Hesperian Health Guides
The Birth
When the head comes out, it will look like this:
Never twist or pull on the baby’s head.
Hold the head gently. Guide it towards the mother’s bottom and away from her belly. Let the rest of the baby’s body come out into your hands.
If the cord is around the neck, you can usually loosen it enough to slip it over the baby’s head or to allow the baby’s body to slide through it. In the very rare times when it is tightly looped around the neck and the baby cannot move past it, you may need to clamp and cut it. Then have the mother push the baby out as fast as possible.
If the shoulders get stuck after the head comes out, move the mother quickly to her hands and knees. Ask her to hold her breath and push hard.
If the baby is still stuck, move the mother onto her back. Ask her to pull her knees back as far as possible toward her armpits. Have a helper push firmly, just above the pubic bone, like this. Move the baby’s head down toward the floor to free the shoulder from under the bone.
You may need to reach into the vagina and turn the baby by pushing on the back of its shoulder. Or sweep the baby’s arm down across its body and out of the vagina. The body should follow easily.
After the birth, put the baby directly onto the mother’s naked chest – skin against skin. This is the safest, warmest place. Gently wipe mucus off the baby’s mouth then nose. Dry the baby well with clean cloths or towels. Then cover the baby and mother with cloths or a blanket. For more on caring for the new baby, see Newborn Babies and Breastfeeding.
Things to check after the birth
- Is the baby breathing? If the baby does not breathe, struggles to breathe, or turns blue, see "Is the baby breathing well?"
- Is the mother bleeding heavily? If she bleeds after the birth, see "After the Birth".
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| Tie a square knot. |
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The cord
There is no rush to cut the cord. After a few minutes, feel it between two fingers. If you can no longer feel a pulse, it is OK to tie or clamp it.
Wash hands well.
Use a sterile clamp or freshly boiled or ironed string.
Tie the cord about 2 fingers away from the baby’s body. Then tie again about 2 more fingers away.
Cut the cord between the 2 ties. Use a brand new razor blade, or a clean scissor or blade. Whatever you use to cut the cord must first be washed and sterilized. Boiled is best. If you cannot boil it, hold it over a flame or clean it with alcohol to kill most germs. After cutting, leave the baby’s cord stump alone to prevent infection. (See information on how to care for the cord stump.)
The placenta
If there is not much bleeding, then there is no rush for the placenta to be born. Wait until the mother feels the urge to push it out. If she is bleeding, ask her to push hard during a contraction. If the placenta does not come out:
- help the mother breastfeed. Breastfeeding right after birth causes contractions that push the placenta out.
- ask the mother to urinate. A full bladder can stop the womb from tightening and pushing out the placenta.
- ask the mother to squat and then push again.
If the mother is losing blood quickly, or if the steps above do not work, try gently pulling the cord. you feel resistance, stop. (Pulling too hard can break the cord or pull out the womb.)
Once the placenta has come out, check it. Are any pieces missing? If so, rub the lower belly firmly to get them out. Give oxytocin or misoprostol. If the missing piece does not come out, get medical help. A piece of placenta left in the womb can cause serious infection and bleeding.
When the mother and baby are safe, take a moment to clean up, wash the mother’s genitals and legs, and offer her food and drink. Help the mother and baby start breastfeeding and offer your blessings and congratulations to the family as they welcome the new baby into the world!
Breech
A breech birth can have serious problems, including the cord coming before the baby or the baby’s head getting stuck inside. Both of these are so dangerous they can cause death. If possible, a breech baby should be born at a well-equipped medical center, especially for a mother’s first baby.
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| A frank breech is the safest of the breech positions. | A footling is the most dangerous. |
- The mother must not push until her cervix is all the way open. Ask her to blow or change positions until she cannot resist the need to push. Then let the body come out on its own. Do not pull on it.
- When the baby’s belly is out, if the cord is very tight, gently pull a little bit loose – so the baby is not held back by it. Otherwise, do not touch the cord.
- When the butt and legs come out, wrap the baby in a clean blanket. If she gets cold, she may try to take a breath and her lungs will fill with fluid.
- If the baby is stuck halfway out, reach inside the vagina to unfold an arm down across her chest.
- If the baby gets stuck at the head, put the mother on her back. Ask someone to push on the very bottom of her belly, just above the pubic bone. Do not push on the top of the belly.
- The baby should now turn to face the mother’s bottom. Support the baby’s body with one arm. Put your finger inside the baby’s mouth or on the baby’s upper lip, and pull it down towards the baby’s chest. This keeps the chin tucked. Put your other hand on the baby’s shoulders, with your fingers against the hard part at the back of the baby’s head to keep the head tilted so it can come out.
- The weight of the baby’s body will move it down, towards the mother’s bottom. Go slowly. Do not pull.
- When you see the baby’s hair, lift the baby’s body up. Keep your finger in its mouth. The face should come out.
- Now ask the mother to stop pushing and blow.
Let the top of the baby’s head come out as slowly as possible.
Be ready to help the baby breathe.
A breech baby is likely to be bruised and swollen on the bottom and legs. This will usually get better in a few days.