Hesperian Health Guides

The Birth

When you can see the baby’s head coming, wash your hands well and put on gloves. See more information if the baby is butt down (breech).

When the head comes out, it will look like this:

A baby's head coming out of a vagina, first face down, then turning to the side

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.

A woman giving birth on hands and knees, with the baby's shoulders stuck after the head has come out

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.

 "illustration of the below: a woman lying on her back while two hands push on her lower belly and two gloved hands move the baby's head down".

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.

Illustration of the below: a hand reaching into the vagina and pushing on the baby's shoulder

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

NWTND pab Page 26-2.png
Tie a square knot.
Hands tying a second knot on the baby's cord

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.

Cutting the cord between the two knots with a razor blade

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

A woman squatting, birthing the placenta into a bowl

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.
A hand gently pulling on the cord, while another hand pushes on the bottom of the womb
Put pressure against the bottom of the womb – to keep it inside – as you give the cord a gentle tug.

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.)

Two hands holding a placenta with a piece missing
piece missing

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!

This page was updated:02 Jan 2018