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+The Project Gutenberg E-text of Emergency Childbirth,
+by U.S. Department of Defence and
+U.S. Department of Health, Education, and Welfare
+</TITLE>
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+<pre>
+
+The Project Gutenberg EBook of Emergency Childbirth, by
+U. S. Department of Defence and U. S. Department of Health, Education, and Welfare
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever. You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Emergency Childbirth
+ A Reference Guide for Students of the Medical Self-help
+ Training Course, Lesson No. 11
+
+Author: U. S. Department of Defence
+ U. S. Department of Health, Education, and Welfare
+
+Release Date: October 14, 2008 [EBook #26923]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EMERGENCY CHILDBIRTH ***
+
+
+
+
+Produced by David Reed and Al Haines.
+
+
+
+
+
+</pre>
+
+
+<BR><BR>
+
+
+<H1 ALIGN="center">
+EMERGENCY CHILDBIRTH
+</H1>
+
+<BR>
+
+<H2 ALIGN="center">
+ A REFERENCE GUIDE FOR STUDENTS OF<BR>
+ THE MEDICAL SELF-HELP TRAINING COURSE<BR>
+<BR>
+LESSON NO. 11
+</H2>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+ACKNOWLEDGMENT
+</H3>
+
+<P>
+We wish to acknowledge with grateful appreciation the many services
+provided by the American Medical Association, through the Committee on
+Disaster Medical Care, Council on National Security, Board of Trustees
+and staff, in the preparation of this handbook.
+</P>
+
+<P>
+From the inception of studies to determine emergency health techniques
+and procedures, the Association gave valuable assistance and support.
+The Committee on Disaster Medical Care of the Council on National
+Security, AMA, reviewed the material in its various stages of
+production, and made significant contributions to the content of the
+handbook.
+</P>
+
+<br>
+
+<H5 ALIGN="center">
+ A joint publication of the<BR>
+ U.S. DEPARTMENT OF DEFENSE<BR>
+ Office of Civil Defense<BR>
+<BR>
+ and the<BR>
+<BR>
+ U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE<BR>
+ Public Health Service<BR>
+ Health Services and Mental Health Administration<BR>
+ Division of Emergency Health Services<BR>
+ 5600 Fishers Lane, Rockville, Maryland 20852<BR>
+<BR>
+ Reprinted December 1970<BR>
+</H5>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+EMERGENCY CHILDBIRTH
+</H3>
+
+<H3 ALIGN="center">
+What To Do
+</H3>
+
+<P CLASS="noindent">
+ 1. Let nature be your best helper. Childbirth is a very natural act.<BR>
+ 2. At first signs of labor assign the best qualified person to remain
+ with mother.<BR>
+ 3. Be calm; reassure mother.<BR>
+ 4. Place mother and attendant in the most protected place in the
+ shelter.<BR>
+ 5. Keep children and others away.<BR>
+ 6. Have hands as clean as possible.<BR>
+ 7. Keep hands away from birth canal.<BR>
+ 8. See that baby breathes well.<BR>
+ 9. Place baby face down across mother's abdomen.<BR>
+ 10. Keep baby warm.<BR>
+ 11. Wrap afterbirth with baby.<BR>
+ 12. Keep baby with mother constantly.<BR>
+ 13. Make mother as comfortable as possible.<BR>
+ 14. Identify baby.<BR>
+</P>
+
+<BR>
+
+<H3 ALIGN="center">
+What Not To Do
+</H3>
+
+<P CLASS="noindent">
+ 1. DO NOT hurry.<BR>
+ 2. DO NOT pull on baby, let baby be born naturally.<BR>
+ 3. DO NOT pull on cord, let the placenta (afterbirth) come naturally.<BR>
+ 4. DO NOT cut and tie the cord until baby <I>AND</I> afterbirth have
+ been delivered.<BR>
+ 5. DO NOT give medication.<BR>
+</P>
+
+<P>
+DO NOT HURRY&mdash;LET NATURE TAKE HER COURSE.
+</P>
+
+<P>
+If it becomes necessary for families to take refuge in fallout shelters
+there will undoubtedly be a number of babies born under difficult
+conditions and without medical assistance.
+</P>
+
+<P>
+Every expectant mother and the members of her family should do all they
+can to prepare for emergency births. They will need to know what to do
+and what to have ready. (See "Expectant Mother's Emergency Kit.")
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+SPECIAL SAFEGUARDS
+</H3>
+
+<P>
+A pregnant woman should be especially careful to protect herself from
+radiation exposure. She should have the most protected corner of the
+shelter and not be allowed to risk outside exposure. She should not
+lift heavy objects or push heavy furniture. If food shortages exist,
+she should be given some preference.
+</P>
+
+<P>
+Fear and possible exertion involved during an atomic attack will
+probably increase the number of premature births and of miscarriages.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+PREPARATIONS
+</H3>
+
+<P>
+Usually there is plenty of time after the beginning of first labor
+pains to get ready for the delivery. Signs of labor are low backache,
+bloody-tinged mucous strings passing from the birth canal, or a gush of
+water from the birth canal.
+</P>
+
+<P>
+The mother will need a clean surface to lie on. Her bed should be so
+arranged that the mattress is well protected by waterproof sheeting or
+pads made from several thicknesses of paper covered with cloth. Cover
+these protective materials with a regular bedsheet.
+</P>
+
+<P>
+A warm bed should be made ready in advance for the baby. It may be a
+clothes basket, a box lined with a blanket, or a bureau drawer placed
+on firm chairs or on a table. If possible, warm the baby's blanket,
+shirt, and diapers with a hot water bottle. Warm bricks or a bag of
+table salt that has been heated can be used if a hot water bottle is
+not available.
+</P>
+
+<P>
+A knife, a pair of scissors, or a razor should be thoroughly cleansed
+and sterilized in preparation for cutting the umbilical cord. If there
+is no way to boil water to sterilize them (the preferred method of
+sterilization), sterilize them by submersion in 70 percent isopropyl
+alcohol solution for at least 20 minutes or up to 3 hours, if possible.
+Sterile tapes for tying the umbilical cord will be needed. (Do not
+remove them from their sterile wrappings until you are ready to use
+them.) If no tapes are available, a clean shoestring or a strip of
+sheeting (folded into a narrow tie) can be boiled and used wet as a
+cord tie substitute.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+STAGES OF LABOR
+</H3>
+
+<P>
+Labor is the term used to describe the process of childbirth. It
+consists of the contractions of the wall of the womb (uterus) which
+force the baby and, later, the afterbirth (placenta) into the outside
+world. Labor is divided into three stages. Its duration varies greatly
+in different persons and under different circumstances.
+</P>
+
+<P>
+During the first and longest stage, the small opening at the lower end
+of the womb gradually stretches until it is large enough to let the
+baby pass through. The contractions (tightening) of the uterus, which
+bring about this stretching and move the baby along into the birth
+canal, cause pains known as labor pains.
+</P>
+
+<P>
+These pains, usually beginning as an aching sensation in the small of
+the back, turn in a short time into regularly recurring cramplike pains
+in the lower abdomen. By placing your hand on the mother's abdomen just
+above the navel, you can feel each tightening of the uterus as an
+increasing firmness or hardness. It lasts for 30 to 60 seconds. The
+pains disappear each time the uterus relaxes.
+</P>
+
+<P>
+At first these pains occur from 10 to 20 minutes apart and are not very
+severe. They may even stop completely for a while and then start up
+again. The mother should rest when she is tired but need not be lying
+down continuously. She may sleep between tightenings if she can. She
+can take a little water or perhaps tea during the entire labor process.
+She should urinate frequently during labor so the bladder will be as
+empty as possible at the time of birth.
+</P>
+
+<P>
+The skin in the vaginal area of the mother should be sponged
+occasionally with soapy water. Special attention should be given to
+cleaning the inner sides of the thighs and the rectal area with heavy
+lather. Soap or water should not be allowed to enter the vagina.
+</P>
+
+<P>
+A slight, watery, bloodstained discharge from the vagina normally
+accompanies labor pains or occurs before the pains begin.
+</P>
+
+<P>
+For first babies, this stage of labor may continue for as long as 18
+hours or more. For women who have had a previous baby, it may last only
+2 or 3 hours.
+</P>
+
+<P>
+The end of this first stage is usually signaled by the sudden pressing
+of a large gush of water (a pint or so), caused by the normal breaking
+of the bag of waters which surrounds the baby in the mother's womb. For
+some women, the bag of waters breaks before labor begins or perhaps as
+the first sign of its beginning. This should not cause the mother or
+those helping her any concerns. It usually does not seriously affect
+the birth.
+</P>
+
+<P>
+Through this first stage of labor, the mother does not have to work to
+help the baby be born. She should not try to push the baby down, but
+should try to relax her muscles. She can help do this by taking deep
+breaths with her mouth open during each tightening.
+</P>
+
+<CENTER>
+<IMG SRC="images/childbirth4.jpg" ALT="Figures 4A, 4B, 4C, 4D" BORDER="2" WIDTH="712" HEIGHT="1118">
+</CENTER>
+
+<P CLASS="caption">
+[Illustration: A. At full term, or after 40 weeks of pregnancy, the
+baby is ready to be born. The cervix through which baby must leave the
+uterus is shown clearly here, still closed. The contractions of the
+muscles of the uterus will open the cervix, and force the baby down
+through the vagina, or birth canal, to the outside.]
+</P>
+
+<P CLASS="caption">
+[Illustration: B. At the end of the first stage of labor the cervix is
+completely open and the baby's head is beginning to come down through
+the vagina. Contractions begin in the lower back and later are felt in
+the lower abdomen. At the time shown here contractions are probably
+coming every 2 minutes, lasting 40-60 seconds and very strong.]
+</P>
+
+<P CLASS="caption">
+[Illustration: C. The first stage of labor usually lasts several hours
+and is hard work. The mother needs to relax, rest, and be reassured.
+Give her water and fruit juices. In this picture the second stage of
+labor is well along. It is shorter than the first stage and the mother
+will now be pushing down with each contraction, helping to force the
+baby into the world. ]
+</P>
+
+<P CLASS="caption">
+[Illustration: D. The head of the baby has been partially born. This
+shows the usual position with the face down and the back of the head
+up. The bag of waters in which the baby is enclosed throughout the
+pregnancy may have broken at the beginning of labor, before or during
+the first stage. It may break now, or have to be torn with the fingers.]
+</P>
+
+<CENTER>
+<IMG SRC="images/childbirth5.jpg" ALT="Figure 4E" BORDER="2" WIDTH="698" HEIGHT="416">
+</CENTER>
+
+<P CLASS="caption">
+[Illustration: E. Here you see the baby's head turned to the right as
+is usual. The shoulders are about to be born. The head must turn so
+that the baby's body can fit into the birth canal and come through more
+easily. After the birth of the baby there will be further uterine
+contractions and the placenta will be separated from the uterine wall
+and expelled.]
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+CHANGE OF FEELING
+</H3>
+
+<P>
+Gradually the time between the labour pains grows shorter and the pains
+increase in severity until they are coming every 2 to 3 minutes. It
+will not be long now before the baby is born.
+</P>
+
+<P>
+At this stage the mother will notice a change. Instead of the tightness
+in the lower abdomen and pain across the back, she will feel a bearing
+down sensation almost as if she were having a bowel movement. This
+means the baby is moving down.
+</P>
+
+<P>
+When this happens, she should lie down and get ready for the birth of
+the child. The tightening and bearing down feelings will come more
+frequently and be harder.
+</P>
+
+<P>
+She will have an uncontrollable urge to push down, which she may do.
+But she should not work too hard at it because the baby will be brought
+down without her straining too hard. There will probably be more blood
+showing at this point.
+</P>
+
+<P>
+<I>The person attending the delivery should thoroughly scrub hands with
+soap and water. Never touch the vagina or put fingers inside for any
+reason. The mother also should keep her hands away from the vagina.</I>
+</P>
+
+<P>
+As soon as a bulge begins to appear in the vaginal area and part of the
+baby is visible, the mother should stop pushing down. She should try to
+breathe like a panting dog with her mouth open in order not to push the
+baby out too rapidly with consequent tearing of her tissue.
+</P>
+
+<P>
+She should keep her knees up and legs separated so that the person
+helping her can get at the baby more easily.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+MOMENT OF BIRTH
+</H3>
+
+<P>
+<I>The person helping the mother should always let the baby be born by
+itself. No attempt should be made to pull the baby out in any way.</I>
+</P>
+
+<P>
+Usually the baby's head appears first, the top of the head presenting
+and the face downward. Infrequently the baby will be born in a
+different position, sometimes buttocks first, occasionally foot or arm
+first. In these infrequent situations, patience without interference in
+the birth process is most important. The natural process of delivery,
+although sometimes slower, will give the child and the mother the best
+chance of a safe and successful birth.
+</P>
+
+<P>
+The baby does not need to be born in a hurry, but usually about a
+minute after the head appears the mother will have another bearing down
+feeling and push the shoulders and the rest of the baby out.
+</P>
+
+<P>
+As the baby is being expelled, the person helping the mother should
+support the baby on her hands and arms so that the baby will avoid
+contact with any blood or waste material on the bed.
+</P>
+
+<P>
+If there is still a membrane from the water sac over the baby's head
+and face at delivery, it should immediately be taken between the
+fingers and torn so that the water inside will run out and the baby can
+breathe.
+</P>
+
+<P>
+If, as sometimes happens, the cord, which attaches the child from its
+navel to the placenta in the mother's womb, should be wrapped around
+the baby's neck when his head and neck appear, try to slip it quickly
+over his head so that he will not strangle.
+</P>
+
+<P>
+After the baby is born, wrap a fold of towel around his ankles to
+prevent slipping and hold him up by the heels with one hand, taking
+care that the cord is slack. To get a good safe grip, insert one finger
+between the baby's ankles. Do not swing or spank the baby. Hold him
+over the bed so that he cannot fall far if he should slip from your
+grasp. The baby's body will be very slippery. Place your other hand
+under the baby's forehead and bend its head back slightly so that the
+fluid and mucus can run out of its mouth. When the baby begins to cry,
+lay him on his side on the bed close enough to the mother to keep the
+cord slack.
+</P>
+
+<P>
+The baby will usually cry within the first minute. If he does not cry
+or breathe within 2 or 3 minutes, use mouth-to-mouth artificial
+respiration.
+</P>
+
+<P>
+<I>Very little force should be used in blowing air into the baby's
+mouth</I>. A short puff of breath about every 5 seconds is enough. As soon
+as the baby starts to breathe or cry, mouth-to-mouth breathing should
+be stopped.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+CUTTING THE CORD
+</H3>
+
+<P>
+There should be no hurry to cut the cord. Take as much time as
+necessary to prepare the ties and sharp instruments.
+</P>
+
+<P>
+You will need two pieces of sterile white cotton tape or two pieces of
+1-inch-wide sterile gauze bandage about 9 inches long to use to tie the
+cord. (If you do not have sterile material for tying the cord but do
+have facilities for boiling water, strips of sheeting&mdash;boiled for 15 to
+20 minutes to make them sterile&mdash;can be used.) Tie the umbilical cord
+with the sterile tape in two places, one about 4 inches from the baby
+and the other 2 inches farther along the cord toward the mother, making
+two or more simple knots at each place. Cut the cord between these two
+ties with a clean sharp instrument such as a knife, razor blade, or
+scissors.
+</P>
+
+<P>
+A sterile dressing about 4 inches square should be placed over the cut
+end of the cord at the baby's navel and should be held in place by
+wrapping a "bellyband" or folded diaper around the baby. If a sterile
+dressing is not available, no dressing or bellyband should be used.
+Regardless of whether a dressing is applied or not, no powder,
+solution, or disinfectant of any kind should be put on the cord or
+navel.
+</P>
+
+<P>
+If the afterbirth has not yet been expelled, cover the end of the
+umbilical cord attached to it (and now protruding from the vagina) with
+a sterile dressing and tie it in place.
+</P>
+
+<CENTER>
+<IMG SRC="images/childbirth7.jpg" ALT="Figure 7" BORDER="2" WIDTH="612" HEIGHT="544">
+</CENTER>
+
+<P CLASS="caption">
+[Illustration: Cut between the square knot by bringing the left tape
+over right tape for first loop and right tape over left for second
+loop. Tighten each loop firmly as tied. Use scissors or a razor blade
+to cut cord.]
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+THIRD STAGE OF LABOR
+</H3>
+
+<P>
+Usually a few minutes after the baby is born (although sometimes an
+hour or more will elapse) the mother will feel a brief return of the
+labor pains which had ceased with the birth. These are due to
+contractions of the uterus as it seeks to expel the afterbirth. <I>Do not
+pull on the cord to hurry this process</I>.
+</P>
+
+<P>
+Some bleeding is to be expected at this stage. If there is a lot of
+bleeding before the afterbirth is expelled, the attendant should gently
+massage the mother's abdomen, just above the navel. This will help the
+uterus to tighten, help the afterbirth come out, and reduce bleeding.
+</P>
+
+<P>
+It may be desirable to put the baby almost immediately to the mother's
+breast for a minute or two on each side even though the mother will
+have no milk as yet. This helps the uterus contract, and reduces the
+bleeding.
+</P>
+
+<P>
+Someone should stand by the mother and occasionally massage her abdomen
+gently for about an hour after the afterbirth is expelled. After that
+the mother should feel the rounded surface of the uterus through the
+abdomen and squeeze firmly but gently with her fingers. The bedding
+should be cleansed and the mother sponged. Washing and wiping of the
+vaginal area should always be done from the front to the back in order
+to avoid contamination. A sanitary napkin should be applied.
+</P>
+
+<P>
+Keep the mother warm with blankets. She may have a slight chill. Give
+her a warm (not hot) drink of sweetened tea, milk, or boullion. Wipe
+her hands and face with a damp towel. She may drop off to sleep.
+</P>
+
+<P>
+The mother's diet after delivery may include any available foods she
+wishes. She may eat or drink as soon as she wants to, and she should be
+encouraged to drink plenty of fluids, especially milk. Canned milk can
+be used and made more palatable by diluting with equal parts of water
+and adding sugar, eggs, chocolate, or other flavoring.
+</P>
+
+<P>
+For the first 24 or 48 hours after delivery, the mother will continue
+to have some cramping pains in the lower abdomen which may cause a
+great deal of discomfort. Aspirin may help relieve these afterpains.
+She should empty her bladder every few hours for 2 days following the
+birth. If her bowels do not move within 3 days after delivery she
+should be given an enema.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+MISCARRIAGE
+</H3>
+
+<P>
+If a pregnant woman shows evidence of bleeding, she should restrict her
+activities and rest in bed in an effort to prevent possible loss of the
+baby. If a miscarriage does occur, keep the patient flat with the foot
+of the bed elevated from 12 to 18 inches to retard vaginal bleeding.
+Keep her warm and quiet, and give her fluids.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+EXPECTANT MOTHER'S EMERGENCY CHILDBIRTH KIT
+</H3>
+
+<P>
+The public health and civil defense agencies of one State have planned
+a 1 1/2-pound emergency childbirth kit made up of basic supplies that
+can be carried in a 1-yard-square receiving blanket.
+</P>
+
+<P>
+The kit consists of the following:
+</P>
+
+<P CLASS="noindent">
+ One-yard square of outing flannel, hemmed (receiving blanket).<BR>
+ Plastic (polyethylene flexible film) for outer wrapping of the
+ kit if desired. (<I>Do not</I> wrap the baby in this plastic film.)<BR>
+ One or two diapers.<BR>
+ Four sanitary napkins (wrapped).<BR>
+ Adhesive tape identification strips for mother and baby.<BR>
+ Short pencil.<BR>
+ Soap.<BR>
+ Sterile package containing:<BR>
+ &nbsp;&nbsp;&nbsp;&nbsp;Small pair of blunt-end scissors (cheapest scissors will do),
+ or a safety razor blade with a guard on one side.<BR>
+ &nbsp;&nbsp;&nbsp;&nbsp;Four pieces of white cotton tape, 1/2 inch wide and 9 inches
+ long.[1]<BR>
+ &nbsp;&nbsp;&nbsp;&nbsp;Four cotton balls.<BR>
+ &nbsp;&nbsp;&nbsp;&nbsp;Roll of 3-inch gauze bandage.<BR>
+ &nbsp;&nbsp;&nbsp;&nbsp;Six 4-inch squares of gauze.[1]<BR>
+ &nbsp;&nbsp;&nbsp;&nbsp;Two or more safety pins.<BR>
+</P>
+
+<P CLASS="footnote">
+[1] You will actually use only two tapes for tying the umbilical cord.
+The two extras are included as a safeguard in case one or two should
+be dropped or soiled. Extra 4-inch squares of gauze also are included.
+</P>
+
+<CENTER>
+<IMG SRC="images/childbirth9.jpg" ALT="Emergency childbirth kit" BORDER="2" WIDTH="668" HEIGHT="228">
+<H4>
+Emergency childbirth kit
+</H4>
+</CENTER>
+
+<P>
+Instructions such as those contained in this chapter also should be
+considered a part of the emergency childbirth kit.
+</P>
+
+<P>
+To make the kit ready to carry, lay the plastic (if used) out flat, and
+lay receiving blanket out flat on top of the plastic. Place the
+diapers, sterile package, soap, sanitary napkins, identification tapes,
+pencil and instructions in the center. Pull two opposite corners of the
+receiving blanket and plastic together and tie. Do the same with the
+other opposite corners, pulling each side together well so that nothing
+will fall out. Then tightly knot the loose ends together in the same
+way, leaving an opening so that the kit can be slipped over the arm for
+carrying the kit while leaving the hands free.
+</P>
+
+<P>
+Such an emergency delivery kit will weigh about 1 1/2 pounds. The
+contents suggested are basic essentials only, for extreme emergency.
+Much more could be added, but the extra weight might mean leaving
+behind some other items needed for survival. Additional supplies could
+be stored in your home shelter to be ready in the event the birth takes
+place there. In the case there is no need for an emergency delivery,
+either in the home, shelter or in some evacuation situation, the
+supplies in the kit can be used in home care of the baby.
+</P>
+
+<BR><BR><BR>
+
+<H3 ALIGN="center">
+IDENTIFICATION TAPES
+</H3>
+
+<P>
+In emergency situations, identification will be particularly important,
+especially if the birth should take place in a group shelter rather
+than a family shelter, or in an evacuation situation.
+</P>
+
+<P>
+Two wide strips of adhesive tape will be needed&mdash;one long enough to go
+around the mother's wrist, and the other long enough to go around the
+baby's ankle. Information should be written on these strips as shown
+below.
+</P>
+
+<CENTER>
+<IMG SRC="images/childbirth10a.jpg" ALT="Identification tape&mdash;for mother" BORDER="2" WIDTH="671" HEIGHT="354">
+<H4>
+Identification tape&mdash;for mother
+</H4>
+</CENTER>
+
+<P CLASS="caption">
+[Illustration: For mother&mdash;Write parents' names, blood types, and
+mother's Rh factor, street address, and whether it is a first or later
+child.]
+</P>
+
+<CENTER>
+<IMG SRC="images/childbirth10b.jpg" ALT="Identification tape&mdash;for baby" BORDER="2" WIDTH="666" HEIGHT="229">
+<H4>
+Identification tape&mdash;for baby
+</H4>
+</CENTER>
+
+<P CLASS="caption">
+[Illustration: For baby&mdash;Write date and hour of birth and parents'
+names and address.]
+</P>
+
+<BR><BR><BR><BR>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of Emergency Childbirth, by
+U. S. Department of Defence and U. S. Department of Health, Education, and Welfare
+
+*** END OF THIS PROJECT GUTENBERG EBOOK EMERGENCY CHILDBIRTH ***
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+</BODY>
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+</HTML>
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+
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