Help a baby be born

Keep your hands clean, keep the baby warm and breathing, let the body do its work, and know the few things you must do yourself because no help arrives in time.

takes patience⏳ a daytradition — not yet hand-tested

Almost every baby that has ever been born was born without a doctor. Birth is not an illness, and a healthy labour needs no clever help — the body knows this work far better than you do. Your job is mostly to keep things clean, keep the baby warm, and stay out of the way of what is going well.

But mostly is not always. There are a few moments where waiting for help is the same as doing nothing, because they are measured in minutes and no runner comes back in minutes. Those moments are on this page too, and they are the reason to read it now — at a table, in the quiet — rather than at night with a frightened woman in the room.

Know what you are up against. For most of human history this was the most dangerous ordinary day in a woman's life. What killed mothers was three things: bleeding after the birth, infection carried in on helping hands, and a baby that could not come out. What killed babies was different: not breathing in the first minute, cold, and infection through the cut cord. Soap, warmth, patience and your own breath answer nearly all of it, and all of them are free. Only one — the baby that cannot come out — needs more than this page has, and for that the answer is to know early and go.

You need

• Clean hands — the most powerful thing on this list, by a wide margin. Scrub with soap or ash and clean water, nails and all, past the wrist. Wash again every time you touch anything else. Dirty hands at a birth have killed more mothers than anything else in this book.
• A blade, boiled on the day — for the cord. When labour starts, boil it a full ten minutes and leave it in the covered pot until the moment you need it. A blade boiled last week and left in a drawer is a dirty blade: what makes it clean is the boiling and having touched nothing since, and only one of those keeps.
• Two ties for the cord, boiled with the blade — clean string or narrow strips of cloth, a hand's length each.
• Clean cloths, more than you think — boiled and sun-dried, kept covered. One to dry the baby, a dry one to wrap it, one for its head, more for the mother.
• A warm, still, private place — out of draught, warmer than feels necessary to you. Warmth is not comfort here. It is the baby's life.
• Boiled water, cooled — for drinking and for washing.
• A plan, made in advance — where real medical care is, how long it takes by night, who runs and who stays. Make it now, while everyone is well.
• Nothing else. No herbs, no potions, no teas to "speed things up", nothing put inside. There is no plant that helps here and several that harm.

Steps

1. Before the day: make the plan, boil the cloths, learn the go-now list. Read the Watch out section until you know it without looking. Cloths can be boiled and dried and put away covered; the blade waits.
2. When labour starts: boil the blade and ties, and warm the room. Then wash your hands.
3. Let labour happen, and do almost nothing. Let her move, walk, kneel, rock, squat — whatever her body asks. Upright and moving usually works better than lying down. Sips of water often. Warm, quiet, small crowd. Hours of this are normal, and a first baby takes far longer than a later one. Slow is not the same as wrong.
4. Wash your hands. Then wash them again. Every time before you touch her or the baby. If you take one thing from this page, take this.
5. Let the birth happen — do not help it. The head comes first, usually face-down, and it comes slowly. A clean hand resting lightly there to steady it is enough. Never pull the baby. And never push on her belly while a baby is still inside her — pushing on a full womb can rupture it and kill her. (Once the afterbirth is out this reverses completely, and rubbing her belly becomes the thing that saves her life — step 12. The difference is whether the womb is empty. Nothing else about it changes.)
6. If you see the cord looped around the baby's neck, do not panic and do not cut. It happens at about one birth in four and is almost always harmless. Hook a finger under it and lift it gently over the head. If it is too tight for that, leave it alone and let the baby be born through it — the body slips out and you unwind it afterwards. Never cut the cord before the baby is born and breathing. Until it breathes, that cord is the only air it has.
7. If the head is out and the shoulders will not follow, this one is yours. The head sits tight against her and seems to draw back; nothing comes with the next push. The cord is being squeezed and the baby has minutes, so there is no going for help — but there is a great deal you can do, and it needs no tools:
   • Do not pull on the head. Pulling tears the nerves of the baby's neck and does not free the shoulder.
   • First, and it usually works: get her flat on her back, and have two people pull her knees up hard — right back onto her chest, thighs pressed to her belly. This tilts her pelvis and opens the way, and it frees about half of stuck shoulders on its own.
   • Then, if needed: while she pushes, have someone press firmly with a fist just above her pubic bone — low down, pushing the baby's shoulder sideways. Never on the top of the womb.
   • Then, if needed: get her onto her hands and knees, and let her push there.
   • Between each, let her push. Keep going. These cost nothing and they are the whole of what can be done.
8. Catch low, and expect slipperiness. A newborn is wet and astonishingly slippery. Hands low, close to where it will arrive, onto a clean cloth — then straight onto the mother's bare chest.
9. The first breath — and your breath if it does not come. Most babies breathe or cry within seconds. If not: dry it hard and briskly, rubbing the back and the soles. That vigorous drying wakes almost every slow baby; it is the rubbing itself that starts them. Wipe muck from the mouth and nose with a clean cloth corner. Do not hang it upside down and do not slap it — an old habit that helps nothing.
   • If it is still not breathing after about half a minute of that, it needs your breath, and it needs it now. Do not send for help and keep rubbing; help will not arrive inside the few minutes this baby has. You are the help.
   • Lay it on its back. Tip the head so the face points slightly up — not chin on chest, not head thrown far back; the neck should look almost straight. This alone opens the airway.
   • Put your mouth over both its mouth and its nose — a newborn's face is small enough.
   • Give small puffs — a cheekful of air, never a lungful. Its lungs are the size of two plums and a hard breath tears them. You want to see the chest just begin to rise, no more.
   • If the chest does not rise, no air is going in — and air that does not go in does nothing. This is the usual trouble, not a rare one, and it is fixable: tip the head again, a little more or a little less. Wipe the mouth and nose again. Make sure your lips seal all the way around both. Then try again. Getting the chest to move is the whole task; until it moves, nothing else you are doing counts.
   • About one puff every second or two — let the chest fall all the way back down between them. Keep it warm while you work. Babies have come back after many minutes of this, so keep going.
   • Stop when it breathes by itself or cries. Then dry it, cover it, and get it onto her chest (step 10). If it stops again, start again.
10. Dry, cover, and hold skin to skin. Take the wet cloth away and put a dry one on — a wet cloth chills as badly as none. Lay the baby bare on the mother's bare chest, cover them both, and cover its head. A newborn is small, damp, has no fat to spare, and cannot shiver properly; it loses heat terrifyingly fast, and cold kills newborns quietly, with no drama at all. Skin to skin is the best warmer there is and it is free.
11. Leave the cord alone for a few minutes, then tie and cut. No hurry: wait until it stops pulsing under your fingers, because the blood still moving through it belongs to the baby. Then tie firmly about two fingers' width from the baby's belly, tie again a hand's width further along, and cut between the ties with the boiled blade. Tight enough that it does not seep. Put nothing on the stump — ever. Not dung, not ash, not mud, not oil, not chewed leaves. The stump is a wound leading straight inside a baby, and dung carries the germ that causes lockjaw. Clean, dry, open to the air: it shrivels and drops off by itself in a week or two.
12. The afterbirth comes next — let it, then guard against bleeding. It usually arrives within minutes, sometimes up to an hour. Never pull the cord to hurry it — pulling can turn the womb inside out, which kills fast. Keep it and look at it: it should look whole, like a thick dark plate. Then, as soon as it is out:
    • Feel her belly just below the navel. You want a hard ball, like a firm grapefruit.
    • If it is soft or boggy, rub it firmly with the flat of your hand until it hardens. This is not a comforting rub. It is hard and purposeful, and it is the single act that saves most of the women who are saved.
    • If it will not stay hard, get her to pass urine. A full bladder physically props the womb up and stops it clamping down — it is the commonest reason a womb will not firm, and emptying it is free and immediate.
    • Keep checking every few minutes for the first hour or two, and often after that.
13. Put the baby to the breast within the first hour. The suckling itself makes the womb clamp — the baby feeding is medicine for the mother, not only food for itself. Do it before either seems hungry. The first milk is thick and yellow and is the most valuable feed of the baby's life: do not throw it away, do not wait for the "real" milk, do not give water or honey instead. It carries the mother's own defences into the baby.
14. Then rest, warm, and watch. Both covered, her drinking plenty, the baby at the breast often. Someone stays awake and watches the bleeding for several hours. Most of what goes wrong goes wrong in the first hours, and it goes wrong quietly.

Watch out

• Go now — heavy bleeding, before or after. Blood soaking cloth after cloth, or a steady flow that does not slow, is the biggest killer of mothers there is. While someone runs: rub the womb hard until it balls up, get her to pass urine, put the baby to the breast, lay her flat, keep her warm. Do all of it and go — never one instead of the other.
• If the womb is hard as a ball and she is still bleeding, look for a tear. Most first births tear the skin below, and a bleeding tear will not answer to any amount of womb massage — it is a wound, and it wants exactly what the treat-cuts guide says every wound wants: a clean cloth, firm direct pressure, held for a full ten minutes without lifting it to look. Peeking restarts the bleeding, and at a birth — everyone frightened, everyone watching — peeking is precisely the thing you will want to do. A tear that soaks through after those ten minutes, or is large, or reaches back to the back passage, needs real care.
• Go now — fits, and the warning that comes before them. A fit in a woman who is pregnant, in labour, or up to six weeks after the birth is a true emergency — the danger does not end when the baby arrives, and believing it does is exactly what kills women in the week afterwards. The warning it gives first: a bad headache that will not lift, blurred or spotty vision, swelling of face and hands, pain high in the belly. While someone runs, and during a fit: do not hold her down, and put nothing in her mouth — not a spoon, not cloth, not your fingers. She will not swallow her tongue; you will break her teeth or block her breathing. Move hard things away, cushion her head, let it pass. When it stops, roll her onto her side so that what is in her mouth runs out instead of down.
• Go now — anything but the head first. A foot, a bottom, a hand, a shoulder, or a loop of cord ahead of the baby. If the cord comes first it is being squeezed and the baby is losing its blood supply: put her knees on the ground with chest down and bottom up, keep her that way, and travel like that if you possibly can.
• Go now — labour that has stopped going anywhere. Strong pushing for hours with no progress means the baby may not fit, and nothing here fixes that. No amount of patience or position beats bone. (This is not the stuck shoulder in step 7 — that is a head already born, and that one you handle yourself, immediately.)
• Go now — the afterbirth still not out after an hour, or coming away torn and incomplete.
• Go now — fever in the mother in the days after, or foul-smelling discharge, or a belly sore to touch. That is infection inside, and it is what dirty hands cause.
• Go now — a cord stump turning angry. Redness spreading from the stump out onto the belly skin, pus, a bad smell, or a baby who goes floppy, feeds poorly, or feels hot or cold to hold. Cord infection kills newborns fast and it is visible to anyone who looks. Look, daily.
• Never push down on the top of her womb to speed a birth — the high, round part you feel above her navel. It is an old, common, lethal habit and it ruptures wombs. Two things are not this, and both are safe: the flat of a fist low down, just above the pubic bone, for a stuck shoulder (step 7); and rubbing the empty womb once the afterbirth is out (step 12), which is the thing that saves her. The forbidden place is the top of a womb with a baby still in it.
• Never put anything inside her — not hands, not herbs, not cloths, not oil.
• Never pull the baby, and never pull the cord.
• A quiet room is not a lazy room. Most of this page is about not doing things. Doing nothing skilfully, with clean hands and a warm baby, is the craft. Interfering feels like helping and mostly is not — except in the three places this page tells you plainly to act: the stuck shoulder, the breath, and the bleeding.

How it works

Bleeding. When the afterbirth peels away it leaves a raw wound inside the womb about the size of your hand, fed by the same big vessels that fed the baby for nine months. Nothing about clotting is fast enough for a wound like that. What closes it is muscle. The womb is a thick bag of muscle, and when it squeezes down it pinches every one of those vessels shut inside its own walls — the body's own tourniquet, made of itself. A hard, balled-up womb is a closed womb; a soft one is an open tap. That is the whole reason you rub her belly until it hardens, the whole reason a full bladder is dangerous (it props the bag open so it cannot close), and the whole reason the baby goes to the breast: suckling sends the signal that makes the muscle clamp. A baby feeding in the first hour is doing more for its mother than for itself.

Infection. Birth leaves a wide-open wound inside, and cuts a newborn's cord — a second open road, straight into a baby with no defences of its own yet. Germs from hands, blades, cloths and dung are not fighting their way in; they are carried in and set down in the warmest, most welcoming place they will ever find. That is why soap and a blade boiled today outrank any skill you could learn, and why nothing whatsoever goes on the stump. For centuries, the fevers that killed women days after a good birth were carried in on the hands of the people who loved them.

Cold. A newborn is the worst-shaped thing imaginable for holding heat: tiny, soaking wet, almost no fat, a huge head, an enormous amount of skin for its size, and not yet able to shiver as you can. It cannot make heat fast and loses it in every direction at once. A wet cloth or a bare head is enough to do it. And cold does not look like an emergency — the baby simply goes quiet and still and stops feeding, which looks like a good baby sleeping.

The breath. A baby in the womb never breathed; its blood was fed through the cord, and its lungs sat folded and full of fluid. Being born is the moment it must swap systems, and the first hard breaths are what shove that fluid out and open the lungs for the first time. Most babies do it themselves. A few stall — and a stalled baby has only the oxygen already in its blood, which is a few minutes' worth and no more. Drying and rubbing is a shout at a baby that only needs waking, and it wakes most of them. But a baby that is truly stalled will not be shouted awake; it needs the first breaths done for it, because it cannot take them itself, and once the lungs are opened and there is oxygen in the blood again, the body usually takes over and carries on alone. That is why your puffs are small: you are not filling a chest, you are opening one. And it is why nobody runs for help at this moment. A baby that is not breathing has about four minutes. Whatever is going to happen to it will have happened long before a runner reaches anyone — so the person standing there is the only help that exists, and puffing is the whole of what help means.

And the one thing knowledge does not beat. Sometimes a baby does not fit, or is turned wrong, or the cord comes first. No cleverness, herb, position or courage fixes those here; they were simply fatal for most of history, for everyone, and they are not fatal now only because real medical care exists and can be reached. Knowing that is not defeat — it is the most useful thing on the page. Everything else here keeps the avoidable deaths away. The rest is a road, a plan, and going early.