Early stages of labor can last many hours. During this time, the mother's contractions open the cervix, and the baby begins to move down the birth canal. Once the cervix dilates fully, the mother usually feels the uncontrollable urge to push, and the baby's head begins to appear at the vaginal opening. If this is the woman's first baby, the pushing may last long enough for medical help to arrive. If it is her second or later baby, the head may deliver very quickly.

Babies are usually born head first, facing down. After the baby is delivered, the placenta detaches from the uterus and is also expelled.

Rupture of the amniotic sac may indicate that the baby will be coming soon. A large amount of clear fluid coming from the vaginal opening all at once or in a trickle suggests amniotic sac rupture (water breaking). The amniotic fluid may be stained green or may contain white or green particles.

• Rapid delivery is most common in women who have:
  • Given birth quickly before
  • Given birth several times before
  • Gone into labor prematurely
• Premature delivery can also be brought on by illness or injury

• Regular contractions that are less than 2 minutes apart (timed from the beginning of one contraction to the beginning of the next).
• Urge to have a bowel movement (due to pressure from the baby's head against the rectum).
• Strong urge to push.
• Bulging vaginal opening -- baby's head visible during contractions (it will recede or pull back between contractions).
• Mother saying, "The baby is coming!"

1. Try to stay calm and reassure the mother.
2. Wash your hands well with soap and water. Wear sterile rubber gloves, if possible.
3. Select a large, flat surface, such as a bed or table, as a birthing area. Provide good lighting and keep the area warm. Cover the area with a clean sheet or towels.
4. Have the mother remove any uncomfortable clothing. Support the mother's head and back with pillows. The mother should lie on her side until the baby is nearly ready to be delivered. At the time of delivery, she should lie on her back with her knees bent and spread apart. If possible, place a folded towel or blanket under the mother's right hip to keep her from lying flat on her back.
5. Have the mother take deep, slow breaths, particularly during contractions.
6. When the baby's head shows, ask the mother to push during each contraction. Have her take a deep breath, hold it, and push for a count of 10. Exhale and repeat for the duration of each contraction. The mother should not push between contractions.
7. Place your hand against the area below the vaginal opening and apply gentle pressure during each contraction. This pressure will prevent the baby from coming too fast. A second hand placed gently against the vaginal opening over the baby's head will help control how quickly the baby's head comes out of the vaginal opening.
8. As the baby's head is delivered, support it with your hands. It will naturally turn to one side. As soon as the head is out, have the mother stop pushing so that the baby's mouth and nose can be cleaned.
9. Clean the baby's mouth and nose with a suction bulb or dry towel (a suction bulb is preferred, if one is available).
10. If the umbilical cord is wrapped around the infant's neck during delivery, hook it with your forefinger and gently but quickly slip it over the baby's head. Do not cut it! If it will not slip easily over the baby's head, don't worry about it. Instead, continue trying to deliver the rest of the baby.
11. Once the head is delivered, the rest of the baby's body generally comes out quickly. Place your hands on either side of the baby's head and gently guide it downwards while the mother pushes until the top shoulder emerges. Then guide the baby upwards and support it's head and shoulders as the rest of the baby emerges. Newborns are slippery, so hold the baby with a towel.
12. If the baby's shoulder seems stuck, tell the mother to push hard. Do not pull on the baby. Press toward the mother's back with your hands in the area just above the mother's pubic hair. You can also try lifting the mother's legs back toward her chest, keeping her knees bent and apart.
13. Once delivered, hold the baby head down and face down, with the feet higher than the head, so that fluids can drain. Hold the baby at about the same height as the vaginal opening. After the baby starts to cry, suction or wipe the baby's nose and mouth again with a clean cloth. The baby may be blue, but will turn pink within minutes, if breathing well.
14. If the baby is not breathing or crying, place the baby's head lower than the feet and slap the soles of the feet. Quickly stimulate the baby by rubbing its back. If the baby does not start breathing immediately, give two quick breaths (very gentle puffs of air into the infant's nose and mouth). Continue to stimulate the baby and dry off the skin to prevent cooling. Gently suction the baby's nose and mouth again to clear secretions, blood, and mucus.
15. If the baby is breathing or crying, dry the baby off. Then wrap the baby in dry towels, covering the head (not the face) to keep him or her warm. Do not wash off the baby or wash the face. Place the baby on the mother's abdomen or chest (but be sure not to pull on the umbilical cord).
16. Encourage nursing. This will stimulate the mother to have the uterine contractions she needs to expel the placenta.
17. Tie a clean shoelace, narrow strip of cloth, or thick string firmly around the umbilical cord (no closer than 4 inches from the baby's navel). Do not use thread -- it will cut through the cord. Do not cut the cord or pull on it. Tying off the cord is necessary to prevent continued circulation of the baby's blood to the placenta.
18. The mother will continue to have contractions until the placenta is expelled. Massaging the mother's abdomen will help the uterus contract and expel the placenta. Wrap the placenta in a plastic bag and be sure it goes to the hospital with the mother and baby.
19. If the mother is bleeding outside the vagina from a skin tear, apply direct pressure with a sterile gauze dressing, washcloth, or fresh sanitary napkin until bleeding stops.
20. Once the placenta has been expelled, massage the mother's abdomen to stimulate uterine contractions. This will help control uterine bleeding. Continue to firmly knead the abdomen at frequent intervals for the first 2 hours after birth. Sometimes the uterus relaxes so completely that all contractions stop -- massage can help restore the contractions.
21. Clean the mother with soap and water. Keep both mother and baby warm. Hypothermia can occur rapidly in newborns. The mother may be more comfortable reclining while she nurses the baby. It is important that both be taken to a hospital as soon as possible for examination.
22. Under normal circumstances, there is no rush to cut the umbilical cord. Placing one tie around it and leaving it alone is better than cutting it with unclean instruments. The infant will not be harmed if the placenta remains attached, as long as both mother and baby receive prompt medical help.
23. If you cannot get medical help, you will have to tie and cut the cord after the baby has been delivered. The following steps are recommended:

• DO NOT try to delay the delivery in any way. Crossing or holding the mother's legs, or pushing the baby's head back into the vagina, can seriously injure the baby.
• DO NOT allow the mother to go to the toilet. Reassure her that the sensation of needing to have a bowel movement means the baby is coming.
• DO NOT allow the mother to push vigorously until you see the mother's vagina bulging with the baby's head. Pushing too early, before the cervix is completely dilated, can tear the cervix.
• DO NOT pull the baby from the vagina.
• DO NOT pull on the umbilical cord.
• DO NOT cut the umbilical cord unless told to do so by a health care professional, or medical help is unavailable.
• DO NOT let anyone cough or sneeze on mother or baby. Keep people with colds, unwashed hands, or open cuts at a distance.
• DO NOT use chemicals or antiseptic products around mother or baby. Soap and clean water are best.

Call for assistance if there is no time to get to the hospital. If you are going to try to reach the nearest hospital, bring emergency childbirth supplies in the car. Emergency supplies should include: a flashlight, pillows, clean sheets, clean towels, suction bulb, sterile rubber gloves, container for the placenta, clean scissors, and two clean cord ties.

• As the expected delivery date approaches, think through all possible scenarios of getting the mother to the hospital when making daily plans. Include arrangements for transportation and supervision of other children as needed.
• Prepare a kit of emergency delivery supplies (listed above) and keep it nearby, in case it is needed right away.