Emergency Childbirth: When Baby Arrives Before the Midwife or Doctor

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Most     births are    spontaneous and normal. The baby is crafted for survival. Relax and    do the following after contacting the midwife or doctor who is on her way:

  1. Move     her to a comfortable place away from the toilet. Call for help.

  2. Make     sure the room is warm and draft free. Remember that baby needs a     warm environment. A clean, dry towel and a hat should be ready for     the baby.

  3. Prepare     a bowl of warm water with provolone iodine solution and a clean     cloth in it. Place a clean under pad under the mother with the paper     side next to her skin. Place another empty bowl (to catch the     placenta later on) in close proximity together with scissors, gauze,     bulb syringe and cord clamp. Put all items gathered on a clean towel.

  4. Wash     your hands thoroughly. Tear open several packs of 4 x 4’s sterile     gauze. Put gloves on if available.

  5. As     the head starts emerging, put gentle counter pressure against the     bulging perineum. Don’t touch anything except the mother and baby so     as not to contaminate. As the baby’s head starts emerging, remind the     mother that she will feel the “ring of fire” which is normal.

  6. Place     a gauze 4 x 4 over the mother’s anus, to prevent contamination. wipe     the feces away, if necessary, and place a clean 4 x 4 over the anus.     Make sure you don’t contaminate the gloves or your hands.

  7. Ask     the mother to pant as the head crowns and is born. Support the     mother’s perineum with both hands.

  8. When     head is out, slide your fingers in along the baby’s neck to feel for     the umbilical cord. If you feel the cord, try slipping it over the     baby’s head. If you can’t, it’s usually not a problem to leave it,     unless it is too tight and keeps the baby from coming out.

  9. If     the cord is very tight: with your fingers placed between the baby’s     neck and cord, clamp with two hemostats or two cord clamps in two     spots an inch apart.

  10. Make     sure you put both clamps on next to each other on the same piece of     cord. Carefully cut between the two clamps and unwind the cord from     baby’s neck. Keep both clamps on and be sure they are clamped tightly.

  11. If     the bag of waters is still around the baby’s face, as it is born,     tear the bag by pinching it apart with your fingers.

  12. Wipe     the baby’s face with a gauze 4 x 4. Use the syringe to suction the     baby, if needed. While keeping the bulb syringe squeezed, gently     place the tip (sweeping from the side) in baby’s mouth and release     the bulb syringe. Spray contents onto a gauze 4 x 4. Do the same for     both nostrils.

  13. Ask     the mother to push as the baby rotates to face one of the mother’s     leg. With one hand under baby’s head and the other on top of it,     exert gentle pressure downward pressure on the baby’s head to     facilitate the delivery of the top shoulder.

  14. When     the top shoulder is out about two or three inches, lift upward on     the baby’s head to help the bottom shoulder come out. The baby’s body     will follow. Hold the baby (with her/his face down) with your two     hands since the baby is slippery.

  15. Place     the baby on mother’s belly with mom lying on her back and both in     tummy to tummy position. Cover the baby and put her/his hat on. Make     sure you don’t pull the umbilical cord.

  16. As     soon as the cord stops pulsating, you can cut the cord. Attach cord     clamp securely 1/2 inch from baby’s belly button. Place gauze under     the cord. Cut cord 1/2 inch away from the clamp on the other side     (away from the baby).

  17. Baby     should be pink. If baby is bluish, white or limp and not crying, do     the following: Run your fingers up the baby’s spine, massaging     vigorously. Flick baby’s feet with your fingers. Having mother talk     to baby, continue the above. Keep baby warm and dry.

  18. If     baby is still not responding and it has been one minute since birth,     begin mouth to mouth resuscitation with gentle puffs from your     cheeks. Keep baby warm and dry and have someone call the emergency personnel.

  19. Watch     for signs that the placenta is detaching such as a gush of blood,     the cord gets longer and mother feels more contractions.

  20. When     the above happens: wrap gauze around section of the cord, so it’s     not so slick. Place opposite hand against mother’s pubic bone and     press gently inward and upward. Ask mother to give little push with     the next contraction. using gentle cord traction, guide the cord     downward as you see the placenta start to emerge, lift upward with     the cord to help placenta out.

  21. Wipe     and warm the baby by wrapping the baby well and putting the baby on     mother’s breast, apply CPR if necessary, wait for the midwife or     doctor to cut the cord, let the mother massage her uterus and stay     with the mother.

Cost of Having a Baby

CAM00363 (1)Childbirth makes up one fifth of all health care expenditures1 and is the most frequent cause for hospital admission2.The cesarean section rate in the home birth study was 3%, whereas the national average was 22.6% in 1991 and 20.6% in 19963. The cost doubles with the following: having a baby in the hospital, formula-feeding, using disposable diapers, hiring a nanny or babysitter, use of crib and other brand names baby foods and baby products. Anderson and Greener4 found unusually high rates of breastfeeding among homebirthed babies. As formula-fed babies are known to have higher morbidity rates5,6, the cost of future medications, doctor visits, and hospitalizations could be lower for home-birthed children.

The actual cost of having a new baby is minimal when the following is chosen: homebirth, midwifery care, breastfeeding for at least a year or more, cloth diapers, stay-at-home mom, infant massage, sleeping with the baby in the family bed, and less use of any accessory or gadgets.

When I have my first baby and second baby, all born at home I was able to save on a lot of things. Friends gave used infant clothes and accessories. I bought baby clothes and accessories from garage sales and discounted places and made some of them too. I saved the biggest chunk of my money by delivering my babies at home with midwives. My health insurance company was glad that it only cost them $2,300 for my homebirth. There are a lot of intangible benefits from my choices of getting care, use of nutritious food combinations and herbs, massage, childbirth classes and many more relaxing walks and exercises. I don’t have to have an episiotomy – a cut, a big tear on my perineum, too much bleeding, anesthesia, Caesarian operation, and other unnecessary medical procedures.

My baby doesn’t have to have Vitamin K injection, male circumcision, not traumatized during birth, not forceped or forced by other means during birth (such as induction) or c-sectioned, brought to me and stayed on my side from birth onwards, massaged by my hands, fed on my breasts, no water or sugar during the first weeks of life, no bottle and pacifier to confuse my breasts, easy to soothe, a calm and healthy full term baby allowed to stay inside my womb for the full term of about 38 weeks. I am glad to share all these things with other moms for only in sharing do we pass on the sacred birth experience to loving generations to come.

References:

1 Mushinski M. Average charges for uncomplicated vaginal, cesarean and VBAC deliveries; regional variations, United States, 1996. Stat Bull Metro Insur Co 1998; July-Sept:17-28.

2 Center for Disease Control and Prevention. Trends in lengths of stay for nonhospital deliveries – United States, 1970-1992. MMWR 1995; 44:335-7.

3 Mushinski M. Average charges for uncomplicated vaginal, cesarean and VBAC deliveries; regional variations, United States, 1993. Stat Bull Metro Insur Co 1994; Oct-Dec:27-36.

4 Anderson RE, Greener DA. A descriptive analysis of home births attended by CNMs in two nurse-midwifery services. J Nurse Midwifery 1991;36:95-8.

5 Riordan J. The cost of not breastfeeding: a commentary. J Hum Lactation 1997;13:93-7.

6 Walker M. A first look at the risk of artificial infant feeding. J Hum Lactation 1993;9:97.

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