Being pregnant happens, and emergency situations won't ask us "Hey, is it ok if I ruin your day?". So let's see what happens if a woman happens to find herself in a situation where she's giving birth alone. First of all this can also happen in non-emergency situations like e.g. the waters breaking a couple of days earlier than the expected hospital arrangement. Second of all, it's important to assess whether you're really going into labour. It's obvious if the waters break, but before that happens, there will be strong contractions and an involuntary urge to push. Those are the early signs, and it's important: to use those you get either yourself into safety/shelter or call 911* (if it's available, or there's a hospital close enough) or call someone to get to you. to resist the urge to push for the moment: if you push and the baby comes out too fast there's greater chance of vaginal tears and uncontrollable bleeding. If you're alone, it's best to ease into it. The span of time a woman has from early symptoms to delivery is longer when a woman is having her first child. So if this is your first child you have more time to react. *if 911 is available the dispatched team will be put on the speaker and provide more guidance until they arrive. Third, if the labour is coming earlier than expected, then the likelyhood of having problems like an overturned baby is lower than overdue pregnancies. After all, if a baby comes earlier then that means it's already positioned into place. Fourth, the woman in delivery has to be placed in a comfortable position, and wash the hands and vaginal area with soap of whatever other disinfectant is available at the moment. There must be plenty of towels handy to wipe the newborn down and keep it warm afterwards. I there are no towels a clean sizable cloth will do. The woman should take a position sideways and not belly-up. It's only suggested to lie on her back if there's a second person there to handle the baby. Instead a sideways position both takes off pressure from your back and veins that feed the umbilical cord, as well as make it easier for the woman to reach down and handle the baby herself. However some people find it more comfortable to squat or stand on all fours, so if you see that a position isn't working just change the position. Instead of pushing (we explained this above), the woman can push by panting. That will enable her to put smaller amounts of pressure. Remember: you actually don't need to push at all to get the baby out, the uterine muscle walls will do that for you. Do not pull the baby. There's a reason I said "handle" instead of "pull" earlier, and that's because you're not supposed to violently tug the baby out, as you could easily dislocate and/or break its bones. Since at first you only grasp the head, it's very easy to decapitate (internaly) the head). You're supposed to gently guide it out and make sure that the umbilical cord isn't tied around its neck. Once the baby is out, make sure to wrap it gently with towels (not suffocatingly tight!), and bring the baby to skin-to-skin contact. That way the baby is kept warm. Do not cut the umbilical cord yet. Leave it be for a few minutes until it gives out all the blood it's capable, because 30% of the baby's blood is still on the placenta. Also cutting in with non-sterile items can cause an infection to the newborn. The umbilical cord will close the flow on it's own, so bother yourself with other things in priority. To help the baby breathe, massage the sides of the nostrils to help the amniotic fluid leave the nasal cavity and massage the back of its torso to encourage respiratory movement. Most babies draw their first breath since their first contact to the external world by the shock of the temperature drop, so there's no need to stimulate by hitting the butt as we see in the movies. Only 1% of babies require resucitation, and when you're alone and realise the baby is not breathing you open the mouth with a finger gently and puff a couple of small breaths into its lung. Don't try to puff breath like you would an adult, as babies have much smaller lungs and it could put too much stress on them. Next comes breastfeeding. After the initiation of breastfeeding there's a rush of oxytocin and the placenta will exit the uterus in about 20 minutes, so there will still be some contractions until that's done and over. In the end wait for the EMTs to cut the umbilical cord in a sterile manner. If you are still alone after you have completed all the above, with no hope of someone else coming to provide you with help, you can cut the umbilical cord by using whatever is closest to a sterilized blade. A heated knife is one idea. A sterilised scalpel blade fresh from the package is a better idea. At this point the umbilical cord has stopped the blood flow on its own so there's less posibility of infection. Sounds like a handful doesn't it? This is why keeping friends with a midwife is handy in a post-apocalyptic setting.