Neurotic behaviour
Neurotic behaviour is a chronic condition and the first aid provider is more likely to be called on to attend the 'by products' of the illness, such as the wounds of a person who self-mutilates or a person who attempts or threatens suicide as a plea for help. If called on to assist in a case like this, treat any injuries objectively - don't comment on the cause. Be sympathetic and provide support as required. Above all, be a good listener!
In conversation, the same rules apply as for conversation with a person in psychosis.
Transient aberrant behaviour
Transient aberrant behaviour is a temporary condition, but no less serious. Severe emotional and physiological stress puts intolerable pressure on the affected person and the resultant outburst has the potential to be violent.
Recognition of the onset of stress likely to cause aberrant behaviour is the key to caring for a potential sufferer.
Sign and symptoms
- History of recent emotionally or physiologically, stressful situation
- Personality - does the person usually cope easily with stress?
- Mood swings, emotional outbursts
- Depression - indifference towards relatives, friends
- Deterioration in personal appearance
- Increased inattention to family/children
Care for a person presenting with these signs and symptoms is initially support and understanding. Remember this is a temporary condition and this event is not 'the real individual'.
Treatment for the condition is referral to professional psychological help. It may be difficult to persuade the sufferer to attend psychological counselling, but if all else fails, encourage them to visit a trusted doctor.
Childbirth emergency
At some time in the future, you may be called on to assist with the birth of a baby. This activity is a most rewarding one for a first aid provider and there is no need to be frightened or nervous about it. The mother requires support and reassurance more than anything else and if you appear calm and confident this will show her you are someone to rely on.
Remember women have been performing the function of childbirth for a long time and the process is natural. You are there to provide any help that may be required during a process that is controlled by the mother. Your active intervention is necessary only in extreme situations. Childbirth is open to infection. It is imperative you take all possible precautions for mother and child against infection from yourself and from the surroundings.
Ensure you wear gloves during the process. If gloves are unavailable, ensure you scrub your hands thoroughly with soap and warm water.
Change your gloves or scrub your hands each time they come in contact with contaminated material, e.g. faeces, blood, etc.
Childbirth occurs in three stages:
- 1st Stage - the onset of labour
- 2nd Stage - the birth of the baby
- 3rd Stage - the delivery of the afterbirth
First stage: onset of labour
The onset of labour may last between two and 24 hours. It begins with cramp-like pains in the lower abdomen, a 'heavy' feeling low down near the pubic area or some may experience back pain. The pains occur regularly every 5-20 minutes and last for approximately 30 seconds.
In some instances, examination of the woman's vagina may reveal a 'show' of bloodstained mucus heralding the imminent birth of the baby. At this point, urgent ambulance or medical attention should be sought.
During this stage, there may occur a 'breaking of the waters'; a sudden flow of fluid from the membrane around the baby.
If it is obvious it is too late to move the woman to hospital, there is little you can do except keep the mother-to-be clean and provide reassurance.
Now the birthing process has begun, you should prepare for it by organising:
- A large plastic sheet to cover the bed or floor
- Two or three clean sheets
- Three clean linen or string ties about 25cm long
- Sharp scissors which have been boiled and kept as sterile as possible
- Sterile pads (large combines are ideal) for the mother
- A warm nappy or 'bunny rug' for the baby
- Towels, face washers and warm water to clean the mother
Second stage: birth of the baby
At this stage, the baby has moved down further into the birth canal. The pains change to 'bearing down' pains. These contractions may stimulate the mother to want to pass a bowel motion.
Do not let her go to the toilet unaccompanied! Check medical aid is on the way.
The baby will move down the birth canal. There will usually be an increase in bloodstained mucus and eventually the top of the baby's head will become visible - this is called 'crowning'. Most babies are born head-first, though occasionally a baby presents buttocks- first. This is known as a 'breech birth' and the mother may be unable to give birth without trained medical assistance.
When you observe the 'crowning' process, if possible again wash your hands or change your gloves, if time allows. The mother may unavoidably pass a bowel motion. If this occurs, remove the faeces completely with a pad and cover the stained area.
The mother will be in some pain and have an urge to 'push'. Encourage her not to hold her breath. Help her stay calm and advise her to 'push' when the urge is very strong.
As the baby is gradually pushed through the opening of the birth canal, gently support its head - do not pull the baby, as it will be delivered normally in successive contractions. Should the umbilical cord be wound around the baby's neck, slide two fingers underneath it and gently ease it over the baby's head. There is enough slack in the cord to do this easily.
When the baby's head appears, it will initially face the anus, but as the baby is delivered, it will spontaneously rotate to face one side. This is quite normal.
Support the baby's head until the next contraction, during which the baby's shoulders will appear. At this point, shift your grip to approximately the baby's armpits and gently lift it towards the mother's abdomen as the final contraction expels it entirely from the birth canal. Take note of the time.
Very occasionally, the baby's head is born but the body is delayed (usually by the shoulders), ask the woman to change her position (try all fours or supported squat).
If the baby presents as a breech birth, it will be born body-first. The baby is unlikely to be expelled normally, so you must attempt to avoid the cord from becoming 'pinched' in the birth canal.
Gently pull down a loop of the cord to relieve the pressure. Get medical help urgently!