Birth Preparation
Part of Midwifery and Childbirth
Setting up the birth space and assembling supplies before labor begins.
Why This Matters
Childbirth emergencies do not wait for you to find equipment. Hemorrhage, cord prolapse, and neonatal resuscitation unfold in seconds. Everything that might be needed must be assembled, organized, and within arm’s reach before labor begins.
Preparation is also the primary infection control intervention. The leading cause of maternal death historically was puerperal fever — infection introduced during childbirth. Semmelweis reduced maternal mortality from 10-18% to under 2% simply by requiring handwashing before deliveries. Most of what preparation achieves is creating conditions where infection cannot enter.
Begin preparation when labor signs appear, not when birth is imminent. A first-time mother may have 12-24 hours of early labor before delivery — use that time.
Assembling the Birth Kit
A complete birth kit contains everything needed from onset of active labor through the first hour after delivery. Organize items into logical groups before you need them.
For the Mother
| Item | Purpose |
|---|---|
| Clean cloths or towels (multiple) | Absorbing fluid, drying, padding |
| Vessel of clean warm water | Cleaning |
| Soap | Handwashing |
| Clean rags for compresses | Perineal warm compress, postpartum |
| Herbal supplies (yarrow, shepherd’s purse) | Hemorrhage management |
| Oral rehydration solution (prepared) | Fluid replacement after delivery |
| Food and drink for laboring woman | Energy maintenance |
For the Baby
| Item | Purpose |
|---|---|
| Warm, clean cloths | Drying and wrapping immediately after birth |
| Towel or receiving blanket | Warmth — newborn loses heat rapidly |
| Clean bulb syringe or cloth | Clearing airways if needed |
| Cord ties or strong string (two lengths, boiled) | Cord ligation |
| Sharp blade (boiled or flame-sterilized) | Cord cutting |
| Warm location prepared | Newborn must not be exposed to cold |
For the Birth Attendant
| Item | Purpose |
|---|---|
| Clean hands — soap and water (essential) | Infection prevention |
| Clean gloves if available | Infection prevention |
| Good light source | Seeing the perineum and birth |
| Bowl or container | Receiving placenta |
| Record materials | Documenting time, events, observations |
Preparing the Space
Location Selection
Ideal birth location:
- Warm — easily maintainable at 22-25 degrees C
- Private — the woman should feel safe and unobserved by unnecessary people
- Accessible — attendant can move around all sides of the woman
- Cleanable — able to clean up blood and fluid, not a location with irreplaceable fabric or materials
- Near water source for handwashing
- Good light (natural during daytime or controlled artificial light)
Surface for delivery: The woman may give birth in whatever position she chooses (standing, squatting, kneeling, lying). Prepare the floor and any furniture surfaces with waterproof covers if available, then clean cloth over that.
Managing the Environment
Temperature: Newborns thermoregulate poorly. The birth space must be warm before the baby arrives, not after. Prepare heat sources ahead of time.
People present: The laboring woman should determine who is present. Unnecessary observers increase her anxiety and may impede labor progress. The birth attendant plus one or two trusted support people is typically optimal. Clear the room of anyone who is not actively supportive.
Noise and disruption: Labor progresses better in calm, quiet conditions. Loud voices, arguments, or stressful intrusions can stall labor. Protect the space.
Handwashing Protocol
The most important preparation step. Hands should be washed before any internal examination or contact with the baby.
Method:
- Remove any rings, bracelets, or watch.
- Wet hands thoroughly.
- Apply soap. Lather vigorously for at least 30 seconds — cover all surfaces including between fingers and under nails.
- Rinse thoroughly under clean running water.
- Dry with clean cloth (not shared cloth).
Repeat before and after any contact with the birth canal, before handling the newborn, and after handling any body fluids.
When soap is unavailable: Use ash (contains lye compounds with antimicrobial properties) mixed with water as a substitute. Or heat-sterilize your hands by holding them near but not in flame (not practical but listed for completeness). Prioritize soap acquisition as part of pre-birth preparation.
Preparing Cord-Cutting Equipment
Infection introduced through the umbilical cord stump causes neonatal tetanus — historically a major cause of newborn death. Absolute cleanliness of cord-cutting implements is non-negotiable.
Two cord ties: Cut two lengths of strong, clean string or narrow cloth strip, approximately 30 cm each. Boil for 10 minutes and allow to cool in a clean, covered container.
Cutting blade: A knife, scissors, or razor blade. Boil metal instruments for 10 minutes. Allow to cool in clean water or air-dry on a clean surface. Alternatively, pass the blade through a flame until it glows red and allow to cool before use.
Do not use: Scissors or blades that have been used for other purposes without sterilization. Unwashed string or thread.
Mental Preparation
Knowledge inventory: Before labor begins, review the key interventions: what to do for hemorrhage, what to do for a baby that does not breathe, what to do for cord prolapse. Mental rehearsal of procedures you hope never to need ensures you can perform them if required.
Communication: Tell the mother clearly what you know, what you will watch for, and what you will do if something goes wrong. Confidence and clarity reduce her anxiety — which directly improves labor outcomes.
Backup plan: Know your escalation path. Is there someone else with medical experience to call? How far is it to any more experienced assistance? At what point in a complication would you move the mother? Having a clear plan reduces panic if problems arise.
Acceptance of uncertainty: Not all birth complications can be prevented or managed without surgical capability. The birth attendant’s role is to do everything within their capability — clean hands, good monitoring, prompt recognition of problems, skilled application of available techniques. Beyond that, acceptance of limits is part of competent practice.
The topics of clean environment and supply kit are covered in dedicated articles.