First Aid for Panganganak

*What will you do if you happen to be with a pregnant woman who, all of the sudden, goes into labour?

In emergencies such as this, it is important that we equip ourselves with pieces of information on initial steps to aiding parturients.

I am to share an article, which was published in Reader’s Digest (November 2008), entitled Call 999! by Leo Hickman. This tells the writer’s experience of attending to his wife’s delivery. Because this was their third child and Jane Hickman’s previous labour had only lasted 45 minutes, they were advised to have a home birth. Unfortunately, the midwives were stuck in traffic so he made an emergency phone call.

Here is the recorded call that details the whole procedure.

17:28:12 (Call answered)

Operator: Emergency ambulance. What’s the problem? Tell me exactly what’s happened.

Leo: Hello, my wife is in labour and is having the baby at home, but she’s really feeling the urge to push. (Leo gives her his address, postcode and telephone number and answers her questions about Jane’s medical history, condition and contractions.)

Operator: OK, I’m organising help for you now. Just stay on the line and I will tell you what to do next. Allow her to sit in the most comfortable position and have her take deep breaths between contractions. Have you got clean towels and blankets?

Leo: Yep.

Operator: Right, I want you to look at her vagina very closely to see how close the baby is being born. (Pause.) OK, do you see any part of the baby now?

Leo: Yeah, I think I can see a head. Yes, I think the top of the head. I think.

Operator: With each contraction, place the palm of your hand against the vagina and apply firm but gentle pressure to keep the baby’s head from delivering too fast and tearing. (She asks who else is in the house and says someone should open the front door for the ambulance crew.)

Jane: (Screaming.) Ohhh, I need to push! I NEED TO PUSH!

Leo: Hang on.
(Long pause while Leo does an examination.)

Operator: How are you doing?

Leo: OK. You know, I don’t think it is the head actually.
(Leo is very scared now: instead of a smooth baby’s head, what he is looking at has become rippled and ridged in appearance and blotchy in colour. He realises that telling the operator he has doubts that it is a head will frighten Jane, but he knows he has to tell the operator everything.)

Leo: Something’s coming out, but I don’t know what it is.
(Jane moaning in the background.)

Operator: You don’t know what it is?
(Jane experiencing another contraction in the background.)

Leo: I think . . . I think it’s part of the sac that hasn’t burst yet. It’s got liquid in it.

Operator: Liquid in it? You need to get a safety pin in case the baby is born in the sac. You need to burst the sac. You need to do that now.

Leo: OK. (To Jane.) OK, wait there, Jane.
(While Jane moans and screams, Leo leaves the bedroom. He runs out on to the landing and freezes, trying desperately to think where he might find a safety pin. After 30 seconds of panic and incoherence, he returns to the bedroom to see that the waters have now started to break.)

Leo: There’s a lot of meconium.
(Meconium - the baby’s first poo - can cause complications, especially in a home birth.)

Operator: There is? (Pause.) OK, you’re still going to need to support the baby. Is it the sac coming out? The baby must be in the sac.

Leo: Yep.

Operator: Is the head coming out?

Leo: OK, the head’s coming!

Operator: Right, you need to support the head and shoulders and hold the hips and legs, OK? It will be slippery so don’t drop him!

Leo: I can see the head. I can see the face!
(The baby’s eyes and mouth are closed and there is no movement in his face at all. Leo had expected the baby to breathe as soon as the head was born, so is feeling frightened now.)

Operator: OK, that’s fantastic. Just keep supporting the baby, OK?

Leo: OK. (Pause.) Jane, you’re doing really well.

Operator: Tell her she’s doing fantastic, OK?

Leo: There’s lots of waters breaking. Come on, little baby. (Jane screaming and moaning.) OK, one shoulder’s coming.
(One arm is now out – in the panic, Leo has said “shoulder” by mistake.)

Operator: OK.

Leo: Come on, little baby. OK, the baby’s out!

Operator: Is the whole baby out?

Leo: It’s quite messy. There’s a lot of meconium.

Operator: Right, what I want you to do is wipe the baby clean. (Pause.) Right, is the baby crying or breathing?

Leo: It’s not fully out yet.
(Perhaps it’s the sight of the thick umbilical cord that makes Leo say this. The baby has in fact been born; he is covered in meconium, including all over his face. The clean towel referred to earlier is now dirty and of no use. Leo is on his knees holding the baby up off the floor, unable to put him down to run for a towel. Jane is unable to turn round to hold him because she can’t get her leg over the cord. Both parents are worried because the baby is only making very small body and facial movements. He looks very blue.)

Operator: Is the baby crying or breathing?

Leo: Yes, it’s crying.
(The baby is making small crying noises.)

Operator: Right, what I want you to do is gently wipe off the baby’s mouth and nose. And dry the baby off with a clean towel. Then wrap the baby in a clean, dry towel, OK?
(Leo shouts t his mother-in-law to bring more towels.) . . .
. . . (Long pause as towels arrive and baby is cleaned and swaddled.)

Leo: Shall I give the baby to Mum?

Operator: Is he wrapped up in a towel?

Leo: Yes.

Operator: Don’t pull the cord too tight and put the baby in mother’s arms. Now make sure to keep the baby and the mother warm.
(Knocking heard downstairs.)
(Two midwives enter he room.)
17:39:28 (Recording ends.)

-Amanah Busran Lao
HAIN Research Associate

Citation:
• Leo Hickman “CALL 999!” Reader’s Digest, November 2008, page 121-125.