260 Where There Is No Doctor 2011
During the first stage of labor, the midwife or birth attendant should:
♦ Wash the mother’s belly, genitals, buttocks, and legs well with soap and warm
water. The bed should be in a clean place with enough light to see clearly.
♦ Spread clean sheets, towels, or newspapers on the bed and change them
whenever they get wet or dirty.
♦ Have a new, unopened razor blade ready for cutting the cord, or boil a pair of
scissors for 15 minutes. Keep the scissors in the boiled water in a covered pan
until they are needed.
The midwife should not massage or push on the belly. She should not ask the
mother to push or bear down at this time.
If the mother is frightened or in great pain, have her take deep, slow, regular breaths
during each contraction, and breathe normally between them. This will help control the
pain and calm her. Reassure the mother that the strong pains are normal and that they
help to push her baby out.
THE SECOND STAGE OF LABOR, in which the child is born: Sometimes this begins
when the bag of water breaks. It is often easier than the first stage and usually does not
take longer than 2 hours. During the contractions the mother bears down (pushes) with
all her strength. Between contractions, she may seem very tired and half asleep. This is
normal.
To bear down, the mother should take a deep breath and push hard with her
stomach muscles, as if she were having a bowel movement. If the child comes slowly
after the bag of waters breaks, the mother can double her knees like this, while
squatting,
sitting propped up,
kneeling,
or lying down.
When the birth opening of the mother stretches, and the baby’s head begins to
show, the midwife or helper should have everything ready for the birth of the baby.
At this time the mother should try not to push hard, so that the head comes out more
slowly. This helps prevent tearing of the opening (see p. 269 for more details).
In a normal birth, the midwife NEVER needs to put her hand or finger inside the
mother. This is the most common cause of dangerous infections of the mother after the
birth.
When the head comes out, the midwife may support it, but must never pull on it.
If possible, wear gloves to attend the birth—to protect the health of the mother,
baby, and midwife.