Supply Kit

Part of Midwifery and Childbirth

What to gather and prepare before delivery — essential supplies for a clean, safe birth in any setting.

Why This Matters

The time to gather birth supplies is not during labor. A midwife who is searching for scissors when the baby is crowning, or discovers there are no clean cloths when the newborn needs drying, has failed the mother before the first complication arose. Preparation is a form of competence — the supply kit, assembled thoughtfully in advance, is the physical infrastructure of a safe delivery.

In the pre-antibiotic era, the content of a midwife’s bag was limited primarily by what she could carry. Yet the principles that guided those kits were identical to those that guide modern ones: cleanliness, cutting instruments, cord management, warmth for the newborn, and means to control bleeding. Everything else is supplementary.

The supply kit described here is designed for a birth attendant in a resource-limited setting. It prioritizes items that are either essential for safety (infection prevention, cord care, newborn resuscitation) or available in most environments without access to modern medical supply chains.

Tier 1: Essential (Non-Negotiable)

These items must be present before labor begins. Their absence significantly increases risk of death.

Handwashing:

• Soap (any type) — for hand scrubbing before and during delivery
• Clean water supply — minimum 5 liters reserved for birth (separate from cooking water)
• Clean cloths for hand drying — dedicate 2-3 cloths for this use only

Cord management:

• Cord ties: 4 pieces of strong, clean string, each 20-30 cm long, boiled for 20 minutes and stored dry in a clean container. Alternatives: pre-cut strips of clean cloth, shoelaces, strips of natural fiber cord. Commercial cord clamps if available.
• Scissors or blade for cutting cord: steel scissors or a single-edge razor blade. Must be sterilized. Boil scissors for 20 minutes; unwrap a new razor blade at the moment of use (factory-packaged blades are sterile).

For the newborn:

• 4-6 clean cloths or towels for drying and warming the baby — large enough to wrap the baby completely
• Hat or head covering for the newborn: even a clean cloth folded into a cap significantly reduces heat loss
• 1-2 blankets for wrapping the newborn

For the birth surface:

• Clean plastic sheeting or disposable pads — protects the birth surface from blood; plastic can be improvised from garbage bags or agricultural sheeting
• 6-8 clean cloths or pads for absorbing blood during and after delivery

Timing:

• A watch, clock, or timing device — for recording time of birth, timing contractions, and counting fetal heart rate

Tier 2: Important (Significantly Improves Safety)

These items are not absolutely essential but substantially reduce specific risks.

Infection prevention:

• Gloves: Clean examination gloves for internal assessments; sterile gloves for delivery if available. Alternatives: no-touch technique (careful positioning to avoid touching non-sterile surfaces) if gloves are completely unavailable.
• Antiseptic: 70% alcohol or iodine solution (Betadine) for hand antisepsis and instrument disinfection
• Chlorhexidine 4% solution: For cord care in high-infection-risk environments; also useful for perineal cleaning

Resuscitation:

• Bulb syringe: For clearing the newborn’s airway of fluid. Can be improvised but a dedicated suction bulb is far more effective. Clean, then boil the rubber bulb between uses.
• Cloth squares for stimulation: Used to dry and stimulate a baby who is slow to breathe

Maternal monitoring:

• Fetoscope (Pinard horn): A trumpet-shaped device for listening to the fetal heartbeat through the abdomen. Can be improvised from a cardboard roll or wooden form, but a dedicated fetoscope is far more effective.
• Blood pressure cuff (sphygmomanometer) and stethoscope: For prenatal monitoring and postpartum hemorrhage assessment. Not standard for a home kit but invaluable.
• Thermometer: For detecting postpartum fever

Lighting:

• Reliable light source for the birth area: a headlamp is ideal (leaves hands free); lantern or candle as backup
• Position lighting to illuminate the perineum without blinding the mother

Cord care:

• Small amount of chlorhexidine for cord cleansing in the first week
• Clean container with lid for storing sterilized instruments

Tier 3: Beneficial (Use If Available)

These items address specific situations and add an additional layer of safety.

Pain relief:

• Paracetamol (acetaminophen): Safe in labor and postpartum; reduces fever and pain
• Ibuprofen: Not used during labor but valuable for postpartum perineal pain from day 2 onward

Hemorrhage management:

• Oxytocin (10 units/mL in ampoule): The most effective uterotonic. Requires refrigeration for storage longer than 1-3 months.
• Misoprostol (200 mcg tablets): Heat-stable alternative uterotonic; 3 tablets (600 mcg) sublingually if oxytocin is unavailable; less effective but far better than nothing
• Tranexamic acid (1g tablets or injection): Reduces bleeding from any cause; give within 3 hours of hemorrhage onset

Suturing:

• Absorbable suture material (polyglactin/Vicryl or catgut) for perineal repair
• Needle holder
• Forceps (tissue or dressing)
• 1% lidocaine solution and syringes for local anesthesia before repair

Newborn:

• Bag and mask (Ambu bag) for newborn resuscitation: The single most effective intervention for a baby who does not breathe. Requires practice to use correctly.
• Pre-warmed blanket storage: Wrap blankets around a warm water bottle to keep them warm in advance

Documentation:

• Birth record form or notebook for recording dates, times, measurements
• Pen (pencil fades; ink smears — use ballpoint)

Preparation and Sterilization Protocol

One week before expected due date:

• Assemble all items and inventory against the checklist
• Identify any missing items and obtain if possible
• Place all cloth items in a pot of clean water and boil for 20 minutes; dry in clean air and store in a covered container
• Sterilize scissors: boil for 20 minutes, store in a clean covered container

24-48 hours before expected delivery (if labor is anticipated):

• Prepare fresh boiled water and store in covered containers
• Set up the birth space: clean surface, lighting tested and positioned, clean sheets on the bed or floor
• Arrange all supplies within arm’s reach of the birth area
• Prepare the cord tying supplies and set them where they can be reached with one hand

Immediately before delivery:

• Open any sterile packages (gloves, fresh razor blade)
• Confirm fetal heart rate is audible with the fetoscope
• Confirm one person is assigned to attend the newborn
• Confirm clean cloths are immediately at hand for drying the baby

Supply Sourcing in Resource-Limited Settings

Improvised cord ties: Any strong, clean string can be used. Options: boiled cotton string, strips of clean cloth, unused shoelaces. Avoid synthetic materials that may be coated. Test strength before use — must not break when pulled firmly.

Improvised gloves: Clean plastic bags with the fingers cut and sealed can provide some barrier protection. Not equivalent to examination gloves but better than bare hands.

Improvised Pinard horn: A cone of tightly rolled cardboard, or a cylinder of rigid material (PVC pipe cut at 45 degrees), transmits sound adequately. The flat end goes against the attendant’s ear, the open end against the abdomen.

Improvised warmth for newborn:

• Skin-to-skin with mother, both covered with a wool or thick blanket
• Warmed stones wrapped in cloth and placed around (not against) the baby
• A fire in the room providing ambient warmth

Improvised antiseptic: Strong alcohol (spirits above 60% — 120 proof) applied to hands after washing with soap is effective. High-proof grain alcohol, medical alcohol, or strong distilled spirits all work. Ethanol is preferable to isopropanol for skin use, but isopropanol at the same concentration is also effective.

Maintaining the Kit Between Uses

A birth kit that is not properly maintained between uses may be worse than no kit — contaminated equipment that looks clean is deceptive.

After each use:

• All cloth items: wash immediately with soap and water, then boil if possible; dry thoroughly
• Instruments: wash with soap and water immediately after use (organic matter blocks sterilizing agents); then reboil before storage
• Replace any disposable items used
• Restock consumed supplies before the next expected use

Checking kit integrity: Review the kit at the beginning of each prenatal visit with the expectant mother. Ensure she knows what is in it, where it is kept, and who should be called when labor begins. A supply kit that the mother cannot locate in the middle of the night is not useful.

The well-prepared supply kit represents the physical manifestation of readiness. A midwife who has assembled, sterilized, and rehearsed with her kit has thought through the birth before it happens — and that preparation shows in outcomes.