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!

(sometimes called Emergency Childbirth, but Birth is An Emergence, not an Emergency)

Easy Steps to a Safer Pregnancy - View e-book or Download PDF - FREE!
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.

Other excellent resources about avoiding toxins during pregnancy

These are easy to read and understand and are beautifully presented.

NOTE - Do not Panic if you don't have any special supplies.  All you really, really need to assist at a birth is your heart and your hands.  It helps if your brain is engaged, too, but many people are so overwhelmed at a birth that you can't really count on this.  It helps if you have some towels and some clean sheets or pillowcases handy.  And at some point, you'll find that it's easier to hold the baby if the placenta isn't attached.  You don't need a special clamp; after a couple of hours, blood will have stopped flowing through the cord, and the cord will be limp and white, like thick spaghetti.  Then you really don't need to clamp it anymore, although if you happen to have some sterile string or a sterile shoelace, that's great.  You can sterilize string, a shoelace, a knife or a scissors by soaking it in alcohol or hydrogen peroxide for 30  minutes. Or if you really cannot create a sterile situation for cutting the cord, you can wait a few hours after the birth and then cut the cord about 5 inches from the baby.  You can also sterilize baby blankets, handkerchiefs or pillow cases by baking them for 2 hours at 220 degrees.  (Keep an eye on it so it doesn't burst into flame . . . it helps to have a baking pan with some water to create steam in the oven.)  Or you can iron a handkerchief or pillowcase at the highest tolerable setting to sterilize it.  Even 20 minutes in a dryer on high will kill a lot of germs.

If you are assisting a family member at a birth, it's probably OK if you don't have any medical gloves handy.  It's important to WASH YOUR HANDS before assisting at the birth, and to try to keep them clean by washing as necessary.

If you're ever uncertain about what to do, count to ten and then reassess.  It's better to be calm and centered and acting judiciously than to be forging ahead without some thought.  Remember, birth was designed to happen without any help at all, so you can always just be there and wait until it's really, really clear that your help is needed.

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.  Leave the umbilical cord intact so that the baby continues to get oxygen through it.
  13. Note the exact time of birth.
  14. If the baby is completely limp and very pale, is not making any noise, and has no facial expression, then the baby is probably unconscious, and you need to take action to resuscitate the baby.  If the baby is moving at all or making any attempts to breathe, then you can proceed as normal.  
  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 before taking a big breath, and it's OK if the baby is sputtering and coughing and clearing out mucous for five minutes or so.
  16. 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 if it's cold.  Shield the baby from breezes and shade the baby's eyes if the light is bright.
  17. 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 her 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.]
  18. 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 the placenta has detached and is ready to be born.  The 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 it in coming through the birth canal.  STOP if the mother complains of discomfort.
  19. 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.)
  20. 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.  Provide her with food and drink as she desires.
  21. Do not cut the cord until at least an hour after the birth, unless the mother specifically requests it, 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.
  22. 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.  At this point, she may want to take a nap, so make sure she and the baby are safe, warm and comfortable, and give them quiet space to rest and recover.  It's a good idea for someone to remain in earshot for the next 24 hours at least.
      1. Assist the mother to a position where she is lying mostly flat on her back on a bed with her bottom at the edge and her feet supported by chairs on either side.  Encourage her not to push until she absolutely has to; you can help her not to push by panting with her through the contraction with short breaths (one to two per second), like blowing out individual birthday candles.  Or she may find it helps to vocalize like singing opera.
      2. Once she is no longer able to pant through her contractions and starts pushing involuntarily, it is helpful to encourage her in strong bearing down efforts.
      3. Keep your hands off the baby until the baby is born to the level of the belly button.  NOTE THE TIME as the baby's head must be born within 8 to 10 minutes.
      4. Then, wrap a warm towel or blanket around the baby's hips to help support the baby's weight.  As the shoulders are being born, GENTLY help to rotate the baby's body so that the baby's belly is towards the ground.  The baby must be facing towards the mother's back in order to facilitate the birth of the head.  When you see the nape of the neck, allow the body to hang down completely, with your hands off the baby but ready to catch the baby as the head is born and released from the mother's body.  Encourage her to push strongly with the next two contractions.  If the contractions are spaced out so that there is more than 30 seconds of resting time in between, then it is a good idea to have someone do nipple stimulation to make the contractions stronger and closer together.   Have a helper put the forefinger on one side of the breast, about 2" back from the nipple, and then put the thumb on the opposite side of the nipple, also about 2" back from the nipple,and squeeze firmly 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.  Do this every 2 seconds and don't be afraid to squeeze hard if necessary to save the baby's life.
      5. There is a lot of disagreement as to whether non-professionals should do anything more at this point because rough manipulation or excessive force may injure the mother as well as the baby.  So, proceed with more advanced maneuvers only if you are calm enough to use very gentle movement to help facilitate the birth.  If you have a choice among attendants to assist with internal maneuvers, keep in mind that smaller hands may be more helpful.
      7. If the shoulders or arms are stuck, gently slide a hand up the baby's back and feel over the nearest shoulder and then gently cup the baby's elbow or hold the baby's hand to bend the baby's arm across the belly and then straighten the arm to bring the hand out.  Then do this with the other shoulder and arm to bring the other hand out.  It is fine to rotate the baby's body a bit by the hips to make more room for your hands to move from one shoulder to the other. Be gentle or you may severely injure the baby!
      8. Once the nape of the neck is visible and the mother has pushed very strongly with two contractions and the baby's head still has not been born, you may need to take action to save the baby's life.  If the head is not delivered within 3 minutes of the shoulders, gently raise the baby’s legs to the ceiling until you can see the face (do not pull the baby from the mother). Use two fingers or your hand to press back the wall of the vagina away from the baby's face.  Wipe the face clear and suction the mouth and then the nose so the baby can breathe.  If the baby does not make a sound or seem to breathe within ten seconds, you should milk the cord to push oxygenated blood from the cord into the baby's body.  Do this by gently pulling as much cord as you can out of the mother's body until you feel more than a little resistance.  Then push the blood that is in the cord into the baby's belly.  Continue to encourage the mother to keep pushing until the head is delivered.  If the baby is breathing, then you have lots of time for the head to finish being born.
      9. Again, it is imperative for the safety of the mother and the baby that your movements are very gentle . . . just strong enough to get things moving.  If the baby is showing no signs of life, then you must further assist the birth of the head so you can properly resuscitate the baby.  You can help by flexing or bending the baby's head so the baby's chin is closer to the chest.  You do this by using your forearm to support the weight of the baby's body as you gently bring you hand to the baby's face.  Put your middle finger in the baby's mouth to make contact with the tongue and put gentle pressure on the baby's lower jaw; put the second and fourth fingers on the baby's cheekbones to help bend the baby's face closer to the chest.  This makes the head seem smaller to the pelvis.
I also have a separate web page for EMTs on how to catch a baby.

This Web page is referenced from another page containing related information about Education/Continuing Education and Miscellaneous Labor and Birth


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