Homebirth Five/After the Birth

1.  When the baby first comes
1. Baby's appearance
1. Color--bluish-grey; will "pink up" after first breaths; hands and feet may stay a little blue
2. Vernix--protective coating on skin
3. Lanugo--fine hair around the face, sometimes on the rest of the body if the baby is a little early
4. Fontanels and shape of head ("molding" is common when second stage labor is long)
5. Milia ("baby acne")--development of sebaceous glands
2. What to do
1. Don't pull on baby's head or force baby to turn during birth
2. Be careful when catching--baby is slippery!
3. Immediately after birth, place baby on mother's tummy or in her arms, against chest (skin on skin is best) and cover both with a towel or blanket
4. It may be a good idea to turn off fans to avoid chilling baby and mother
5. Make sure baby is breathing--baby may or may not cry at first; turn over on side or tummy to help expel mucous and use bulb syringe if necessary
6. Encourage the baby to suckle as soon as possible; this helps with expelling placenta
7. Do not pull on cord to hurry placenta OR cut cord before it stops pulsating
2. Delivery of the placenta (third stage labor)
1. Function of the placenta (also called "afterbirth")
1. Provides nutrients for the baby
2. Provides oxygen for the baby
2. Attached to both mother (implanted in wall of uterus) and baby (by umbilical cord)
1. Develops from fertilized egg
2. All blood in placenta belongs to baby
1. Mother's blood does not mix with baby's, unless birth attendant pulls cord to remove placenta, or cesarean section is done
2. In "non-interventive management of third stage," Rh negative is not a concern, thus rendering Rhogam unnecessary. (Rhogam is manufactured from blood products, thus carrying all the risks and concerns of associated with their use.)
3. When cord is cut before it stops pulsating:
1. Deprives baby of needed blood
1. Can cause poor circulation in baby
2. Increases risk of developing heart murmurs in first two weeks of life
3. Decreases iron available to baby
4. Can cause respiratory distress
2. Increases risk of maternal hemorrhage
1. Placenta shrinks as blood leaves
2. Contractions that pump bood into baby also are responsible for encouraging placenta to detach
4. Full blood supply in baby can increase likelihood of jaundice in baby
1. Normal physiologic jaundice has never shown to be harmful
2. Jaundice is a part of the natural process (the liver detoxifying baby's system), and can actually be beneficial (God always knows what He's doing!)
3. Detaches after baby is born
1. Transfer of blood from placenta causes it to shrink
2. Uterine contractions reduce uterus in size and clamp down on blood vessels where placenta was attached
3. Uterus shrinks faster than placenta, causing placenta to separate and preventing hemorrhage
4. Placenta is expelled from vagina
1. May take for a few minutes to a few hours (though most medical personnel are not that patient)
1. Not dangerous as long as mother isn't extremely pale and has no fever
2. Pulling on cord to force placental separation can cause part of placenta to be retained
2. As with birth, walking or being in upright position may help (sitting on toilet, squatting, etc.)
4. The passage of the placenta signals the end of the pregnancy
3. Postpartum
1. Immediately
1. Care of the baby
1. First and main concern is keeping the baby warm
2. Breathing is sometimes a little fast; baby may cough up phlegm
3. First and only food should be breastmilk--NO water or formula! Nurse early and often is the best rule
1. Production of mother's milk is triggered by separation of placenta
2. Milk will not "come in" for 2-5 days after birth (shorter span with home birth and/or successive babies)
3. Mother's breasts already produce colostrum, which is perfectly designed for a newborn--rich in glucose and antibodies--SEE OUTLINE SEVEN!
4. Any vernix can be simply wiped off or, better yet, rubbed into baby's skin
5. Bathing is optional--can lower baby's temperature. Some mothers like to get into tub with baby immediately (not allowed in most hospitals, or even recommended--OK at home where your body is already immune to any germs present)
6. Be prepared for passage of meconium--sticky dark green or black (tar-like) first bowel movement
1. First feedings stimulate the baby's digestive system to pass this
2. It may be in small amounts over the span of a day or two, or all at once (from birth on!)
7. A friend may enjoy weighing, measuring, and dressing baby while someone else helps clean up mother and birthing area
2. Care of the mother
1. Uterus will continue contracting to shut off blood vessels that were attached to placenta--this prevents hemorrhage
1. Stimulation in the form of nursing the baby is most helpful--even if the baby only wants to mouth or lick the nipple
2. Some caregivers do extra stimulation by hand if bleeding seems to be heavy
3. Some passing of clots is normal
2. Mother may have chills or shaking--plenty of blankets will help, and make sure mom is not left alone on narrow bed
3. Someone should help mother to the shower or toilet the first time
3. Mom and baby should be tucked into bed after cleanup--and enjoy the afterglow of God's glory!
1. Support team needs to give new father and mother time alone with each other and baby, even if just a few minutes right after birth
2. Mother may be a little hungry and thirsty right away, or she may just want to sleep
4. Disposal of placenta
1. It's interesting to look it over, just to see what helped feed your baby all those months--also to check for retained pieces
2. Seal placenta in plastic trash bag and burn or bury it--illegal to throw in trash
2. First 24 hours
1. Mother may feel weak
1. Normal--labor is hard work!
2. She needs to rest as much as possible for at least a week, preferably two
2. Some women have rather intense afterpains, especially during and after nursing
1. This is good! It means uterus is contracting well
2. Relaxing through them (as in labor) is best means of dealing with it, also shower, bath, or hot compresses on lower belly
3. More common with subsequent pregnancies
3. May have rather large blood clots
1. Normal
2. More common with larger babies
3. May be as big as a tennis ball
4. Lochia (blood flow after birth)
1. May last for 2-6 weeks
2. Will change from bright red to brown to yellowish
3. May increase after too much activity
4. May stop and start again several times
5. Mother should not soak more than one pad every two hours
5. Uterus should shrink to size of grapefruit (at level of navel or below) and stay fairly hard
1. Check for this after delivery of placenta
2. Massaging abdomen can help if needed (again, nurse baby often!)
3. Keeping bladder as empty as possible is essential at this time
6. Elimination may be rather uncomfortable at first
1. Urination may be rather difficult (from stretching) or sting (if tears)
1. Mother should go the first time within a couple of hours after the birth
2. This will help the uterus stay contracted, preventing undue bleeding
2. First stools
1. May not need to go for a couple of days
2. Hospitals dispense stool softeners as a matter of course; at home eat plenty of fiber (prunes, raisins, bran cereal) with lots of liquid
3. If hemorrhoids are a problem (from pushing), witch hazel (applied topically) or sitz baths can help
3. Use peri bottle for more comfortable cleanup
7. Slight fever is common in mothers with any kind of tear or cut--remember that fever is the body's way of fighting infection
8. Any infection or retained piece of placenta will often resolve in 24 hours if left alone
1. Placental piece will be expelled in lochia
2. Lymph glands may enlarge in response to infection; this means the body is working properly
9. Help for sore bottoms
1. Sitz bath (with or without herbs) is very soothing
2. Goldenseal and comfrey are the best herbs, either in a bath or directly on bottom for tears
3. Contracting pelvic floor muscles before sitting down can help, especially on toilet; when muscles are relaxed, tissues won't be pinched or pulled
10. Begin simple exercises
1. Kegels
2. Pelvic rocking
3. First week
1. Rest, rest, rest
1. Do not do any household chores
2. Sleep when baby sleeps
2. Take time to get to know your baby and adjust to changes
3. Nursing helps to maintain hormone levels, permitting a more gradual return to pre-pregnancy state
4. Eat well
1. If husband can't cook, leave out simple recipes for him to fix
2. Freeze casseroles, soups, breads, etc., during last month of pregnancy
3. Tell friends who ask "what they can do" to provide a family meal (real friends should offer, but childless ones may not think of it)
4. Good nutrition is essential
5. Call for help if any problems!!!
1. Breastfeeding
2. Baby care
3. Mother's physical condition
4. Recovering from birth
1. By six weeks postpartum, most women are physically recovered from vaginal delivery (add two weeks for c-section)
2. Weight can be lost as quickly as six to eight weeks with no special attention if mother is breastfeeding
1. Not a good idea to diet either immediately postpartum or while breastfeeding
2. A healthy diet is the best way to make sure there is not unnecessary weight (same guidelines as before
3. Baby is usually settled into family by six weeks
4. Sex
1. The general suggestion is that intercourse be avoided until lochia has stopped and any stitches are healed
2. May be uncomfortable at first
1. Breastfeeding mothers may want to use extra lubrication (K-Y jelly or comparable)--caused by hormonal changes (not all breastfeeding mothers experience this)
2. May be painful for several weeks or months if there was a stitched tear or episiotomy (some women are fine as soon as stitches heal)
3. Desire may not be as strong for a while
1. Mother and father may both be too tired
2. Mother's desire only may be decreased
1. "Touched-out" from frequent body contact
2. Hormones from breastfeeding
3. Stress from demands of caring for new baby
3. Father's desire may be decreased
1. The shock of witnessing birth may temporarily reduce ardor
2. The stress of another family member to provide for may also take a toll
5. Return of fertility
1. Non-breastfeeding mother may ovulate 2-8 weeks after birth
2. "Ecological" breastfeeding usually delays ovulation for 6-14 months (sometimes longer). (See Breastfeeding and Natural Child-Spacing by Sheila Kippley) Obviously this is God's intention because women who have a baby every year have many physical problems as they get older--lactation is a time of rest for the reproductive system.
1. No supplemental bottles
2. No pacifiers
3. Baby nursed "on cue"
4. Family bed
5. Minimal mother-baby separation
3. Birth control
1. We feel the Biblical view is that it is in God's hands (see separate Bible study on this issue)
2. NFP is next-best option (correspondence course available on sympto-thermal method)
3. Hormonal methods
1. Birth control pills
1. Many side effects (read package inserts)
2. Abortifacient (usually suppresses ovulation but can cause early abortion or later miscarriage if ovulation occurs anyway)
3. Not recommended while breastfeeding
2. Norplant
1. Many side effects
2. Can leave scarring
3. Not recommended while breastfeeding
4. Abortifacient properties unknown at this time, but likely considering effects of hormone therapy in general
3. Depo-Provera
1. Many side effects
2. Can prevent milk production if given immediately after birth
3. Huge initial dose
4. See 3 and 4 above
4. Spermicides
1. All "barrier methods" are used in conjunction with spermicides
2. Have fairly high failure rate (13-20%)
3. Can cause birth defects if conception occurs anyway (damages sperm)
4. May increase miscarriage rates
5. Intrauterine device (IUD)
1. High rate of infection
2. Can cause sterility
3. Abortifacient
4. Can cause severe pain and bleeding during menstrual cycles
6. Condoms
1. Often used with spermicides
2. High failure rate (10-25%)
3. May cause burns at vaginal opening
4. Decreases husband's sensation (and sometimes wife's)
7. Pray very hard before you make a decision about this and be true to what God tells you

Intro | Class 1 | Class 2 | Class 3 | Class 4 | Class 5 | Class 6 | Class 7

Plain Text Version of Outline