Tag Archives: homebirth

How to catch an unplanned homebirth

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”.


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.


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.


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.


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.


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.


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.


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.


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.


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.


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!

Vaginal birth an option for breech babies in Canada

Recently, I was reflecting on my second pregnancy and the anxiety I felt at having a breech baby at 32 weeks. As a midwife I knew that there was still “lots of time for the baby to turn”, as I’d told so many expectant mothers over the years. But as a mother longing for a natural homebirth, I couldn’t help but worry. The reason for my worry was because all women in Australia that have breech babies are suggested to have a caesarean section. Thankfully the baby turned himself around (possibly aided by my yoga and positioning at home) and I was able to live my dreams.

A web search revealed the blog called “In My Mother’s House” by a Canadian midwife named Sheila Simms Watson. I have linked to her post on February 7th, 2011, where she forwards a link to a post from another blog from 2009, commenting on the change of policy in Canada to now allow vaginal breech births as an option instead of automatically suggesting every woman with a breech baby have a caesarean. The original blog also talks about how there was going to be training set up to equip obstetricians to competently assist in vaginal breech births. I wonder how Canada is going 2 years down the track?

In Sydney there are only a handful of obstetricians that will “allow” women to “attempt” a breech birth. By accepting their help, women are forced to birth on the doctor’s terms, which, at least in my experience, usually includes a mandatory epidural, syntocinon and episiotomy. It is well documented that supine positioning is the worst for facilitating normal birth, why should a breech birth be any different. It seems obvious that movement and gravity would help and that the body’s own oxytocin is sufficient for labour and birth, but the doctor’s fears of a bad outcome irrationally override the normal processes of labour. So if women want a normal vaginal breech birth they have no option but to have a home birth with a private midwife. I have no problem with this except that they can be expensive, with most not covered by medicare, so not accessible to all women. This could lead to an increase in unassisted home births, where no skilled people are present to provide emergency care if needed.

The highly controversial, flawed and 11 year old “Term breech trial” formed the basis for the Australia-wide policy of suggesting Caesareans for breech births. If only RANZCOG could hurry up and review their guidelines in a similar way that Canada did in 2009, Australian women may too be allowed the opportunity to have a vaginal breech birth. Here’s hoping!