by Rosemary Romberg
This is not a recommendation for do it yourself home birth. If you wish to have your baby at home, you should have a competent, well-trained, experienced birth attendant. However, in the event that the baby does arrive before you can get to the hospital or birth center, or before your attendant for home birth gets to you, these are some things to know:
1. If the choice is between getting in the care and making a mad, frantic dash to the hospital or birth center, versus having the baby at home by yourself, your safest choice is to stay at home. (If you, as the mother are at home with no other adult present, this is your only choice! Please don’t be foolish enough to try to drive while you are in labor!) The possibility of being killed or injured in a traffic accident, especially with a speeding, emotionally frantic driver, vastly outweighs any danger of medically unattended birth. Also, you are running the risk that the baby will be born in the car before you reach your destination. If this happens, the husband or other accompanying person will be busy driving and won’t be able to help with the birth. The mother will not be very comfortable giving birth in a moving vehicle, and during the colder part of the year, the baby may get dangerously chilled.
2. Remember that most women who have complicated births have longer labors which give them plenty of time to get to the hospital or place of delivery. Almost all births that proceed rapidly occur with little no complications.
3. The birth will make a mess with blood and amniotic fluid. If possible, get away from your new sofa, expensive bedspread, or anything that could be ruined. Also, if possible, get several clean towels to put under the mother. Fresh newspapers are essentially sterile and can also be used.
4. As the baby’s head crowns, try to allow the baby to ease out slowly. Bearing down and pushing hard at this point will almost certainly cause tearing. If there is time, the husband or other supporting person should make his/her hands as clean as possible before catching the baby. Clean washcloths moistened with warm water can be used to help ease the perineum around the baby’s head.
5. If a foot, leg, or bottom appears instead of a head, or if the cord starts to come out first, do not try to deliver the baby. The mother should get into “knee-chest” position (on her knees with the rest of her body scrunched down — in this position the cord is less likely to be pinched) and get to the hospital as quickly as possible. The baby must get oxygen through the umbilical cord until he/she is born and can breathe. Therefore, if anything pinches the cord, which can happen with a breech presentation or a cord prolapse, the baby’s health or life may be in danger. Most head down births are easy and uncomplicated, but a breech birth or a cord prolapse require medical attention and possibly Cesarean delivery.
The baby will have a better chance of survival if another person pushes against the baby by reaching into the vagina and holding the baby back. With a cord prolapse this will keep the head or presenting part off the cord so that blood will continue to go through it. With a breech presentation, this will keep the baby from being born until medical attention is available.
If a breech baby is coming out so fast that he/she cannot be held back (for example if the entire lower half of the baby’s body is already out of the vagina) the mother should attempt to push the baby out as quickly as possible. If she stands up or squats, gravity can help the baby to be born more quickly. If the baby is not coming out quickly enough, the person attending her can reach inside the vagina, find the baby’s mouth, and make an air passageway so that the baby can start to breathe. Sometimes it is helpful for the birth attendant to apply firm downward pressure on the mother’s uterus to help get the baby born. As soon as the baby is born as far as where the umbilical cord is attached, you have approximately 5 minute to get the rest of the baby out safely. However, remember that tightly grasping or pulling hard on the baby can cause more damage than the breech birth itself.
(Although this prospect may sound frightening, please remember that the possibility of having to attend to an emergency breech delivery is extremely unlikely. Approximately 98-99% of all babies present head down. Usually birth attendants can detect a breech presentation during prenatal care and will either attempt to turn them or make arrangements for the mother to go to the hospital in plenty of time. [Although breech births have happened in birth centers and planned home births, most would agree that a breech presentation should be attended to in a hospital.] Also a foot, leg, or bottom is not as firm or solid of a presenting part as a head. Therefore, a breech baby usually requires a longer, slower labor than a head down baby, thus giving the mother plenty of time to reach the hospital.)
6. KEEP THE BABY WARM! The baby is wet when he/she is born and can lose body heat rapidly. It is not good for the baby to get chilled. Even in a room of normal temperature such as 70 degrees, the baby can get too cold. (Remember that until birth all he/she experienced was 98.6 degrees.) Dry the baby off and wrap him/her in clean baby blankets or towels. The baby’s head is ¼ of his/her body, so be sure to cover it too. Skin-to-skin contact between the mother and baby at the time of birth is beautiful and desired by many mothers. If this is what the mother wants, you can put the baby on the mother’s abdomen and then put blankets over the baby.
7. Nurse the baby immediately, even if you were not planning to breastfeed. This will stimulate the uterus to contract and help expel the placenta, and prevent excessive bleeding.
8. It is not necessary to cut the cord. The baby can stay attached to the cord indefinitely. Medical attendants will have the proper clamps and sterile equipment for this. However, if you must cut the cord, dip the scissors in rubbing alcohol first. DO NOT cut the cord without tying it or clamping it next to the baby first. The cord can be tied with clean dental floss or a soft piece of string that has first been boiled or placed in rubbing alcohol or hand sanitizer.
9. Normally an extra push or two by the mother will expel the placenta. Do not pull on the cord to try to remove the placenta. Sometimes getting up and squatting or sitting on the toilet will help get the placenta out. If the placenta does come out, put it in a bowl or similar container and save it so that medical attendants can examine it. If it does not come out, wait for medical attendants to assist with this stage.
10. The mother can massage her own uterus, or the attending person can do this for her. The uterus normally gets considerably smaller as soon as the baby is born. It should feel like a hard solid lump inside of the abdomen. If the placenta is not yet out, this may help to expel it. It the placenta is out, massaging the uterus will help it stay small and hard (involute) so that she will not bleed too much. After the placenta is out the uterus should be about the size of a grapefruit.
11. Get medical attention as soon as possible. If you were planning a home birth anyway, get your birth attendant to come to you immediately. If you were planning to give birth in a hospital or birth center, try to get your birth attendant to come to you rather than you to them, especially if it is winter time. It is not easy for a mother or baby to have to travel elsewhere immediately after birth, and if the weather is cold it is better not to expose the baby to frigid temperatures.
If your birth attendant insists that you come to the hospital or birth center, or if medical conditions make this necessary, consider calling an ambulance rather than having a very excited new father drive. The ambulance will probably be warm and the technicians can provide immediate medical attention if necessary.
12. Your birth attendant or other medical professional will need to check you and the baby for a number of things. He/she will check your perineum to see whether or not you have torn and if so will probably stitch the area. He/she will make sure your uterus is as small and hard as it should be and that you are not bleeding too much. He/she will check your blood pressure and check the placenta to make sure it is normal and in one piece. He/she will do a thorough examination of the baby to make sure that he/she is normal and healthy. If both the mother and baby are okay it is perfectly safe to remain at home or return home after being checked over. If it is necessary or desired to stay in the hospital, the mother and baby will have to stay outside the regular maternity ward, probably in a room together. This is because the birth did not take place in a sterile environment and could introduce outside germs to other babies in the nursery.
c. 1982; (Revised – 2012)