Most births go well, even in emergency settings without medical professionals present. The human body is extraordinarily well-designed for birth, and in the vast majority of uncomplicated deliveries, your primary role is to support the process rather than control it. However, complications do occur — and when they do, knowing how to respond can be the difference between life and death for both mother and baby.
This guide covers recognising imminent delivery, supporting the birth, immediate newborn care, cord management, placenta delivery, and responses to the most common emergency complications. It does not provide training equivalent to obstetric care. If a healthcare provider can be reached, always seek professional assistance.
Recognising Imminent Delivery
Labour has three stages:
- First stage: Uterine contractions begin and dilate the cervix to 10 cm — this stage can last hours to days
- Second stage: Delivery of the baby — begins at full dilation, ends at birth
- Third stage: Delivery of the placenta
The decision to assist with birth in the field becomes relevant when delivery is imminent — specifically, when:
- Contractions are 2 minutes apart or less
- The mother has an overwhelming urge to push — this is a reliable sign that the baby's head is at or near the vaginal opening
- The baby's head is visible at the vaginal opening (crowning) — delivery is minutes away
If you can see the baby's head: Do not attempt to delay or prevent delivery. Support it.
⚠️ If this is not the first baby, labour typically progresses significantly faster than for a first birth. A mother who reports a strong urge to push should be assessed immediately — she may be delivering imminently.
Preparation
If time allows before delivery:
- Call emergency services — even if paramedics cannot arrive in time, dispatcher guidance is available over the phone; keep the line open
- Lay the mother down on the cleanest available surface — a blanket or towel on the floor is better than a bed if you need to catch the baby
- Gather supplies:
- Clean towels, cloths, or blankets to receive the baby and keep it warm
- Gloves (disposable or any clean alternative if available)
- Clean string, shoelace, or strips of fabric for the cord (if cord clamps are unavailable)
- Clean scissors or a blade (for cord cutting if needed — not always necessary immediately)
- A clean container or bag if possible
- Position the mother — lying on her back with her knees bent and feet flat, or semi-reclined at approximately 45 degrees; whatever is most comfortable for her
- Wash your hands thoroughly
Supporting the Birth — Second Stage
Crowning
When the baby's head begins to emerge (crowning):
- Support the baby's head gently — place the flat of your hand against it to prevent it from emerging too rapidly. A gradual emergence reduces the risk of tearing.
- Do not pull — let the mother's contractions do the work
- Encourage the mother to breathe rather than bear down as the head is emerging — this slows the delivery of the head
- If the amniotic sac is still intact around the head, tear it gently with a finger to allow the baby to breathe — the membrane must be ruptured
Checking for the Cord
Once the head is delivered, immediately check for the umbilical cord around the neck (nuchal cord):
- Feel gently around the neck with a finger
- If the cord is loose, slip it over the baby's head before the next contraction delivers the body
- If the cord is tight and cannot be slipped over the head, loop it over the baby's shoulder as the body delivers — do not pull on it
Delivery of the Body
The body typically follows the head within one or two contractions:
- Continue to support the head — the baby's head will naturally rotate to the side
- With one contraction, the top shoulder delivers; with the next, the bottom shoulder; then the body slides out
- Be ready — wet newborns are extremely slippery. Have a firm, two-handed grip ready as the body emerges
- Deliver onto a surface or into your hands — do not allow the baby to fall
The Baby's First Moments
- Keep the baby warm immediately — dry the baby with a clean towel; wet babies lose heat rapidly; replace the wet towel with a dry one
- Stimulate the baby — vigorous drying is usually sufficient stimulation to initiate breathing; gently rub the back or soles of the feet
- Position the baby — at or below the level of the mother's uterus while the cord is still pulsating; ideally place on the mother's chest skin-to-skin
If the Baby Does Not Cry or Breathe
A baby that does not cry within 30 seconds of birth requires immediate assessment:
- Dry and stimulate — if not already done
- Clear the airway — tilt the head slightly back into a neutral position (not over-extended); use a bulb syringe if available to suction the mouth then nose; if no syringe, use a clean cloth to wipe visible secretions from the mouth
- If still not breathing within 60 seconds: Begin newborn CPR — 30 gentle chest compressions using 2 fingers on the centre of the chest at a rate of 120/min, followed by 2 very small breath puffs; continue until breathing begins or emergency services arrive
- Keep the baby warm throughout resuscitation attempts
Cord Management
Delayed Cord Clamping
Current guidelines recommend delaying cord clamping for at least 1–3 minutes after birth in uncomplicated deliveries. The cord blood returning to the newborn during this time carries significant iron and red blood cells. During this time, the cord will stop pulsating — it changes from blue and turgid to white and limp.
Cutting the Cord
Cord cutting is not immediately urgent. Do not cut the cord unless:
- You have something to tie or clamp the cord securely at two points
- Emergency services are significantly delayed and the cord is preventing movement
- The placenta has delivered and the cord is inconvenient
If cutting is necessary:
- Tie a secure knot with clean string/shoelace/fabric approximately 2 cm from the baby's umbilicus
- Tie a second knot approximately 4 cm from the first (farther from the baby)
- Cut between the two ties with clean scissors or a blade
- Check the baby's end of the cord for bleeding — if bleeding, tie more tightly
Third Stage — Delivery of the Placenta
The placenta typically delivers within 5–30 minutes after birth. Signs that placenta delivery is imminent:
- Gush of blood from the vagina
- Umbilical cord lengthens slightly
- Uterus feels firmer and rises in the abdomen
Do not pull on the cord — traction on the cord before the placenta is fully separated can cause haemorrhage or uterine inversion.
Encourage the mother to push gently with contractions to deliver the placenta.
Retained placenta (not delivered within 60 minutes) is a medical emergency — risk of severe haemorrhage. Urgently seek medical assistance.
Postpartum Haemorrhage
Postpartum haemorrhage (PPH) is excessive bleeding after delivery — defined as more than 500 ml (roughly a large teacup). It is the leading cause of maternal death globally.
Signs: heavy, continuous bleeding from the vagina that soaks through pad after pad; uterus is soft and not contracting properly; mother becomes pale, dizzy, and weak.
Field response:
- Fundal massage — place a hand firmly on the lower abdomen over the uterus and massage in a circular motion; this stimulates uterine contraction and reduces bleeding. The uterus should feel firm like a contracted muscle.
- Breastfeed the baby — if the baby is stable, putting the baby to the breast triggers oxytocin release, which contracts the uterus
- Treat for shock — lay flat, raise legs, keep warm, IV fluids if available (in a medical setting)
- Emergency services urgently — PPH is rapidly fatal without definitive treatment
Complications to Recognise
Breech Presentation
The baby presents bottom-first or feet-first rather than head-first. Signs: you see buttocks or feet at the vaginal opening rather than the rounded head.
Field response:
- Do not attempt to pull the baby out
- Support the body as it delivers; do not allow the weight of the body to put traction on the head (which must still navigate the birth canal)
- The head should follow within 60–90 seconds of the body delivering; if not, emergency intervention is needed (beyond the scope of field assistance without training)
- Call emergency services immediately upon recognising breech presentation
Shoulder Dystocia
The head delivers but the shoulders do not follow. A medical emergency with a narrow window for intervention.
- McRoberts manoeuvre: sharply flex the mother's thighs onto her abdomen (bring her knees toward her chest)
- Suprapubic pressure: a second person presses firmly downward on the mother's lower abdomen just above the pubic bone
- Do not apply traction on the baby's head
Quick Reference
| Situation | Action |
|---|
| Imminent delivery (urge to push + visible head) | Support; do not delay; call emergency services |
| Delivering the head | Gentle support; no pulling; slow emergence |
| Nuchal cord | Slip over head or shoulder; do not cut unless essential |
| Baby doesn't breathe within 60 sec | Clear airway; stimulate; newborn CPR |
| Cord cutting | Tie twice; cut between; check for bleeding |
| Placenta retention >60 min | Emergency services urgently |
| Postpartum haemorrhage | Fundal massage; breastfeed; emergency services |
| Breech | Do not pull; call emergency services immediately |
This guide provides general information for emergency childbirth assistance. All births should involve qualified medical or midwifery professionals whenever accessible. The information here is intended for situations where professional care cannot be reached in time.