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Modern neonatal care in a fully equipped and staffed hospital connected to a power grid will be all but a memory in TEOTWAWKI. In the event of SHTF where professional medical services are no longer available it is completely up to the parent(s) to assist the newborn in the traumatic transition from womb to world. Knowledge of basic neonatal field care will increase the chances of survival for a newborn. This article is divided into three sections: Pregnancy, Transition, and First 48 Hours.

Pregnancy

The first section of this article deals with pregnancy. To begin our discussion of field care for your newborn, it is prudent to address women’s lifestyle choices today that will directly impact the success rate of their pregnancies and infant health tomorrow. In anticipation of potential TEOTWAWKI, we maximize our survival chances through diligent stockpiling, training and construction. In the same spirit, women should maximize their future children’s survival chances through healthy lifestyle choices that could contribute to a more robust pregnancy.
Women who have medical conditions such as diabetes, asthma and/or high blood pressure are at increased risk of having infants with difficult transitions. In addition, women who smoke, drink and/or use controlled substances during pregnancy are also increasing the risks for their future children. I thereby urge women to adopt and maintain healthy diets, exercise regularly, and break any addictions to nicotine and/or alcohol ASAP. Healthy lifestyle choices apply just as strongly for men, of course. Pursued jointly as a couple, healthy lifestyles can be more easily achieved and maintained. When SHTF, we must be in prime condition because there will be nobody and nowhere to run to for help.
It is estimated that approximately 15-30% of pregnancies end in miscarriage regardless of access to professional medical care. Of the uncomplicated, full-term pregnancies that result in delivery, 90% of infants transition without need for any intervention. 10% of infants will need some form of help, and of those, 1% will need intensive intervention. It is crucial to be prepared to assist the 10% with the acknowledgement that there is little that can be done for the 1% with intensive needs. Simply put, out of 100 babies born, 9 will need your help to survive the transition.

Transition

The second section of this article covers transition. The “transition” for a newborn is generally the first six hours of life. A newborn needs to be immediately evaluated to determine its initial state of health. Doctors have developed a simple system to do this called APGAR, which stands for APPEARANCE, PULSE, GRIMACE, ACTIVITY, and RESPIRATION. Each criteria are given a score from 0–2 based on the appearance and behavior of the baby. All scores are added up to determine whether your newborn is healthy or needs immediate help. The scores are calculated as follows:
APPEARANCE: blue=0; pink with blue extremities=1; pink=2
PULSE: no pulse=0; pulse<100=1; pulse>100=2
GRIMACE: (response to rubbing/scratching) no response=0; weak cry=1; loud cry/pulling away=2
ACTIVITY: floppy limbs=0; some flexing of limbs=1; flexing of limbs against resistance=2
RESPIRATION: absent=0; weak and irregular=1; strong, crying=2
The sum of these scores gauges the initial health of the baby as follows:
NORMAL: 7–10
LOW: 4–6
CRITICALLY LOW: 0–3.
APGAR can be administered by anybody. But in the heat of the moment, rational behavior and memory can be impaired. I suggest that you write down the basic APGAR scorecard on an index card and pack it in your BOB. If the APGAR guidelines are lost or forgotten, remember these basic guidelines: a baby born at term, crying or breathing with pink color and good tone can stay with the mother; a baby born floppy, silent or bluish must immediately be resuscitated.
Basic resuscitation is begun by briskly rubbing down the baby with a clean towel or cloth. This stimulates crying and reduces the risk of hypothermia. Infants who are not in severe danger should respond fairly quickly to physical stimulation. If they do not, they need advanced neonatal resuscitation. Infant CPR, unfortunately, is far beyond the scope of this article. While many individuals might have training or have cursory knowledge of basic adult CPR, all of it goes out of the window when it comes to infants. Infants are extremely delicate and can be fatally injured with even the most delicate efforts and loving intentions. This is why as a professional physician I direct parents and young couples to attend Infant CPR and/or Neonatal Resuscitation classes that are offered by the American Red Cross and American Heart Association as well as numerous institutions recommended. Go to www.redcross.org or www.heart.org to learn more.
Keep in mind that it is well within your abilities to rescue an infant in jeopardy. Nearly one half of all newborn deaths occur within the first 24 hours after birth. Many of these deaths are caused by asphyxia (inability to breathe). This means that with proper training, you could be equipped to effectively deal with a common complication among newborns. If you expect to become a parent within the next ten years, equip yourself with this valuable training and knowledge while it is still available.

First 48 Hours

The final section of this article covers general newborn field care topics including delayed cord clamping, umbilical stump care, skin-to-skin, breastfeeding, and nutrition.
The average newborn has about 300mL of blood (one can of soda) with a portion of the blood still in the placenta after delivery. If you were to place your hands on the umbilical cord before the placenta was delivered, you could feel the cord pulsating; this signifies that blood is being transfused back into the baby from the placenta. People pay thousands of dollars to collect and store the umbilical cord blood, with the hope that in the future the stem cells in the cord blood can be used if needed. There are OBGYNs who encourage the use of delayed cord clamping to auto-transfuse the baby with its own stem cells. The process is simple: do not clamp and cut the cord until you feel the cord stop pulsating. If there is concern for fetal compromise and resuscitation must be performed quickly , milk the cord several times towards the baby before clamping and cutting. Make sure to use sterilized instruments for cord clamping and cutting. In a survival scenario, submerge all knives, instruments and towels in a pot of boiling water for five minutes or more. Note that the tool or implement with which you retrieve the sterilized items from the pot must itself be sterilized first. A simple workaround is to pour the boiling water out of the pot and handle the knives and instruments upon actual intended usage.
There is no evidence that there needs to be any further care of the umbilical cord stump if the umbilical cord was clamped/cut in an aseptic (free from disease-causing bacteria) manner. In a sterile environment, dry cord care (keeping the stump clean and dry) is effective. Take care that the infant’s diaper is folded down below the umbilical stump. Dry cord care is recommended when sterile instruments have been used during delivery but this cannot be guaranteed without an autoclave machine. Therefore umbilical stump care may be necessary. Studies have shown that cleaning the umbilical stump with chlorhexidine reduced the rate of infection and newborn mortality. In the absence of chlorhexidine, use an antiseptic ointment or rubbing alcohol. The umbilical stump will separate after one week.
Skin-to-skin care – also called “Kangaroo Care” – describes a way of holding a newborn so that there are no clothing barriers between the infant and the mother. This form of mother-infant interaction has been shown in multiple studies to be beneficial. The benefits include assisting the baby to sleep better, breastfeed sooner, breastfeed better and increase weight gain faster. Research shows that this form of contact helps regulate the baby’s physiologic processes including pain responses, temperature, breathing, and heart rate. Preterm and low-birth weight infants who are born in resource-poor settings particularly benefit from kangaroo care. In a typical labor and delivery floor, stable infants are immediately placed on the mother’s abdomen in this manner to ease the stressful transition they undergo in childbirth. In a resource-poor setting, kangaroo care should be initiated immediately after childbirth for at least 30 minutes, but can last as long as the mother is able to tolerate. There are no guidelines for how long skin-to-skin care should continue, but many proponents encourage multiple daily episodes (short or long) for up to six weeks postpartum. Fathers may also contribute to this process and perform skin-to-skin care.
Breastfeeding is the recommended form of infant feeding by multiple medical associations because of the numerous benefits to the infant as well as to the mother. Breast milk promotes intestinal growth/motility, protects against infections or certain chronic diseases, and provides optimal nutrition. This process can be frightening and frustrating for some parents. Adequate positioning and latch are important for successful breastfeeding.
For good positioning, place a pillow on the mother’s lap for support, and then place the infant on the pillow. Using the arm opposite the breast that is being used to breastfeed, cradle the infant so that his/her head is supported by a “C” formed with the hand around the base of the skull. An effective latch is characterized by the infant’s mouth covering the entire nipple and much of the areola. The baby should not be sucking the nipple only.
Newborns in a hospital receive a regimen of standard care: eye ointment for the prevention of gonococcal infection, vitamin K to prevent bleeding, hepatitis B vaccine, and blood sugar and bilirubin monitoring. This battery of care will of course not administered in TEOTWAWKI. Certain steps can be taken, though, to evaluate and improve the health of the baby with the means at hand.
Infants are born with nutritional stores that will supplement them during the first few days after birth. Weight loss is normal in infants in the first week of life. However, weight loss greater than 10% is cause for concern. Signs of infant dehydration include: lethargy, loose skin, decreased urine output, and delayed capillary refill time. Capillary refill can be assessed by applying pressure on the infant’s sternum for 5 seconds; if the color fails to return in less than 3 seconds, this suggests dehydration. Monitoring of input and output ought to be done as well. Newborn babies feed every 2-3 hours during the first month of life. Also, urination and defection should occur within the first 24 hours of infant life. Consider supplementing with formula if available.
In summary, this article has attempted to promote awareness about TEOTWAWKI field care for your newborn. Hopefully it has provided numerous touch points from which you can launch your own study, training, and preparation. While all our means of shelter, sustenance, and defense will ensure our personal survival in a WROL, only our children ensure our collective survival.

Disclaimer: This article for educational purposes. It is not a substitute for medical care under the direct supervision of a physician or in a hospital.

James,

In a recent TCCC class, more info was covered on why hemostatic infused gauze is preferred over Hemostatic granules.
 
The concept for Hemostatic agents was first explored with the use of instant mashed potatoes dumped into a wound. The blood soaked the potatoes thickening them up and helping aid the blood in clotting. This was efficient, until it was realized that the potato “granules” were being carried into the blood stream and causing blood clots. Obviously, this is a very bad thing. When the hemostatic agent was first created in a granule form, it did the same thing as the mashed potatoes did, only faster. However there was a small chance of the granules once again escaping into the blood stream causing blood clots.
 
In a combat zone where helicopters were used for evacuation of wounded – same as in most rural areas of America, the rotor wash would blow the granules out of the wound (bad) and sometimes blow them into the eyes of the medics or others present causing eye issues.
 
After application of the granules, Gauze of some sort as well as a trauma bandage had to be applied.
 
Next up in the evolution of progress was Hemostatic Infused Gauze. This has avoided the issue that the granules had, and helped speed up the blood clotting due to the Gauze being applied as the Hemostatic is. In a situation where a Hemostatic agent is being applied, clearly time is life. So removing one step out of the blood stopping and bandaging equation is a good thing.

Just something to be aware of. – Bluelinesheepdog

Hi James, 
Sometimes the easy solution to a serious medical supply problem is hidden right in front of us. I am and adult-onset Type 2 insulin-dependent diabetic prepper. My life depends on a regular and continuous supply of medicines.

What will I do when all of the available test strips for my “Accu-chek” Aviva blood tester strips are out of date and will not function in my Veterans Administration-supplied tester?

In the military we were taught that the winners  learn to adapt, overcome, and improvise. After the military, as a self- employed father of four, I learned another  basic rule of success in difficult times, for dealing with dangerous events, and for most important activities. When I see that I have a serious problem, and I am not winning, I change the rules! This is not all that complicated.

When my glucose test strips are out of date for my Veterans Administration (VA) supplied tester, I simply change the date in the tester itself. 12-12-2012 becomes 12-12-2011, or what ever past date will allow the tester to only see a test strip that is not out of date. 

I lie to my tester about the date. My tester  knows that I am a nice guy, and it always believes me, and uses the out of date strips.

An additional small piece of knowledge, which can be extremely valuable to  folks like myself, is the real time facts about refrigeration of insulin. Most refrigerators cool the contents to 37-38 degrees F and that is  below the recommended safe temperature range of 60 – 86 for insulin. Our home is well insulated and I keep the current usage insulin bottles on top of my desk with full confidence that it is safe to use because our inside house temperature stays at about 65 – 70 F all year. One bottle of insulin lasts me about 9 days.  from the Internet concerning insulin temperature safety:

  It is usually okay to keep a bottle of insulin you are using at room temperature for up to 28 days provided  the room temperature is 59º to 86º F. 

We live in the high desert in the southwest and of course there are seasonal summer days of 100 plus degree outdoor temperatures. For cooling in the event of a serious power outage,  we have pre-positioned the materials for our Zeer Pot Fridge, in our garage.  For full written and picture instructions on construction and usage just doe web search on the phrase “zeer pot fridge” and you will be in the cooling stuff business. Just don’t wait until the power goes out to search for instructions. Although we have not yet needed it, we have tested it. We  feel very safe knowing it does work and  having the required materials needed on hand. 

A Zeer Pot is is a zero electrical power evaporative cooler that will take most items from 95 degrees down to 35 degrees in about 12 hours. Fresh vegetables will actually stay fresh for about 7 – 10 days.  It is simply two inexpensive large clay pots with a smaller one inside a larger pot. They are separated by a thick, about 2 inches, layer of very fine ground sand. Just pour water slowly into the sand until the sand is fully saturated with the water, then put your item to be cooled into the smaller pot and cover the 2 pots with a damp cloth . The evaporation process will cool the contents very nicely. Just keep the sand and the cover wet!

Now let us talk about paying for our preparedness stuff. We have been able to partially fund our prepper medical supplies thru my status as a VA-enrolled veteran. I took my private non VA doctors medicine prescriptions into my VA primary care doctor.  

The VA doctor then wrote new VA scrips for the meds and filled them for me at little or no cost to us. There’s a maximum $8 co-pay for “some” higher income  vets. This co-pay varies with the specific county a vet lives in. Google VA.gov and search the site for co-pay information.

I do not get our less-expensive OTC medical items from the VA because the congressional funding for VA is never enough. Lets not even think about politics and funding for our vets health care. Forget what the military recruiters said about lifetime free health care. They actually believed that line themselves. They are not getting free care either. Additionally when we can afford to get both the VA meds and the non-VA meds, I have been able to buy some extras to build up a medicine reserve supply. 

I also have to deal with chronic obstructive pulmonary disease (COPD), which is very serious and often very dangerous. For respiratory emergency quick relief, which is usually 3-4 times daily, I use an albuteral inhaler. The VA  sends them to me monthly at no cost to me. And we do appreciate the VA care I get!

For the all important reserve supply, I use an (S)albuteral puffer.  These inhalers are inexpensive and area available from India. Before I made my first overseas purchase, I did my regular safety research and  talked to my non-VA doctor about the Indian supplied medicines.  He did not have a problem in any way.  I do try to remember to rotate my medical supplies so as to use the oldest first. I tested their service with a single stand-by box of 15 inhalers I purchased from an Indian pharmacy that were manufactured in Australia by Smith-Glaxo-Kline, a huge company. My cost, to include their standard $25 shipping, for 15 inhalers,  was $77.50. The inhalers themselves cost were $3.50 each. That bought me a full one year supply

About ten years ago at Costco my inhalers cost about $4.50 each.  With the federally required new propellants, these inhalers locally now cost about $45 each without insurance, and about $10 each with insurance, provided you have a written prescription. There is no requirement for a prescription by  the overseas vendors. There are many Indian pharmacies available and I have had good results doing business with AllDayChemist.com. This Indian company supplied inhalers use the same  FDA-required type propellants as do the American-supplied inhalers. 

The small shipping box was plainly marked as a personal health product not for resale. Nothing was hidden and everything about the medicine contents was completely honest and open. It came through our Customs cleanly with no import costs and then passed through our U.S. Postal system with zero complications or delays. 

I now have an ample 2++ years reserve inhaler supply on hand.  We also have great peace of mind and enough meds to be able to share with others if it should become necessary. We believe that we do not have enough for ourselves unless we have enough to give some to the needy, those who are truly not able to help themselves.

We have been taught many important lessons of preparedness and frugality by the many entries published in your blog site and by the many friends with who we have spent countless  hours talking about current event and how best to be ready for whatever may come our way. We are very fortunate to have a terrific relationship with our close neighbor the world’s best veterinarian who smiled and handed me a thick catalog of everything that might ever be used in his clinic. To this very day I have an icon of that web site on my Mac computer startup screen.  There are a great many good veterinary supply sources available through the Internet. Google is a great way to search, but it really doesn’t matter which search engine someone uses. 

We have used the Internet to obtain most of our preparedness supplies and my sweet wife even bought some medical scrubs to do her gardening chores. They were on close out sale at 99 cents per item.

Another great buy was FISH MOX FORTE (Amoxicillin 500 mg ) @ 100 tablets for $27.96.

It is very important to maintain a low profile in situations where a person is planning to acquire animal medications for possible disaster times usage. Try to be sure before you bring up these topics that the person you are going to ask for help in your buying activities will not be likely to say no and never forget that you asked.  It may be best to wait until you are at the veterinarian for a regular pet care visit and ask about backup pet meds in cause there is another serious power outage. Just start the topic and then wait for the veterinarian’s response .

You will be able to gauge the veterinarian’s prepper status easily. You will benefit greatly from a diligent web search of information concerning the use and availability of pet medications and vet clinic supplies that are readily available through the internet.

Support the troops coming home from these very difficult multiple deployments. They are usually in bad shape emotionally. The stats are frightening. The Post-Traumatic Stress Disorder (PTSD) rate is 41%. The marriage breakup rate is 80%. And 15% of our “combat” returnees are female. These fabulous women fly our planes and drive our trucks and live in harm’s way every day. We have the finest military force this nation has ever fielded. Better educated. Better motivated. Better trained. They are our best. I am proud to be a veteran of our military. I am proud of my American Legion brothers and sisters. I am proud to be the grandfather of a infantry grandson.