One thing I notice about couples who choose to have an unassisted birth - they are generally people who have really done their homework. I think we could all take a page from their book. I wish all couples took responsibility like most freebirthing couples do, and were as well-informed and prepared. Couples will be more empowered and confident, regardless of their chosen birth setting and care providers, if they do. And you never know when this knowledge could come in handy - don't think it couldn't happen to you! I *thought* I was pretty clued up about birth ... and look what happened to me: my second baby was born in a shopping mall. More on THAT story here! Who knows, one day it might be you helping a mama give birth in a car, in IKEA, in a box with a fox, on a train in the rain ...
So here are some simple and clear words from Jenny Blyth:
BASIC INSTRUCTIONS FOR A QUICK OR UNASSISTED BIRTH
Generally speaking, births that happen quickly are also births in which problems do not have the time to develop.
Stay calm and in the present moment.
Know that at this moment in time, nothing else exists but the people present at the birth…in other words, try to accept this fact rather than focusing on or anticipating the arrival of ‘outside help’.
Make sure the mother is as comfortable as possible in whatever position she may be in.
Gather some towels, washcloths, toilet paper/tissues/paper towels, and a bucket or large bowl for the placenta.
Encourage the mother to stay calm, breathe, and listen to what her body is telling her. Reassurance can be helpful.
Notice when the labia start to part and the baby’s head becomes visible. Try to help the mother to use her breath to ease the head out and offer to support her vagina with your hand.
After the baby is born, he or she needs to be in drainage / recovery position. The baby will be very slippery! Place the baby’s head lower than the body, and make sure the face is pointing down (to help expel mucous).
Disentangle cord if necessary. It may be around the neck or wrapped around the torso, arms or legs.
Keep the baby on skin and make sure he or she is warm, pink and alert. A homebirthed baby does not always scream or cry loudly, but it should be obvious that the baby is ‘present’.
Sometimes during the birth of the baby, particularly in the pause that occurs right after the birth of the head, a mom feels ‘stuck’ as the shoulders align to be born. A pause is normal; a feeling of being ‘stuck’ is not.
This is accompanied by a baby whose head is out past the mouth but you can’t see much of the neck.
The best option for this situation is for the mom to change her physical position, often turning onto her hands and knees, or just simply rising to a squat or standing position.
You or the mother can also add a bit of directed traction to the baby’s head towards the sacrum.
If none of the above appear to be making much difference, you can put two fingers in along side the baby's shoulders and wiggle the baby’s back a bit in order to shift the position of the shoulders.
Midwife Gail Tully's site, Spinning Babies, has more information on shoulder dystocia here
Watch for bleeding that is excessive and / or continuous (a trickle bleed that persists for awhile may be deceptive: it won’t look like much but actually adds up to a significant amount of blood loss.)
Bring the mother's attention to any concerning bleeding. This is her body and her blood and she has some amount of control over it.
Make sure her bladder stays empty.
If she is in water, get out immediately.
Use towels or pads that are light in color so you can monitor blood loss.
Give 2 glasses of fluids immediately - preferably a hydration blend rather than plain water.
Encourage the baby to latch onto to the breast.
If you have any herbal tinctures or homeopathics for haemorrhage, use them accordingly.
If the bleeding is dramatic and uncontrollable and you have prescription syntocinon available, inject it intramuscularly into the thigh.
Work on getting the placenta out. If bleeding is due to a partially separated placenta, this may not be easy. It may help to try squatting / kneeling and gentle, steady cord traction towards the anus while the mother pushes and her uterus is held firmly through the stomach. Be gentle and steady; do not use force.
If the placenta comes away, continue to hold and massage the uterus through the stomach. It should be firm and at the level of the belly button.
If the placenta won’t come away and the bleeding is steady and uncontrollable, you need to transfer immediately to hospital.
Be very aware of the mother’s clarity of mind and skin tone. Watch for cold, clammy skin and perspiration.
Notice the color of the water after it breaks. It should be clear. If it is greenish black, the baby has passed meconium (baby poo). You want to clear this from the baby’s mouth and nose before the first breath.
Use the ear bulb syringe or your own mouth to suck the fluid from the baby’s mouth and nose.
Keep the baby’s head lower than the body.
Make sure the baby’s color is pink and not grey, and that the baby is alert and not limp.
If there are significant breathing problems, help should be called immediately.
In a well oxygenated baby, the skin colour is usually pinkish and the baby seems alert and awake. It often takes 30 seconds or so for a baby to take its first breath naturally.
Blowing air over the baby’s face can stimulate breathing, as can squeezing the arms and legs and rubbing the soles of the feet or along side the spine.
Babies should always be kept warm, including a baby hat to prevent heat loss through the moist head.
If the baby is limp and white, this is a sign of poor oxygenation. Stimulate with your breath and fingers as above.
If this is not enough, lay the baby flat and put the head in line with the body. Blow 5 short breathes into the baby’s mouth and nose. You can also try diaphragmatic rocking: hold the baby under the neck and between the ankles and tip the baby one way and then the other. This exerts pressure on the baby’s diaphragm and stimulates the gasping reflex.
If there is still no response (only a couple of minutes may have passed since the baby was born) then you need to check the baby’s heartbeat. Keep blowing breath into the baby’s mouth and nose. Feel for a heartbeat with your fingers on the baby’s chest. Put your ear on the chest to listen for one.
If the baby’s heart is beating, then keep breathing for the baby at a rate of 1 breath every 3 seconds until the baby is breathing starts or help arrives. Keep the baby warm.
If no heartbeat is present, begin infant CPR. Make sure an ambulance has been called.
Infant CPR: Cardio Pulmonary Resuscitation
Resuscitate as above, but include CPR:
Use 2 fingers to compress the chest in the lower half of the sternum.
Compress 1-2 cm depth
Do 15 compressions and 2 breathes in 10 seconds
Check heart rate frequently.
Continue until the baby responds or help arrives.
Jenny Blyth is the author of Birthwork: A compassionate guide to being with birth
I love this book, it is one I read over and over. Jenny also runs excellent workshops, often together with Midwife Fiona Hallinan, on body awareness, and 'making space in the pelvis', rebozo etc. If you ever fortunate enough to have one of these workshops run in your area, consider it a gift and try to attend - you'll not regret it.
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