The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Basics of Birth for those who don't know nothin' 'bout birthin' babies!

A Primer for Doing Your Best to assist at an unplanned unassisted birth.  This was written for our local CERT (Community Emergency Response Team) and assumes that you have a standard emergency OB kit.  (NOTE - If your kit contains latex gloves, it's best to try to replace them with non-latex gloves.  You can buy single pairs of sterile vinyl or nitrile gloves from Cascade Healthcare Products. You need at least 2 minimum - 1 for catching the baby and 1 in the rare case that you need to go in after the placenta. Ideally, you would have at least 4 pairs of sterile gloves so that you don't have to be perfect in your timing of putting them on for the birth.)

1. Act as if you're calm and keep your voice quiet.  This really helps!  Try to breathe slowly and deeply.  Birth is not an emergency . . . . it is an emergence.  Reassure her that you have the birth supplies and that everything is fine.
2. If this is not a first baby for her and mom is pushing, then go directly to Step 6.
3. Provide as much emotional and physical support as the mom wants, which may not be any if she is an experienced birther.  If she has supportive family that she wants present, they're probably scared, too, so just ask them to breathe slowly and deeply and stay close to hold her hand if she needs and to offer her a sip of water in between contractions.  Clear out non-helpful bystanders. Anyone who might touch the baby should wash their hands.  Assist the mother to wash her hands if they appear dirty.  Baby wipes can be used to clean hands if there's no water.
4. For a first baby, just support the mom to do whatever she wants. Anytime she looks scared or says she can't do it, reassure her that she is doing a great job and that everything is going well. She needs to drink at least 1 cup of water or non-acidic juice every hour and to empty her bladder regularly; recommend that she try to urinate at least once each hour but it's OK if she can't.  She can eat whatever she wants, although it's best to eat simple foods: yogurt, pasta, soup or just honey. A first baby labor is usually 12 to 24 hours. If she is getting tired, you can help her to get into a supported sitting position, such as sitting on a pillow on a kitchen chair and leaning on a pillow on the kitchen table.  Or you can create supports with pillows on her bed or the sofa, but lying down during labor is usually very uncomfortable, and reclining on her back can move the baby into an unfavorable position..  At some point, she may start to enter the "transition" to the pushing stage: she may appear to be in a great deal of distress, she will probably say that she can't do it, and she may feel very hot and then feel chilled and then feel very tired and just want to go lie down for a little bit.  At this point, it's fine if she really wants to lie down and it's the most comfortable position for her; help her to get comfortable lying on her left side, with her right knee bent forward a little bit, supported by a pillow. At some point, she will start making grunting noises, and then she will obviously be "pushing", i.e. bearing down.  [NOTE - ]  Then stay present to her but still support her in doing whatever she wants until you see at least a 2" diameter of the baby's head that stays there even when she's not pushing.  (If she needs a suggestion about a good pushing position, she might try being on her knees and leaning on a sofa.  Or if she is struggling to find her rhythm for more than 15 minutes, you might suggest that she try pushing on the toilet, but remind her to tell you when she feels the head starting to come out.) Then go to Step 6.
5. If you have time, you can create some absorbent underpads by opening up some clean newspapers and stacking them to about an inch thick.  Cover them with a clean sheet or fold them into a clean pillowcase or just cover them with a clean towel.  It's nice to have at least one large one for the birth and immediate postpartum and then a clean one for after the birth.  Even more is even better - up to 6 is nice.  (Optionally, you can use clean towels on top of plastic or clean sheets on top of blankets on top of plastic.  The key is to try to have something clean next to her and the baby; have something absorbent underneath that; and try to protect the surroundings from anything that might soak through.)
6. When the birth is imminent, help her to lie down on her side on the clean overdrape or any clean cloth, sheet, towel on a bed, sofa or the floor. (You want to make sure there's no way the baby could fall a long distance when he/she emerges; babies are very slippery!)  A side-lying position also helps to prevent perineal tearing.  (Do not fight her about the position but maybe put a cushion on the floor if she is standing up.  Hands and knees or kneeling positions are generally fine.  Or she may want to sit on the edge of the sofa and catch the baby herself.) Use a baby wipe to remove any obvious stool (fecal matter) that is pushed out as the baby's head comes down.  It is OK if the baby comes into contact with the mother's stool, although it's nicer to wipe it away.  If you have time and her hands are dirty, help her to wash them or at least wipe them on a baby wipe.
7. Put on sterile gloves so you'll be ready to touch the baby if the baby needs help.  At most births, you will not need to touch anyone. (Reserve at least one pair of sterile gloves in case you need them to remove the placenta.)
8. Reassure her that she is doing a great job and that everything is going well.
9. It may take a while for the baby's head to emerge fully so that you're seeing more than the top of the baby's head.  Encourage the mother to stop pushing once you see 4" across the top of the baby's head; explaining that this helps avoid a tear. .  She can pant or give short, grunty pushes if she needs to.  Her body will keep pushing the baby out even if she isn't trying; this is ideal.
10. Finally, there will be one contraction that births the head fully so the baby's chin is out. Then there will be a pause of about 60 seconds. The head will probably rotate about a quarter turn on its own.  You do not need to touch the baby at this point.
11. Encourage the mother to reach down and touch her baby's head and then to reach down and help her baby out with the next contraction.  This will help prevent perineal tearing.  It's fine if she wants you to be the one to catch the baby.
12. The next contraction will bring the rest of the baby.  [See below  if there is cord around the neck that is preventing the baby's body from being born or if the shoulders are stuck for more than a minute.] Have your hands ready to support the weight of the baby's body if necessary. Encourage the mother to bring the baby up to her chest or as far as the cord length will allow.
13. Note the exact time of birth.
14. Help the mother to dry the baby thoroughly with clean cloths.  This will help stimulate the baby to breathe.  Remove wet cloths and cover the baby with a dry cloth. Keep the baby skin-to-skin on the mother's warm body, covered with the receiving blanket and then the plastic-lined underpad to keep the heat in.  Shield the baby from breezes and shade the baby's eyes if the light is bright.
15. The baby needs to be warm in order to begin getting oxygen from breathing.  The baby continues to get oxygen through the umbilical cord for 5-10 minutes after the birth so it is OK if baby takes a minute to start breathing
16. Typically, the baby takes a few minutes to cry, sneeze, cough, sputter and cry some more to get the breathing working properly.  Then the baby will start looking around for the mother's face; encourage her to look at her baby and talk gently and lovingly to welcome the baby.  At about 15 or 20 minutes after the birth, the baby will start to look interested in breastfeeding; baby will be sucking on the hand, licking the lips, turning the head from side to side or bobbing the head. Help the mother to lie down comfortably on her back, with her head on a pillow.  Place the naked baby with the head between her breasts and allow the baby to maneuver to the breast and latch on by himself/herself.  If the baby is not able to move to find the nipple after 15-30 minutes, then you can position the baby with the mouth directly over the mother's nipple.  The mother may need to shape the nipple by compressing the breast with her thumb and forefinger about two inches back from the nipple to make it more pointy and fit into the baby's mouth better.  Ideally, there will be someone who can help with breastfeeding, but the most important thing is for the baby to stimulate the mother's nipples to control the bleeding and help bring the milk in.  Allow the baby to nurse for as long as desired, even up to 2 hours.  Babies often poop a few minutes after they start nursing.  You can just put a diaper under the baby's bottom to keep the mother clean, or you can diaper the baby if the mother prefers. [NOTE - Normal newborn poop (meconium) is like black tar for the first couple of days.  You get bonus points if you can get some olive oil or baby oil on the baby's bottom with every diaper change so the meconium doesn't stick so much.]
17. Meanwhile . . . the placenta usually comes about 5-10 minutes after the birth; the baby can remain in the mother's arms and even keep nursing through all the placental activity unless there is a major emergency.  Watch for sudden gush of blood and lengthening of cord.  This means placenta has detached and is ready to be born.  Placenta will usually be pushed out easily by mother.  You can assist the mother to kneel or stand (still holding the baby) to allow the placenta to fall out; be prepared to catch it in a bowl or pot as a splattering placenta is really messy, AND it is still attached to the baby!  Or if the mother chooses to remain lying down, you can use one of the gauze pads to grasp the cord close to the mother's body.  Ask her to tell you when she is having a contraction, and then GENTLY tug on the cord with gentle downward pressure to assist its coming through the birth canal.  STOP if the mother complains of discomfort.
18. After the placenta is out, immediately press fingers slowly and gently into abdomen at  the mom's belly button - you'll feel the top of the uterus.  It may be somewhat spongy or slightly firm or rock hard if she's having a contraction.  Do slow and gentle circular massage to encourage contraction of the uterus.  This is extremely important, especially if there's a constant flow of blood. (You can put the placenta into a clean plastic bag to contain the mess, and just tuck it alongside the mother's hip as the baby nurses.)
19. Ideally, you can help the mother into a safe, comfortable location within 15 minutes of the birth and then keep her lying down for the next 1.5 to 2 hours.  Women usually feel strong for about 15-20 minutes after the birth, but then weird things happen to blood pressure, and women often faint if you try to get them up too soon after the birth.  At about 1.5 to 2 hours after the birth, she will need to empty  her bladder.  Walk with her to the toilet and stay with her in case she starts to feel faint.  (You can turn your back and check in every minute or so to assess her well-being.)  Ideally, you will have some clean (warm?) water that she can squirt over her perineum to relieve the stinging as she urinates and to clean the perineum afterwards.  Help her back to bed.  She should urinate at least every couple of hours while she is awake; a full bladder prevents the uterus from staying contracted and may increase her postpartum bleeding.
20. Do not cut the cord until about an hour after the birth, or if the mother wants you to, or if you need to move the mother and baby a long way to a safer location. If you are moving the baby a short distance, you can just carry the placenta close to the baby, with some slack in the cord.  Before you cut the cord, put an identifying band of some kind on the baby with the mother's name and date of birth, and put a matching band on the mother and father or other family member.  TO CUT THE CORD: use the sterile plastic umbilical clamps to clamp the cord about 3 inches from the abdomen, then 2 inches beyond that, and cut between the 2 clamps with the disposable scalpel or any sterile knife or scissors.  You can sterilize a knife or scissors by scrubbing it clean and then boiling for 20 minutes or soaking in alcohol or hydrogen peroxide for 20 minutes.
21. Once you are safely past 2 hours after the birth, then just encourage the mother to hold the baby close to keep the baby warm.
22. DO NOT MESS WITH ANYTHING UNLESS HELP IS OBVIOUSLY NEEDED.  For example:
1. IF THE BABY IS BREECH - Most babies are born head first, but 3-4% are born butt first, i.e. breech.  If you see a black tar-like substance coming out of the mother, this may mean that the baby is coming butt first.  If the baby is a few weeks early or smallish,
2. IF THERE IS CORD AROUND THE NECK that is preventing the baby's body from being born - If the cord is loose enough, you can loop it over the baby's head or make a wider loop for the body to come through.  If that still doesn't work, the bring the baby's head up onto the mom's thigh so the body can be born without the baby's neck having to come away from the mother's body.  DO NOT CUT THE CORD UNDER ANY CIRCUMSTANCE.  The cord provides oxygenated blood to the baby for about 5 minutes after the birth and is the best form of resuscitation.  Cutting the cord is cutting the baby's lifeline.
3. IF THE SHOULDERS ARE STUCK - If it has been more than two minutes since the head emerged fully to the baby's chin/neck, and the next contraction didn't bring the baby, then the shoulders may need some help.  Assist the mother into a hands and knees position, which will help to rotate the shoulders.  If the next contraction doesn't bring the baby, then help her to stand up and put one foot up on a chair at her side and sort of do a lunge. BE PREPARED TO CATCH THE BABY!  If the next contraction doesn't bring the baby, then you need to assist with the birth by putting a hand inside with your palm along the baby's back and then go sideways to help the baby bend one shoulder forward and then go back across the baby's back to help bend the other shoulder forward.  If you can hook a finger under the baby's armpit, you can use gentle force to help bring the baby's shoulder out. If the head is turning dark purple, then it is URGENT to get the baby out as soon as possible.  Go through all the positions again: hands and knees, lunge against chair (try other side this time), hands and knees again so you can try bending the baby's shoulders forward again.  If there is someone present with smaller hands, ask them to try bending the baby's shoulders forward.  DO NOT PULL ON THE BABY'S HEAD!
4. IF THE BABY IS UNCONSCIOUS - If the baby is limp, with eyes closed and not making any sound of any kind and no muscle activity, then the baby needs help to start breathing.  Blow 3 times on the baby's face/mouth, as if you're blowing out birthday candles.  Use the bulb aspirator to suck mucous out of the baby's mouth: Squeeze it before putting it into the mouth, suck out the mouth, and then squeeze out any contents onto a clean towel.  Then suction each of the baby's nostrils. If the baby is still unconscious, then you need to start mouth-to-mouth resuscitation.  If you breathe too hard into the baby's lungs, you can cause the lung to explode.  So don't take a big breath of air; just breathe in normally through your nose, and then gently breathe out into the baby's mouth/nose, keeping a good seal.  Do this a couple of times and then see if baby is breathing on its own.  If not, breathe 15 times more for the baby, SMALL, SHORT puffs, about one per second. If you can tell for sure that there is no heartbeat (ideally by listening to the baby's heart with a stethoscope or your ear), then you need to start chest compressions on the baby.  Use VERY gentle force - just two fingertips between the baby's nipples, but turned sideways so they're in line with the baby's sternum.  CPR on a baby is done with 3 chest compressions to 1 puff of air, about 1 second for each action.
5. IF THE BABY IS NOT BREATHING WELL - It is OK if the baby is still coughing or sneezing a bit, and it is normal for babies to breathe about once per second, but if the baby is still struggling to breathe about 2 minutes after the birth, it may help to have the mother hold the baby with the head lower than the body, with the mouth towards the floor, to help drain the baby's airway.  You could use the bulb aspirator to suction the baby's mouth and then the nose.  If the baby's hands are cold, you need to find a way of warming the baby.  You could have the baby lying between the mother and another family member to create a very warm space for the baby. The baby must be naked to get warmth from naked skin.  Cover them all with a towel to create a warm area, but make sure the baby can get enough air easily.
6. IF THE MOTHER IS BLEEDING TOO MUCH - If you are not used to being at births, even normal bleeding will look like way too much to you.  It is normal for the placenta to come with up to a cup of liquid blood or blood clots.  And it is normal for a woman to lose up to another cup of blood over the next 15 minutes.  But it's possible that she may bleed too much (defined below). The baby's nursing helps to contract the uterus to stop the bleeding, or you can do other forms of nipple stimulation.  When you don't have appropriate medications, then the best way to stop bleeding is with nipple stimulation, which causes the mother's body to produce hormones to cause the uterus to contract, which is what stops the bleeding.  If the baby will nurse vigorously, that is excellent.  If not, then if the mother has another young child who can nurse, then that is very good.  Or the mother's partner could simulate breastfeeding by sucking with the nipple about 2" into their mouth.  Alternatively, her helpers can do manual breast compressions every 2 seconds, which is very much like milking a cow if anybody there knows how.  Or you can put your forefinger on top of the breast, about 2" back from the nipple, and then use your thumb on the bottom of the breast, about 2" back from the nipple, and squeeze and hold the breast tissue as if you were putting pressure where the baby's gums would be.  If you can roll your thumb towards the nipple, that helps even more.
7. If the placenta is STILL INSIDE and she is bleeding profusely (a river of blood - more than a cup a minute) then it is best to do whatever you can to get the placenta out. Use firm nipple stimulation to create contractions. Try gentle, gradual pulling on the cord while she is having a contraction..  If that doesn't work, put your hand on the mother's abdomen, with the thumb pointing downward and the top of your hand at her belly button.  Imagine that there is a small 8" cushioned dinner plate that needs to be squeezed from the inside of a cantaloupe.  Put gentle pressure with your hand about halfway down her abdomen.  Do not push so hard that you turn the uterus inside out; this could kill her; if this happens, make a fist in the birth canal and shove the uterus back inside to turn it the right way again. (If the mother has already lost more than 3 cups of blood and the placenta is still inside, then you need to put on fresh sterile gloves and go inside the mother's body; find the placenta (like a small dinner plate but about 1-2" thick). If you can grasp part of it and remove it, that's great.  If it's still partially attached, make your hand like a spatula and gently work your hand between the placenta and the mother's insides until the placenta is fully separated and can be brought out in one piece.)
8. If the placenta is OUT and she is bleeding profusely - After the placenta is out, then if it ever seems that the blood is flowing so fast that she is losing more than half a cup a minute, then you need to take action as described in Step XX.  After the placenta is out, you can "rub up a contraction"--after the birth, the uterus is like a cantaloupe between her pubic bone and her belly button.  You can massage her belly below the belly button until you feel the uterine muscle contracting under your hand.  If nothing else is working, you can put a fist in the middle of her abdomen, halfway to the belly button. Then push down gently but very firmly; she may complain of pain, but this is the only kind of pressure that will stop the bleeding.  (Putting pressure on the outside of the birth canal - the vulva - does nothing to stop the bleeding.)
9. IF THE MOTHER'S PERINEAL TISSUES HAVE TORN BADLY - Most women do not need suturing when the baby is born calmly in a side-lying position.  Many women will have a perineum that looks very bruised and swollen, and it is very difficult even to tell if the tissues are torn. Suturing can wait 6-12 hours in an emergency.  Ideally, you will be able to find someone within that time frame who can evaluate the perineum and suture the tissues if necessary.  In any case, you do not need to clean a perineal wound if the birth occurred in a reasonably clean area.  If the area was dirty, you could gently pour the saline irrigation fluid over the perineum to wash out the tears a bit.  Then instruct the mother to keep her knees mostly close together while the tissues are healing.  (Try to keep the insides of the knees within 18" of each other; no tailor sitting to breastfeed!)  She should keep her knees together and clench her bottom when she gets up and down from bed or the floor.)
10. IF THE MOTHER IS WEAK FROM BLOOD LOSS - Help her to drink at least 2 cups of fluid.  If she has lost a lot of blood, help her to drink 2 more cups.  This will keep her blood pressure up so she will not lose consciousness.  If she starts losing consciousness, treat for shock (lying down with head lower than body, legs raised) and get as much fluids into her while she is still conscious.  Do not give fluids to someone who is unconscious.
11. IF THE BABY IS NOT ABLE TO NURSE - A healthy full-term baby in a warm, stress-free environment can go for 24 hours without food.  However, if the baby looks skinny (no baby fat) or if you cannot keep the baby in a warm, stress-free environment or the baby needed help breathing, then the baby must nurse within 2 hours after the birth and then every 2-3 hours. Or if the baby's body feels cold or the baby is very jittery, then the baby needs some nutrition right away.  If the mother is not well enough to nurse the baby, but will probably be well enough in a few hours, then you can tide the baby over with some corn syrup or maple syrup on the baby's gums or even some white or brown sugar or molasses in sterile water on a clean spoon. (NEVER USE HONEY as this may contain botulism spores.) The baby doesn't need much--just about a teaspoon of sugar at each feeding, anytime the baby wakes or cries from hunger.  If you think that the mother will not be well enough to feed the baby for more than a day, then try to find another woman in her family who is currently lactating and will be able to nurse the baby on an ongoing basis.  Do not ask a stranger to do this unless it's a matter of life and death, as HIV and other blood-borne diseases can be transmitted through breastfeeding.  If you cannot find anyone to nurse the baby at all, then use one of the approved syrups (NOT HONEY!) until you can find some prepared formula for the baby.  In a real pinch, any nursing mother could express milk onto a clean spoon to be used to feed the baby; this protects the nursing mother from the baby's germs.