UnBreaking Birth

I recently watched this video "UnBreaking Birth" - a lecture by Ryan McAllister. It is basically a version of the lecture I have given a couple of times as a guest lecturer undergraduate women's/sexual health classes.

"How you're born affects the rest of your life, and can affect the rest of your mother's life, too"

"There are a host of values at play beyond safety"

He says our birth care system is broken for at least 4 reasons:

1. There isn't a sufficient amount of space and time to build an adequate relationship between the mother and the caregivers
2. Our interventions have become routine, instead of based on the mom and baby's best interests
3. Those interventions are often opinion-based
4. There are conflicts of obligation within the hospital that systematically cause behavior that is out of alignment with the mom and baby's best needs

"Even when they know that practicing a different way would be better for their clients, they have some reason to practice differently. That means that there are conflicts of obligation in the hospital. At times, when the hospital's best interest is over here, and the patient's best interest would mean you behave this way, the hospital's best interest wins."

"Obstetrics has been organized around handling high-risk, emergency surgical births. and they may do this well. But treating all births this way actually derails well-birth, which is the vast majority of births. So I think we need to keep the good of this system and pair it with another approach that doesn't break well-birth."

"How could we possibly find or create highly trained experienced professionals who have evidence based practices, who work within a strong relationship wit h the mother, compassion for newborns, and don't experience conflicts of obligation with a large institution?... Those practitioners already exist. They are independent midwives."

The video does not have ALL of the information on the topic, but is a nice overview for consumers. It covers:

• Why birth is broken (evidence that we spend more on maternity care in the U.S. but have worse outcomes; evidence that c-sections are too high and it is not caused by women being in worse health)
• The 4 reasons he believes our maternity care system is broken 
• A system that would work better for well-birth (certified professional midwives, birth centers)
• What YOU can do to help improve the system

This would be a great video to share in a class, because it is only 32 minutes long.

"Being aware of and making available these other options, especially independent midwives, but also including other birth assistants such as doulas, is key to unbreaking birth in the U.S."

I like the way the UnBreaking Birth says about the indicators that we have a serious problem. It is basically a run-down of why I do what I do as a public health professional and a doula/childbirth educator:

there are terrible health disparities by race and socioeconomic status

infant and maternal mortality rates are higher than in 45 other nations

the maternal mortality rate has risen every year since 1995 while in most other countries it has decreased

only 25% of obstetric practice guidelines are based on good scientific evidence, many are overtly contra-indicated

common hospital policies are not in the best interest of moms and babies

and we spend more than any other nation on healthcare

Homebirth Cesareans (HBC)

The Homebirth Cesarean project is a book-in-progress about mothers who planned home or birth center births but had to transport to the hospital for a Cesarean section. 

The project shines a light on the experiences of women who plan an out of hospital birth and then transfer, at some point in pregnancy or labor, for a cesarean. It also serves to honor the experiences of midwives and birth professionals, and to help both moms and midwives better navigate care. 

 The project was begun by a mother and midwife, Courtney Jarecki and Laurie Mednick, after their own Homebirth Cesarean experience. I asked them a few questions about their project. Here are their answers:


What about your personal experiences with birth brought you to your work on this project? 

As a doula, childbirth educator, midwifery student and apprentice, Courtney was steeped in the world of birth for many years before becoming pregnant. She planned a homebirth and looked forward to bringing her baby into the world at home with her husband and dogs by her side. After over 50 hours of labor, she transported to the hospital during for a cesarean. The shock of this  experience and the loss of her homebirth, shook Courtney deeply, as it does many women have homebirth cesareans (HBC).

A homebirth cesarean is not just an unexpected birth outcome. It can be a shattering blow to a woman’s confidence, sense of self and identity, her values, and it produces the kind of grief that only the loss of a deeply held dream can. As Libby, a HBC mom says, “The loss of my homebirth is as profound as the cesarean itself.”

Eight months after her daughter was born, Courtney sat down to discuss the birth with her midwives, specifically, to give them feedback. From that two hour conversation, Laurie’s interest was piqued. She invited Courtney back to discuss writing an article that would shine a light on these rarely discussed, heretofore unnamed births. Courtney proposed a book, and so the HBC project was born.

What are some of the responses that you are getting from moms, midwives, and other maternity care professionals? 

In addition to co-authoring a book with the woman who was her midwife, Laurie Perron Mednick, Courtney started a closed Facebook support group for women processing their homebirth cesareans. The group began a little over a year ago with a handful of friends. It has since grown to over 900 members, including birth professionals who are interested in learning how to better care for HBC mothers.

Since 2011, Courtney and Laurie have interviewed over 150 mothers, midwives, and birth professionals. The feedback is overwhelmingly positive. The need for HBC to have a voice and to be represented is very present and deep. HBC mothers often feel like they no longer belong to the natural birth community, but neither do they fully identify with women who planned hospital births. They often say they feel like outcasts with no identity or community. The HBC project brings these women’s stories to the forefront and gives them a sense of belonging. As one mother said during a storytelling event to raise funds for the HBC project, “I’m a librarian. And I like things to be categorized and have a place on the shelf. Because of HBC, I have a name, I have a category, and I finally found a place on the shelf.”

The response from maternity care professionals has been very supportive. Courtney and Laurie have interviewed professionals ranging from therapists, midwives, OBs, to globally recognized birth experts such as Michel Odent and Sarah Buckley. All shared their insights on the HBC experience, and many mentioned that there was a real gap in the birth discussion about these kinds of births.

What form does the research take, what will the book contain, and are you planning on doing anything else with the information you gather?

The research for this book is rooted in Courtney and Laurie’s own HBC experience as mother and midwife, respectively. That experience guided the research process, which includes phone, video, and email interviews. The interviews are casual, with guiding questions that help elicit the participants’ views and experiences on HBC topics.

The book will feature several complete birth stories, each focusing on a different theme, including two stories from solely the partner’s perspective and one story from mom, partner and midwife. Overall, the book has roughly 15 chapters focusing on a different phase of the homebirth cesarean experience, including prenatal conversations, labor, transfer, the cesarean experience, hospital stay, and what it’s like after the first postpartum year. The appendix will contain helpful handouts for birth professionals and information for HBC families. Overall, the book provides first hand descriptions of what mothers have experienced, and information on how care providers can support women in these circumstances.

The research has also given rise to Courtney and Laurie developing a series of classes for birth professionals. The first class offered is called Speaking of Cesareans, and teaches midwives and birth workers how to broach the transport and cesarean conversation with clients prenatally.

What sort of things are birth professionals saying about homebirth cesareans? 

Sarah Buckley, she encouraged women to submit their homebirth cesarean stories so they get heard and read as part of the natural birth culture. She said, “People want to hear these stories, they are beautiful.”

The idea that we need to hear more about HBCs in the current birth discussion was echoed by Michel Odent who said: "If you look at the research, more women want to give birth at home and these births are becoming increasingly difficult. The HBC project is very important because there are going to be more and more women in this situation who have ideals about homebirth, who end up with a cesarean."

What sort of things are mothers saying about homebirth cesareans? 

Mothers often express that they feel like their births are “dirty secrets” of the homebirth community, and that by having a cesarean, they failed the natural childbirth movement they so deeply believed in. Mothers also say that they felt woefully unprepared for the possibility of cesarean, and that they believed that by talking about one prenatally, they might end up causing one. This is magical thinking they now deeply regret. As one HBC mother said, “Can you imagine if we didn’t teach pilots how to crash land because we thought talking to them about it was too scary?” Before this project, a birth that started at home and ended in the operating room didn’t even have a name. Mothers, like the one mentioned above, say that they appreciate having a way to describe their births that feels like it captures the hard work and intention of homebirth while still voicing the surgical outcome. 

What is one thing you want the public to know about homebirth cesareans?

That they happen. They happen to all kinds of women in all kinds of circumstances. They are real births and they deserve to be discussed and honored.

__________________
Thank you to Courtney and Laurie for sharing this great project with me! 

For more information, please visit the HBC website: 
http://homebirthcesarean.com 
 
Click here to see the public Facebook page 

 Twitter: https://twitter.com/HBCesarean   #hbcesarean

Doula for a Home Birth

I think its interesting that most people I encounter who know little to nothing about doulas right away tend to assume that I attend only home births. They'll ask something about if I do mostly home births or if I'll do hospital births, too, or if I only do births in water, or even if I catch babies. "Doula," if its even known, is assumed to be a "hippy" or "alternative" choice, associated with birthing at home. In reality, if I only attended home births, I might not have very many to attend! 99% of women in the U.S. deliver in the hospital. If I want to have any doula clients, in the hospital I must be! And, indeed, the reason many women hire a doula is precisely because they are giving birth in a hospital.

I also think its interesting, then, that many people who do think about planning a home birth do not think that a doula is even necessary at a home birth at all. Many say that they have a midwife, what do they need a doula for? Won't the midwife do everything that a doula does? In reality, this varies. Some midwives may not show up early in labor, and may wait until the time seems close to attend the birth. Or, if they have other clients whose births are imminent, they may have to leave to attend them. Furthermore, if a midwife attends a birth without an assistant, then she isn't likely to be able to check blood pressure, take notes, set up birth equipment, etc AND provide the physical and informational support that a doula provides.

Photo Credit

There are some midwives who work in pairs, where one can take care of the medical side of things and the other can provide doula support. And there are many midwives who want to be there in a doula capacity for a long labor! But this is not true 100% of the time, and many women and partners feel they greatly benefit from having a doula at their home birth.

To read more about perspectives on doulas at home births, check out this post from Citizens for Midwifery: Doulas and Homebirth

What do you think about Doulas at Home Births?



  

Home Births and the Public Health Response Webinar

Home Births and the Public Health Response: Promoting Informed Choices and Healthy Outcomes

This seminar took place Wednesday, July 20, 2011 from the John Hopkins Bloomgberg School of Public Health in Maryland and was broadcast live online. These are my notes from the webinar, along with some of Dr. Declerq's slides. 

Eugene Declerq, PhD Assistant Dean, Doctoral Education Professor, Community Health Sciences
Boston University School of Public Health

We're talking very small numbers

Historical Context:

• As the number of hospital beds increased, out of hospital birth decreased. 
• Supreme Court determines that even though midwife's (Porn) birth outcomes were as god or better than local doctors, they could not separate midwifery from medicine, so she was charged with practicing medicine without a license. 
• Nurse midwifery came about so midwives could work unders direct supervision of doctors
• Netherlands remain the only industrialized country with a sig. portion of births at home, now at 26% of all births are at home. 
• Trend in England and Wales - only industrialized country other than US showing a sig. increase in home birth. 
• U.S. post 1989 - Decrease in out of hospital birth but a jump at around 2008... but very small numbers. 
• 2003 live birth certificate asked "planning status" of home birth. 83% of home births in 2006 are planned home births. 

Present Day

• Planned home births in the U.S. are white/non-hispanic. Small numbers of other ethnic/racial groups. The increases have occurred almost completely in white/non-hispanic mothers. 
• Overwhelmingly married, usually over 30, full gestation. More likely to be in rural areas, well-educated, nonsmokers. 75% of cases tend to be mothers who have given birth before. The people having home birth in the U.S. are a selective group.
•  The primary group attending home births (planned or unplanned) are Certified Professional Midwives. CNM's have dropped off, esp. because of legal constraints (also physicians).
• Gestational age distribution - the average in the U.S. is 39th week. The planned home birth distribution shows the classic distribution with the peak at 40 weeks. 
• Significant increases have occurred in California, MD, Vermont, Ohio, Kentucky, VA, NC, 

"Other" could actually be attended by an "illegal" midwife but signed off on by a father, for example.

So many inferences can be made from this slide

Maryland

• Home birth rates jumped in 1994 but declined until 1999, until a slow general increase. 
• Not all planned home births end up at home. The transfer rate for home births is roughly 15%. 
• Much higher proportion of black/non-hispanic home births in MD than in the rest of the US, but could be unplanned home births. 

Mairi Breen Rothman, CNM, MSN Certified Nurse Midwife
Metro Area Midwives and Allied Services

• Birth center births are like having a home birth at someone else's house. There is nothing there that a midwife wouldn't have at your home. They both involve trained midwives who know how to use medications, IV fluids, oxygen, resuscitation, acute care period, etc. 
• In a home birth you have no institutional bacteria, and it doesn't require a nervous woman and partner to get in a car and drive somewhere and then leave in a few days.
• The safety of home birth has been established again and again (Olsen 1977, Johnson & Daviss 2005, Leslie and Romano, Janssen Saxell et al 2009), in North American and abroad. 
• Wax et al, recent meta analysis AJOG - deeply flawed inclusion data 
• included pre-term infants in hospital; includes data from birth certificates that do not differentiate between planned and unplanned home births; did not consider culture, geography, health care systems impact)
• Why women choose home birth (Boucher-Bennett et al 2009)
• Number one reason: SAFETY
• Avoidance of unnecessary medical interventions
• Previous negative hospital experience
• More control
• Comfortable, familiar environment
• Home birth patients feel they are not listened to and respected in the hospital
• Public Health: more women are choosing midwives, so how can we make this option safe.
• Ideal scenario is that everyone who is qualified to attend births is licensed, operating within the system, has access to the model of care she chooses, we have enough midwives and no unattended home births, streamlined way to do hospital transfers, midwives can collaborate or consult with physicians, and that Medicaid covers all services. 
• Bottom line: Birth is about Women. The discussion is about the Sovereignty of Women.
• Frequently we hear "Should women be allowed...?" Have you ever heard "Should men be allowed...?"
• "If we take good care of the mothers, the mothers will take care of the babies" - Kitty Ernst

Notes from the Q&A Discussion:

We can't have randomized trials of birth, so they are typically retrospective and women are matched. Frequent limitation: can't distinguish planned home birth and which home births become hospital births. 

Studies frequently find that low-risk pregnancy/births are comparable at home and in the hospital.

One study found that matched women being cared for by midwives prenatally other than physician care had a 19% lower infant mortality rate and 33% lower low-birth weight rate. Midwifery care is designed to optimize women's self-care during pregnancy.

Midwives are extremely selective at picking women to attend at birth at home because they don't want anything to go wrong at home. Age is generally no issue. 

Problem with Medicaid - payment doesn't cover everything. Midwives get a very low payment that doesn't cover all over-head. 

The Healthcare Reform Act has this impact on pregnant women - will cover all pregnant women who are not covered. Also, pay for certified professional midwives but only in a birth center. CNMs will be paid by medicaid at 100% of the physician fee schedule. 

Low risk moms in any setting - 97% of babies are fine. What's important is to have emergency pathways to deal with babies that need help. The best thing to do for women choosing home births is to have those systems in place, so that women can access the medical system without being punished. 

The British system is instructive - give people a real option to have home birth - they are at about 3%. The U.S. has a more antagonistic view of home birth so we might at some point get up to 1.5%. Probably no huge shift in the future. But maybe there will be a much more activist maternity movement in the U.S.

Quiet revolution - women are quietly examining their options, looking at research, making a choice. More and more true as time goes on. 

Physician-attended home births data - who are these physicians? Could be a physician sign-off at a home birth transfer or an unplanned home birth on birth certificates. Highly unlikely that physicians are at home with mother while she is laboring, attending the delivery, cleaning up, and leaving. 

From a historical perspective, CNMs and CPMs have has some divisions and competition. These days there is an attempt by the ACNM and MANA to work together. 

____________

The presenters' slideshows are posted under "Documents" here 
There will be a link online at the Johns Hopkins Bloomberg School of Public Health archiving this webcast for future viewing.
Learn more about Eugene Declerq's work (and what he looks like) in his video Birth by the Numbers

My Thoughts on Hospital Birth vs. Home Birth

On the heels of a 21 hour birth with a client, my longest yet (and also finally a birth that counts as my last birth for certification! yay!), I am going to share some thoughts.


Here are a few things about Hospitals Births that solidify my desire to have a Home Birth:

1. I HATE directed pushing. Hate it. You do not need to be told when and how long and how strong to push in order for your baby to come. You also do not need to "know" that you are 10 cm and then be "allowed" to push. You will know when it is time to push. You will feel the urge!

I think women push much more effectively when they follow their bodies. They breathe more than they do with directed pushing, which gets more oxygen to the baby and themselves. They do not push so hard that they are not letting their perineum tissue stretch, and so they tear less. They tend to push in more effective positions, especially if they are not in a hospital confined to the bed (which is more convenient for the doctor).

I told my client recently who was experiencing a nurse who was telling her not to push during a strong pushing contraction because she had to "give the baby a rest, she's having her head compressed a lot," that this was HER show. She needs to push and breathe when she feels it is right.

2. Monitors. Constantly attached and tethered, constantly beeping and squeezing, constantly readjusted. I think they are so freaking obnoxious. They also haven't been shown to identify and prevent what they are "supposed" to (see my post Where's the Evidence Based Medicine?) How can I labor effectively if I am so profoundly irritated?

I don't think the blood pressure cuff, thermometers, contraction monitors, heart rate monitors, etc etc really help my baby have a safer labor and delivery. I think they hinder that which creates a healthy birth, namely, a mother who is at peace and as comfortable as possible, a mother who can get up and more around and be in any position she likes, a mother who doesn't feel encumbered or worried.

3. Not being able to eat or drink whatever I want. Again, there is no evidence that eating and drinking during labor is bad, but its certainly true that not being able to eat or drink lowers your energy level and also makes your labor unpleasant. I'd much rather eat and drink what I want for energy than be attached to a painful IV.

I also think its ridiculous that we withhold such a thing from a laboring woman. Its like its some power trip to be able to control their eating (and their peeing, too, if mom has to have a urinary catheter).  All part of the Rite of Passage (see: Robbie Davis-Floyd).

4. People telling me where and how and in what position I can labor/birth. Uh uh, no. I am going to labor how I damn well please. I am not going to stay still in that bed just so YOU and the hospital record room can have a "nice strip on the monitor." I am not going to lay here and suffer pain that would be alleviated by moving or a hot shower just so you can fill in your charts with my blood pressure. That's bullshit.

I'm also going to push in whatever position feels the most comfortable for me. I don't care if its hard for you to catch the baby that way - I don't actually need you! I can catch my own baby! Or my husband can do it! One does not need a medical degree to catch a baby. That baby is coming whether we like it or not, and its coming in whatever position I choose at that moment.

5. The hospital atmosphere. Strange smells, weird sounds, the fact that hospitals are full of illnesses and germs, and being in someone else's territory. I've never liked the sterilization smells of doctors offices and hospitals. They just remind me of being sick and uncomfortable. I don't think I could fully relax in an atmosphere where people can come and go as they please, touch me and tell me what to do whenever they please, and me and my family have to "ask" to be able to do things or go places. I also don't want to feel embarrassed during my labor, and I don't want people there that I don't know. That atmosphere can stall a labor, and I've seen it happen.


I should emphasize, also, that all of these things also solidify my decision to have a home birth because I want a natural birth. If you want a natural birth, STAY OUT OF THE HOSPITAL.


What about you, what do you think? Other than the "safety" or "fear" aspect of the hospital vs. home birth debate, tell me what prompted you to make the decision you did!

A new way to sell a product... with a Home Birth!

Take a look at this advertisement for a bed featuring a home birth!

A Medical Anthropologist Discusses Home Birth

This is a fantastic article that touches on the medicalization of childbirth, an important issue in medical anthropology, as well as the safety of home birth, the high rates of high maternal and perinatal death in the US, public health, the dominance of biomedicine, how midwives and doctors should be working together, etc etc!

I wish I had seen this before I presented on biomedicine and medicalization of childbirth in my biocultural medical anthropology class this week, I totally would have loved to use it!



Why Home Births Are Worth Considering

by Melissa Cheyney

Assistant Professor of medical anthropology and reproductive health

Posted: September 9, 2010 07:00 AM

A new analysis by Dr. Joseph Wax comparing home births and hospital births, which was published in the recent issue of the American Journal of Obstetrics and Gynecology, not only presents misleading conclusions, it drives a wedge between two groups that cannot afford a greater divide: medical doctors and midwives.

The study documents similar perinatal (or the period immediately surrounding birth) mortality rates for home and hospital births, but claims a three-fold increase in neonatal (measured up to 28 days after delivery) mortality for home deliveries. Yet this analysis contains serious limitations and concerns those of us who practice midwifery in an out-of-hospital setting.

Beyond the issue of the flawed methodology, which has been addressed by several national organizations, including the Coalition for Improving Maternity Services and the Midwives Alliance of North America, there are serious cultural implications to this study.

As a medical anthropologist, I am concerned with the chasm with doctors and the medical establishment on one side, and midwives and the home birth movement on the other. In Oregon, where we have both licensed and unlicensed midwives working in home and in birth center settings, research has shown deep mistrust between doctors and some midwives. Many doctors have expressed the belief that only hospital births are safe, while midwives say they often feel marginalized and disrespected.

Such studies only deepen this mistrust and have the potential to increase hostility during encounters when midwives and their clients have to seek hospital care for complications. The end result is a system that can be detrimental to women and their babies because of the impaired ability to communicate across a cultural divide. Instead of a maternity system based on fear and misinformation, we need a system based on collaboration and mutual respect.

The United States is already the butt of jokes in the international public health community. We spend more on health care than any other high-income nation, while simultaneously serving the lowest percentage of pregnant women, as several of our key health indicators continue to decline each year. According to Eugene Declercq of the Boston University School of Public Health, the U.S. now has the highest number of maternal deaths relative to all other high-income nations, and we also rank second worst for perinatal deaths.

The U.S. has not reported a significant decrease in maternal mortality rates since 1982, and the Center for Health Statistics indicates that the rate of cesarean section in this country is now at a whopping 32 percent, marking the 11th consecutive year of increase. As the incidence of cesarean section rates rise, so do medical complications for mothers and babies, along with associated health care costs. The World Health Organization recommends a cesarean rate of no more than 10 to 15 percent, so our rate is two to three times higher than it should be.

The answer among the U.S. medical establishment has been to throw more expensive technology at the problem rather than retracing our steps to see where we went wrong. Instead of admitting that something is fundamentally broken with the system, organizations like the American College of Obstetrics and Gynecology continue to endorse the idea that medicalized hospital births are the only safe route for women.

We know that 99 percent of women in the U.S. are giving birth in hospitals, yet the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where one-third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.

While maternal mortality rates decreased among our peer nations between 2000 and 2005, they increased by more than 54 percent in the United States during the same time period. The two major differences between the U.S. and other nations, which have superior maternal and infant health outcomes, are that the latter offer universal health care and rely more extensively on cost-effective midwives as a public health strategy.

Consider the economics of the situation. The cost of a cesarean in the United States is about $15,000 and an uncomplicated vaginal birth averages $8,000 (without prenatal or postpartum care), while homebirth midwives charge $2,000 to $4,000 -- a fee that includes care from conception through the postpartum period. Exploring the option of home and birth center birth with midwives for low-risk women should be at the core of national health care reform and research. Instead, several generations of high-tech, low-touch birth and a pervasive cultural belief that birth is imminently dangerous -- even in healthy, low-risk women -- has led to powerful cultural blinders that limit options for women.

In anthropology, we say that "normal is simply what you are used to." The power of socialization and the dominance of biomedicine have kept us from systematically examining a variety of birthing environments and providers as viable alternatives to the expensive and interventive hospital delivery that has become the norm in the U.S.

Finally, I must briefly address the study by Dr. Wax and his associates. Let me first say that their study found no difference between home births and hospital births when measuring perinatal death, which is the primary indicator for evaluating the safety of a mode of delivery. Yet, the study chose instead to focus on neonatal death, generally accepted as death within the first 28 days of birth and to emphasize this part of their research. A complex mix of psychosocial and clinical factors, including congenital anomalies, Sudden Infant Death Syndrome, unsafe home environments, and poverty, can all contribute to death in the first month of life. As Dr. Michael Klein of the Child and Family Research Institute in Vancouver, B.C. points out, after removing low-quality studies and out-of-date statistics, the Wax study actually demonstrates no difference in outcomes between home and hospital-based delivery, even for neonatal mortality.

Yet the authors included faulty data in their total analysis, comparing apples to oranges by mixing different types of data sets, such as grouping low-risk with high-risk mothers, and including babies born unintentionally at home.

As an anthropologist, I see a study like this as harmful to women and as having a much larger social impact than the authors possibly intended. For instance, there are many women in rural areas and women who are uninsured, or under-insured, whose only option is to give birth under the care of a midwife. How does this study affect these women? A study like this only exacerbates and undermines often already negative and tension-fraught relationships, making it more difficult for out-of-hospital midwives and physicians to work together when needed.

There is something to be learned from the centuries-old traditions of midwifery, and I believe that if doctors and midwives, including those who work in the home setting, could be willing to learn from and respect one another, women and babies in our country would benefit. After all, we are all working for the same end result: a happy and healthy mother and baby. Our differing visions of how to get there will require an attitude of cultural humility and a willingness to listen. Studies like the Wax study take us in the wrong direction.

Catching up on Great Articles

It turns out that Graduate Assistantship work hours can be a great time to catch up on some birthy blogs! While my workload here at work is light, I am going to post some interesting posts I've noticed recently that are worth a read:


Home Birth... Why I Did It (& I'm Not a Hippie)
Because we have to keep bringing this point home... "I gave birth at home. And no, I’m not a hippie. I’m a college educated, business minded woman"
She writes, "My hope is that by sharing my story, I may encourage at least one mom to do her own research so she can make the best decision for her  childbirth experience... I’m certain almost all women are capable of a  natural birth, and if they take back that right, we will have healthier and happier moms, dads and babies out there."
I posted this one on my personal facebook page and it spurred a big discussion... if only I could get that type of response on here! :)


Women who breastfeed even one month reduce their diabetes risk
This is a hugely important study find, because diabetes is quickly becoming a pandemic thanks to unhealthy eating worldwide.

When Pushing Turns Purple: What's a Doula to Do?
from Birthing Beautiful Ideas... Illustrates the frustrations with the frantic and unnecessary "HOLD YOUR BREATH AND PUSH! 1... 2... 3... 4... 5... 6... 7... 8... 9... 10... AGAIN! HARDER!" that nurses always seem to want to do in labor and delivery.


Volumes: a huge problem
...by Public Health Doula. I find this post fascinating because she explains just how and why many women end up over-feeding their newborns.  She discusses just how much an infant should be eating, why they are being overfed, where the problem stems from, and so on. Over-feeding can lead to, other than trouble with breastfeeding, obesity later in life.

Water Birth

Though I've mentioned water birth before, and read a lot about it, I realized I've never really blogged about water birth!

Water Birth has been shown to provide excellent birthing experiences for both mother and child. The mother experiences a more relaxed environment in which she feels in control and free to follow her body's urges. The buoyancy of the water does wonders to alleviate labor pains without the need for IV pain medication. Perineal trauma is also reported to be less severe. Additionally, you don't have to worry about clean-up or stains... everything goes out with the bathwater.

Advocates for water birth also state that a water birth eases the transition for the baby from the birth canal into warm liquid that resembles the intra-uterine environment.

- Water birth can take place at home, in a birthing center, or in a hospital. 

- Temperature of the water: should be somewhere between 95 and 100 degrees, so that the mother is comfortable.

- The cost to purchase or rent a birthing pool runs between $118-375 plus shipping.  However, it's possible that your insurance company may reimburse the pool rental or purchase fee. If you give birth at a hospital there is no need to bring your own. Types of birth pools

Want to read/watch some Water Birth stories?

Kristen at one of my fave blogs, Birthing Beautiful Ideas, writes about her In-Hospital VBAC Water Birth

A Beautifully-made video of a Water Birth

Rixa at Stand and Deliver blog writes about the birth of her second child at home, including video. 

A video of an "unusual" water birth in a hospital where the couple are left quite alone.

A short video where mom catches her own baby.

Waterbirth International has a page with several water birth stories.

I will definitely labor in water, an excellent form of pain relief that has no negative side effects but a multitude of positive effects.


Frequent concerns with water birth:

- Infection: Hospital staff, especially L&D nurses, will frequently cite "infection" as the reason for not getting into a bathtub, either to simply labor or to give birth. Some will say you can only get in if your water has not yet broken, others will say not at all. Most OB's will refuse water births because they do not want to deliver a baby by bending over by the tub.
(The truth is, YOU can deliver your baby in a tub, simply by reaching down and pulling your baby up once he/she is born. Or dad can! Moreover, with a full birthing tub (as opposed to a regular in-wall bathroom tub), your support team and midwife, etc can be all around you 360 degrees, and can be wherever they are needed, such as to help deliver the baby.)
As long as the bath has been cleaned, there is little to no risk of infection for the baby. Also, the baby will be colonized by its own mother, anyway, on the way out, and by her skin and breast immediately after.

- Slowed Labor: There is a possibility that the relaxing effects of the water, and the tendency to lay immobile for some time, sometimes slow labor. For this reason, many professionals suggest that mom wait until 5 cm dilation to enter the tub. If you are birthing at home and not receiving cervical checks, I would recommend entering and exiting the water whenever you felt like it.

- And the big one...

What prevents baby from breathing under water?
There are four main factors that prevent the baby from inhaling water at the time of birth:

1.  Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby's muscles for breathing simply don't work, thus engaging the first inhibitory response.

2.  Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.

3.  Water is a hypotonic solution and lung fluids present in the fetus are hypertonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hypertonic solutions are denser and prevent hypotonic solutions from merging or coming into their presence.

4.  The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemoreceptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.

For a more complete description, click "read more."

Being a Doula in Ireland

This article was published in International Doula, the quartlerly publication of DONA International, volume 18, issue 2, 2010.

Being a Doula in Ireland

by Tracy Donegan, CD(DONA)

As Ireland's only DONA approved birth doula trainer, I thought I would share my experiences of the Irish birth scene and give you a little flavor of the life of a doula in Ireland.

I began the first doula service in Ireland four years ago, and we continue to be faced with strong opposition from doctors and midwives. This situation is very frustrating for a DONA approved birth doula trainer, as most doulas cannot attend hospital births unless they are the designated birth partner - making the mom choose between her partner and her doula. Some of the less-busy hospitals are slightly more accommodating, but we are always aware that we could be asked to leave a birthing room at any moment without any justification.

Preparing for Birth in Ireland

Of course, the US favourite, What to Expect When You're Expecting, is very popular with Irish moms-to-be. There are two Irish pregnancy books. One of these is my own, The Better Birth Book: Taking the Mystery (and Fear) Out of Childbirth. My second book is due out this summer and is a guide to cesarean birth and VBAC in Ireland. Another popular book in Ireland is The Irish Pregnancy Book, written by Peter Boylan, a former Chief of Obstetrics. This book is extremely medicalized and recommends episiotomies, birthing on the bed, rupturing the membranes routinely, Pitocin and immediate cord clamping.

Childbirth classes are provided free by the hospital and by several independent providers. I teach an antenatal class called GentleBirth, which incorporates birth hypnosis, active birth and informed decision-making. I have also created a positive birth preparation program as a home study class.

Birth in Ireland

Similar to the United States, arond 98 percent of babies are born in the hospital. Homebirth services are very limited and are provided by a few self-employed midwives and a couple of hospital homebirth programs.

Approximately 75,000 babies are born in reeland every year. Around 26,000 babies are born in the capital city of Dublin, but there are only 30 birthing suites available. You can imagine what that means for moms who want to labour in their own time! A natural, unmedicated birth in uncommon unless the mother arrives at the hospital in advanced labour.

There are two Midwife Led Unites (onsite birth centers) in Ireland. There are curently no stand-alone units, but this is something I would like to establish when I finish my midwifery degree in two years. Doulas are generally accepted as additional birth partners within these units as the care is much more focused on mother-friendly practices.

The active management of labour protocol began at our National Maternity Hospital in Dublin and is still very common in Ireland (waters are broken on admission and if mom is not following the one centimetre per hour dilation rule, she is augmented with Pitocin). Approximately 40 percent of first-time moms attending our National Maternity Hospital are augmented. There are roughly 8,000 births in this hospital, but there is only one shower in the labour ward and no bath. So, being at home with a labouring mom can really help her stay comfortable and in control of her own environment.

Maternity care is free to European citizens. About 40 percent of healthy moms will choose private obstetric care and will pay approximately $6,000 to their doctor, who may or may not attend the birth. All of the care during labour is provided by midwives.

Evidence-based practices are very limited and not all the staff appreciate those parents who do their homework and express particular birth preferences, such as delayed cord clamping. Informed choice is almost non-existent.

Although most moms give birth in a private room, they will sometimes labour in a ward with 12 or more other women.

Water birth is only available at a homebirth with a self-employed community midwife. Two of our largest hospitals have beautiful pools but refuse to even let moms labour in them. I organized a water birth study day in July 2009 with a UK expert on water birth for students, midwives and doulas. None of the staff from the two hospitals that have birth pools attended.

Ireland's cesarean rate is approximately 25 percent to 30 percent in some places and is increasing. VBAC rates vary widely depending on the hospital and can be anywhere from 6 percent to about 70 percent. Episiotomy rates are still high and range from 10 percent to 40 percent in places.

Unlike in the United States, all healthy babies room in with their moms in the hospital. Even so, postnatal care leaves a lot to be desired. Often, post-cesarean moms are unable to reach their crying babies or are too medicated to take care of a newborn; and the shortage of night staff makes this situation even worse. Moms get little privacy after birth, and a woman can sometimes share a postnatal ward with up to eight other moms and babies.

Breastfeeding rates leaving the hospital are very low (around 35 percent) and artificial feeding is the norm. Although we have quite a few Baby-Friendly hospitals, breastfeeding rates remain low.

Ireland's Birthing Future

There are several active doulas in Ireland, but in some areas there are no doula services available. It is my hope that as more mothers demand that doula care be an option available to them in hospitals, we will see an increase in the accessibility of doula services and more options available to birthing women.

Hypnosis for Childbirth

When I became a doula I began hearing a lot about hypnosis for childbirth. Generally, pregnant moms will take workshops or listen to CDs from either Hypnobabies or Hypnobirthing.

Hypnosis for childbirth is another childbirth education and preparation method. At first it sounds hokey, but from what I've seen and heard it is really similar to other coping methods and seems to really work for a lot of moms! It is also similar to what birthing mamas seem to already do: get into a zone inside themselves, listen to their breathing for calm, and so forth. I haven't had the pleasure of attending a hypnosis childbirth yet, but I am looking forward to it.

What Is It and How Does It Work?

by Kerry Tuschhoff, HCHI, CHt, CI 

Mention Labor and Delivery to an expectant mom in her last trimester, and chances are good that her heart will begin to race, her mind floods with concern and in some cases, panic. She knows that the day is coming when a force much bigger than herself will take over and her body will govern itself completely. For some women this is a very fearful event, but for a Hypnobabies mom, it is an eagerly anticipated challenge. 

These wise women use hypnosis to eliminate pain and fear from the birthing experience. In the past, the word "hypnosis" conjured up images of stage hypnotists re-creating Elvis, or mesmerizing others into embarrassing situations. Now it is common for hypnosis to be used therapeutically in many areas of medicine, dental and surgical anesthesia and personal therapy sessions. Even so, there are many misconceptions regarding hypnosis that can dissuade those contemplating this powerful tool. Here are a few FACTS:

* All hypnosis is self-hypnosis; the hypnotherapist is only the guide. A person chooses to enter into a hypnotic state, stay in and come out at will.

* Approximately 90-95% of the population can be hypnotized. Willingness, belief and motivation have great influence over hypnotizability.

* During hypnosis you are neither asleep nor unconscious, and will always "come out" whenever you wish. You are always in complete control.

* Stronger-minded and stronger-willed people are easier to hypnotize; not the other way around as is usually assumed.

* You cannot be made to divulge information or do anything against your will while in hypnosis.

*Hypnosis is not Satanic or religion-oriented at all, just a way to direct your inner mind toward the positive for great personal benefit. 

*We are all in states of hypnosis many times a day already!

What about Childbirth Hypnosis Classes? 

When learning how to use hypnosis for childbirth, you are taught an understanding of how the uterine muscles will work efficiently together, as they were designed to do, when the body is completely relaxed. The depth of relaxation necessary can easily be achieved with hypnosis so you learn these skills in class, and practice them at home every day until your baby arrives. Important: Comfort in childbirth depends on much more than deep relaxation, so you are also taught the most in-depth hypnotic anesthesia techniques that exist. These make a huge difference in creating your truly comfortable birthing experience, and are easily learned and practiced.

Your Birth Partner can have a very integral role in the preparation process: listening to the CDs, reading the handouts and guiding the Hypno-mother into deep relaxation with hypnosis scripts. They are also an invaluable part of the labor and birth process as they help you to focus and concentrate, as well as supporting you physically. Please note: Mothers without partners can easily learn, practice and use Hypnobabies on their own. All aspects of Labor and Birth are covered in Hypnobabies classes, as well as information on Nutrition, Exercise, Avoiding Complications and Back Labor, Fear Clearing Sessions, Birth Plans, Consumer Issues and Postpartum as well as much more.

HypnoBirthing aka the Mongan Method

How does HypnoBirthing differ from other childbirth preparation methods?

Unlike other childbirth methods that teach you how to cope with and manage pain, HypnoBirthing is based on the premise that childbirth does not necessarily need to be painful if the mother is properly prepared and relaxed. When women understand that pain is caused by constrictor hormones, created by fear, they learn, instead, to release fear thus creating endorphins—the feel good hormones. They are then able to change their expectations of long, painful labor and are able to replace them with expectations of a more comfortable birthing.  Rather than exhausting, shallow breathing and the distraction techniques of typical “prepared childbirth” programs, HypnoBirthing parents learn deep abdominal breathing and total relaxation, enabling the laboring mother to work in harmony with her body and her baby. This allows her to achieve a shorter and more comfortable labor for herself and baby.

What HypnoBirthing looks and sounds like:

Christianity and Hypnosis

I have heard that many Christians are adverse to the suggestion of hypnosis because of the fear that it conflicts with their beliefs. I have heard of doulas being hung up on because they mentioned hypnosis visualizations as a possible coping technique. Here is what the hypnobabies website has to say:

It is important to remember that hypnosis is a state of mind that we are all already in many times a day, so it’s a very natural thing in our lives and is not an “altered state”. We are automatically in hypnosis when driving, swimming, doing other sports, sitting in church or a lecture, reading, watching television or movies or on the computer (a screen of any kind) and when waking up or going to sleep. In Hypnobabies we are simply guiding that process in a very positive way to create an easy, fear-free comfortable childbirth experience. Since our program is designed for women of every faith and belief system to use, it contains no “new-age” or other content that would offend anyone. Many of our Hypnobabies moms are Christian and have had wonderful success with Hypnobabies while incorporating their beliefs into our hypnosis scripts and practice as well as adding prayer into the actual hypnosis when giving birth. We have come to realize that that women know what they need and will find it in Hypnobabies, adapting it perfectly and serenely to their own religious or non-religious belief systems. They always do.

To read what a few Christian hypnobabies practitioners have to say, read here.

Can HypnoBirthing be beneficial to someone who has special circumstances or who must have a C-section?  

Yes! The HypnoBirthing website lists a great deal of ways that hypnosis training can help prepare you for a Cesarean section!

A Hospital Hypnobabies Birth 

FYI: in Hypnobabies they use different birth terminology than we normally do. Here are 3 terms that are used in the video:

• Contraction = Pressure Wave
• Labor = Birthing Time
• Transition = Transformation

 

Both Hypnobabies and HypnoBirthing offer doula companion training, to become a hypnobabies doula, for example. Specially trained to work with hypnosis birthing women. If this is something you'd be interested in, doulas, definitely check out their websites! 

Lotus Birth

As mentioned before, there are benefits to delayed clamping and severance of the umbilical cord for the baby. There have been few recent arguments that delayed clamping is dangerous. Here is another, more "extreme" practice related to the umbilical cord.

A Lotus Birth is one during which the umbilical is not cut.

Ever.

The placenta and baby are left attached until the umbilical cord naturally detaches.

Herbs, essential oils and salts are applied to assist in the drying process and keeps odor at bay. The umbilical cord usually comes off on its own 3 - 10 days postpartum. The placenta is kept in a little pouch and goes around with the newborn.

It is considered a gentler, non-violent form of birth.

I have found several articles online that claim that,

"Lotus birthed babes appear more calm and healthy than their counterparts whose cords are immediately cut. They receive quite a bit of extra blood, rich in nutrients and oxygen, that boosts their immune system. The placenta helps their liver by filtering toxins from the baby's blood as long as the pumping continues. Their navals heal faster, and they can have their first bath sooner. The experience is gentler on the child and very special for all involved."

Lotus Birth, aka Umbilical Nonseverance, is generally practiced only at home or birth center births. This seems pretty clear, I'd say, since hospital attendants generally clamp the cord immediately.

Wikipedia has this to say about the historical development of Lotus Birth:

In Tibetan and Zen Buddhism, the term "lotus birth" is used to describe spiritual teachers such as Gautama Buddha and Padmasambhava (Lien-hua Sen), emphasizing their entrance into the world as intact, holy children. References to lotus births are also found in Hinduism, for example in the story of the birth of Vishnu.
Although recently arisen as an alternative birth phenomenon in the West, delayed umbilical severance and umbilical nonseverance have been recorded in a number of cultures including that of the Balinese and of some aboriginal peoples such as the African !Kung.
Early American pioneers, in written diaries and letters, reported practicing nonseverance of the umbilicus as a preventative measure to protect the infant from an open wound infection.

Sarah J Buckley, a popular proponent for Lotus Birth, writes about her experiences with Lotus Birth. She says that Lotus Birth was named in 1974 when

Clair Lotus Day, pregnant and living in California, began to question the routine cutting of the cord. Her searching led her to an obstetrician who was sympathetic to her wishes and her son Trimurti was born in hospital and taken home with his cord uncut. Lotus birth was named by, and seeded through, Clair to Jeannine Parvati Baker in the US and Shivam Rachana in Australia, who have both been strong advocates for this gentle practice.

The practice then gained notoriety in the yoga community when Jeannine Parvati Baker wrote a book called Prenatal Yoga and Natural Childbirth. She saw it as the practical application of the yogic value of ahimsa.


Lotus Birth has also been observed in non-humans.

Primatologist Jane Goodall, who was the first person to conduct any long-term studies of chimpanzees in the wild, reported that they did not chew or cut their offspring’s cords, instead leaving the umbilicus intact. Because humans share 99% genetic material with chimpanzees, some lotus birth practitioners refer to chimpanzee practice as a natural practice for humans as well. (Since many cases of chimpanzee cord separation have also been documented, further studies are required.)

 

photo: http://naturalpregnancy.wordpress.com/

Emergency Unassisted Labor and Delivery Guide

A great deal of women give birth unassisted by a trained healthcare provider. This includes women in developing countries who give birth on the side of the field and then go right back to plowing, women in developing countries who don't have money or access to a care provider or health facility, women all over the world who plan to birth unassisted at home, and women who find themselves having an unplanned unassisted birth before their care provider can be with them.

This post is about the last group of women: the women who hadn't planned on birthing without help, at home or in the car or wherever, but hopefully have access to emergency supplies. Its also a great crash-course for the women, or dad/partner, about the basics of labor and delivery, and mom and baby postpartum.


Amy Romano on Science and Sensibility wrote a great post on Birth during Times of Disaster: Keeping Women and Babies Safe

In it she included a link to an emergency childbirth guide from the American College of Nurse-Midwives that includes a lot of really great information for women and partners who must deal with an emergency birth in a location where there are no skilled birth attendants present. I include some bits of the text below:


FROM THE AMERICAN COLLEGE OF NURSE-MIDWIVES
Giving Birth “In Place”: A Guide to Emergency Preparedness for Childbirth
Deanne Williams, CNM, MSN

This is not a “do-it-yourself”guide for a planned home birth, nor is it all the information you need for every emergency. It is not meant to replace the knowledge and skills of a doctor or midwife. The information is a basic guide for parents-to-be who want to be ready in case they have to give birth before they can get to a hospital or birth center.

CALL FOR HELP
If you think you are in labor, try to get to a hospital, birth
center, or clinic. If you are alone or travel seems unwise,
call the emergency number in your community and ask for
help. After you have called for help, keep your front door
unlocked so that rescue workers can get in if you are unable
to come to the door. Call a neighbor to come and help the
family. If the phones are working, keep talking to emergency
services or your health care provider who can “talk
you through” a labor and birth.
If your labor is going fast and birth seems near, stay at
home and have your baby in a safe place rather than in the
back seat of the car. Fast labors are usually very normal,
and the mothers and babies can both do well. Slow labors
will give you time to get to a hospital or birth center, or for
a health care provider to get to you. Get out your supply kit
and put the supplies where you can easily reach them.
As the helper, your job is to
Keep mom comfortable. It is good for her to walk, take a
shower, get a massage, and move even if she is in bed.
Be sure she drinks lots of fluids. Water, tea, and juice are
the best.
Be sure she goes to the bathroom every hour.
Say and do things that create a calm feeling, even if you
are very nervous.
Wear gloves if you are going to be touching blood.
Wash your hands or gloves often.
Do not let pets into the labor and birth room.
Talk to mom about the sounds of childbirth. Making
groaning or crying noise during labor is ok and can help
the mom-to-be. It can scare the helpers. So mom has to
try to not scream and lose control, and the helpers have
to let mom make the noise that helps her cope.
Decide how to help other members of the family. Will
they be present for the birth? What do they need to
feel safe?


PREPARE THE BED
To keep the mattress from getting wet, cover it and the
sheets with a shower curtain and then cover the shower
curtain with another clean sheet, plastic-backed under pads
and lots of pillows for comfort. The mother may want to
spend a lot of time in bed, or she may prefer to be on her
feet or in a chair. Whatever feels best is okay.

WHEN THE BABY’S HEAD IS COMING FIRST
If you know your baby has been head down during the last
weeks of pregnancy, chances are good that the baby will be
head first at birth. This is the most common position for a
baby. First labors can last for 12 hours or more, whereas the
next babies can come much faster.

The Urge to Push
The longest part of labor is the time it takes for the cervix
to open wide enough for the baby to pass into the birth
canal or vagina (first stage). You can tell the cervix has
feel with your fingers to find out if the cord is around the
baby’s neck. If you find a cord around the neck, this is not
an emergency! Gently lift the cord over the baby’s head, or
loosen it so there is room for the body to slip through the
loop of cord.
The baby’s head will turn to one side and with the next
contraction the mother should push to deliver the body. If
the body does not come out, push on the side of the baby’s
head to move the head toward the mother’s back. The
shoulder will be born. The rest of the body slips out easily
followed by a lot of blood-colored water.

If the Head Is Born but the Body Does Not Come Out After
Three Pushes
The mom must lie down on her back, put two pillows under
her bottom, bring her knees up to her chest, grab her knees,
and push hard with each contraction. After the baby is born,
place her or him on the mother’s chest and tummy, skin to
skin, and cover both with towels. If the baby is not crying,
rub her back firmly. If she still does not cry, lay her down
so that she is looking up at the ceiling, tilt her head back to
straighten her airway, and keep rubbing. Not every baby
has to cry, but this is the best way to be sure the baby is
getting the air she needs.

If the Baby Is Gagging on Fluids in Her Mouth and Turning
Blue
Use the baby blanket to wipe the fluids out of her mouth
and nose. If this does not help, use the bulb syringe to help
clear things out. Just squeeze the bulb, place the tip in the
nose or mouth, and release the squeeze. This will suck fluid
into the bulb. Move the bulb away from the baby and
squeeze again to empty the bulb. Repeat until the fluid is
removed.
If the baby is still not breathing, follow the CPR
directions.

THE UMBILICAL CORD
There is no rush to cut the cord. All you have to do is keep
the baby close to the mom so the cord is not pulled tight. If
you pick the cord up between your fingers, you can feel the
baby’s pulse. Within about 10 minutes the pulse will stop.
At that time you can tie and cut the cord. Remember the
cord is connected to the placenta (afterbirth) which is still
inside the mother.

THE BABY
At the time of birth, most babies are blue or dusky. Some
cry right away and others do not. Do not spank the baby,
but rub up and down her back until you know she is taking
deep breaths. Once the baby starts to cry, her color will be
more like her mom, but her hands and feet will still be blue.
Now is the time to keep the baby warm. Remove the wet
towel that is over the baby and put another dry towel and
blanket over the mother and baby. Put a hat on the baby.
The mother can help keep the baby warm with her body
heat.
Put the baby to breast. Even if you did not plan to
breastfeed, one of the safest things you can do for mom and
baby is put the baby to breast. A breastfeeding baby helps
keep the mother from bleeding too much and gets the food
it needs right away. If the cord is too short to allow the baby
to reach the breast, it is ok to wait until you cut the cord.

CUTTING THE CORD
There are no nerve endings in the cord so it does not hurt
either the baby or the mother when it is cut. It is very
slippery so take your time because there is no rush. Wash
your hands, put on gloves and then get the container with
the scissors and shoelace. Tie one of the laces around the
cord very tightly with a double knot about 3 inches from the
baby’s tummy. The baby will cry when she is uncovered
because she is cold, not because it hurts. Tie the other
shoelace around the cord about 2 inches from the first knot.
Pick up the scissors by the handle without touching the
blades. Cut between the knots you have tied. It is rubbery
and tough to cut especially if you have dull scissors. After
it is cut, place the end of the cord that is still connected to
the mother’s placenta into the mixing bowl. Cover the baby
again to keep her warm.

THE PLACENTA OR AFTERBIRTH (THIRD STAGE)
The placenta looks like a big piece of raw meat with a shiny
film on one side. On the other side it has membranes that
are attached to the placenta (the membranes look like skin
that has been peeled off). When the placenta is ready to
come, you will see a gush of blood from the vagina and the
cord will get a little longer. Put the bowl close to the
mother’s vagina and put more waterproof pads under her
bottom. Ask the mother to sit up and push out the placenta
into the bowl.
There will be a lot of blood and water coming after the
placenta. Firmly rub the mother’s stomach below her belly
button until most of the bleeding stops. This will hurt but
needs to be done. The heaviest bleeding should stop in a
minute and then the bleeding will be more like a heavy
period. If the bleeding increases again, very firmly rub the
mother’s lower belly until the bleeding slows. When it is
firm, you will be able to feel the uterus (womb), which is
the size of a large grapefruit, in the lower belly. A firm
uterus is a good thing because it will stop the mom from
bleeding too much.
Mom’s bottom and her uterus may be sore. You may see
places where the mother’s skin has torn around her vagina.
Most of these tears will heal without any problems. Mom
will feel better when you put an ice pack on her bottom
where the baby came out and then put the sanitary pad on
top of the ice pack. She may want to take a couple of pain
pills at this time.

Put the placenta in a medium-sized trash bag and wipe
off any blood on the outside of the bag. Put this bag into a
second trash bag. Take the placenta with you to the hospital
or birth center. If you cannot leave the house for more than
4 hours, put the bagged placenta in a container with a lid
and put it in the freezer.

CLEAN UP
After the mother has delivered the placenta and the bleeding
has slowed down, give her a drink of juice, soup, or
milk and something to eat like crackers and cheese or a
peanut butter and jelly sandwich. Put on gloves to clean up
the bed. Roll up the sheet and pads inside the shower
curtain and put in a large plastic bag. Have clean under pads
ready to cover the sheets and a sanitary pad for the mother.
The dirty sheets and towels can be washed in cold water
with bleach or ammonia added. Wear gloves when touching
items that are bloody. Put a diaper on the baby or you will
be sorry!

BREASTFEEDING
It is important for the mother to breastfeed the baby in the
first hour after birth and at least every 2 hours until her milk
comes in.
● Breastfeeding will keep the uterus firm and decrease
bleeding.
● Colostrum, the liquid that is in the breasts right after birth
until the milk comes in, will give the baby all of the food
she needs and it will help prevent infection.
● Even if the emergency situation continues for days,
weeks, or months, there will always be a ready supply of
safe and perfect food for the baby.

Getting Started With Breastfeeding
A newborn will nurse best in the first hour after birth when
she is awake and alert. The mother may be more comfortable
if she lies on her side with pillows under her head. The
mother and baby should be face-to-face and belly-to-belly.

The baby will also nurse better if they are skin-to-skin (see
Figure 2).
The mother should place her nipple and breast against the
baby’s lips. The baby will lick and try to nurse. The mother
needs to help out by placing her nipple into the baby’s open
mouth. It may take a few tries before the baby can start
sucking. If the baby is sleepy, rub her belly and back firmly
to wake her up. If the baby is too sleepy, try uncovering her
for a short time and rubbing the mother’s nipple against the
baby’s lips. If the mother gets tired, take short breaks and
start again. Once the baby nurses for the first time it gets
easier.
If the baby sucks a few times and then lets go and the
mom has large breasts, mom may need to help the baby
breathe by using her finger to hold some breast tissue away
from the baby’s nose.

What to Avoid
● Don’t use a pacifier or a bottle to start the baby sucking.
It confuses some babies because they do not suck the
same on the mother’s breast and a bottle or pacifier.
● Do not separate the mother and baby for very long. The
more they stay together, including when they sleep, the
sooner breastfeeding will be well established.

CARE OF THE MOTHER
If you still cannot get to the hospital or birth center to be
checked, the mother should go to the bathroom within
an hour after the baby is born.
If the room is cold, you can use the hot water bottle to
help keep the baby warm. Just wrap the warm bottle
in a blanket and place it next to the baby’s back.

After birth in a hospital, women are usually offered
Tylenol or Advil for pain every 3 to 4 hours as
needed. This would be a good choice at home if the
mother does not have an allergy to this medication.
When a new mother gets out of bed for the first time, she
may feel dizzy. It is important to have her leave the
baby on the center of the bed and get up slowly:
● Sit up on the side of the bed to see how she feels.
● Have an adult take her to the bathroom and wait to be
sure that she is not feeling faint.
● If she says she is going to faint, believe her and have her
lie down on the floor. Do not attempt to walk her back to
bed. You have about 10 seconds to get her down on the
floor before she passes out and bangs her head on the way
down! Once she is down flat, she will wake up and feel
better. Just wait a few minutes and then carefully help her
back to bed.
In a couple of hours the mom may want to take a shower.
Be sure she has had something to eat and is not dizzy when
she gets up. It is good to have someone close by because
dizziness can return quickly.


To read more of this guide, including a list of emergency supplies to keep on hand, what to do if baby comes bottom first, and baby care in the first couple days, click here.