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. EMERGENCY CHILDBIRTH A REFERENCE GUIDE FOR STUDENTS OF THE MEDICAL SELF-HELP TRAINING COURSE LESSON NO. 11 ACKNOWLEDGMENT 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. 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. A joint publication of the U.S. DEPARTMENT OF DEFENSE Office of Civil Defense and the U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Services and Mental Health Administration Division of Emergency Health Services 5600 Fishers Lane, Rockville, Maryland 20852 Reprinted December 1970 EMERGENCY CHILDBIRTH What To Do 1. Let nature be your best helper. Childbirth is a very natural act. 2. At first signs of labor assign the best qualified person to remain with mother. 3. Be calm; reassure mother. 4. Place mother and attendant in the most protected place in the shelter. 5. Keep children and others away. 6. Have hands as clean as possible. 7. Keep hands away from birth canal. 8. See that baby breathes well. 9. Place baby face down across mother's abdomen. 10. Keep baby warm. 11. Wrap afterbirth with baby. 12. Keep baby with mother constantly. 13. Make mother as comfortable as possible. 14. Identify baby. What Not To Do 1. DO NOT hurry. 2. DO NOT pull on baby, let baby be born naturally. 3. DO NOT pull on cord, let the placenta (afterbirth) come naturally. 4. DO NOT cut and tie the cord until baby AND afterbirth have been delivered. 5. DO NOT give medication. DO NOT HURRY—LET NATURE TAKE HER COURSE. 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. 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.") SPECIAL SAFEGUARDS 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. Fear and possible exertion involved during an atomic attack will probably increase the number of premature births and of miscarriages. PREPARATIONS 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. 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. 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. 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. STAGES OF LABOR 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. 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. 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. 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. 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. A slight, watery, bloodstained discharge from the vagina normally accompanies labor pains or occurs before the pains begin. 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. 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. 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. Figures 4A, 4B, 4C, 4D [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.] [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.] [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. ] [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.] Figure 4E [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.] CHANGE OF FEELING 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. 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. 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. 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. 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. 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. She should keep her knees up and legs separated so that the person helping her can get at the baby more easily. MOMENT OF BIRTH 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. 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. 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. 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. 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. 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. 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. 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. Very little force should be used in blowing air into the baby's mouth. 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. CUTTING THE CORD There should be no hurry to cut the cord. Take as much time as necessary to prepare the ties and sharp instruments. 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—boiled for 15 to 20 minutes to make them sterile—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. 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. 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. Figure 7 [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.] THIRD STAGE OF LABOR 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. Do not pull on the cord to hurry this process. 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. 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. 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. 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. 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. 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. MISCARRIAGE 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. EXPECTANT MOTHER'S EMERGENCY CHILDBIRTH KIT 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. The kit consists of the following: One-yard square of outing flannel, hemmed (receiving blanket). Plastic (polyethylene flexible film) for outer wrapping of the kit if desired. (Do not wrap the baby in this plastic film.) One or two diapers. Four sanitary napkins (wrapped). Adhesive tape identification strips for mother and baby. Short pencil. Soap. Sterile package containing: Small pair of blunt-end scissors (cheapest scissors will do), or a safety razor blade with a guard on one side. Four pieces of white cotton tape, 1/2 inch wide and 9 inches long.[1] Four cotton balls. Roll of 3-inch gauze bandage. Six 4-inch squares of gauze.[1] Two or more safety pins. [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. Emergency childbirth kit Emergency childbirth kit Instructions such as those contained in this chapter also should be considered a part of the emergency childbirth kit. 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. 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. IDENTIFICATION TAPES 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. Two wide strips of adhesive tape will be needed—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. Identification tape—for mother Identification tape—for mother [Illustration: For mother—Write parents' names, blood types, and mother's Rh factor, street address, and whether it is a first or later child.] Identification tape—for baby Identification tape—for baby [Illustration: For baby—Write date and hour of birth and parents' names and address.] 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 *** ***** This file should be named 26923-h.htm or 26923-h.zip ***** This and all associated files of various formats will be found in: https://www.gutenberg.org/2/6/9/2/26923/ Produced by David Reed and Al Haines. Updated editions will replace the previous one--the old editions will be renamed. Creating the works from public domain print editions means that no one owns a United States copyright in these works, so the Foundation (and you!) can copy and distribute it in the United States without permission and without paying copyright royalties. Special rules, set forth in the General Terms of Use part of this license, apply to copying and distributing Project Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm concept and trademark. Project Gutenberg is a registered trademark, and may not be used if you charge for the eBooks, unless you receive specific permission. If you do not charge anything for copies of this eBook, complying with the rules is very easy. You may use this eBook for nearly any purpose such as creation of derivative works, reports, performances and research. They may be modified and printed and given away--you may do practically ANYTHING with public domain eBooks. Redistribution is subject to the trademark license, especially commercial redistribution. *** START: FULL LICENSE *** THE FULL PROJECT GUTENBERG LICENSE PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK To protect the Project Gutenberg-tm mission of promoting the free distribution of electronic works, by using or distributing this work (or any other work associated in any way with the phrase "Project Gutenberg"), you agree to comply with all the terms of the Full Project Gutenberg-tm License (available with this file or online at https://gutenberg.org/license). Section 1. General Terms of Use and Redistributing Project Gutenberg-tm electronic works 1.A. By reading or using any part of this Project Gutenberg-tm electronic work, you indicate that you have read, understand, agree to and accept all the terms of this license and intellectual property (trademark/copyright) agreement. If you do not agree to abide by all the terms of this agreement, you must cease using and return or destroy all copies of Project Gutenberg-tm electronic works in your possession. If you paid a fee for obtaining a copy of or access to a Project Gutenberg-tm electronic work and you do not agree to be bound by the terms of this agreement, you may obtain a refund from the person or entity to whom you paid the fee as set forth in paragraph 1.E.8. 1.B. "Project Gutenberg" is a registered trademark. It may only be used on or associated in any way with an electronic work by people who agree to be bound by the terms of this agreement. There are a few things that you can do with most Project Gutenberg-tm electronic works even without complying with the full terms of this agreement. See paragraph 1.C below. There are a lot of things you can do with Project Gutenberg-tm electronic works if you follow the terms of this agreement and help preserve free future access to Project Gutenberg-tm electronic works. See paragraph 1.E below. 1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" or PGLAF), owns a compilation copyright in the collection of Project Gutenberg-tm electronic works. Nearly all the individual works in the collection are in the public domain in the United States. If an individual work is in the public domain in the United States and you are located in the United States, we do not claim a right to prevent you from copying, distributing, performing, displaying or creating derivative works based on the work as long as all references to Project Gutenberg are removed. Of course, we hope that you will support the Project Gutenberg-tm mission of promoting free access to electronic works by freely sharing Project Gutenberg-tm works in compliance with the terms of this agreement for keeping the Project Gutenberg-tm name associated with the work. You can easily comply with the terms of this agreement by keeping this work in the same format with its attached full Project Gutenberg-tm License when you share it without charge with others. 1.D. The copyright laws of the place where you are located also govern what you can do with this work. Copyright laws in most countries are in a constant state of change. If you are outside the United States, check the laws of your country in addition to the terms of this agreement before downloading, copying, displaying, performing, distributing or creating derivative works based on this work or any other Project Gutenberg-tm work. The Foundation makes no representations concerning the copyright status of any work in any country outside the United States. 1.E. Unless you have removed all references to Project Gutenberg: 1.E.1. The following sentence, with active links to, or other immediate access to, the full Project Gutenberg-tm License must appear prominently whenever any copy of a Project Gutenberg-tm work (any work on which the phrase "Project Gutenberg" appears, or with which the phrase "Project Gutenberg" is associated) is accessed, displayed, performed, viewed, copied or distributed: 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 1.E.2. If an individual Project Gutenberg-tm electronic work is derived from the public domain (does not contain a notice indicating that it is posted with permission of the copyright holder), the work can be copied and distributed to anyone in the United States without paying any fees or charges. If you are redistributing or providing access to a work with the phrase "Project Gutenberg" associated with or appearing on the work, you must comply either with the requirements of paragraphs 1.E.1 through 1.E.7 or obtain permission for the use of the work and the Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or 1.E.9. 1.E.3. If an individual Project Gutenberg-tm electronic work is posted with the permission of the copyright holder, your use and distribution must comply with both paragraphs 1.E.1 through 1.E.7 and any additional terms imposed by the copyright holder. Additional terms will be linked to the Project Gutenberg-tm License for all works posted with the permission of the copyright holder found at the beginning of this work. 1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm License terms from this work, or any files containing a part of this work or any other work associated with Project Gutenberg-tm. 1.E.5. Do not copy, display, perform, distribute or redistribute this electronic work, or any part of this electronic work, without prominently displaying the sentence set forth in paragraph 1.E.1 with active links or immediate access to the full terms of the Project Gutenberg-tm License. 1.E.6. You may convert to and distribute this work in any binary, compressed, marked up, nonproprietary or proprietary form, including any word processing or hypertext form. However, if you provide access to or distribute copies of a Project Gutenberg-tm work in a format other than "Plain Vanilla ASCII" or other format used in the official version posted on the official Project Gutenberg-tm web site (www.gutenberg.org), you must, at no additional cost, fee or expense to the user, provide a copy, a means of exporting a copy, or a means of obtaining a copy upon request, of the work in its original "Plain Vanilla ASCII" or other form. Any alternate format must include the full Project Gutenberg-tm License as specified in paragraph 1.E.1. 1.E.7. Do not charge a fee for access to, viewing, displaying, performing, copying or distributing any Project Gutenberg-tm works unless you comply with paragraph 1.E.8 or 1.E.9. 1.E.8. You may charge a reasonable fee for copies of or providing access to or distributing Project Gutenberg-tm electronic works provided that - You pay a royalty fee of 20% of the gross profits you derive from the use of Project Gutenberg-tm works calculated using the method you already use to calculate your applicable taxes. The fee is owed to the owner of the Project Gutenberg-tm trademark, but he has agreed to donate royalties under this paragraph to the Project Gutenberg Literary Archive Foundation. Royalty payments must be paid within 60 days following each date on which you prepare (or are legally required to prepare) your periodic tax returns. Royalty payments should be clearly marked as such and sent to the Project Gutenberg Literary Archive Foundation at the address specified in Section 4, "Information about donations to the Project Gutenberg Literary Archive Foundation." - You provide a full refund of any money paid by a user who notifies you in writing (or by e-mail) within 30 days of receipt that s/he does not agree to the terms of the full Project Gutenberg-tm License. You must require such a user to return or destroy all copies of the works possessed in a physical medium and discontinue all use of and all access to other copies of Project Gutenberg-tm works. - You provide, in accordance with paragraph 1.F.3, a full refund of any money paid for a work or a replacement copy, if a defect in the electronic work is discovered and reported to you within 90 days of receipt of the work. - You comply with all other terms of this agreement for free distribution of Project Gutenberg-tm works. 1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm electronic work or group of works on different terms than are set forth in this agreement, you must obtain permission in writing from both the Project Gutenberg Literary Archive Foundation and Michael Hart, the owner of the Project Gutenberg-tm trademark. Contact the Foundation as set forth in Section 3 below. 1.F. 1.F.1. Project Gutenberg volunteers and employees expend considerable effort to identify, do copyright research on, transcribe and proofread public domain works in creating the Project Gutenberg-tm collection. Despite these efforts, Project Gutenberg-tm electronic works, and the medium on which they may be stored, may contain "Defects," such as, but not limited to, incomplete, inaccurate or corrupt data, transcription errors, a copyright or other intellectual property infringement, a defective or damaged disk or other medium, a computer virus, or computer codes that damage or cannot be read by your equipment. 1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right of Replacement or Refund" described in paragraph 1.F.3, the Project Gutenberg Literary Archive Foundation, the owner of the Project Gutenberg-tm trademark, and any other party distributing a Project Gutenberg-tm electronic work under this agreement, disclaim all liability to you for damages, costs and expenses, including legal fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH DAMAGE. 1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a defect in this electronic work within 90 days of receiving it, you can receive a refund of the money (if any) you paid for it by sending a written explanation to the person you received the work from. If you received the work on a physical medium, you must return the medium with your written explanation. The person or entity that provided you with the defective work may elect to provide a replacement copy in lieu of a refund. If you received the work electronically, the person or entity providing it to you may choose to give you a second opportunity to receive the work electronically in lieu of a refund. If the second copy is also defective, you may demand a refund in writing without further opportunities to fix the problem. 1.F.4. Except for the limited right of replacement or refund set forth in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. 1.F.5. Some states do not allow disclaimers of certain implied warranties or the exclusion or limitation of certain types of damages. If any disclaimer or limitation set forth in this agreement violates the law of the state applicable to this agreement, the agreement shall be interpreted to make the maximum disclaimer or limitation permitted by the applicable state law. The invalidity or unenforceability of any provision of this agreement shall not void the remaining provisions. 1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the trademark owner, any agent or employee of the Foundation, anyone providing copies of Project Gutenberg-tm electronic works in accordance with this agreement, and any volunteers associated with the production, promotion and distribution of Project Gutenberg-tm electronic works, harmless from all liability, costs and expenses, including legal fees, that arise directly or indirectly from any of the following which you do or cause to occur: (a) distribution of this or any Project Gutenberg-tm work, (b) alteration, modification, or additions or deletions to any Project Gutenberg-tm work, and (c) any Defect you cause. Section 2. Information about the Mission of Project Gutenberg-tm Project Gutenberg-tm is synonymous with the free distribution of electronic works in formats readable by the widest variety of computers including obsolete, old, middle-aged and new computers. It exists because of the efforts of hundreds of volunteers and donations from people in all walks of life. Volunteers and financial support to provide volunteers with the assistance they need, is critical to reaching Project Gutenberg-tm's goals and ensuring that the Project Gutenberg-tm collection will remain freely available for generations to come. In 2001, the Project Gutenberg Literary Archive Foundation was created to provide a secure and permanent future for Project Gutenberg-tm and future generations. To learn more about the Project Gutenberg Literary Archive Foundation and how your efforts and donations can help, see Sections 3 and 4 and the Foundation web page at https://www.pglaf.org. Section 3. Information about the Project Gutenberg Literary Archive Foundation The Project Gutenberg Literary Archive Foundation is a non profit 501(c)(3) educational corporation organized under the laws of the state of Mississippi and granted tax exempt status by the Internal Revenue Service. The Foundation's EIN or federal tax identification number is 64-6221541. Its 501(c)(3) letter is posted at https://pglaf.org/fundraising. Contributions to the Project Gutenberg Literary Archive Foundation are tax deductible to the full extent permitted by U.S. federal laws and your state's laws. The Foundation's principal office is located at 4557 Melan Dr. S. Fairbanks, AK, 99712., but its volunteers and employees are scattered throughout numerous locations. Its business office is located at 809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email