How (and Why) To Prevent Pregnancy if the SHTF *graphic

18 Dec

It’s a rare individual that doesn’t have a wife, girlfriend, mother, daughter or granddaughter that isn’t of childbearing age (say 13 to 50 year old).  Even if they aren’t related to you personally, they could be in your survival group.  Remember that, even if you have a little girl that’s 5 years old now, one day she will come of reproductive age.

In a long-term survival situation, society will be unstable and organized medical care will be spotty at best and nonexistent at worst.  When we reach the point

that we are scrambling to survive, one of the least welcome events is one that, for many families, is ordinarily considered a blessing:  A pregnancy.  Further down the road, when and if society re-establishes itself, we will have the responsibility to repopulate the world.  Until that time, however, a pregnancy and the possible complications that accompany it will be a burden.

So why is it important to prevent pregnancies in the early going of a societal collapse?   Well, we know that the death rate among pregnant women (also known as the Maternal Mortality Rate) at the time of the American Revolution was about 2-4% per pregnancy.  Given that the average woman in the year 1800 could expect an average of 6-10 pregnancies over the course of her reproductive life, the cumulative Maternal Mortality Rate easily approached 25 per cent.   That means that 1 out of 4 women died due to complications of being pregnant, either early, during the childbirth, or even soon after a successful delivery.

If a  collapse occurs, we might be faced with unacceptable levels of risk to our women because we won’t have either medicine or medical supplies in which treat pregnancy and childbirth complications.  There could be deaths simply because there are no IV fluids or medications to stop bleeding or treat infection.  This would happen at a time that we will need every member of our survival group to be productive individuals. Growing food, managing livestock, perimeter defense, and caring for children will take the energy of all involved.  When a pregnancy goes wrong, it takes away a valuable contributor from the survival family (sometimes permanently) and places an additional strain on resources and manpower.

Now, I don’t want everyone to think that I’m saying that all women will die during their pregnancy. What I am saying is that not all survival groups have prepared to obtain the knowledge, resources, and ability to deal with the complications that could occur.  Every Prepper should stop and think about the danger to which you could be exposing Mrs. Prepper, if you aren’t ready for every possibility.  Also, if people are rioting in the streets and your garden isn’t doing so well yet, do you really need to add a newborn baby to your list of responsibilities?

So, what’s your plan?   Even long-time Preppers haven’t spent much time figuring out what birth control method they will use in a collapse situation.   Have you included condoms in your bug-out bag?  The majority have not, so congratulations if you did.  That means you’ve thought about more than just beans and bullets.

It’s important to have condoms in your storage, but condoms can break; even if they don’t, they won’t last forever.   With spermicide, condoms expire and become brittle after 2 years; without spermicide, perhaps at most 5 years.   Some women use IUDs (intrauterine devices) to prevent pregnancy.  Some of these use hormones that wear off over time. They must be inserted into the body of the uterus, something best done by someone with experience to prevent injury.

Birth control pills are useful, but are difficult to get more than a few months’ supply at any one time.  Insurance companies tightly control when women can get their next pack of pills.  Some offer 3 month’s supply at a time, but you still have to wait until the end of those 3 months to get more.  Even if you could get them, they cost a bundle if purchased outside of insurance plans.  The cost of stockpiling several years’ worth these can be difficult for the average person.

As such, we will have to go back to a natural form of birth control: Natural Family Planning (the modern version of the Rhythm Method). Although not as effective in preventing pregnancy as the Pill, it is 90% effective if implemented correctly.  There is no need to put hormones into your system and no side effects. Natural Family Planning is a time-honored strategy to prevent pregnancy that fits in well with any collapse strategy.

This method involves trying to figure out your fertile period and avoiding unprotected intercourse during that time.  This method works best on women who have relatively regular cycles.  Cycles are predictable if a woman releases an egg for fertilization (this is called ovulation) on a regular basis.

If you or your partner has 28 day menstrual cycles, you can bet that ovulation is occurring. A pregnancy is likely in any couple having regular sexual relations. So likely, in fact, that 80-85% of couples can expect a pregnancy within the first year of a collapse situation if not careful.  The egg will disintegrate in 24-48 hours, however, if not fertilized.

You can tell the day that you or your partner is ovulating by doing a little research.  This involves, in part, taking your temperature with a thermometer daily for a cycle or two. There are actually special thermometers that are used for this purpose called Basal Body Temperature Thermometers, although I would think that any thermometer that goes up by 1/10 degree increments would do (e.g., 98.1, 98.2, 98.3 degrees Fahrenheit).  Make certain to take temperatures daily at the same time, preferably before you get out of bed in the morning.

When you ovulate, your basal body temperature goes up about half a degree and stays up until the next period. Make a graph or chart of the daily temperatures and you’ll see a pattern develop. Always count Day #1 as the first day of menstrual bleeding to start with.  Once you’ve done this for a few cycles, you will have a good idea about when you or your partner is at risk for getting pregnant.  A common physical symptom that goes along with this: Many women will notice some one-sided discomfort in the lower abdomen when they ovulate.

Let’s say that you or your partner has 28 day cycles and that the temperature rise occurs around day 14.  You should avoid having unprotected sexual intercourse from about day 10 – day 18 (a few days prior and a few days after the likely day of ovulation).  If ovulation occurs later, say day 16, just move the “danger” period over to day 12 – day 20.  Ovulation may occur a couple of days earlier or later in any one cycle, so you want to have a margin of error in determining the time period eligible for fertilization.

Observing the cyclical changes in cervical mucus is a useful adjunct. The cervical mucus method is based on observation of the character of cervical mucus during the course of the menstrual cycle. Before ovulation,

To use this method, it’s important to understand how cervical secretions change during a typical menstrual cycle. Generally, you’ll see:

  • Little or no cervical secretions for several days after each period.
  • Sticky, thick secretions for the next few days
  • Then, the mucus becomes clear and watery for the next three or four days — this is when ovulation is occurring.
  • A thicker and less quantity of cervical secretions until the period ends.

Cervical mucus, once obtained, will be thick; spreading your fingers will cause it to snap.  During ovulation, spreading two mucus-laden fingers will cause the watery mucus to stretch significantly before breaking.

As evaluating your cervical mucus involves placing your finger deep inside the vagina all the way to the cervix, make sure you have washed your hands thoroughly and have an ample supply of gloves.  Remember, you may be in a situation where sanitary and hygienic conditions may not exist.

Performed correctly, the Natural Family Planning method is an effective and completely natural way to prevent pregnancy.  In a collapse, it will allow you to decide when things are stable enough to bring a newborn into the world.

In a survival situation, you won’t have access to ultrasound technology to take a look at the fetus; whether it’s a boy or a girl will once again become a mystery.  Even twins might be a surprise.

Without prenatal mega-vitamins, babies will be smaller at birth. This may also not be so bad, since Caesarean Section will no longer available.  It’s less traumatic for the mother to deliver a 6 or 7 pound baby than a 10 pounder.

Despite all the possible complications that I mentioned in the previous section, pregnancy is still a natural process.  It usually proceeds without major complications and ends in the delivery of a normal baby.  Although your pregnant patient will not be as productive for the survival group as she would ordinarily be, she will probably still be able to contribute to help make your efforts a success.  To make a pregnancy a success, the medic will need to have a little knowledge of the subject and an idea of how to deliver the fetus.

We are, of course, fortunate to have simple tests that can identify pregnancy almost before your miss a period.  What if these tests are no longer available?  You will have to rely on the following tried and true signs and symptoms to identify the condition:

  • Absent menstruation
  • Tender Breasts
  • Nausea and Vomiting
  • Darkening of the Nipples/Areola
  • Fatigue
  • Frequent Urination
  • Backache

These symptoms, in combination, are indicative of pregnancy. The timing of each will be variable; some will be noticed earlier than others.  It should be noted that this investigation will likely be necessary only in those women experiencing their first pregnancy.  Once you have been pregnant, you will most likely know when it happens again.

Of course, as time goes on, the abdominal swelling associated with uterine and fetal growth will be undeniable.  Stretch marks come later, as do hemorrhoids, backache, and varicose veins (all very common but not universal).  These changes are part and parcel of the average healthy pregnancy. Most of the above will improve after the pregnancy is over, but may not disappear completely.

So, what’s the due date?  This is the question everyone will want answered once a pregnancy is identified.  A human pregnancy lasts 280 days or 40 weeks from the first day of the last menstrual period to the estimated date of delivery.  This used to be called the “estimated date of confinement” because, yes, they confined women to their beds as they approached it.

This date is simple to calculate if you have regular monthly periods.  To get the due date, subtract 3 months and add 7 days to the first day of the last period.  Example:  If the first day of last menstrual period (LMP) is 9/7, then the due date is 6/14.

If the woman does not know when her last cycle started, you can still estimate the age of the pregnancy by physical signs.  When you gently press on the woman’s abdomen, you will notice a firm area (the uterus) and a soft area (the intestines).  Identify the uppermost level of firmness, and you will able to estimate the approximate age of the pregnancy.  If the “lump” is peaking just over the pubic bone, you’re at 12 weeks.  Halfway between the pubic bone and the belly button is 16 weeks.  At the belly button is 20 weeks.  Each centimeter above the belly button adds a week, so have a measuring tape handy.  A term pregnancy will measure 36-40 Centimeters from the pubic bone to the top of the uterus.

Twins, as you might imagine, will throw all of these measurements out the window. They will occur in 1 in 60 births, more often if there is a family history.  Don’t worry about triplets: They occur in 1 in 7,000 births, unless you use fertility drugs.

Once you have identified the pregnancy, you should make every effort to assure that your patient is getting proper nutrition.  Deficiencies can affect the development of the fetus, so obtaining essential vitamins and iron through the diet will give the best chance to avoid complications.  If you have stockpiled prenatal vitamins, use them.

Common early pregnancy issues will include hyperemesis, as described in the last section.  Be sure to ask your physician for prescriptions for Zofran and/or other anti-nausea medications to add to your stockpile.  Hyperemesis will disappear in almost all women as they advance in the pregnancy.  Dry bland foods, like crackers, are helpful in getting a woman through this stage.  Ginger tea is a time-honored home remedy to decrease “morning sickness”.

Another early pregnancy issue is the threatened miscarriage.  This will be characterized by bleeding or spotting from the vagina, along with pain that simulates menstrual cramps.  As 10% of pregnancies end in miscarriage and a higher percentage threaten to, this will be an issue that you must know how to deal with.

Other than placing your patient on bed rest, there will not be much you’ll be able to do in this circumstance.  Some of these pregnancies don’t continue because the fetus is abnormal, and no amount of rest will stop many of these pregnancies from ending very early.  The good thing is that a single miscarriage generally does not mean that future pregnancies will be unsuccessful.

Keep a close eye out for evidence of infection, such as fever or a foul discharge from the vagina.  Women with these symptoms would benefit from antibiotic therapy.

Pregnant women should be evaluated periodically to see how the fetus is progressing.  Besides verifying progressive growth in the size of the uterus, the fetal heartbeat should be audible via stethoscope at around 16-18 weeks, or much earlier if you have a functioning battery-powered fetal heart monitor (also called a Doppler ultrasound).  These are available for sale online. Your exams should be more frequent as the pregnancy advances.  Every 4 weeks until 22 weeks or so, then every 2 weeks until 35 weeks, then every week thereafter.

                                                                Old-timey “Fetoscope”, still on sale online

Weight gain is desirable during pregnancy; you should shoot for 25 pounds or so, total.  Blood pressure should be taken regularly to rule out pregnancy-induced hypertension.  Elevated blood pressures behoove you to place your patient on bed rest.  Lying on the left side will keep her blood pressure at its lowest.  Check for evidence of edema (swelling of the feet, legs and face) as well as excessive weight gain).

As the woman approaches her due date, several things will happen.  The fetus will begin to “drop”, assuming a position deep in the pelvis.  The patient’s abdomen may look different, or the top of the uterus (the “fundus”) may appear lower.  As the neck of the uterus (the cervix) relaxes, the patient may notice a mucus-like discharge, sometimes with a bloody component.  This is referred to as the “bloody show” and is usually a sign that things will be happening soon.

As the woman approaches her due date, several things will happen.  The fetus will begin to “drop”, assuming a position deep in the pelvis.  The patient’s abdomen may look different, or the top of the uterus (the “fundus”) may appear lower.  As the neck of the uterus (the cervix) relaxes, the patient may notice a mucus-like discharge, sometimes with a bloody component.  This is referred to as the “bloody show” and is usually a sign that things will be happening soon.

If you examine your patient vaginally by gently inserting two fingers of a gloved hand, you’ll notice the cervix is firm like your nose when it is not ripe and soft like your lips when the due date is approaching.  This softening of the cervix is called “effacement”. As time goes on, the sides of the cervix will thin out, until they are as thin as paper.

Dilation of the cervical opening will be slow at first, and speed up once you reach about 3-4 cm.  At this level of dilation, you will be able to place two (normal-sized) fingertips in the cervix and feel something firm; this is the baby’s head.

Contractions will start becoming more frequent.  To identify a contraction, feel the skin on the soft area of your cheek, and then touch your forehead.  A contraction will feel like your forehead.  False labor, or Braxton-Hicks contractions, will be irregular and will abate with bed rest, especially on the left side, and hydration.  If contractions are coming faster and more furious even with bed rest and hydration, it may just be time to have a baby!  A gush of watery fluid from the vagina will often signify “breaking the water”, and is also a sign of impending labor and delivery.  The timing will be highly variable.

The delivery of a baby is best accomplished with the help of an experienced midwife or obstetrician, but those professionals will be hard to find in a collapse situation.  If there is no chance of accessing modern medical care, it will be up to you to perform the delivery.

To get ready for delivery, wash your hands and then put gloves on. Then, set up clean sheets so that there will be the least contamination possible.  Tuck a sheet under the mother’s buttocks and spread it on your lap so that the baby, which comes out very slippery, will land onto the sheet instead of landing on the floor if you lose your grip on it.  Place a towel on the mother’s belly; this is where the baby will go once it is delivered.  It will be very important to dry the baby and wrap it in the towel, as newborns lose heat very quickly.  Newborns are also susceptible to infection, so avoid touching anything but mother and baby if you can.

As the labor progresses, the baby’s head will move down the birth canal and the vagina will begin to bulge.  When the baby’s head begins to become visible, it is called “crowning”.  If the water has not yet broken (which can happen even at this late stage), the lining of the bag of water will appear as a slick gray surface.  Some pressure on the membrane will rupture it, which is okay at this point.  It will help the process along.

To make space, place two gloved fingers in the vagina by the perineum.  This is the area between the vagina and anus.  Using gentle pressure, move your fingers from side to side.  This will stretch the area somewhat to give the baby a little more room to come out.

With each contraction, the baby’s head will come out a little more.  Don’t be concerned if it goes back in a little after the contraction.  It will make steady progress and more and more of the head will become visible.  Encourage the mother to help by taking a deep breath with each contraction and then pushing while slowly exhaling.

On occasion, a small cut is made in the bottom of the vagina to make room for the baby to be delivered. This is called an “episiotomy”. I discourage this if at all possible, as the cut has to be sutured afterward.  I always make this decision as the head is crowning.

As the baby’s head emerges, it will usually face straight down or up, and then turn to the side.  The cord might appear to be wrapped around its neck.  If this is the case, gently slip the cord over the baby’s head. In cases where the cord is very tight and is preventing delivery, you may have to doubly clamp it and cut between. This will release the tension.

Next, gently hold each side of the baby’s head and apply gentle traction straight down. This will help the top shoulder out of the birth canal.  Occasionally, steady gentle pressure on the top of the uterus during a contraction may be required if the mother is exhausted.  Once the shoulders are out, the baby will deliver with one last push. The new mother can now rest.

Put the baby immediately on the mother’s belly and clean out its nose and mouth with a bulb syringe.  It will usually begin crying, which is a good sign that it is a vigorous infant.  Spanking the baby’s bottom to get it to cry is rarely needed, and is more of a cliché than anything else.  A better way to stimulate a baby to cry is to rub the baby’s back.

Dry the baby and wrap it up in a small towel or blanket.  Clamp the cord twice (2 inches apart) with Kelly or Umbilical clamps, and cut in between with a scissors.  Delivery kits are available online with everything you need, including drapes, clamps, bulb syringes, etc.

Once the baby has delivered, it’s the placenta’s turn. Be patient: In most cases, the placenta will deliver in a few minutes.  Pulling on the umbilical cord to force the placenta out is usually a bad idea. Breaking the cord due to excessive traction will require your placing your hand deep in the uterus to extract it, which is traumatic and can introduce infection.  You can ask the mother to give a push when it’s clear the placenta is almost out. If traction is necessary for some reason, place your fingers above the pubic bone and press as you apply mild traction.  This will prevent the uterus being turned inside out (a potentially life-threatening situation) if the placenta is stubborn. A moderate amount of bleeding is not unusual afterwards.

Once the placenta is out, examine it.  The “maternal” surface is grey and shiny; turn it inside out and you will see the “fetal” surface, which look like a rough version of liver.  The fetal surface is separated into compartments called “cotyledons”.  If a portion of the placenta remains inside, you may have to extract it manually.  The maternal and fetal surfaces, respectively, are shown in the images below:

                                                 Manual Extraction (very uncomfortable)

The uterus (the top of which is now around the level of the belly button) contracts to control bleeding naturally.  In a long labor, the uterus may be as tired as the mother after delivery, and may be slow to contract.  As a result, this may cause excessive bleeding. Gentle massage of the top of the uterus (known as the “fundus”) will get it firm again and thus limit blood loss.  You may have to do this from time to time during the first 24 hours or so after delivery.

Place the baby on the mother’s breast soon after delivery.  This will begin the secretion of “colostrum”, a clear yellow liquid rich in substances that will increase the baby’s resistance to infection.  Suckling also causes the uterus to contract; this is also a factor in decreasing blood loss. Monitor the mother closely for excessive bleeding over the next few days.  In normal situations, the bleeding will become more and more watery as time progresses.  This is normal.  Also, keep an eye out for evidence of fever or other issues.

Human pregnancy and delivery is a natural process and, usually, proceeds in an uncomplicated manner.  Learning to help the process along and identifying problems will give you the best chance of bringing a healthy baby (from a healthy mother) into the world.  Even in a survival situation, seek out experienced professionals that can help.

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