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👶 Childbirth, Newborns & Young Children When No Help Is Coming

Getting a mother and baby through pregnancy, birth and the first weeks, and keeping young children alive and learning, with no hospital, pharmacy or phone. Current WHO guidance comes first. Hesperian's A Book for Midwives (2026) and Where There Is No Doctor (2025) add detail; where they differ from WHO, this guide gives the WHO answer. The books are in Medical\Childbirth-Children (Birth, Newborn, Mothers, Child-Health), Medical\A Book for Midwives, Medical\Field-Care\Childbirth-Newborn, Medical\Where There Is No Doctor and Southern-Oregon\Children-Learning.

⚠️ Rules that prevent the worst outcomes

📋 Plan now, while doctors and pharmacies still exist

Cheap medicines bought ahead save mothers and children. Most need a US prescription, so talk to a doctor now:

Medicine For Notes
Misoprostol Preventing and treating bleeding after birth No fridge needed; keep dry (WHO, p. 19). Can be handed out before a home birth (BfM, p. 231)
Oxytocin Same; WHO's first choice Must stay at 36–46 °F (2–8 °C); without cold storage use misoprostol (same page)
Tranexamic acid (TXA) Bleeding that won't stop 1 g into a vein, only within 3 hours of birth; needs someone who can start an IV (WHO, p. 47)
Amoxicillin 250 mg Child pneumonia; infection after a birth emergency IMCI, p. 16
ORS packets, zinc, mebendazole, vitamin A Diarrhea, worms, measles IMCI, p. 20
Vitamin K 1 mg injection Every newborn PCPNC, p. 153

Vaccines: bring children up to date on WHO's schedule: hepatitis B within 24 hours of birth; DTP, polio, Hib, pneumococcal and rotavirus; two doses of measles vaccine (WHO Table 2, Dec 2025). A child who fell behind resumes without repeating doses (Table 3). Adults: tetanus boosters, MMR if never vaccinated, and Tdap in every pregnancy (general practice).

Clean birth kit (PCPNC, p. 169; BfM, p. 152; the kit drawn, WTND p. 254): soap and a nail brush, gloves (or very clean plastic bags), a new razor blade, 3 strings 8 in (20 cm) long, a suction bulb (using one, BfM p. 214), many clean cloths, a warm blanket, 3 bowls, plastic for the placenta, clean water and a way to heat it, light, and the bleeding medicine. Add a blood-pressure cuff and stethoscope (how to use them, BfM p. 123), a newborn bag-and-mask (Bag valve mask), a digital thermometer and a hanging scale (general practice).

Transport: there is no 24-hour ER in the Illinois Valley (Start Here). The nearest delivery hospital is in Grants Pass, about 30 miles, an hour or more once roads or fuel fail (general knowledge). Decide now who drives or carries her, and save fuel for it.

📚 Go deeper: WHO Bleeding After Birth — medicines; WHO catch-up table — missed vaccines; A Book for Midwives, ch. 9 — supplies.

🤰 Pregnancy: checkups and danger signs

Go for help at once, day or night, for bleeding from the vagina, fits, severe headache with blurred vision, fever with weakness, severe belly pain, or fast or difficult breathing (PCPNC, p. 162). She eats more, rests and drinks no alcohol (same page). Smoke harms pregnant women more: in fire season keep her in a "cleaner air room" with a box-fan filter (EPA).

📚 Go deeper: A Book for Midwives, ch. 8 — every prenatal check; PCPNC counselling sheets — birth plans.

🛏️ Labor and birth: what helpers do

Labor has started with painful contractions every 20 minutes or less, waters breaking, or a bloody sticky discharge (PCPNC, p. 162). During labor (WTND, p. 259):

Never: drugs to speed labor (they can kill mother and child — WTND, p. 266), anything in the vagina, pushing on the belly (it can tear the womb — BfM, p. 205), pulling on the cord.

Leave for Grants Pass now if waters broke with no labor after 6 hours, contractions last over 12 hours, she soaks over 2–3 pads in 15 minutes, or the placenta isn't out 1 hour after the baby (PCPNC, p. 170).

Right after the baby is born (a head-first birth, WTND p. 261; Childbirth):

  1. Dry the baby, lay it skin-to-skin on the mother's belly, and cover it, head too (BfM, p. 240).
  2. Feel her belly for a second baby, then give the bleeding medicine within 1 minute — misoprostol 400–600 µg by mouth, or oxytocin 10 units in the thigh. (The 800 µg dose is for treating bleeding, below.) Never before the last baby is out (WHO, p. 19).
  3. Cut the cord after 1–3 minutes (same page), once it is white and stops pulsing; waiting gives the baby iron. Tie it tightly 2 finger-widths from the belly, tie a second string farther out, and cut between with a new or sterilized blade (BfM, pp. 214–215; tying and cutting, WTND p. 262; Umbilical cord). A baby needing breathing help gets it cut at once.
  4. Let the placenta come by itself, and check it is whole (PCPNC, p. 169; Placenta).
  5. First breastfeed within the hour. No bath the first day. Don't leave the mother alone for 24 hours (same page).

The cord coming from the baby's belly: a tight first tie 2 finger-widths from the belly, a second tie farther out, and the cut between them Wait 1–3 minutes, tie twice, cut between the ties (a diagram drawn for this guide).

Cord care: clean and dry, nothing on it. Dirt and dung cause tetanus (WTND, p. 263; Neonatal tetanus). WHO's one exception is 7.1% chlorhexidine daily for a week, where a health authority recommends it (PCPNC, p. 169). Fold the diaper below the stump; it usually falls off within 1–3 weeks (sometimes in 5–7 days).

📚 Go deeper: A Book for Midwives, ch. 12 — the birth in drawings; PCPNC home delivery.

🩸 Heavy bleeding after birth: the #1 killer

Bleeding after birth kills more mothers than anything else (general knowledge), and delay is a common reason they die (WHO, p. 59). A soft womb causes about 70% of it (p. 9).

Feel the womb every 15 minutes for the first hour. Hard like your forehead is good. Soft like the tip of your nose needs rubbing (how to rub it, BfM p. 224). The top should be at or below the navel (WHO, p. 29). Teach the family to check and rub (BfM, p. 236).

Dangerous bleeding: measure, don't guess (WHO, p. 43; p. 15):

Then do ALL of these within 15 minutes, in any order (WHO "MOTIVE", p. 47):

Step What to do
Massage Cupped hand on top of the womb; rub in circles until hard. Alone? Massage first
Oxytocic Misoprostol 800 µg under the tongue, or oxytocin 10 units in the thigh. Nauseous? Pills go in the rectum (BfM, p. 231)
TXA 1 g into a vein over 10 minutes, if someone trained and under 3 hours
IV fluids If you can; if not, sips of rehydration drink while awake (BfM, p. 239)
Examine Baby to the breast; help her urinate; placenta whole? torn and bleeding? (BfM, p. 236)
Escalate Head for Grants Pass if bleeding stays heavy or passes 1,000 mL (WHO, p. 57)

Still bleeding?

  1. Squeeze the womb between two hands: a gloved fist in the vagina above the cervix, the other hand pressing the womb down onto it (BfM, p. 237; WHO drawing, MCPC p. 178). Hold at least 5 minutes; it hurts, so tell her. Don't wait for shock, and don't pack the vagina (WHO, p. 73).
  2. Or press a fist hard on the belly just above the navel until the pulse in her thigh disappears, and keep pressing (BfM, p. 238; WHO drawing, MCPC p. 179).
  3. Shock: feet up, keep her warm, sips if awake, nothing by mouth if unconscious (BfM, p. 239).
  4. Help more than 1 hour away? Amoxicillin 1 g plus metronidazole 1 g by mouth, once (BfM, p. 231).

Squeezing the womb between two hands, side view: a gloved fist inside the vagina pushes up against the womb while the other hand presses it down from outside Step 1: squeeze the womb between the fist inside and the hand outside, for at least 5 minutes (MCPC, p. 178).

A fist pressing hard on the belly just above the navel while the other hand feels for the pulse in the thigh Step 2: press until the pulse in her thigh disappears, and keep pressing (MCPC, p. 179).

📚 Go deeper: WHO action plans — the bundle and shock; A Book for Midwives, ch. 13 — the family's part.

🔄 Stuck shoulders and breech

Stuck shoulders: the head is born, pulls back like a turtle, and the shoulders won't come. The baby has about 5 minutes before brain damage (BfM, p. 210). Call every helper. WHO's order (MCPC, pp. 243–244):

  1. Knees to chest: two helpers push her bent knees firmly up to her chest (MCPC p. 244).
  2. Press hard just above the pubic bone, not on the belly, while you draw the head steadily downward. Cup the head; don't grip the neck; never jerk.
  3. Hand inside along the baby's back: push a shoulder toward the baby's chest to turn it.
  4. Bring the back arm out, swept across the chest.

Hesperian tries hands-and-knees first (BfM, p. 211); use it if WHO's steps fail. Never push on top of the womb: it can burst. Be ready to help the baby breathe.

Breech (bottom first) with no hospital (BfM, pp. 215–217): feet first is the most dangerous kind. No pushing until the cervix is fully open. Hands off: the bottom, belly and legs come on their own, and you never pull on the baby. Wrap the body so it doesn't chill and gasp inside her. A helper presses above the pubic bone to keep the head tucked. Hold the baby by the hips, never the belly (p. 217; "hold the baby at the hips, but do not pull," MCPC p. 378).

A breech baby coming bottom first, seen from below: the helper's two hands hold the baby by the hips Hold the baby at the hips, never the belly, and don't pull (MCPC, p. 378).

📚 Go deeper: A Book for Midwives, ch. 12 — each move drawn; WHO Managing Complications — hard births.

🫁 A baby who isn't breathing

Most babies breathe within 1–2 minutes, and drying is often enough. Never hold a baby upside down or slap it (BfM, p. 241). WHO's steps (PCPNC, p. 152; Neonatal resuscitation):

  1. Dry and rub the back. Not breathing, or only gasping? Start within 1 minute of birth. Cut the cord; move the baby to a warm, dry, flat place.
  2. Open the airway: head slightly tipped back, a folded towel no thicker than ¾ in (2 cm) under the shoulders (MCPC p. 311). Suction only if the mouth or nose is full.
  3. Breathe for the baby: mask over chin, mouth and nose (fitting the mask, MCPC p. 313). Give 5 squeezes and watch the chest rise; if it doesn't, fix the head and seal. Then 40 breaths a minute (one every 1½ seconds).
  4. No bag? Your mouth over the baby's mouth and nose: small puffs from your cheeks only (BfM, p. 242).
  5. After 1 minute, check the heart with a stethoscope or 2 fingers on the chest. Count 6 seconds, times 10 (BfM, p. 243).
  6. Stop when the baby breathes over 30 times a minute without deep chest sucking-in. Skin-to-skin, check every 15 minutes.
  7. No heartbeat (or under 60) after 10 minutes of good breaths: the baby has died. Stop and care for the family.

A newborn lying on its back with the head tipped back slightly to open the airway Head only slightly tipped back: a newborn's neck is bent back less than an adult's (MCPC, p. 311).

Four baby faces with a breathing mask: the right size covering chin, mouth and nose; wrong when held too low, too small, or too large The mask covers the chin, mouth and nose, but not the eyes (MCPC, p. 313).

Alone with a bleeding mother? Baby first, then her medicine and womb check as soon as you can (WHO, p. 17).

📚 Go deeper: PCPNC resuscitation chart; A Book for Midwives, p. 242 — rescue breathing drawn.

🌡️ Warmth, small babies and newborn danger signs

Warmth: skin-to-skin, head covered, out of drafts. A baby needs only one more layer than an adult (BfM, p. 240). Watch for overheating in valley summers over 100 °F, and chilling November–March (general knowledge).

Kangaroo care for babies under 2,500 g (5½ lb) or born 3+ weeks early (WHO KMC, p. 10):

Kangaroo care: a small baby in a diaper and hat lying upright on the mother's bare chest between her breasts, head turned to one side, legs bent and spread Upright, skin to skin between the breasts, head to one side, hips spread; then wrap the cloth high across her chest (WHO KMC guide, p. 31).

Newborn danger signs: treat as an emergency (Caring for the Newborn at Home, p. 71):

Newborn antibiotic doses: BfM, p. 279.

Jaundice (IMCI, p. 46):

📚 Go deeper: WHO Caring for the Newborn at Home — checking each sign; WHO KMC guide — pictures.

🤱 Breastfeeding and the mother's recovery

Breast milk only for 6 months. Unmodified animal milk is not suitable under 6 months; it can damage the kidneys (WHO IYCF, p. 18). A baby who can't suckle is fed by cup, not bottle (p. 81; cup feeding, p. 86). No breast milk? See the Food Security guide for wet-nurses, relactation and formula.

Enough milk? After day 5: 8–12 feeds a day with visible swallowing, pale urine at least 6 times a day, yellow stools 3+ times a day until 6 weeks, birth weight back by 2 weeks, then 5–7 oz (150–200 g) a week. Few wet diapers or dark urine is a reliable warning (IYCF, pp. 135–136).

Breast problems (good and poor attachment, IYCF p. 42):

Two side views of a breastfeeding baby: well attached, with the mouth wide, lower lip turned out and chin on the breast; poorly attached, sucking on little more than the nipple with much of the dark skin showing Well attached: mouth wide open, lower lip turned out, chin touching the breast, more of the dark skin showing above the mouth than below (IYCF, p. 42).

Womb infection (fever 100.4 °F / 38 °C or more, bad-smelling discharge, chills, belly pain, fast pulse) can kill quickly. Antibiotic plan: BfM, p. 271. Check mother and baby within 24 hours, on day 3, on days 7–14 and at 6 weeks (PCPNC, p. 170).

Depression after birth hits 1 in 10 to 1 in 5 mothers, and her baby grows worse too (Thinking Healthy, p. 11):

📚 Go deeper: WHO Infant Feeding (2025) — breastfeeding problems; Thinking Healthy — the sessions.

🤒 Sick children under 5: fever, breathing, diarrhea, measles, worms

Danger signs: act now — can't drink or breastfeed, vomits everything, has had fits, very sleepy or can't be woken (IMCI, p. 5), or fever with a stiff neck (p. 8).

Fever is a sign: look for the cause. Give plenty to drink, boiled water for babies (WTND, p. 76). Paracetamol (acetaminophen) every 6 hours for high fever: one 100 mg tablet at 2 months–3 years, 1½ at 3–5 years — with 500 mg tablets, ¼ and ½ (IMCI, p. 17). No aspirin for children.

Pneumonia: count breaths for a full minute, child calm (IMCI, pp. 6, 45):

Age Fast breathing
Under 2 months 60 or more
2–12 months 50 or more
1–5 years 40 or more

Fast breathing or chest sucking in means pneumonia: amoxicillin 250 mg twice a day for 5 days — 1 tablet at 2–12 months, 2 at 1–3 years, 3 at 3–5 years (syrup 250 mg/5 ml: 5, 10 or 15 ml) (p. 16).

Diarrhea. Severe dehydration is two or more of: very sleepy or unconscious, sunken eyes, drinks poorly or not at all, a pinch of belly skin taking over 2 seconds to flatten (IMCI, p. 7; the pinch, WTND p. 151; Dehydration).

Measles starts like a cold with red eyes; days later a rash spreads from behind the ears downward (WTND, p. 311). Give vitamin A: 100,000 IU at 6–12 months, 200,000 IU from 1 year (IMCI, p. 20). Clouded eyes or deep mouth sores mean severe measles (p. 8).

Worms: pinworm itches at night. Cut nails short, wash hands and bottoms every morning, treat the whole family (WTND, p. 141). Hookworm enters bare feet (how it spreads, WTND p. 142): latrines and shoes (p. 142). Mebendazole 500 mg once, from age 1, at most every 6 months (IMCI, p. 20). Untreated creek water brings giardia and weeks of diarrhea (general knowledge).

📚 Go deeper: WHO IMCI charts — every decision and dose; WHO Treatment of Diarrhoea — plans A, B, C.

📏 Growth, malnutrition and toddler food

Weigh monthly and plot it on the WHO-standard charts in pounds and inches (boys; girls; Growth chart). A homemade beam scale works (WTND, p. 297; Steelyard balance). A baby whose weight drops across 2 lines is not growing well (IYCF, p. 136).

Arm measurement (MUAC), 6 months–5 years, around the middle of the upper arm (IMCI, p. 10; MUAC): under 11.5 cm, or swelling of both feet (Kwashiorkor), is severe malnutrition; 11.5–12.5 cm is moderate; 12.5 cm or more is OK. Mark a paper strip at 11.5 and 12.5 cm (rule of thumb). Refeeding a severely malnourished child needs care: WHO 1999 and the Food Security guide.

Toddler food and water (WHO, p. 38; p. 46; "five keys to safer food," IYCF p. 56):

📚 Go deeper: WHO Complementary Feeding — first foods; WTND, ch. 21 — growth charts.

🛡️ Accidents: drowning, burns, poisoning

📷 A child ate a plant, berry or mushroom? Keep a piece (and any vomit) and photograph the plant: the plant and mushroom identifier may name it for whoever is helping. Don't wait for it to act.

Drowning: a small child can drown in a few centimeters of water in a bucket (WHO, p. 78). Empty buckets and tubs; cover wells, cisterns and barrels (p. 86). Here that means rain barrels (Rain barrel), stock tanks, ditches, and the cold, deep pools of the Illinois and Rogue rivers (general knowledge).

Burns: keep babies away from fires and wood stoves; turn pan handles inward. Cool a burn in clean cool water (not ice) up to 20 minutes. Never grease, fat, herbs or dung (WTND, p. 96). Canning kettles and soap-making lye are local hazards; see the Field Care guide.

Poisons: lock up lye, kerosene and lamp oil, rat poison and medicines (iron pills especially), and never store them in drink bottles (WTND, p. 103). Teach children to leave alone western water hemlock by creeks and ditches, "the most poisonous plant in North America" (PNW 109; Cicuta douglasii), and the death cap mushroom (BCCDC; Death cap).

If a child swallows poison (WHO, p. 155):

  1. Get them away from it; strip soaked clothes; flush skin and eyes with lots of water.
  2. Airway and breathing first. Unconscious: on their side (ATP p. 79).
  3. Activated charcoal within 1 hour helps for many poisons, not fuels, lye, alcohol or iron.
  4. Do not make the child vomit. WHO no longer uses it, and it harms with fuels and caustics.

📚 Go deeper: WHO Child Injury Prevention — what works; WTND first aid.

📚 Keeping children learning at home

Babies and toddlers learn through play and talk (WHO/UNICEF cards):

Age Play and talk
Newborn Skin-to-skin; look into the baby's eyes and talk
6–9 months Clean household things to bang and drop (pot and spoon)
9–12 months Peek-a-boo; hide a toy under a cloth; name things
1–2 years Stack, fill and empty containers; simple questions
2 years + Count, name and compare; stories, songs, picture books

Reading: the McGuffey Primer adds about 6 new words a lesson, by phonics or whole words (Primer), then the First, Second and Third Readers.

Arithmetic: count real beans, corn or pebbles before pictures, then write out the sums to 20 (Ray's Primary). Mental math needs no paper (Intellectual); written math goes on in the Practical, with answers for parents in the Key.

Older children teach younger ones: a 6th-grader working at 4th-grade level can help a 2nd-grader. Train tutors, or they fall back on threats and put-downs (Peer Tutoring, p. 21).

📚 Go deeper: Care for Child Development — if a child seems slow; Key to Ray's — worked answers.

⚠️ Old advice in the library to ignore

Old book What it says Do this instead
WTND, p. 103 Make a poisoned child vomit "with your finger or very salty water" Never. Salt is on that page's poison list; WHO dropped vomiting (p. 155)
WTND, p. 259 An enema in labor WHO: no enema (PCPNC, p. 63)
WTND, p. 270 Alcohol on the cord at every diaper change Dry cord care; only 7.1% chlorhexidine where advised (PCPNC, p. 170)
WTND, p. 152 Home drinks often beat ORS; ORS contains zinc WHO: home recipes get mixed wrong (p. 13). Stock ORS and zinc tablets
WTND, p. 266 Save bleeding medicine for emergencies WHO: every mother, within 1 minute (p. 19)
BfM, pp. 242–243 Rescue breaths about 30 a minute; stop after 20 minutes WHO: 40 a minute; stop at 10 minutes with no heartbeat (PCPNC, p. 152)
BfM, p. 279 Jaundiced baby in direct sun No direct sun. Feed often; watch palms and soles (IMCI, p. 46)
PCPNC, p. 163 At least 4 prenatal visits WHO now says 8 (2016; not on the drive). Check monthly, then weekly
Ray's Primary, p. 11 Stop finger-counting It's a normal step (general practice)
Ray's Practical, p. 72 Mills, eagles, 1877 prices Skip or update the money problems
McGuffey Readers (1909–1920) 19th-century morals and stereotypes Read them with the child (general practice)

📚 Go deeper: PCPNC, p. 170 — WHO's list of harmful birth practices; WHO Child Injury, p. 155 — current poisoning first aid.

🖼️ Pictures & diagrams

Look before you try it. 🖼️ = drawings in the books on this drive; 📷 = photos in the offline Wikipedia.

Pregnancy and getting ready

Labor and birth

Bleeding and hard births

The newborn

Breastfeeding

Sick and growing children

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