Homebirth Four/Labor and Delivery

1.  Eight-month checklist and birth kit (for DIY home birth)
1. General overview at eight months or so
1. For baby
1. Clothing--stocking hat, diapers, t-shirts or onesies, socks or booties, bunting for going out (if cold weather), receiving or other blankets, separate supply of cloth diapers (flat or prefold) or old receiving blankets for use as spit-up cloths
2. Miscellaneous equipment--car seat (essential), baby swing (nice, but not necessary), carrier or baby sling, for outings (baby prefers being close to you, rather than in carriage or store cart)
2. Have birth supplies sterilized, assembled, bagged and ready (listed below)
3. Camera or camcorder ready (at least for afterwards)
4. Prepare food for support team (casseroles, baked goods--in freezer)
5. Childcare arranged for/overnight bag for them packed, if necessary
6. Borrow or purchase nursery scales
7. Have makings for "birth-day" party or cake, if desired
8. Get exemption form for PKU test (explained more fully in section on newborns), if going this route
9. Think about where you may want to give birth, and prepare accordingly
1. Thoroughly clean area (especially bathroom)
2. Make bed with one layer of clean sheets under a plastic protector of some sort, then an absorbent pad or blanket and second set of sheets over all, in the event of midnight water breaking. This way, after the birth, all you have to do is strip away soiled sheets and plastic protector and voila! Clean bed!
10. Prepare clean clothing for yourself, as well--comfy tees or short nightgowns are good for labor itself, and something to change into afterwards that will facilitate nursing
2. The birth kit itself (NOTE: I found it helpful to organize supplies by the following method and have everything in separate 2-gallon Ziploc bags, stored under the sink in the bathroom or somewhere in bedroom. Others have had equal success just assembling what they call a "baby box" containing a customized version of my list.)
1. During labor
1. Blue chux pads, half a dozen or so; OR bath towels, 2 or more (will need more during birth, so try to ration these if quantities are limited!)
2. Large waterproof sheets, for bed or floor
3. Gauze pads OR washcloths, for small cleanups
4. Flexible straws, for drinking while lying down
5. Olive or almond oil, for perineal massage
6. Massage lotion (can take ordinary lotion and add a few drops of favorite essential oil, such as lavender, for additional soothing effect)
2. During birth
1. Towels, 2 or more
2. Receiving blankets, 2-4, for drying and swaddling baby
3. Washcloths, 6-12, for hot compresses
4. Povidone iodine, for cleansing hands and/or perineum--OPTIONAL (also useful for postpartum; mix with water for use in peri bottle)
3. After birth, for baby
1. Rubber bulb syringe, for suctioning nose and mouth
2. Cord clamps or clean (preferable sterile) shoestring
3. Alcohol wipes or bottle of alcohol and cotton balls, for cord stump
4. Goldenseal powder, for cord care and any perineal tears
5. Paper tape measure, handy for measuring baby's length and head circumference
6. Birth certificate and footprinter
7. Clothing--baby hat, two diapers, t-shirt or onesie, socks or booties, soft blanket
4. After birth, for mother
1. Labor and delivery summary, if desired (keeping some kind of written record of labor can be interesting later, when nobody remembers what happened when!)
2. Dishpan or pail and plastic trash bags for catching and disposing of placenta
3. 2 sanitary pads and mesh briefs, or incontinent briefs/pads, whichever you prefer (have a stock of a couple dozen pads and/or briefs ready...hospital-size pads available through SLC or can use Stayfree Ultra-thins--most comfortable!)
4. 8-oz. "peri" bottle, for rinsing after going potty (saves uncomfortable wiping)
3. PERSONALIZE THIS LIST--be prepared!!!
2. Labor begins
1. When? A note on due dates
1. Often inaccurate
1. Based on a 28-day cycle, which may or may not hold true for each woman
2. Each baby has its own timetable
2. Time is in God's hands - Genesis 21:2 "For Sarah conceived and born Abraham a son in his old age, at the set time of which God had spoken of him"; Luke 1:57 "Now Elizabeth's full time came for her to be delivered, and she brought forth a son:, 2:6 "So it was, while they were there, that the days were completed for her to be delivered"; Ecclesiastes 3:2 "A time to be born, and a time to die...."
3. Well-nourished mothers may go past "due" date
2. Pre-labor ("Braxton-Hicks" or "false" labor)--contractions not usually regular (though can be), often stop/slow when activity is changed. Drink 1-2 glasses of water (can be caused/aggravated by even mild dehydration). Though they can be annoying, they do serve a purpose in preparing the uterus for active labor. Some women even dilate a few centimeters during this time.
3. True labor
1. "Lightening"--the baby "drops," as the head settles into the pelvis
2. May lose cervical plug up to a week (or more) before labor--may be blood tinged (normal), brown, or not even noticed at all
3. Baby may move less (not always)
4. May have "diarrhea"
5. Quality of contractions changes (contraction=the muscular tightening of the uterus, which pushes the baby against the cervix to dilate or open it, and down into the birth canal)--usually regular, closer together, and stronger, to the point of needing to relax through them
6. Water may break--usually not until late in labor; may gush or just leak
1. Appearance
1. Should be clear; may contain bits of vernix or lanugo
2. May be meconium stained--can signal fetal distress but not always; pale yellow or green is not a particular concern (common when baby is "overdue"). Dark green or black is a concern--pray!!
2. No such thing as a "dry birth"--your body continues to produce amniotic fluid even after water breaks
3. Helps baby and mother if intact
4. Amniotomy (artificial breaking of water) should be avoided
1. Only shortens labor by average of 15-20 minutes
2. Increases danger of infection
3. Makes contractions more painful
4. Loss of cushioning for baby's head
5. Effective less than 50% of the time as a method of starting labor
5. Premature rupture of membranes (PROM)
1. Not dangerous if no internal exams done
2. Mother should watch for signs of infection (fever, odor, etc.)
3. Often prevented by good nutrition, avoiding all internal exams
4. If prolapsed cord is a concern, can do rectal exam if absolutely necessary (not recommended)
7. "Bloody show" (reddish mucous)--usually begins during active labor and continues throughout--good sign that dilation is occurring
3. First stage labor
1. Changes in the cervix ("neck" of the uterus)
1. Effacement
1. Thinning
2. Pulling up/drawing back
2. Dilation (or "dilatation")
1. Opening
2. Most used as criteria for determining progress of labor by medical personnel
3. Lack of measurable "progress" in this area is diagnosed as "dystocia" (one reason for avoiding vaginal exams altogether--see chapter on Interventions)
3. Complete effacement at 100% and dilation at 10 cm
2. Length and intensity affected by baby's position
1. Anterior--most common and most desirable--baby facing toward spine
2. Posterior--may make labor more painful and delivery longer--baby facing forward (back of head against mom's tailbone)
3. Breech--bottom or feet presenting first
1. Used as excuse for cesarean--but unnecessary
2. Upright position essential for delivery
3. Baby more likely to have a little trouble breathing
1. Extra suctioning might be needed
2. Baby needs mother, not a warmer
3. Cesarean would not prevent respiratory complications
4. Transverse (extremely rare)--baby lying sideways in uterus--one of the truly valid medical reasons for cesarean, though most often caused by inducing labor before baby has settled properly into pelvis
3. Baby's movement during labor and birth
1. Station of head
1. - (minus) = not engaged (head settled in pelvis)
2. 0 (zero) = engaged
3. + (plus) 1, 2, 3 = descending
4. +4 = crowning
2. "Cardinal movements"--how the baby flexes and rotates through birth canal (accomplished by uterine pressure alone--no outside assistance needed)
3. Remember that the baby is designed to go through this process
1. Labor itself conditions the baby to life outside the womb
2. The baby's head will mold to fit through the birth canal
3. Pregnancy hormones soften the mother's joints, allowing pelvis to open during birth
4. Emotional changes in the mother
1. A better standard of progress than dilation
2. Early labor--excitement
3. Active labor--seriousness
4. Transition--discouragement, other drastic mood changes
5. Pushing stage--"second wind" (unless extremely tired)
6. For a fuller discussion of this, read Natural Childbirth the Bradley Way
5. Pain and discomfort
1. Society's view of pain and discomfort in general--gone are the days when patience, stamina, and discipline were expected character traits
2. The fear/tension/pain cycle--one leads to another, in a vicious circle, until broken
3. Coping techniques
1. Prayer and scripture reading--truly focus on the Lord
2. Praise--from the mother herself and those around her
3. Total body relaxation (may not be sufficient in late labor)
4. Massage (back, feet, legs especially comforting)
5. Change position often
1. Walking--great to keep labor progressing
2. Leaning forward against wall, furniture, or support person during contractions
3. Sitting up/rocking chair
4. Hands and knees helpful during back labor
5. Side-lying if very tired
6. Straddling a chair, facing back; beanbag; "birth ball" are other options
6. Food and liquids in moderate amounts
7. Water--in shower or tub
8. Hot or cold compresses, as desired (on back or belly and, later, perineum)
9. Music
10. Strong hand (or arms) to hold
11. Listen to and go with your body ("ride the waves") rather than seeking to distract yourself--VERY IMPORTANT
6. Things for support people to remember
1. Remind her to use bathroom often (once hourly is good; a full bladder can hinder labor)
2. Don't leave her alone if you can help it
3. It's perfectly fine for the mother to vocalize--a low moan is best, because it keeps the body loose and relaxed; high-pitched screaming signals tension
4. Losing control occasionally is not a big deal, but the mother shouldn't be in a constant state of hysteria
5. Breathe with her (deep, slow breaths) if she starts to really lose it
6. She may not be able to tell you what she wants; offer a change in coping measures (suggest something specific) if it seems what you're doing just isn't quite "getting it"
7. She may be abrupt of snappish deep in labor; don't take her sharpness personally. Remember she is not quite "herself"--labor is INTENSE and her reactions will probably be rather raw
8. Encourage her and praise her efforts often
9. Provide yourself drinks and snacks; labor may take a while and you can tire out, too
4. Second stage labor
1. Signs that you're finally dilated
1. Contractions may change (again)
1. Slightly less intense
2. May be farther apart
3. May stop altogether for a short time
2. Feelings of pressure (inside) shift downward
3. May feel a need to push (often mistaken for need for bowel movement)
4. Perineum begins to bulge; vulva begins to open as baby's head descends
2. Pushing
1. Don't until you feel an overwhelming need to do so
1. Decreases chance of tearing
2. Saves energy for when you really need it
2. Position
1. Whatever's comfortable
1. Side-lying if extremely tired
2. Full or standing squat--provides up to 30% more room in the pelvis
3. Hands and knees--good for posterior baby, or if shoulders get stuck
4. Kneeling--often very comfortable, also good for big baby
5. Sitting--not as good, puts pressure on tailbone
2. DO NOT LIE ON BACK
1. Increases length of pushing stage
2. Practically guarantees need for episiotomy/likelihood of tearing (all pressure on perineum)
3. Breathe through pushing contractions; try to avoid holding your breath
4. May take some time (be patient!!)
1. Usually longer for first baby
2. Remember--"in God's own time"
3. Slower pushing stage allows tissues to stretch gradually (faster is thus not always better) and for baby to "find" his own way down
5. Might be a good idea to have something to bite down on
1. Husbands not usually suitable for this
2. Arm/hand will be sore if used for this purpose
3. Should generally try to keep mouth relaxed during pushing--correlation between tension of mouth and that of pelvic floor muscles
6. What you will see
1. The awesome design of a woman's body becomes evident as the tissues expand and unfold to accommodate the baby's head
2. As the baby's head begins to appear, it may look white or bluish-gray and wrinkled, from the compression of the fontanel--THIS IS ALSO NORMAL!
3. The baby's head may recede in between pushes, especially with a first-time mother--this is to help the vagina unfold more slowly
4. Water may break at this time if not earlier
1. Sometimes amniotic sac bulges below/in front of baby's head
2. Be prepared for sudden squirt or gush
7. The mother will feel incredible pressure in her bottom area
1. Burning sensation ("rim of fire") is often felt as the birth outlet stretches
2. Use this to help you gauge how much to push (too much may cause tearing)
3. DON'T PANIC AND TENSE PELVIC FLOOR MUSCLES! Consciously open your body and let and baby out! (Support people can encourage verbally here)
4. Hot compresses (washcloth wrung out in hot water) or olive oil on perineum can be very comforting
5. Actually emptying bladder or bowels during pushes is very common but can be embarrassing for mother; be prepared
3. The birth itself
1. Crowning occurs when the head is no longer sliding backward between contractions; the vaginal outlet encircles the widest part of baby's head
2. When the baby's head is born, check to see if cord is around baby's neck (be gentle!)
1. If cord is present, it may be slipped forward over baby's head if enough slack
2. If cord is too tight to slip over baby's head and baby goes into distress (turns darker blue), clamp in two places and cut between clamps
3. Using bulb syringe to suction mouth and nose at this point is optional (often done in hospital); mother's intact perineum will help squeeze fluid from baby's lungs during birth
4. Mother may feel like resting a little after birth of head--fine as long as baby's color does not darken
5. Baby may immediately open eyes, cry a little
6. Shoulders come forward one at a time after head
1. Allow a little time for baby to turn
2. If shoulders seem to be a problem, have mother turn on hands and knees to "unhook" baby from pelvis; otherwise have mom get completely upright (standing or otherwise)
7. After shoulders, the baby's body slides out easily

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