Ring 999 and say a birth is in progress. Crews attend these regularly and the call handler will talk you through it in real time.
1Wash your hands thoroughly. Clean towels, clean sheets, hot water, boiled string and scissors set aside.
2Let her choose her own position and let her push when her body pushes. Do not coach it.
3Support the head with a light hand as it emerges. Never pull, twist or press.
4Cord round the neck? Hook a finger and lift it over. Too tight to move, leave it and let the baby be born through the loop.
5Baby out: dry it vigorously, including the head, discard the wet towel, hat on, skin to skin on her chest, cover both.
6Not breathing after a minute of drying and rubbing? Neutral head, clear the mouth, then 5 gentle cheek-puff breaths.
7Do not cut the cord while the baby is not breathing, and do not rush to cut it at all.
8Baby to the breast as soon as possible. Suckling contracts the uterus and is the best thing you have against bleeding.
9Feel for the firm grapefruit below the navel. If it is soft, massage it hard until it firms. Repeat whenever it softens.
Placenta arrives
Usually 5 to 30 minutes after
Never
Pull the baby, or pull the cord
Cord equipment
Boiled 10 minutes. Neonatal tetanus is the risk
Bleeding alarm
A pad soaked in under an hour
The mistake that costs lives: Helping. Standing there doing nothing feels like negligence, so people pull the head, coach the pushing, tug the cord to hurry the placenta, and cut the cord promptly because that is what happens on television. Every one of those does harm: traction on a baby causes permanent nerve injury and can kill, pulling the cord can invert the uterus, and cutting early takes blood the baby should have received. The attendant's whole job is hygiene, warmth, hydration and watching for bleeding. Babies are delivered by the mother. Your hands are there to catch and support, not to deliver, and the discipline of keeping them still is the skill this page is actually asking for.
Most births need no help at all, and your job is warmth, hygiene and watching for bleeding. This page covers the normal course, the signs that something is not normal, and what to do when nobody is coming.
Two things are true at once and this page holds both.
Most births need no assistance. Babies are delivered by the mother, not by the attendant, and in the overwhelming majority of cases the right thing to do is keep your hands off, keep everyone warm and clean, and let it happen.
And when it goes wrong it goes wrong fast, in ways that need a skilled person and equipment. This page cannot make you that person and does not pretend to.
Start here, before anything happens
What a normal birth looks like
Knowing the normal course tells you when to worry, which is most of what a non-expert can usefully contribute.
First stage. Contractions begin, irregular and far apart, becoming regular, stronger and closer together. This is the long part, often many hours, and can be much longer with a first baby. The cervix is opening. Nothing is required of you but reassurance, fluids and calm.
Second stage. Contractions become very strong and close, and the mother feels an overwhelming urge to push. This usually lasts minutes to a couple of hours. The baby's head becomes visible, retreating between contractions and advancing a little each time. Then it crowns and stays visible.
Third stage. The placenta is delivered, usually within 5 to 30 minutes of the baby, with further mild contractions.
Things that are normal and alarming: a great deal of noise, vomiting, shaking, passing urine or stool during pushing, a gush of fluid when the waters break, and blood-streaked mucus. None of these are emergencies.
What you actually do
Position: let her choose. Upright, kneeling, on all fours and squatting are all effective and often better than lying on her back. Do not put her flat on her back and tell her to push because that is what films show.
Do not tell her when to push. Her body will do this. Coached pushing against the urge is unhelpful.
Prepare, while there is time: clean towels (several, and more than you think), a blanket for the baby, hot water, a clean sheet, a bowl for the placenta, and clean string or shoelaces and scissors boiled for 10 minutes in case the cord needs tying later.
The baby arriving
Support the head as it emerges, with a light hand. Do not pull, do not twist, do not press.
Let the head turn on its own. It rotates naturally to let the shoulders through.
If the cord is around the neck, which is common and usually harmless, gently hook a finger under it and lift it over the head. If it is too tight to move, do not cut it: let the baby be born through the loop, which usually works, and unwrap afterwards.
The shoulders come one at a time, then the body follows quickly and slipperily. Be ready. Newborns are extremely slippery.
Lay the baby on the mother's bare chest immediately.
The first minutes
Drying is the stimulation. Rubbing a baby briskly with a towel is usually all that is needed to start it breathing and crying. There is no need to hold it upside down or smack it.
Heat loss is the main early danger. Newborns lose heat extremely fast, a wet newborn in a cool room chills within minutes, and hypothermia in a newborn is genuinely dangerous. Dry, cover the head, skin to skin, cover both. That is the treatment and it is free.
Do not wash the baby. The waxy coating protects it. Do not bathe for at least 24 hours.
The cord and the placenta
Do not cut the cord immediately, and do not rush it. Leaving it attached for several minutes lets a significant volume of blood transfer to the baby, which measurably improves iron stores. Wait until it has stopped pulsing, at minimum, and there is no harm in waiting far longer.
If there is no reason to cut it at all, do not. The baby can stay attached to the placenta indefinitely. In a setting with no sterile equipment, not cutting is safer than cutting badly.
If you must cut it, after it has stopped pulsing and after the placenta has delivered if you can wait that long:
Tie firmly with boiled string or shoelace about 5 cm from the baby's belly.
Tie again about 3 cm further along.
Cut between the two ties with a boiled blade or scissors.
Check the stump is not bleeding. If it is, tie again more tightly.
The placenta delivers itself, usually within 5 to 30 minutes, with a small gush of blood and a final contraction. Never pull the cord to hurry it. That can invert the uterus, which is immediately life-threatening.
Keep the placenta. If help is later reachable, it needs inspecting to check nothing was left behind. Retained placenta causes bleeding and infection.