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How to catch an unplanned homebirth

January 23rd, 2012

Ok, so it has been a shamefully long time since I posted anything at all. This is due to life becoming crazy, two beautiful boys becoming even more active and needing a lot of attention, returning to work earlier than planned and our little family moving back in with my parents (arrrrgh). Needless to say, the spirit has been willing but the flesh has been weak (and tired and very time poor). So I thought I’d ease myself back into it with a fun topic. Thank you to my loyal friends and readers for waiting so patiently and urging and encouraging me to continue. I hope you enjoy this one.

If there is one question that first-time parents ask that makes me laugh a little bit on the inside, it’s this:

“What happens if the baby comes too quickly and I don’t make it to the hospital?”

The reason it’s funny is because the percentage of first time mothers who plan to have a hospital birth but don’t make it to the hospital, is extremely low (probably around the same percentage, or less, than babies born on their due date, ie. not very many). I can appreciate though, that it is a valid concern for some people who may have had very quick births previously or who have a very strong family history of quick births.

It’s also a funny question because the obvious answer to that question is – “You have a baby”. The truth is, if you are a full term, healthy pregnant woman without any pregnancy complications, and you are going to have your baby quickly, then it is very likely that the baby will be born healthily without complications (whether born at home, in the car or at hospital). This is a generalisation of course, as there can be emergency situations in any birth, but the MAJORITY of “born before arrival” babies and their mothers are happy and healthy when they arrive (usually by ambulance) to the hospital to be assessed.

But I thought I could highlight a few things for you, for peace of mind and so you are prepared “just in case”.

STAY CALM

No one benefits from panicking. Especially mums and babies. Encourage the mother to take deep slow breaths, focusing on really slowing down the “out” breath, as this helps relax muscles.

MOVE  SOMEWHERE SAFE AND COMFORTABLE

Women will often be in the bathroom when they realise they are too late to be transported to hospital. If this is the case, bring in some towels, pillows and blankets to make sure the woman doesn’t get cold and sore from the tiles and to make sure the baby isn’t born onto something hard and cold. If the woman is standing or kneeling, place a pillow covered by  towel in between her legs. If she is lying down, put a pillow behind her head and a few towels under her bottom.

RING FOR HELP

An ambulance is probably the quickest and safest method of transport if you think you are literally about to have a baby. The phone operator can also guide you through what to do over the phone. If you have time, ring the hospital to let them know what’s happening so they can be prepared and they too might be able to offer you assistance over the phone.

WHEN YOU CAN SEE THE HEAD

Encourage the woman to breathe the baby down and not to push. This will help the perineum to stretch slowly and not tear. If she can’t help but push, that’s ok – sometimes the feeling is involuntary and uncontrollable. When you can see a tennis ball sized amount of head, it is very near the crowning stage. Encourage her to blow out really big breaths. The contraction will do the rest of the work. You need to put the phone down and place your hands together in a cupped position next to the woman’s vagina, just in case the baby’s head and body come out quickly in one contraction.

AFTER THE HEAD IS BORN

The baby’s face will usually start to rotate to one side before or during the next contraction. This is the time to get your catcher’s mits on if you haven’t already. The baby will be born with the next contraction. Encourage the woman to push and the baby’s shoulders and body will be born. If the woman is lying down, it is ok to guide the baby gently onto a towel on the floor if you don’t feel confident to hold it all at once. Note – babies are VERY slippery when first born. If the woman is standing, hold a towel over your arms and let the baby gently fall into the towel then pull the baby close to your chest. When the mother is sitting in a comfortable position, you can then hand her the baby. Place the baby skin to skin on the mother’s chest and wipe over with a towel then cover with a blanket.

DO NOT TOUCH THE CORD

While the cord is still attached, the baby is still receiving oxygen and nutrients from the mother. This is especially important if the baby is not crying or moving normally. Do not tie the cord with ANYTHING. It is perfectly healthy to leave the cord attached until the placentas is birthed. Even after the placenta is birthed – LEAVE THE CORD ALONE. Just wrap the placenta in a towel and place in a plastic bag next to the baby. It is a huge infection risk to tie or cut the cord with anything that is not sterile, so leave it to the ambulance or hospital to deal with.

WHAT IF THE BABY’S NOT BREATHING

Turn the baby so that their head and body are facing the mother’s chest, in between her breasts, making sure their nose is free of course. Rub the baby all over, especially on the bottom of the feet. This will usually stimulate a response from a healthy baby who is just a little stunned from a quick birth. It is unlikely that you will need to do anything more than this, and if you do hopefully help will have arrived. If the baby is still very floppy and very blue or white, turn the baby back over onto it’s back but keep it on the mother’s chest. Clear it’s mouth and nose of mucous with a gentle wipe, then cover it’s mouth and nose with your whole mouth and give a gentle breath. Keep breathing into the baby’s mouth and nose at a rate of one every 2 seconds. Hopefully the baby will respond well and start breathing on it’s own. Remember – unexpected fast births usually have a very happy ending.

KEEP EVERYONE WARM

Wet blankets can cause a baby to lose heat very quickly as they have an immature thermo regulator, so keep mother and baby in dry warm blankets. Make sure baby stays skin to skin with the mother as this will keep them the warmest. Don’t wrap the baby up, just place blankets over the top of the two of them. Mother’s bodies can raise their temperature by 2 degrees to accommodate for a cold baby.

KEEP HYDRATED

Offer the mother water and juice. Keep the baby near the breast so they can learn how to self attach. Don’t be too stressed about initiating breastfeeding. Just let it happen naturally, and if it doesn’t, babies are usually fine to wait for an hour or two until someone can assist with feeding.

WHAT IF THE MUM STARTS BLEEDING

This can be quite scary because most people are not used to seeing a lot of blood. Keep in mind that sometimes the blood is mixed with amniotic fluid and can look like a larger volume than it actually is. It is normal for there to be a small amount of blood loss at the time of birth and when the placenta is birthed. Anything under 500mls is acceptable. Think about what a 500ml bottle of water would look like if it’s spilled – huge right? So although it may look like a huge amount of blood, it may still be normal. It’s not normal when the blood keeps trickling or streaming after the placenta is out. In this case you need to rub the uterus very firmly. To do this, you place a hand horizontally across the woman’s belly button and press inwards about 10-20cm and rub downwards in a circular motion. What you should be feeling is a hard round ball about the size and shape of a cricket ball. If you do not feel this, keep rubbing HARD. EVEN IF IT HURTS. The woman may feel some gushes of blood and/or some clots pass, then the bleeding will hopefully settle. You can also put pressure on the woman’s perineum, as bleeding is sometimes caused by bad tearing. Assist the woman to breastfeed, as this can help to stop bleeding by releasing oxytocin, the hormone responsible for uterine contractions. If the bleeding does not settle down, then hopefully the ambulance you called earlier will arrive soon, if they haven’t already.

 

Remember remember remember – stay calm. It is highly likely that everything will be normal. Now sit back, relax, pop some bubbly and enjoy your beautiful new baby!

P.S. It’s a myth that you need boiling water – except to make yourself a cup of tea when it’s all over!

Beth’s brilliant birthing

September 7th, 2011

I have been very quiet on the blogging front as my life has been busy lately, with many little dramas. One of the good dramas was the birth of my sister’s second baby girl, just over a week ago. I asked her permission to tell her story from my perspective, so here it is…

It was a Sunday and we had just finished church when my sister called and asked if we wanted to go out to yum cha for lunch. She said she had been having “period-like” pains since about 4am and she wanted to go out to keep herself occupied. She had also been having mild period pain for about a week and a half prior, so she wasn’t sure that this was the real thing. She was 39 weeks and 4 days pregnant. Her first daughter had been born at 39 weeks and 2 days, so she was already feeling “overdue”. She also thought that this baby might be a boy, and boys in our family tend to come late, so she wasn’t too concerned.

So the whole family, parentals included, went out for lunch. If she was having pains, she wasn’t giving anything away. She looked great, if not a bit tired. As we left to go home, I said “see you tonight?” and she said “yeah maybe, I’ll let you know”.

As night descended, I thought maybe the niggles had died down because I hadn’t heard any more from her. But of course, as soon as I hopped into bed at about 10:30pm my phone rang. It was Beth telling me the pains had started becoming stronger at about 8pm and she’d called mum to come and be around to look after soon-to-be big sister. She also called so I could defrost some breast milk I had expressed for my 7 month old. We had joked that I could just bring him along to the birth because he still feeds a lot at night.

So I defrosted some milk and tried to go to sleep, which was impossible as I was buzzing with excitement. I eventually fell asleep but woke every hour thinking, “is my phone working? Did I miss her call?”. But 3 am rolled around and still nothing. My midwife brain couldn’t turn off. I was thinking either the pains have switched off or the baby is posterior and taking it’s time. Then finally the phone rang and it was Ben telling me the pains were now every 2-3 minutes, lasting 20-30 seconds and getting more intense. I had slept in my clothes so I could just jump out the door but then I realised my toddler would be waking in 2 hours and my hubby had to leave for work early on Mondays. I gently woke him and asked him if it was ok to leave him with the kids (this had always been the plan, but we didn’t know the baby would come on a busy work day), and he said he didn’t think he’d be able to get the kids both ready in time to drop them with mum and go to work. So the joke of bringing my baby, became a reality. I bundled the sleeping beauty into the freezing car and scurried over to Beth’s house.

Luckily bub stayed asleep when we got there so I could focus on my sister. It often happens that when something in the birthing environment changes (like a new person coming in, or going to hospital), if the woman is not in rip roaring labour, the contractions slow down for a time before they pick up to what they were previously doing. As I was standing with my sister, her pains were coming every 2-3 minutes but they were barely lasting 10 seconds and she only had to breathe deeply twice and they were finished. I had a quick feel of her belly in the standing position, which is pretty impossible, but to me the baby did feel a little posterior. That’s when I started to worry.

Her first labour had been very straight forward – a few hours of prelabour, then gradually increasing contractions and baby born after about 7 hours. I was afraid that this was going to be a long, drawn out labour, which she would have trouble coping with after such a quick first birth. I didn’t say any of this to her of course, but I think she could read my mind. She kept saying “why are these pains so short? Why is it taking so long? Do you think it’s posterior?”. I tried to reassure her and give non committal answers. But she’s my sister. She could see through my vagueness. Nevertheless, she stayed calm and in the moment. Just focusing on breathing and swaying her baby down.

I tried my best to be her doula, supporting her and Ben and protecting her birth space. After a while I left her and Ben to labour together so I could make some tea and breastfeed. They are such a good team, Beth breathing and resting, Ben timing and making sure the heat pack was always hot and she stayed hydrated. Even though they were both calm and focused, my pesky midwife brain kept sprouting negative thoughts that I tried as hard as I could to ignore. I tried to remember to trust in my sister’s birthing ability. She is a fabulous birther.

At about 5:30am she said she felt like going to the hospital. I was thinking silently “oh no, not yet, you’re not established, we’ll be there for hours and the doctors do their rounds at 8 and they’ll want to intervene and it will start a cascade of events”. But as you know women know their own bodies and know when it’s time. So I trusted her, left mum with the kids and helped pack everything into the car. She told me later that she had known it was not as intense as last time yet, but she didn’t want to get to hospital in the day time and have to have contractions when everyone would be arriving for work and the foyer would be filled with people. Smart girl.

During the drive Beth had a few contractions. They weren’t too intense but they had started lasting 20-30 seconds again. Good, progress. I warned her that, depending on who was working, they might want to examine her to see how dilated she was, as her contractions were still quite mild. She was not very keen at all because she had not needed a vaginal examination fist time round as baby had been born an hour after arriving. Luckily, it was a very good experienced midwife who was working and I told her Beth wasn’t keen on an examination. She was happy to wait and see how things went.

After about half an hour, when Beth had gotten settled in the room, she was rocking and swaying with the contractions and sitting on a fit ball in between. Still the contractions were about 30 seconds long and about 2 minutes apart. Then during a more intense pain, she felt a “pop” and her waters broke. There was only a little trickle, but as soon as I pulled her pants off I saw that the amniotic fluid was meconium stained (which means the baby had done a poo inside). Again immediately my midwife brain turned on and I couldn’t help thinking “oh no, the baby is distressed, something is wrong, she isn’t overdue so why would the baby poo other than being distressed?”. When will I learn to just be patient and trust birthing women and babies? I was also thinking “she’ll have to be continuously monitored and she’ll hate that cos she won’t be able to move around and then we’ll get a bad trace and the doctors will want to intervene some more, and the paeds will have to be present for the birth, and they will take the baby away and not let her have skin to skin and it’s all going to end badly”. All the while these stupid negative thoughts were rolling around my head, I outwardly stayed calm and reassured her by reminding her that my first born had had very thick meconium and he had been fine when he was born.

The CTG machine was put on and the baby’s trace was perfect, reactive and happy. I started to calm down and think more positive thoughts. It’s amazing how, when it’s a family member, you think all the worst case scenario things straight away. Normally a little bit of thin mec doesn’t cause me much concern because it’s so common and babies are usually fine. I was hoping my sister’s mind reading ability was being dampened by her inward focus to get through the pain.

After her water’s broke, it was game on. The contractions started doing what I had expected them to do the whole time. They were strong, lasting 45 seconds and coming every 2 minutes. This was more like it! She was having to breathe very deeply and occasionally let out a roar. I was getting excited. She was getting to the primal stage, where anything goes. She got tired of standing, so she jumped up kneeling on all fours on the bed. During the height of the contractions she was starting to use a high pitched scream. I really wanted to remind her to use low, growling sounds, as high pitched sounds can be restrictive and increase tension and pain. But I was too chicken. I didn’t want to annoy her during this immensely intense stage.

It turns out I didn’t have to worry, because within about 3 contractions she was groaning and grunting like she needed to push. I told her she was doing a great job and to follow her instincts and what her body was telling her to do. She became a bit agitated and was telling me I just had to tell her when she could push. I thought she was probably fully dilated by her behaviour and she also had the dark red line down her bottom crack which is a sign of full dilatation. I said she could try pushing and see if it felt better, just go with the flow.

Next contraction she was determined. She pushed like a champion birther and let out a huge scream at the end which caused the midwife to come running back into the room. I had put gloves on just in case the baby popped out before the midwife came in (I was secretly hoping it would). She was starting to show all the outward signs of immenent birth. I asked Ben if he’d like to help the midwife catch the baby. He was a bit apprehensive but excited. After about another 3-4 pushes the baby was crowning. When a midwife starts to be able to see the head of a baby, we usually make some remark about the amount of hair, to encourage the mum to push. This was no different, but this time the baby did really have a lot of hair!

One more gentle controlled push without a contraction and a gorgeous little face appeared, followed quickly by a teeny tiny body. The midwife and Ben caught the perfect little baby and tears of joy streamed from his face. Beth sat up so she could look through her legs to see the baby. “it’s a girl” she exclaimed, overwhelmed and relieved. I helped hold the beautiful little creature so Beth could roll over onto her bottom and meet and hold her new princess for the first time. She looked so tiny, cradled safely in the arms of her two loving parents. What better place to be? Absolute bliss!

As it turned out the paed only just made it to the birth and left about 2 minutes after, as the baby was crying and obviously thriving. The time was 7:10am. All my worry was unfounded, she had beaten the doctors by almost an hour! She had trusted her body and the process of normal birth. She had once again achieved the amazing miraculous feat of birthing her baby.

I am so proud of my big sister. She is an inspiration to me in so many ways. Especially through her birthing and mothering. She is a brilliant birther, a brilliant mother and a brilliant sister. I love her. And I love her babies.

This one’s for you Bee <3 xox