Emergency delivery, the unplanned birth of a neonate outside of a health care facility, may occur when labor progresses very quickly or when circumstances prevent the woman from entering a facility.

Whether assisting at an emergency delivery or instructing the person who is, your objectives include establishing a clean, safe, and private birth area; promoting a controlled delivery; and preventing injury, infection, and hemorrhage.

Unopened newspaper or large clean cloth (such as a tablecloth, towel, or curtain)

Bath towel, blanket, or coat (to cushion and support the patient’s buttocks)

Gloves

At least two small clean cloths

Clean, sharp object (such as scissors, new razor blade, knife, or nail file)

Ligating material (such as string, yarn, ribbon, or new shoelaces)

Clean blanket or towel (to cover the neonate)

Boiling water

Offer support and reassurance to help relieve the patient’s anxiety. Encourage her to pant during contractions to promote a controlled delivery. If possible, provide privacy, wash your hands, and put on gloves.

Position the patient comfortably on a bed, a couch, or the ground. Open the newspaper or the large, clean cloth, and place it under the patient’s buttocks to provide a clean delivery area. Elevate the buttocks slightly with the bath towel, blanket, or coat to provide additional room for the delivery.

Check for signs of imminent delivery—bulging perineum, increase in bloody show, urge to push, and crowning of the presenting part.

As the fetal head reaches and begins to pass the perineum, instruct the patient to pant or blow through the contractions because forceful bearing down could cause extensive maternal lacerations. Place one hand gently on the perineum to cover the fetal head, control birth speed, and prevent sudden expulsion.

Avoid forcibly restraining fetal descent because undue pressure can cause cephalohematoma or scalp lacerations, head
trauma, and vagal stimulation. Undue pressure can also occlude the umbilical cord, which may cause fetal bradycardia, circulatory depression, and hypoxia.

As the fetal head emerges, immediately break the amniotic sac if it’s intact. Support the head as it emerges. Instruct the patient to continue blowing and panting.

Locate the umbilical cord. Insert one or two fingers along the back of the emerging head to make sure the cord isn’t wrapped around the neck. If the cord is wrapped loosely around the neck, slip it over the head to prevent strangulation during delivery. If it’s wrapped tightly around the neck, ligate the cord in two places. Then carefully cut between the ligatures, using a clean, sharp object or, if possible, a sterile one.