Pregnancy, Birth & Infant Care

1. Prenatal Care

Good outcomes start months before birth. The aims: a well-nourished mother, early detection of problems, and a clean plan for the day.

• Nutrition: extra calories, protein, iron (dark leafy greens, beans, organ meat), and iodine. Anaemia (pale eyelids/gums, exhaustion) is common and dangerous at birth — prioritise iron-rich food.
• Track the pregnancy: note the date of the last period to estimate the due date (~40 weeks / ~9 months from it). Feel for the baby's growth and movement (regular movement from ~mid-pregnancy is reassuring).
• Watch for warning signs that need urgent help if possible: severe swelling of face/hands, bad headaches with blurred vision (signs of pre-eclampsia — can lead to fatal seizures), any bleeding, severe vomiting, fever, or the baby stopping movement.
• Rest and water in late pregnancy; avoid heavy toxic work, alcohol, and tobacco.
• Plan the birth: a clean, warm, private space; a trained-as-possible attendant; the birth kit ready; and a transport plan if things go wrong.

2. Labour & Normal Birth

Labour has three stages. Most of it is waiting and supporting — let the mother move, drink, and find her own positions.

Stage 1 — Opening (longest)

Contractions start mild and far apart, then grow stronger, longer, and closer. The cervix gradually opens. This can take many hours, especially for a first baby. Keep the mother hydrated, calm, upright and moving; time contractions. The waters may break (clear fluid is normal).

Stage 2 — Pushing & birth

1. When the mother feels a strong urge to push and the cervix is fully open, she pushes with contractions. Support her in whatever position works (upright, hands-and-knees, and side-lying all work).
2. Wash your hands and use clean (ideally sterile) gloves. Keep everything around the birth clean.
3. As the head crowns, support the perineum and let the head deliver slowly between contractions to reduce tearing — do not pull.
4. Feel whether the cord is around the neck; if so, gently slip it over the head or loosen it.
5. The body follows with the next push. Support the baby — they are slippery. Note the time of birth.

Stage 3 — The placenta

The placenta usually delivers within 5–30 minutes. Do not pull on the cord. Let it come with a gentle contraction and the mother's push. Check the placenta looks complete — retained pieces cause dangerous bleeding. Tie/clamp the cord in two places once it stops pulsing and cut between the ties with a clean blade; dip the baby's cord stump in antiseptic.

3. Birth Danger Signs

• Prolonged obstructed labour — strong contractions for hours with no progress, or the baby's hand/cord/buttocks presenting first (not head). This may need skilled help or surgery; start arranging transport early.
• Cord prolapse — the cord appears before the baby and gets compressed. Position the mother knees-to-chest (bottom up), keep the cord warm and moist, do not push it back, and get emergency help — the baby's oxygen is at risk.
• Seizures / pre-eclampsia — convulsions in late pregnancy or labour are life-threatening; protect from injury, lay on her side, and get help; magnesium sulphate is the treatment where available.
• Baby not breathing at birth — see Newborn, below: dry, warm, stimulate, and give rescue breaths.
• Green/brown waters, foul smell, or fever — signs of distress or infection.

4. Postpartum Care (Mother)

• Watch bleeding for the first hours and days; some bleeding (lochia) is normal and tapers over weeks, but soaking a pad an hour, large clots, or a return of heavy bleeding is an emergency (see above).
• Infection watch: fever, foul-smelling discharge, or a tender belly in the days after birth signals a womb infection — needs antibiotics and care.
• Rest, fluids, iron-rich food, and help with chores. Keep the perineum clean; warm water eases healing of tears.
• Mental health: brief "baby blues" are common; persistent despair, inability to care for the baby, or thoughts of harm need real support (see Psychology & Morale).
• Encourage the mother to pass urine and to move gently to reduce clot risk.

5. Newborn — The First Hours & Days

At birth

1. Dry the baby vigorously with a clean cloth and keep it warm — newborns lose heat fast. Skin-to-skin on the mother's chest, covered, is the best warmer.
2. Most babies cry and breathe at once. If not breathing: keep warm, rub the back/feet to stimulate, clear the mouth then nose. If still not breathing after ~30–60 seconds, give gentle rescue breaths — small puffs (just a cheekful of air) over the nose and mouth, about 40 per minute, watching the chest rise.
3. Let the cord stop pulsing before cutting; keep the stump clean and dry.
4. Put the baby to the breast within the first hour — the first milk (colostrum) is rich in immunity.

First days

• Keep warm and fed — feed on demand, day and night, ~8–12+ times in 24 h.
• Cord care: keep clean and dry; redness/swelling/pus/smell around the navel is a serious infection.
• Output tells you intake is enough: wet nappies increasing over the first week and regular stools.
• Jaundice (yellow skin/eyes) is common around days 2–4; mild fades, but deep yellowing in the first 24 h, or a lethargic baby who won't feed, is dangerous.

6. Breastfeeding & Infant Feeding

Breast milk is the safest, most complete infant food — and in a grid-down world, the only reliably clean and free one. Protect breastfeeding above almost anything.

• Latch: baby's mouth wide, taking a large mouthful of areola (not just the nipple), chin to breast. A good latch doesn't pinch and you hear swallowing.
• Supply follows demand: frequent feeding makes more milk. A well-fed, hydrated, rested mother makes plenty; stress and dehydration reduce it.
• Sore/cracked nipples usually mean a shallow latch — fix the latch; air-dry; a little breast milk on the nipple heals it. Hot, red, painful breast with fever is mastitis — keep feeding/draining that side, rest, warmth; may need antibiotics.
• If the mother can't feed: another lactating woman (wet-nursing) is the safest alternative. Animal milk must be diluted and is a poor, risky substitute for young infants; formula needs clean water and is unsustainable. Prioritise any human milk.
• Around 6 months, begin soft solid foods alongside continued breastfeeding.

7. Infant Illness — Danger Signs

Babies get sick fast. Any of these means act now — warmth, fluids/feeding, and skilled help if reachable:

Dehydration from diarrhoea/vomiting is a leading killer — give frequent breast milk and oral rehydration solution (see Medicine Making → ORS). Pneumonia (fast/laboured breathing) and newborn sepsis (a baby that is "just not right," off feed, too hot or too cold in the first weeks) need antibiotics urgently — these are not "wait and see" situations.

8. Birth Kit

Assemble and keep clean, sealed, and ready well before the due date:

• Clean cloths/towels (drying and warming), clean plastic sheet
• Soap, clean water, antiseptic (iodine/chlorhexidine), sterile gloves
• Two cord ties (clean tape/string) and a clean/boiled blade or scissors for the cord
• Bulb syringe (clearing the airway), a warm hat for the baby
• Sanitary cloths/pads for the mother, container for the placenta to inspect
• Where available and someone is trained: misoprostol (postpartum bleeding), a thermometer, and basic newborn-safe antibiotics
• The bundled A Book for Midwives printed or on the device