Planning for Childbirth Complications at Home
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Ahhhh yes….the battle cry of the medical types. The concerned and ubiquitous question from the fearful, the ignorant, the gullible and the trusting masses and one of the biggest reasons that UC-ers “plan oops-es” rather than announcing their plans.
“BUT WHAT IF SOMETHING GOES WRONG?!?”
There are a variety of things that can go wrong in childbirth. Childbirth is a normal, natural bodily function but as we all know in the unlikely event that something goes wrong it can result in maternal or fetal death. Trust me - homebirth mothers do not want a bad ending any more than hospital mamas. We just prepare, educate ourselves, rule out the vast majority of things that can “go wrong” and have a plan to deal with the unexpected so we do not have to deal with all the things that can “go wrong” by virtue of having a medical birth.
Why things “go wrong” in childbirth:
COMPLICATIONS BY WORLD GEOGRAPHY
Where a woman is born, raised and gives birth has a very tremendous impact on her maternal & infant mortality rates. Thankfully for me, I live in the US where I have sanitary conditions, running water, heat, a knowledge of bacteria, I am not a child, I do not have a misshapen, stunted or deformed pelvis from malnutrition or corsets and I know basic infant care. In addition, I do not live days from the nearest medical facility that makes me provide my own latex gloves and cord clamps. Yes, I agree that the prospect of childbirth is a terrifying and dangerous proposition for women who live in Chad, Sierra Leone or Niger but by virtue of my location, I have already ruled out the majority of complications that can kill me or my baby in childbirth. Both hospital and homebirth advocates will agree on this issue.
FORESEEABLE CHILDBIRTH COMPLICATIONS
I have also ruled out potentially deadly childbirth complications through basic prenatal care. While I totally understand why women choose to have an unassisted pregnancy, I found it more prudent to pick and choose from prenatal care options that could actually diagnose a potentially deadly problem. I had an ultrasound at 18 weeks to rule out any placental issues that would preclude homebirth (and require a cesarean). I check my blood pressure every 2 weeks to 1 month. With those two steps, I ruled out potentially deadly preeclampsia and placental problems. The majority of both homebirth and hospital advocates will agree on this issue. I think this is one case of technology being able to help, rather than hurt and I am happy to take the risk of an ultrasound to rule out such a serious complication.
UNNECESSARY MEDICAL INTERVENTIONS
It is always a human rights violation to harm another human being for the sake of convenience, profit or to cover your ass.
This is the point where homebirth and hospital birth advocates part ways. I believe in a very simple concept. It is always a human rights violation to harm another human being for the sake of convenience, profit or to cover your ass.
I guess hospital people could argue that covering their ass is a form of self defense but guess what…laboring women and their helpless infants are not attacking them. The future parents are innocent and trusting while hospital birthing attendants (OBs, L&D nurses and CNMs) continue to harm mothers and babies physically and psychologically for their own benefit and the benefit of the institutions that employ them. And it makes it worse (not better) that women are voluntarily walking into that situation because of trust, ignorance and fear. It is sick, cruel and as I stated previously, a blatant human rights violation.
That is why I consider hospital interventions to be “something going wrong in childbirth”. Something going terribly, terribly wrong. I would rather die of a heart attack or a lightning bolt than be beaten to death or shot by someone. Why? Does it really need explaining how much different a tragedy is when it is unnecessary and caused by other human beings? It brings a whole new set of “Why” questions to the table. How other humans can harm trusting, innocent human beings is simply beyond my comprehension.
Therefore, by avoiding a hospital birth, I will be avoiding the the majority of childbirth complications unique to the medical model. The complications may be small and insidious interventions that slow labor and lead to more harm or it might be an all out birth rape or physical assault that can permanently damage me or my child for life.
A few of the potential complications I am ruling out by giving birth at home are: leaving my comfort zone, letting strangers touch & view my “bits and pieces”, separation from my current child, travel during labor, wheelchair (how offensive is that?), paper gown, pelvic exams, IVs, maternal & fetal monitoring, birthrape, treated like child, condescending patronizing attitudes, idiotic labor positions, exposure to multiple infections & bacteria via hospital environment and unwashed hands, synthetic, dangerous and untested chemicals to keep me silent & immobile or to blast the baby from my womb, arbitrary birth timetable, arbitrary rules, forced (purple) pushing, episiotomies, active management of 3rd stage (immediate cord amputation, manual cord traction, pitocin shot), forceps, vacuum extractors and cesareans, immediate separation from my newborn (who will be subjected to horrible tests & procedures of her own), formula samples, fights to room in, etc.
These are things that can “go wrong” and they can and do haunt women and children for life with physical and psychological scars related to violent births, failure to breastfeed exclusively, possible increase of autism, ADHD and who knows what else. Of course the medical community only considers it “something going wrong” if baby or mom dies and they get sued. And they are looking out for whose best interests?
UNFORESEEABLE, UNEXPECTED CHILDBIRTH COMPLICATIONS
This is the hot point between UC-ers and midwives. I, like other UC advocates, feel that handling these variations of normal is not rocket science and with a reasonable amount of preparation and knowledge can be handled on the spot and if not, then the birthing mother can make the decision to transfer to a medical facility just as easily as a midwife can. I have 2 hands, basic diagnostic equipment, mirrors and a brain.
It seems to irritate the hospital advocates that “people like me” will go to the hospital or call 911 if something goes (seriously) wrong and expect the docs to “fix everything”….I’m sorry but isn’t that what ERs and EMTs for? Nobody gets that kind of grief for calling 911 after a heart attack or car accident. I guess there aren’t billions of dollars to be made on people before the heart attack or car accident or they would get grief for using emergency services too.
I think one of the things that irritates me about everyone’s homebirthing “concern” is the basic belief that laboring women have the intelligence/competence level of a rabbit. Even while being tortured and mutilated during my first birth, I was able to think, make decisions and I would have gladly called 911 to get me the heck out of there if I wasn’t already in a hospital.
That said, I am totally confident in my ability to diagnose and react to the following problems, in the unlikely event that these unforeseeable but not necessarily emergency situations arise:
- Cord wrapped around neck
This has got to be the biggest fear when you mention homebirth or UC to the general population and interestingly the most unfounded. Babies receive oxygen through the cord until it is clamped or cut. When their head delivers they are not going to strangle because they are not breathing through their windpipe yet. Even after their entire body delivers, they will be receiving oxygen from both pulmonary (lungs) and placental sources. If the cord is wrapped around the neck when the head delivers, I will simply hook a finger under the cord and loop it over the baby’s head. This condition is so common that the cord is wrapped around the neck of up to 1/3 of babies that are birthed vaginally. - Meconium Stained Amniotic Fluid
Meconium is a marker for fetal distress, not the cause of it.
12% of births have meconium staining (resulting from fetal stress, inductions including castor oil, hypoxia) and 2 out of 1,000 are severe. Many studies point to not only inductions as the cause (inductions are more common in post mature) but that the damage happens in utero, not as a result of delivery practices (ie: damage is done during the induction, not the first post-delivery breath) and that immediate suctioning is NOT useful or beneficial.
“The risks to the baby of routine, deep suctioning simply for the presence of meconium are: trauma, hypoxia, bradycardia, increase of BP leading to increased risk of intercranial haemorrhage in preterm infants, severe pulmonary artery vasoplasm in babies with pre-existing pulmonary artery hypertension-particularly in mec-stained babies, cross-contamination of bacteria or viral infection between newborns and care givers. ” Gentlebirth.org
Meconium is a marker for fetal distress, not the cause of it. A crying, delivered baby can simply be observed and monitored. In the very, unlikely event of thick, particulate meconium and my baby requires resuscitation, I can make the decision to transfer to the hospital for treatment/evaluation. Iwill transfer for pre-delivery fetal distress but not for suctioning ability.
“The presence of mec. and a truly sick baby are extremely rare in the home due to the lack of so many interventions incurred in the hospital setting the aggravate or even precipitate meconium. because the baby is put into stress.”Gentle birth
- Shoulder Dystocia:
Shoulder dystocia and sticky shoulders are somewhat common in hospital births because of shrunken pelvic outlets due to ridiculous birthing positions. Since I do not have to worry about someone else’s view, I obviously won’t be delivering on my back, therefore closing off my pelvis by 30% or so. Many unconscionable obstetricians will actually break the poor baby’s collarbone before having the mother switch positions.Hospital shoulder dystocias are also caused by routine interference with the natural rotation that babies will do on their own after the head is delivered. Again, this wont be an issue for me because nobody will be trying to unnaturally twist my baby out of my body.
Unnatural, forced and purple pushing can also cause SD by forcing the baby into the pelvis before it has the opportunity to rotate. I will let my uterine contractions do the pushing at the optimal pace. Most midwives (and few obstetricians) will admit that the vast majority of shoulder dystocia are not real shoulder dystocia at all but rather “sticky shoulders” that resolve itself easily and quickly with position changes.
That said, if the baby’s head emerges and the shoulders do not follow within 2 contractions, I will not pull, twist, yank or otherwise try to force the baby out. I will:
- Assess the situation and reposition myself
- Arch my back and get on all fours
- Get on one foot and one knee
- Stand up
- Perform hip circles and rotations
- Check my baby’s head color
- Use a doppler to check my baby’s heart rate (for pinched cord)
- Dance the dystocia away (dance, hop, bounce, stairs if you have them)
- reach inside if able and hook finger under baby’s lower arm and rotate toward face.
- Call 911.
Shoulder Dystocia Unofficial Stats: “Serious SD is reported at 3- 8/1000 — and these should deliver with a little work [and result from gestational diabetes, birthing positions and obstetrical practices]. SEVERE shoulder dystocia should be almost unheard of in the absence of forceps or vacuum extraction. Gentlebirth.org
- Breech Birth
Many homebirth or direct entry midwives consider a breech birth a variation of normal. To hear a modern obstetrician tell it, breech is a certain death sentence without a cesarean. The standard protocol for homebirthing a breech is simply not to do anything. Don’t pull, twist or yank. Standing or all fours are excellent positions.I will transfer or call 911 if:
Cord prolapses
My baby does not deliver within 5-7 minutes of navel appearing.
Fetal heart tones drop at any point - Baby not breathing
It is normal for babies to not breathe or cry for a couple of minutes after the birth. The very first course of action is to do nothing. Room air, snuggles and leaving the lifeline (umbilical cord) intact are all most babies need.If she does not start breathing after a couple of minutes, I will call 911 and:
1. Hold face down and to the side
2. Rub hand up and down spine to expel mucous
3. Diluted Cayenne tincture under tongue
4. Artificial respiration (as pictured here)
5. Bring baby into room with steaming hot shower
6. Mouth to mouth using air from cheeks, not lungsI will also call 911 if she is born blue, white, limp or unresponsive
- Excessive Bleeding and Postpartum Hemorrhage
Due to the fact that maternal hemorrhage is a leading causes of maternal death, particularly in developing countries, this is one of the biggest fears of homebirth. I consider it something serious, worth paying attention to, but I am simply not going to let “them” harm me and my child throughout the birth process because “they” have access to blood transfusions.The odds of PPH are slim anyway, particularly in the absence of placental issues which I have already been screened for with prenatal ultrasounds. The odds are even lower since no idiot will be physically ripping the placenta from my uterine wall while it is still working or amputating the cord while it is still attached to a working placenta.
Lastly, PPH does not happen in minutes. Even in an absolute worst case scenario, a woman will bleed to death in 2 hours and a much more likely scenario is 24-48 hours or more. If I had to hike 3 days to the nearest medical facility on a dirt road that didn’t have surgeons or blood transfusions anyway, this would clearly present a potentially life threatening situation. I live in the United States however, within 1 mile of a hospital, EMTs, trained surgeons and an ER.
Needless to say, some women, despite a gentle, physiological natural birth, do in fact bleed and this is my plan of action in the unlikely event that I experience excessive bleeding that doesn’t quickly subside on its own:
First of all, whether I am bleeding excessively or not I am going to take the following steps because they facilitate natural detachment and expulsion of the placenta and of course allow me maximum bonding time with my new baby:
- I will leave the cord intact and let the placenta detach naturally, when it is no longer needed
- Keep my baby skin to skin with me
- Breastfeed
- Empty my bladder
- Give myself a gentle fundal massage
If bleeding continues, I will position myself over a bowl or waterproof pad that I can collect and measure the blood because blood in a chux pad or toilet bowl can appear to be much more than it actually is and I will have no way of knowing if I am bleeding excessively or not if i cannot measure it. I will be concerned and possibly transfer if I bleed more than 2 cups of blood, have abnormal blood pressure readings or the top of my uterus is expanding rather than contracting and the following remedies do not stop the bleeding.
Before I transfer or call 911 for excessive bleeding, I will:
- Place a piece of placenta piece under tongue because the hormones tell my body that the baby is delivered and can stop PPH immediately
- Cayenne tincture reportedly stops the bleeding within seconds
- Shepherds purse can cause clotting and I would rather avoid but I will use if 1 and 2 don’t work
- Call 911 or transfer if bleeding does not stop
- The following conditions MAY indicate transfer depending on the severity and the circumstances:
Fetal Heart Tones
Maternal Hemorrhage
Delivered baby not doing well/breathing/etc
The following conditions necessitate immediate transfer:
Cord Prolapse
Transverse Baby
Placental Abruption
Fetal Distress
Shock
I would like to think that this post will alleviate the “worries” of my family but I highly doubt that they will read this carefully and with an open mind if they read it at all. It is much more fun to “worry” and discuss it amongst themselves based on their own fears, dogma, myths, lies and fairy tales that they have been told since their own births. Sad but true, ignorance really can be bliss.
Needless to say, perhaps this post can help clear up some confusion among the open minded and clear headed who are looking for an alternative to a medically managed birth and I think many more women would choose a natural path if they had any idea how safe and wonderful it really is.
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November 3rd, 2008 at 8:45 am
Your posting is one of the most well written, well researched, logical sane articles I have ever read. You have done a lot of research and your competence, knowledge and planning serve to dispel almost any fears one could face with home birth.I hope other mothers to be read this article and allow themselves another option.
My calendar is marked and I look forward to the wonderful day that Bianca makes her world debut.
November 3rd, 2008 at 8:47 am
Dear Mada,
Thanks! I am looking forward to it too!
November 26th, 2008 at 9:11 am
Smart woman. Women have done the same throughout history.
My Mother had 5 of her 9 at home unassisted. It was natural,calm, and safe. No meds, no needles, no bright lights & cold hands. Just Momma & family.
I wish you well.
Your new bebe is lucky!
January 26th, 2009 at 2:51 pm
This is a great blog entry to read, whether you are planning on having your baby at home or in the hospital - or if you know someone that is having a baby. Thanks for posting!
June 3rd, 2009 at 7:29 am
My mother gave birth on me at home. But still I believe that the safest place to deliver a baby is in the hospital. Just pray a lot that there’s no unwanted things happen during a delivery.
June 3rd, 2009 at 1:40 pm
Dear Michelle@st louis bjj,
There are ALWAYS unwanted things happening at every, single, solitary hospital birth.
June 7th, 2009 at 6:57 am
Sometimes, you could never avoid unwanted circumstances to happen during child birth. I mean, it’s one of the most high risk events in a woman’s life, especially when she is on a high-risk pregnancy. But, the best way to prepare for childbirth is education and of course, seeking a doctor’s advice. It doesn’t really matter whether you give birth on a hospital or a home. What’s important is that you see to it to follow precautionary measures and sterility.