ON SURVIVAL AND THE NEW ARRIVAL

The news of an impending birth from a woman glowing with the radiance of pregnancy is normally wonderful news, celebrated with fanfare, tears of joy and announcement notices flying through the mail.

However, in a long-term survival situation, society will be unstable and dangerous; organized medical care will be meager, at best—with any available resources focused on life-or-death injuries, not prenatal care—and a pregnancy will most likely be considered a serious challenge and a dire burden. Moving quickly over rough terrain, staying sheltered with substandard food and supplies, and/or experiencing stress and physical hardships are not conducive to carrying a baby to full term.

But it’s not impossible, because millions of babies have been born under what amount to primitive conditions. In fact, according to Dr. Enrico Pietrantonio, M.D., OB/GYN, “In the United States, approximately 35,000 births (0.9 percent) per year occur in the home. Approximately one-fourth (8,750) of these births are unplanned or unattended.”

IN THE UNITED STATES, APPROXIMATELY 35,000 BIRTHS PER YEAR OCCUR IN THE HOME.

PRENATAL PREPARATION

Without delving too deeply into the rudimentary aspects of procreation, let’s just agree that babies happen (sometimes when you least expect them) … and they change everything. If there are women of childbearing age in your group, there is no reason not to be completely prepared by including pregnancy-/delivery-related supplies and skills in your cache of gear.

Research Materials: Obtaining some basic midwifery skills would be very helpful for ensuring a safe and successful birth experience. Include in your training lessons Lamaze, a technique used to control breathing and cope with labor pains. Aside from taking classes, add to your survival literature a couple of books that very well might save a life or two.

Birth Emergency Skills Training (BEST), by Dr. Bonnie U. Gruenberg, covers topics such as pain and bleeding in pregnancy, hypertension, preterm labor, abnormal fetal heart rate, neonatal resuscitation, shock, trauma, syncope and cardiac arrest, among many others. Although there is little information about emergency childbirth or off-the-grid prenatal care, What to Expect When You’re Expecting is a mainstay for any woman who has questions during pregnancy.

Emergency Obstetrical Kit: If your SHTF partner is pregnant, the die has been cast and, barring a miscarriage, a baby will be the result. Before this happens, put together a DIY obstetrical kit of materials related to childbirth so that everything you’ll need to help deliver the baby is in one place and easy to reach.

• Clean towels, blankets and sheets
• Clean underpad for the bedding (a plastic sheet will do)
• Sterile gloves, scissors and umbilical clamps (or sterilized shoelaces)
• Apron
• Sanitary pads
• Newborn diapers (cloth diapers might ultimately be more practical)
• Witch hazel
• Water squirt bottle
• Bulb syringe (to suction the baby’s mouth and nose)
• Ice packs
• Doppler monitor (these are inexpensive sound amplifiers that can monitor heart rate and the baby’s movements)

Nausea and Headaches: A normal part of any pregnancy is “morning sickness,” which can be uncomfortable and draining. Consider packing in your supplies a dozen emesis bags (or any small plastic bags for vomit will do), anti-nausea gum made from ginger and plenty of liquids to keep the mother-to-be hydrated. Dehydration can lead to constipation, headaches, preterm delivery, low amniotic fluid levels and delivery complications. For example, DripDrop is a powdered electrolyte mixture that is easily stored and, when mixed with water, is effective at reversing dehydration, specifically in pregnant women.

Food and Pregnancy: Keeping a well-stocked food supply is essential to maintaining a healthy mother and, as a result, a healthy fetus. However, there are some foods more helpful to a developing baby than others.

• Eggs are rich in choline, which promotes brain growth.
• Milk and Greek yogurt, which has twice the protein of regular yogurt, are good sources of calcium for bone development.
• Any fruits and vegetables—specifically apples, oranges (vitamin C deficiency is one of the causes of preeclampsia), bananas and spinach, which prevents anemia during pregnancy.

Freeze-dried fruit, whole-grain crackers, sunflower seeds, granola bars and powdered milk (with calcium) are great shelf-stable foods that travel well and store for long periods of time. Also include plenty of beans, lentils and oats. Beans and lentils, as well as peas, nuts and corn, are high in natural folate, which can stave off birth defects during the first trimester. Navy beans, along with tuna and potatoes, are a good supply of iodine—a much needed nutrient for a baby’s developing nervous system.

Postpartum Supplies for Mother and Baby: To put this delicately, childbirth is messy and will wreak havoc on the woman’s body so that even weeks later, she will be uncomfortable and might still be in pain. Consider a portable bidet (basically a squeeze bottle with an angled spout that will direct soothing water where she needs it). Also include in your stores a jar or two of any natural herbal salve to ease hemorrhoids and perineal soreness. Some of the better brands include organic herbs such as St. John’s wort, witch hazel and calendula.

Caring for the baby’s health and well-being will be paramount, especially in the first few weeks to months. Learn baby CPR skills and methods to cure infant conditions such as jaundice, colic, hiccups, et al. Have a huge supply of diapers on hand in several sizes, as well as some newborn diapers and plenty of clothes, including hats, mittens and shoes, for a variety of weather conditions,.

Although the infant’s best source of nutrition is mother’s milk, it might not be available in your situation. Whether the mother cannot produce milk or doesn’t survive delivery (unlikely, but possible), a good supply of formula and a way to sterilize bottles/nipples is paramount. Most unopened cans of powdered formula will last around a year, but once the seal is cracked, it’s good for a month (and when mixed, only about 24 hours).

By keeping these supplies at the ready— especially after you’ve learned the good news that another mouth to feed is on the way—you’ll be better prepared to make the mother-to-be comfortable and on a healthy track toward a normal childbirth. Updating your bug-out bag with a pregnancy and new baby in mind will ensure that if you have to leave quickly, all members of your party—including the newest ones—will be taken care of.

WHEN WILL THE BABY COME?

What’s the baby’s due date?

This is society’s polite way of asking when you had sex. The answer might not be that straightforward. A human pregnancy lasts approximately 280 days, or 40 weeks, from the first day of the last menstrual period. This date is simple to calculate if you have regular monthly periods. Simply subtract three months and add seven days to the first day of the last period.

If the woman does not know when her last cycle started, you can still estimate the length of the pregnancy by physical signs. When you gently press on the woman’s abdomen, you will notice the firmness of the uterus and the soft area of her intestines. Locate the uppermost area of firmness. If the bump is peaking just over the pubic bone, the baby is at 12 weeks.

Halfway between the pubic bone and the belly button is 16 weeks. At the belly button is 20 weeks. From there, add a week for each centimeter above the belly button. A full-term pregnancy will measure 36 to 40 centimeters from the pubic bone to the top of the uterus.

PRENATAL MEDICINES AND ALTERNATIVES

Eating a healthy diet is the best way to receive all the nutrients the mother-to-be and developing baby need during pregnancy. However, prenatal vitamins will not only help cover any nutritional gaps in the mother’s diet, they might be used to supplement a poor diet, as is typically found in a long-term emergency situation.

As mentioned already, folic acid, iron, iodine and calcium are especially important for a developing baby. However, most brands of prenatal vitamins contain a great deal more than those four. Because the shelf life of most vitamins is a couple of years (and even taking expired prenatal vitamins, although less effective, will provide some benefit), there is no reason not to have nine months’ worth on hand in your supplies. Consider prenatal vitamins that contain—

• 400 micrograms (mcg) of folic acid
• 400 IU (International Unit) of vitamin D
• 200 to 300 milligrams (mg) of calcium
• 70 mg of vitamin C
• 3 mg of thiamine
• 2 mg of riboflavin
• 20 mg of niacin
• 6 mcg of vitamin B12
• 10 mg of vitamin E
• 15 mg of zinc
• 17 mg of iron
• 150 micrograms of iodine

With this in mind, increasing foods rich in the nutrients mentioned in this article might offset some deficiencies, but rest assured, millions of healthy babies were born long before the development of modern medicine and prenatal nutrition guidelines.

NINE MONTHS OF ANXIETY

In addition to keeping you and your crew alive in whatever calamity has befallen the world, ahead of you is a nine-month-long road of anxiety, questions and uncertainties … all culminating in an inevitable delivery during which the mother-to-be—quite possibly a loved one, to boot—will experience excruciating pain in less-than-ideal conditions.

During these months building up to the big event, there is time to prepare the environment and to keep close tabs on the expectant mother. It is important to keep her healthy and relatively stress free. If you are in an environment that harbors mosquitoes, make a homemade repellent or keep her indoors and away from mosquitoes (there are many mosquito-borne illnesses to worry about, including the much-publicized Zika).

Dr. Pietrantonio adds, “Women should take all precautions to avoid mosquito bites— including the use of EPA-approved bug spray with DEET—covering exposed skin, staying in air-conditioned or screened-in areas, and treating clothing with permethrin.”

Encourage the mother-to-be to sleep on her left side. It not only helps improve kidney function, it also increases blood flow to the uterus. Using pillows or cushions to support her legs will make her more comfortable.

During the pregnancy, there are several common complications that will need to be monitored:

High Blood Pressure: Also called “hypertension,” this condition occurs when the arteries carrying blood to the organs are narrowed. Blood might have trouble reaching the placenta, which will slow the growth of the fetus. Common factors for high blood pressure are obesity, family history and diet. Sometimes, the symptoms can be alleviated by exercise, diet changes and even stress-reduction techniques such as yoga and meditation.

Gestational Diabetes: Gestational diabetes means that there is a build-up of glucose in the body during pregnancy, because hormonal changes restrict the body’s ability to make insulin. Controlling the blood sugar levels during pregnancy, as well as exercise, might control this complication.

“Regular physical activity during pregnancy improves or maintains physical fitness,” says Dr. Pietrantonio. “It helps with weight management, reduces the risk of gestational diabetes in obese women and enhances psychological well-being.”

Preterm Labor: Simply put, this is labor that begins before the 37th week. Babies in labor before this time have an increased risk for health problems, because the lungs and brain finish development in the last few weeks. Progesterone is a hormone that has been used to slow or stop preterm labor. Braxton Hicks contractions are sometimes difficult to distinguish from signs of preterm labor.

Iron-Deficiency Anemia: Pregnant women need more iron than normal for the increased amount of blood they produce during pregnancy. Symptoms of a deficiency in iron include feeling tired or faint, experiencing shortness of breath and becoming pale.

Severe Nausea: Although having some nausea and vomiting is normal during pregnancy, particularly in the first trimester, some women experience more-severe symptoms that last throughout the pregnancy. Women may experience weight loss, reduced appetite, dehydration and feeling faint if nausea is persistent.

THE BIG DAY—STAGES OF LABOR AND DELIVERY

The big day has arrived, as you knew it would, and you have created an environment conducive to what is about to happen. The lighting is low, almost dim. Consider bringing in some natural smells like wood, plants, flowers, the ocean, chocolate or vanilla to comfort the woman while in labor. If possible, play soothing music (anything that has 60 to 70 beats per minute), which will help with relaxation. If possible, gather water and some ice for the mother-to-be to chew on and a stress ball to squeeze when contractions begin.

Have your obstetrical kit ready, because as soon as the uterine sack is ruptured (that is, the mother’s water breaks), birth is imminent, and it will follow three stages.

STAGE ONE

During the early part of labor, when the cervix begins to dilate and open the birth canal, contractions will begin. Be mindful of false labor contractions, because true contractions come at regular intervals, do not stop and can last up to a minute. They will grow stronger and more frequent over time. This stage can last up to 15 hours (or longer), during which time the amniotic sac might rupture.

Going for a short walk will determine if the contractions are true. Don’t overtax the mother and, at this point, allow nature to lead the way. Encourage the mother, remain calm and stay close by. It is important that she remain hydrated, so perhaps provide some water (and even a light meal if she is hungry).

A good technique to employ at this stage is called “abdominal breathing”: The mother relaxes her whole body and breathes deeply, making the abdomen rise and fall. This relieves tension and muscle strain during contractions and keeps the baby well oxygenated. Sometimes, squatting or lying in a lukewarm bath will help ease the discomfort of the contractions.

When the contractions are about three to four minutes apart and last around a minute each, it is the beginning of stage two. At this time, she might vomit, shake, feel hot or cold, and have intense back pain as the baby’s head rubs against the nerve bundle in her sacrum. Your main job is to stay calm and positive: Assure her that she is doing a great job and that everything is normal.

STAGE TWO

At this time, the cervix will be fully dilated. When the contractions start, the mother should take a deep breath, hold it and gently push through the contraction. It is important for her not to push too hard, because this will tire her out (and she’ll need her energy for the big pushes). Have her rest between contractions, because this stage could last up to four hours.

It is time for you to suit-up with sterile gloves and apron and have the sterile sheets, towels and plastic cover at the ready. Avoid contacting the vagina with anything that isn’t sterile. The mother should squat, lie on her side with her knees apart or stay up on all fours while pushing and change positions if it feels like the contractions are not producing results.

The baby could begin to crown (the head will start to show), and the mother might experience a burning feeling (the perineum stretching), but she should resist the urge to push hard at this point, so as not to tear the perineum. With a sterile gauze, support the baby’s head as it emerges.

Do not pull on the baby’s head, but do check to see the location of the umbilical cord and that it isn’t around the baby’s neck. The head will be facing down but will turn toward the mother’s thigh as the shoulders appear (have the mother pull her knees up to her chest and push if the shoulders are being difficult. Usually, after the shoulders, the baby will come right out, but the mother might need one last push to get the rest of the baby out. If, after a couple of contractions, the baby does not fully arrive, carefully hook a finger under its shoulder and gently pull.

Have clean towels, pads and gauze ready to receive the baby, because they sometimes come quickly. Babies are slippery, so be careful. Hold the baby with its head up so that mucus can drain, and use the towels to dry him/her off.

Use the bulb syringe to suction any mucus from the baby’s mouth and nose. If the umbilical cord will reach, lay the baby on the mother’s bare chest and cover both with a warm blanket. Crying is normal and usually encouraged (but don’t spank the baby to induce crying; that’s a myth).

STAGE THREE

Even though the baby is born, there’s still work to be done. Once the baby is out, wait 30 seconds and then use the clamps or sterile shoelaces to tie off the umbilical cord in two places about 2 inches apart. Then, cut the cord between the clamps or laces with scissors. The cord left on the baby will eventually dry up and fall off on its own.

According to Dr. Pietrantonio, “Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.”

The placenta (the “afterbirth”) will soon be delivered, but it can take up to 30 minutes for it to come. Never pull the cord. A few trickles of blood and some clotting are both normal.

Observe the mother for shock, and treat her accordingly. Massaging the grapefruit-sized uterus through her abdomen and employing an ice pack will help keep it contracted and will reduce the chance of hemorrhaging.

Now, as you can imagine, you have some cleaning up to do.

WHAT TO DO WITH THE PLACENTA

The placenta is usually only about a pound in weight, and while the squeamish might quickly disregard the placenta as a gross bag of mucus and blood, cultures as old as recorded history have placed a special focus on it. In Nepal, the placenta is called bucha-co-satthi, which means “baby’s friend,” while people in Cambodia, Peru, Nigeria and other parts of Africa bury the placenta (sometimes with full funeral ceremonies). And it is said that a person who doesn’t know where his placenta is buried will lack progress in life. In Hawaii, a tree is planted with the placenta so the tree grows as the child does. Many cultures, including some in the West, consume the placenta in many different ways (similar to cooking any kind of food).

After a woman has a baby, many changes quickly begin to occur in her body. Hormones revert to pre-pregnancy levels, organs shift and blood levels decrease—just to name a few. This transition can sometimes be difficult. Placentas contain hormones that, when consumed in the immediate postpartum period, can make the change easier.

Most hospital births result in the placenta being incinerated as medical waste. In an emergency situation, if burying it isn’t an option, you might simply want to discard it in a well-sealed plastic bag.

THE HEARTBREAK OF MISCARRIAGE

“Miscarriage” is the term used to describe a pregnancy loss from natural causes before 20 weeks. According to the American College of Obstetricians and Gynecologists (ACOG), as many as 20 percent of pregnancies end in miscarriage. Signs of an impending miscarriage can include vaginal spotting or bleeding, cramping, or fluid or tissue leaking from the vagina. However, merely bleeding from the vagina does not mean that a miscarriage will happen or is happening.

The loss of pregnancy after the 20th week of gestation is called a “stillbirth.” Conditions that can contribute to a stillbirth include developmental abnormalities, placental problems, poor fetal growth, chronic health issues of the mother, poor prenatal care and infection.

In some cases, there is nothing that can be done but grieve.

 

Editor’s note: A version of this article first appeared in the June 2017 print issue of American Survival Guide.