything possible will be done within the realm of modern medicine to prevent the birth from occurring until many weeks later, preferably no earlier than week 36. Often complete bed rest, only allowing the mother to get up to go to the bathroom is called for. Sometimes the mother can be confined to bed literally for months, which can lead to irritability, and depression. Steps must be taken to keep her as entertained as possible without tiring her out, i.e. puzzle books, novels, videos, crocheting or knitting, crafts, magazines, or any other “sit-down” hobbies she may have. Abstinence from sexual intercourse may also be necessary as pressure on the cervix, or stimulation of the breasts can trigger contractions. Medications such as Magnesium Sulfate may also be necessary to stave off contractions.
The third trimester starts with week 29 and ends with week 40 or when the baby is born. During the last part of the pregnancy the mother may still feel somewhat energetic, though tires more easily. She may begin to have swelling of her hands and feet. As the due date approaches she may find herself extremely tired and irritable…tired of being pregnant. No longer is she thrilled to have everyone comment on her burgeoning belly, which by now may be as big as a basketball, and she definitely doesn’t want anyone to touch it!!! She will also be extremely emotional during this time, crying over anything and everything, and sometimes over nothing. She will feel unattractive and extremely fat. Reassurance and patience on the part of the expectant father are of the utmost importance.
Most of the weight gained during the pregnancy is gained during the last trimester. The baby for the most part is completely developed, with just some fine tuning to the nervous and respiratory systems, and now is mostly just gaining weight himself. The mother should feel the baby move quite a bit and be very active within her as he runs out of room to play and stretch. If more than 24 hours go by without feeling the baby move, professional assistance should be sought, for it may be necessary to be hooked up to a fetal heart monitor or have an ultrasound.
During weeks 36 through 40, the final weeks of the pregnancy, the mother may go through a “nesting” phase. This is a period of intense energy totally devoted to cleaning the house from top to bottom and side to side and rearranging and sorting the contents of the nursery a dozen or more times, in preparation of the new baby’s arrival. During this time it is pointless to try and convince the mother to rest, because she will not rest until her internal task of preparing for her baby is complete to her specifications! Another thing to expect is the possibility of false labor, technically called Braxton-Hicks Contractions. Though false labor feels conspicuously like the real thing, the determining factors are checking for dilation of the cervix and timing the regularity of the contractions. Most often, false labor contractions will not maintain regularity. They may start at five minutes apart, then three minutes, then 10 minutes, back to five, up to seven, then stop. Most women have at least one episode of false labor before the real thing. It’s always best to see the doctor and let him determine whether or not the labor is real.
First pregnancies are notorious for being late; meaning the mother is overdue, past her due date. Usually doctors will allow the pregnancy to go up to 42 weeks, then if the mother still shows no signs of delivering spontaneously, labor will be induced by means of medication given intravenously, such as Pitocin.
When a woman is pregnant with her first child, and has had no miscarriages or abortions, she is called a PrimiGravida. Primi meaning first and Gravida meaning number of pregnancies. If she has one living child and is pregnant with her second, and has had no miscarriages or abortions, she is a Para 1 Gravida 2. This means she has one live child and two pregnancies. By living child, it means a child that was carried to term and lived…not if that child died later in childhood. If she is pregnant with her third child has two live children and two miscarriages she is a Para 2 Gravida 5, meaning two live children and a total of five pregnancies. When asking a pregnant woman how many times she has been pregnant, get her reply, then ask how many children she has…if the numbers don’t match, ask whether or not she has had any miscarriages or abortions. These numbers are important. Usually PrimiGravida’s have longer labors and harder deliveries, whereas multigravida’s may have a shorter labor and easier deliveries. This is not a rule….exceptions always occur…but generally, this is what happens.
Usually before labor begins, and by labor I mean the contractions, the mother’s cervix will begin to efface. Effacement means to thin. It goes from being about an inch thick to being paper-thin. A digital pelvic exam can determine the percentage of effacement…for example, the cervix is 25% effaced, means it’s thinned down a quarter of the way, but still has three quarters to go. If it is 50% effaced, she still has half way to go. During this effacement, the mother may begin to have vaginal spotting or bleeding, and the blood may be mixed with mucous. This is literally the mucous plug that was in the cervix coming out. Sometimes it is called the “bloody show”, though I personally hate that term. I call it what it is…losing the mucous plug. The process of effacement can take a few minutes to a few hours to a week or more…there is no set time, for each woman is different. Once the mother has become 100% effaced, the opening in the cervix will begin to dilate. The dilation is measured in centimeters. It goes from 0 centimeters (no dilation) to 10 centimeters, which is fully dilated. The dilation is also checked by digital vaginal exam, by inserting two fingers into the vagina. THIS IS NOT RECOMMENDED FOR UNTRAINED PERSONS!!! If the person checking the mother can insert one fingertip into the cervix, she is considered to be dilated 1 cm. Two fingertips is 2 cm. Two fingertips with a space in between is 3 cm. As the cervix dilates out, the fingers of the person examining the mother will spread into a “V” shape. Imagine a fingertip in each space of that “V” is a centimeter. The most that “V” can spread is usually 5 cm, so at 6 cm and up they run their fingers along the edge of the cervix and gauge what the dilation is…experienced labor and delivery nurses are good at it. Now imagine a circle with a 10 cm diameter…that is how big a fully dilated cervix is, and usually when feeling it on exam, you will also feel the baby’s head pushing down. It is imperative that the mother NOT push during contractions if her cervix is not fully dilated. This can cause tearing of the cervical wall which will cause intense bleeding during and after the delivery. These tears are repaired surgically. To prevent pushing during contractions many couples take Lamaze or other types of childbirth classes to teach them breathing techniques and relaxation techniques. For some women this is very helpful, for others it isn’t. Personally I recommend it because learning the breathing alone is helpful.
Now while this dilation is happening the mother is also experiencing contractions. The best way I have found to describe a contraction is to imagine a huge tourniquet, about a foot wide, around your middle being ruthlessly twisted and turned every few minutes until its excruciatingly tight, AND at the same time trying to defecate a piece of feces the size and weight of a bowling ball. The band is the contractions and the bowling ball is the baby moving down into the birth canal.
Contractions begin as a mild twinge across the upper abdomen and are usually bearable. They may be as many as 20 minutes apart, and only lasting a few seconds. As time progresses, the strength, frequency and length of the contraction will increase. Again, there is no set time for this to occur. Some women go through the first stage of labor for literally days…others hours, for a few, minutes. Things to look for when measuring contractions are, how far apart they are, and the duration of the contractions. To time them, you count from the end of one contraction to the beginning of the next. You will also count the duration of the contraction, or how long it lasts. Initially the time between contractions will be greater than the duration. As the time for delivery gets closer, the two will begin to equalize, meaning, if the contractions start at 10 minutes apart and last for 20 seconds, they will eventually get to five minutes apart lasting 45 seconds, then to three minutes apart lasting one minute, then one minute apart lasting a minute. These are only examples. The actual times will most likely differ.
Sometime during the course of labor, the amniotic sac, or the bag of waters, will rupture. The amniotic sac is the bag that surrounds the baby inside the uterus and it is filled with fluid to cushion the baby. When the water breaks, there is a large “gush” of liquid from the vagina. This liquid should be mostly clear. If it is green or brown colored, or has clumps of what looks like dark green tar in it, it is called meconium staining. This means the baby has had a bowel movement inside the mother and there is a possibility he could have breathed some of it into his lungs. ANYTIME there is a meconium stained birth, be prepared to do aggressive suctioning and possible respiratory resuscitation on the newborn. Even if the water breaks early in labor, the amniotic fluid is constantly being produced, so the possibility of a “dry birth” is a myth (though we will talk about ways of adding lubricant to minimize tearing). In certain situations, the doctor will manually break the water by inserting a small blunt hook, called an amni-hook, through the vagina and into the cervix, puncturing the sac. In a PSHTF situation, this will not be recommended for untrained individuals. If the baby begins to deliver and the water still hasn’t broken, the sac will protrude through the vagina. Usually simply touching it or pinching it between two fingers will break it.
Supplies Needed for the Birth
In most movies when a baby is about to be born, someone inevitably shouts, “Go boil some water!” Well, other than sterilizing instruments, the water doesn’t have much of a purpose! Some of things you will need to have immediately available before the delivery are:
Plenty of clean towels
A small bulb syringe for suctioning the nose and mouth
A sterile scalpel or sterilized surgical scissors for cutting the cord
Two clean pieces of string or commercial cord clamps
Several clean receiving blankets
Two large tubes of KY jelly or other water based lubricant (optional)
Several large super absorbent sanitary napkins
A small knitted cap for the baby
Many pairs of latex or vinyl gloves (don’t have to be sterile)
Cloth or disposable diapers
Several trash bags
Blood Pressure Cuff
These supplies need to be within reaching distance at the moment of delivery, for time is of the essence and the baby won’t wait for you to get them!
When the mother begins to feel the urge to push, this is the last stage of labor, called transition. During transition, the baby is moving down the birth canal and preparing to come out. The baby’s head will press on the mother’s rectum and she may feel the urge to go to the bathroom for a bowel movement. DO NOT allow her to sit on the toilet! Most likely she does not need to actually have a bowel movement, but if she does, simply clean it up from the bed or floor, where ever she is laying. In years past, and even in current times, many babies have been expelled into the toilet from mother’s sitting on the toilet while in the transition phase of labor. It’s much easier to clean up poop, than to resuscitate an infant who has inhaled and aspirated toilet water!
At this point delivery is imminent. How imminent is the question. When the cervix has fully dilated to 10 centimeters, the mother may begin to push. The act of pushing can take hours or minutes. There are several positions for the mother to be in during the actual delivery and to have effective pushing. Putting the mother’s legs in stirrups or having her hold her bent knees apart are a couple of them. My favorite, and what seems to be the most comfortable and effective, is to have the mother (lying on her back) pull her bent knees up to her sides, and put her arms around the outside of her legs and behind her thighs and pull toward her shoulders. You will need two additional people to help with this, perhaps the father and another family member. Have one person stand on the mother’s right side, facing her and using the hand closest to her foot, hold her foot and during contractions, help her pull her bent legs toward her shoulders. This person’s other arm should be behind the mother’s back, pulling her forward. This “crunching” motion will be natural for her during a contraction. The person on the left should mirror the same thing. When the contraction is over, let the mother lay back and rest and catch her breath as best as she can, then repeat the whole process on the next contraction.
One technique to prevent tearing of the vaginal wall is a procedure called an episiotomy. This is a small cut made in the vaginal wall to enlarge the opening for the baby to pass through. Many doctors have stopped performing episiotomies and instead opt for extra lubrication. This can be accomplished by using KY jelly or some other water based lubricant. With gloved hands, squeeze the entire contents of one large tube of KY into one hand. Then gently inserting that hand into the vagina, coat the vaginal walls with the lubricant. This technique works very well, but again, it is not recommended for untrained individuals.
To explain pushing, tell the mother to wait until the beginning of her next contraction, then when it starts, take a deep breath, hold it, and bear down like she is trying to have a bowel movement. The “coach” should count slowly and evenly to about ten, then have her take a quick breath, hold it and bear down again. Usually after two cycles of holding the breath and counting, the contraction should be over. It may take several of these cycles before crowning is visible. Crowning is when the vaginal opening begins to bulge and you can see the top of the baby’s head. At this point the contractions will be continuous and the mother will need to push continuously until the head delivers. When you can see the top of the head, place the palm of your gloved hand over the vaginal opening and apply gentle counter pressure to prevent what is called an explosive birth, which can cause the vaginal wall to tear. Verbal encouragement to the mother is essential. Let her know what great job she is doing and explain everything you see. This will keep her motivated to push, even when it hurts so bad she just wants to give up.
When the head delivers, it should be face down, and will naturally turn to the side as the face delivers. After the head is completely out, have the mother STOP pushing and pant. Panting will keep her from wanting to push. At this point everything you need should be close by and within reach. Carefully feel around the baby’s neck to insure the cord is not wrapped around the neck. IF it is, try to gently loosen it and pull it over the head. If it is wrapped several times, you may have to cut it while there to prevent strangulation when the body delivers (we’ll talk about that in a sec!). You will now need to suction the baby’s mouth and nose before the chest delivers to prevent aspiration of any fluid or mucous in the baby’s airway. The change in pressure from the inside of the mother’s body to the outside world will stimulate the baby to breathe, so suctioning while the chest is still inside is the best way to prevent aspiration. To do this, gently turn the head to the side and depress the bulb syringe. DO NOT depress the bulb syringe while it is inside the baby’s mouth or nose!!! This will blow the fluid and mucous you are trying to get out, deeper into the airway. Now with the syringe depressed place the tip inside the baby’s mouth, past the gums and release the bulb with a sweeping motion. Pull the syringe out, and depress it several times to expel what was sucked up. Repeat the process again, still suctioning the mouth. Next do each nostril, remembering to depress the bulb BEFORE inserting it into the orifice. Suction each nostril and the mouth a minimum of twice. IF there is meconium staining, suction as long as it takes, until there is no longer fluid or mucous coming out. The reasoning for suctioning the mouth first is newborn’s are obligate nose breathers, and if by chance the mother can’t hold on and she pushed the baby out, if the nose is clear, the baby will take a breath and the fluid in the mouth is going to get sucked into the trachea. Always remember; suction the mouth first, then the nose!
After you have sufficiently suctioned the mouth and nose, have the mother begin to push again on her next contraction. The shoulders will deliver next, and this is the most difficult point in the delivery. Occasionally the shoulders will get stuck and you may have to use a finger to gently pry one shoulder out, the second will follow spontaneously. After the shoulders deliver, the rest of the body will slide right out! Note the time when the baby was completely delivered. The cord will remain inside the mother, so take care not to pull the baby too far away from the mother. This new little critter will be extremely slippery!!! Once he delivers, lay a towel over the mother’s stomach and lay the baby on the towel and let the mother hold him there. Now we have to cut the cord! Using the strings or the commercial cord clamps, place the first clamp approximately five inches from the babies body and place the second approximately two inches away from the first, closest to the mother. Now using a scalpel or scissors, cut the cord between the two clamps. If using string, tie each piece of string in the same locations, using a square knot. Make the knot as tight as you possibly can. Now a second medic or helper is necessary. One person should take over care with the infant and one person must finish up with the mother.
At this point the mother will still be having some light contractions and has to deliver the placenta, or afterbirth. The placenta is usually round shaped, about eight inches in diameter and about an inch to two inches thick. It is important to know what it should look like incase it breaks apart while delivering. Care must be taken to remove all parts of the placenta or serious infection will occur. It may take up to thirty minutes after the baby is delivered for the placenta to deliver. Sometimes placing pressure on the top of the uterus, called the fundus, will help to expel it more quickly. Having the newborn nurse can also help because stimulation of the breasts causes a natural release of Pitocin, which is the chemical that causes contractions. After the placenta delivers, examine it to insure it is complete and not torn or broken apart, then place it in a bag for disposal. Place a sanitary napkin over the mother’s vagina, cover her up, and let her sit up and enjoy her new baby.
Care of the Newborn
Once the baby is delivered, it should be wrapped in a receiving blanket and moved to a separate table, preferably one with warming lights over it (even regular light bulbs will work, just make sure they aren’t shining directly in the baby’s eyes). The baby will be covered with fluid and a white pasty substance called vernix. Using a dry towel, dry the baby completely, starting with the head and working downward. Most newborns urinate soon after birth (my daughter peed on my chest, immediately after she was delivered!) so be prepared for it. At one minute and five minutes after birth, an assessment of the newborn should take place. The assessment is called the APGAR, which stands for Appearance, Pulse, Grimace, Activity, and Respiratory effort. Assessing these five areas will help you determine how well the infant is doing. Each area has a score of 0, 1, or 2 and the maximum score is a 10. Most of the time the second score will be higher than the first.
Appearance- This is looking at the baby’s skin color. Most newborns will appear pink (red), blue, or a combination of the two. If the baby’s entire body is blue at the first scoring, resuscitation may be necessary and it receives a score of zero for this category. If the torso is pink and the extremities are blue, the baby will receive a score of one. If the entire body is pink or red, the score is a two.
Pulse- To take a newborn’s pulse rate a stethoscope is necessary. Place the stethoscope bell over the baby’s heart and count the beats for a full minute. It should be very rapid and sound similar to a horse galloping. The infant should have a pulse rate of AT LEAST 100 beats per minute. It may be as high as 180 beats per minute! If the pulse is 100 beats per minute or higher the score will be a two. If it is 80-100 beats per minute the score will be a one and resuscitation equipment should be available. Usually more stimulation by drying the baby off more or flicking the soles of the feet will raise the heart rate. If the pulse is below 80 the score will be zero and resuscitation should begin. For a newborn, a pulse rate below 80 is fatal because the heart is not pumping enough blood to sustain the body. CPR should be started and compressions should be done to make the heart rate at least 100 beats per minute.
Grimace- This is the baby’s response to stimuli. The stimuli can be anything that makes him cry. If the baby is crying spontaneously without being stimulated, the score is a two. Flick the sole of the baby’s foot and if the cry is loud and the baby draws up into a ball, the score is still a two. If after flicking the foot the baby only gives weak cry and doesn’t withdraw from the stimuli, the score is a one. If there is no response to the flicking, the score is a zero.
Activity- The baby should have some movement in its extremities. The arms should be flailing and the legs kicking. If this is the case, the score is a two. If there is slight flexion of the extremities, the score is a one. If the extremities are flaccid, the score is zero.
Respiratory effort- This is observing how well the baby is breathing. If there is a lusty cry, this indicates good air movement and the score is a two. If the baby is whimpering, and you can see good chest expansion, the score is a one. If there is no crying, slow respirations, less than 30 per minute, the score is a zero.
You’ll notice that when scores of zero are given, warning bells should be going off in your head telling you this is infant needs some extra attention and more than likely resuscitation. If resuscitation is necessary do it immediately…nothing takes priority over that. In many cases extra stimulation and suctioning of the airway can increase the respiratory effort and pulse rate, and can raise the APGAR substantially on the second test.
You should repeat this APGAR test again five minutes after the baby is born. The score should be higher this time, and the baby should be alert. After the APGAR tests, allow the parents to hold and cuddle their new baby for awhile, then the baby will need to be bathed and weighed, measured, and footprinted. While this is happening, allow the mother to take a shower, not a bath.
When bathing a newborn, use tepid water.
It should feel warm when you submerge your elbow in it. Wash the
baby hair and body, removing the rest of the vernix, then be sure to dry
him off completely. If scales are available, get his weight.
Next using a measuring tape, measure his length, chest circumference, and
head circumference. If supplies for footprinting are available,
footprint him. Now that we have finished poking a prodding, diaper
him, replace the cap on his head, and bundle him in a receiving blanket.
Keeping him warm is of the highest priority. If the mother is ready,
return the baby to her and allow her to begin nursing. In a PSHTF
time, nursing will be this child’s best defense against the outside world.
He will receive nutrients and antibodies to protect him against common
Complications During Pregnancy
There are several complications that can arise during pregnancy, some can be life threatening for both mother and baby. Many of these complications are dealt with carefully at best in current times and with all of the conveniences of modern medicine. During PSHTF times, it’ll be dealt with as best we can.
This is defined as regular, rhythmic contractions between 20 and 36 weeks gestation. Contractions that occur every 7 to 10 minutes can cause dilation of the cervix. Bed rest is essential at this time, and in current times drug therapy will be initiated to halt the contractions.
Premature Rupture of Membranes
This is the rupture of the amniotic sac prior to the onset of labor, or before 36 weeks gestation. Bed rest is still recommended. The mother should not take baths, and the caregiver should not perform vaginal exams, due to the risk of infection.
Pre-Eclampsia presents itself with three major symptoms: Hypertension, edema (gross swelling in the extremities and face), and protein in the urine. It can be classed as mild or severe depending on the severity of the symptoms. For mild cases a blood pressure of 140/90 or greater than 30mm systolic and 15mm diastolic from baseline. The edema will be +1 or +2, meaning if you depress the swelling and it takes one to two seconds for the indentation to disappear. The proteinuria will also be +1 or +2, but in a PSHTF case, we most likely won’t have the means available to test the urine. For severe cases the blood pressure will be 160/100 or greater than 60mm systolic and 30mm diastolic above baseline. The edema will be +3 to +4, with pulmonary edema or cyanosis. Urinary output will be less than 400cc in 24 hours. The proteinuria will be +3 to +4. The patient may also have headaches (brain swelling), visual disturbances, epigastric pain, increased reflexes, and shortness of breath. This patient should lay on her left side to remove any pressure off the vena cava and aorta. Drug therapy with Magnesium sulfate would be established, as well as some other medications. This is a serious condition, and needs to be monitored closely for the patient could lapse into seizures or coma.
This is the progression to seizures and coma from pre-eclampsia. This condition can be fatal to the mother and/or baby. Treatment is the same as for pre-eclampsia, as well as treating the seizures.
This condition is when the placenta attaches itself in the lower portion of the uterus covering the cervical opening. Normally it would attach itself at the top of the uterus. It is characterized by painless bleeding, but the bleeding will be constant and can cause the mother to go into shock. More than likely the mother will need blood transfusions and the baby will need to be delivered by cesarean section.
This is a premature separation of the placenta from the uterine wall. It can cause bleeding into the amniotic sac and severe pain for the mother. The mother will need blood transfusions and the baby will need to be delivered by cesarean section. This can be a fatal situation for both the mother and the baby.
A breech delivery is when the baby hasn’t turned properly and the feet deliver first. During a Breech delivery, the legs and torso will deliver, but the arms will get caught inside the mother. One of the biggest problems with this, is when the chest delivers, the baby is going to take a breath, and inhale fluid. This is one of the specialized cases where it is okay to put your sterile gloved hand into the mother’s vagina. In most breech deliveries, the baby will be face down and you will need to insert your hand into the vagina under the baby and press down creating a “tunnel” for the baby to breath. You will also have to manipulate the arms and shoulders out of the vagina and get the head out quickly to prevent asphyxiation. As soon as the baby is delivered, aggressive suctioning is necessary to clear the airway. It is common for a breech baby who is delivered vaginally to have a broken arm or collarbone. A sling made with a small section of roller gauze is used to hold the arm still for three weeks until it heals and there are usually no long term problems from it. In current times, a breech baby is found by ultrasound and is usually delivered by cesarean section.
A limb presentation is when an arm or leg comes out of the vagina first. This is a dangerous situation for the baby and the mother. The baby must be turned inside the uterus, and this is a very dangerous task and it should only be done by trained individuals. In current times the mother should be transported to the hospital as soon as possible lying in the knee chest position, which is on her hands and knees with her bottom in the air.
Another potentially fatal situation for the baby, this is when the cord comes through the vaginal opening before the delivery. The compression of the cord can be fatal for the baby. The cord should be wrapped in a moist sterile dressing and two fingers should be inserted into the mother’s vagina to alleviate pressure from the cord. The mother should get to the hospital as soon as possible.
Most of these situations are rare, and if they should occur during a PSHTF time, will be dealt with as best we can. Having the knowledge about what could happen is half the battle.
I hope this article helped those of you who are pregnant or could become pregnant. Learn all you can while the resources are available.
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