Monday, August 30, 2010

Preparing for Unassisted Birth

This information is compiled from various sources for informational purposes only.  If you or someone you know is preparing for a possible unassisted birth, this should not be your only information source.

Rather than post a list of necessary items, I'll give some guidelines.  There are very few truly necessary things for birth, and you can generally make do with what you already have at home.  

For instance, one mother had an unexpected home birth with no supplies:  

They had just moved and most of their things were still in storage when she unexpectedly went into labor three weeks before the due date.  All they really had was a t-shirt to wrap the baby in after it was born, and they used thread to tie the cord and scissors from a first-aid kit to cut it.

Someone I know had a similar experience:

They were planning a hospital birth, but the mother had a very fast labor (40 minutes) and the baby was born in the bathroom before the father had even arrived home to help.  She had called him home from work and he got there after the baby was born and helped deliver the placenta.  He used a shoelace to tie off the umbilical cord, and kid scissors to cut it.

Unplanned home birth carries more risks compared to planned home birth.  Some women have a history of fast labor, and there are times they just don't make it to the hospital or the midwife doesn't get to their home in time for the birth itself.  In these cases it may be a good idea to plan for a possible unassisted birth in case things go so quickly that the preferred plans don't work out.

The first and most important piece of advice:  Have faith.  Trust in your body's ability to birth this baby.  In his book "Childbirth Without Fear" Dr. Grantly Dick-Read states that 95% of births can safely take place without any intervention.  This means the odds are in your favor to safely birth your baby without help.

"I like to tell my clients to remember their grandmothers and other female ancestors. Since the beginning of time, the women in her bloodline have given birth successfully, otherwise she, herself, would not be here having a baby." - Melissa Chappell, Doula

Follow your body and do what instinctively feels right.  Don't try to analyze anything, just let your mind go into the primal state that it will naturally go to if you let it.

Dr. Gregory White has a book about birth for fire fighters and police officers, in case they get a 911 call to a birth.  It's a step-by-step guide that tells how to catch a baby.  Dr. White says "any normal 8 year-old can do this."  If you have an older child or partner who can help, you can prepare yourself and them by reading this book.

Check for a nuchal cord: When the baby's head is out, slip your index finger in to feel for the cord.  If there is a cord around the neck the baby may be able to "birth through the cord" or do a somersault as the head stays close to the mom's body.  If the cord is very tight you may have to flex the baby's head and slip the cord over it.  Very rarely do you need to cut the cord and unravel it before the rest of the body is birthed.

What if the head is out, but the body is taking a while?  The body generally slides out soon after the head, and usually comes out with one push.  If it seems to be taking a long time, the baby's shoulder may be caught on the pelvic bone.  True shoulder dystocia is rare, but generally simple to handle.  Just get up on your hands and knees, and it will help shift the baby's position and allow the rest of the body to come out easily.  If this doesn't help, then you can reach in with your finger and gently pull the shoulder toward the baby's chest and release it.

What do I do when the baby is out?  After you or a support person has caught the baby, simply bring the baby up to your torso.  The placenta will still be inside, and the baby will still be attached to it by the umbilical cord.  There is no need to cut the cord before the placenta is out.  

How do I help the baby breathe?  Most babies can expel the remaining amniotic fluid from their lungs by simply spitting it out.  You can help your infant do this by holding the baby face down with your hand supporting the tummy.  If you're concerned that it may not be coming out fast enough you can use your own mouth over the baby's mouth and nose to gently suck out the fluid.  Suck, spit, suck, spit, etc.  The baby may cry a bit once the fluid is out, which is a good indication of breathing.  If you have a bulb syringe, you can use it to suction the fluid out, but this isn't as gentle as the other methods described.  Always remember to suction the mouth first, and then the nose.  It may help you remember this by remembering that M comes before N in the alphabet.

How do I keep the baby warm?  The easiest way to do this is by keeping the baby against your warm skin, and place a towel or blanket over the baby and yourself.  Breastfeeding is an excellent way to keep the baby warm and happy.

How do I help the placenta come out?  You may or may not feel contractions after the baby is out.  Do not pull on the cord.  This can cause fragments of the placenta to be left inside, leading to hemorrhage, or some cords may snap when pulled.  You can help the placenta come out by squatting.  Allow the baby to breastfeed, and this will help the uterus contract effectively to birth the placenta. 

When should I cut the cord?  After the placenta is out you can wait for the cord to stop pulsating before cutting it.  You can use anything clean to tie off the cord.  Braided embroidery thread or string, or a shoelace will work just fine.  There's no need to tie it off in two places.  Simple tie the cord close to the baby's belly button and cut it on the side of the thread away from the baby.  You can even choose to leave the cord intact and simply wrap the placenta in a towel or chux pad and place it near your baby's feet.  The cord will naturally detach within a few days to a week.  Leaving the cord attached is known as Lotus Birth, and you may research this option beforehand.

How do I know if I'm bleeding too much?  Blood loss is completely normal after birth, so don't worry when you see blood.  It's also normal to see blood clots come out with the placenta or afterward.  Trust your feelings more than your brain, as how you feel will be a good indication of how well you are doing after the birth.  You can drink cinnamon tea to help prevent hemorrhage.  Most people have cinnamon in their spice rack, and you can add 1 tsp of cinnamon per cup of water.  2 1/2 cups of blood loss or more is considered hemorrhage, but it can be tricky knowing how much blood you've actually lost.  You may choose to prepare yourself by doing tests prior to the birth:

Put different amounts of water mixed with catsup and pour it on pads, or towels on the floor, or in the bath tub.  Squirt catsup as fake clots.  Always measure before pouring so you can get a good idea of what that amount looks like after it's been spilled.  This will give you a visual indication of how much is too much.

You can even eat a small portion of the placenta as an effective way of preventing or treating hemorrhage.  One way to do this is by making a placenta smoothie.  Midwives in Hawaii use this, and it's recommended to add 1 tsp of placenta to 8 ozs of juice.  Red juices work best, such as cherry or tomato.  Just mix it in the blender and drink.

If you or the baby seem unwell in any way, do not hesitate to call for help.  Most of all, trust your instincts.  If you and the baby are both well, just let the natural endorphins take over and enjoy the memory of your amazing birth and your new little bundle!



What did you think of this?  Do you have anything to add that might be helpful?

7 comments:

  1. I really found this imformative and useful. The idea of doing "blood" tests before labor is a good tip. Thank you for posting, I plan to share. :)

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  2. Great post. A friend of mine had a completely unexpected homebirth years ago. She was resting in her bedroom while her husband grabbed a few things to take to the hospital (they were early). Her 7 year old son - who was a very devout little Christian - came in and said, "Mom, you're not going to make it to the hospital. But don't worry - everything will be ok."
    Sure enough a few minutes later, she managed to make it to the bathroom in time to deliver. Her son caught the baby while her husband called the paramedics. It was incredible. She said it was a miraculous experience!

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  3. Perfect! I was so glad to see this wasn't a supply list! You covered the important parts, anything else is just extra.

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  4. Good, concise information! That first story was me (unless there are a lot of other UC mommas who had that exact same situation). I just want to clarify one point; though we were not expecting our son to come three weeks early, we were planning an unassisted birth - just not under those circumstances. I was glad I had done so much preparation in advance for our UC because the unanticipated circumstances didn't shake my confidence and I knew what to do!

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  5. Yes Amy, I believe that was your story :) I had posted on the facebook page asking for UC advice and information, which helped me put together this post. Thanks so much to everyone who commented, and to those who contributed to my research for this post.

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  6. This has really nice practical information.... I love how succint it is after spending time looking for something like this before my son's birth. Some mamas don't worry about nuchal cord as baby will tend to cartwheel out if left undisturbed. I read this in Whapio Diane Bartlett's article on the Holistic Stages of Labor and think it is comforting to know... just my two cents since i missed the research phase! This would make a lovely e-book or something!

    Thanks,
    Krista Arias

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  7. Krista, thanks for the feedback :) My research for this was mainly done by consulting an experienced home birth midwife and several UC moms. I've had someone else mention that it's unnecessary to check for a nuchal cord for the same reason you mentioned. Nuchal cord is a common worry, but almost never a problem. I wanted to include it in this because of the myths surrounding it, but I might update it with more information.

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