Trouble visualizing the logistics of a birth in my home...

[Dot-to-Dot]

I am interested in the idea of a home birth...but last time, I had some minor issues and I wonder how these things would go down in the event of a home birth.  Would appreciated any experienced HBer's chiming in.

1.  Well, first of all, as I moved around my hospital room I was dripping blood all over the floor, the bathroom, the bed.  How do you walk around your home dripping like that?  I do NOT want to wear underwear and a pad, that sounds SO annoying while in labor.  And post partum they had to change my sheets because I'd be leaking blood.  I can't imagine just throwing away a few sets of sheets from home.  And going to the bathroom post partum was often messy with blood on the toilet seat or bidet...I don't want my mom or husband (or ME!) to have to clean up blood all over our home.  It almost seems more comfortable to do that in a place where people are periodically coming in to clean and refresh everything for you.

2.  I had a lot of trouble with the baby fitting through my hips.  She was large and I guess I am somewhat small in the pelvis.  I have no recollection of uterine contractions once active labor started.  It was blinding, puking, paralyzing pain for about 5 straight hours with no break in between like a contraction would have.  Pure bone crushing pain that overshadowed the uterine contraction.  I'm sure a doula would want me to try different positions...but I could not move and screamed for so many hours that my entire neck and chest were swollen for a week after birth I worry I will scare or wake up my 1yr old).  Seriously..it was so far off from how people explained labor pain.  I didn't want a single intervention last time, including breaking water...but I always wondered if I'd just broke the water would things have gone faster?  Or just harder.  What does a midwife do in the case of a small hipped/big baby woman?  Anything?  :/

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that?  

4.  I progressed to 9 and had a lip - never got to wait for the urge to push.  The doctor asked if I wanted to push and I immediately instructed my husband to hoist me into a squat and pushed that child out so fast that I had a 4th degree tear.  oops.  But I wanted to be DONE and my powers just overcame me when he said I could push.  My doc says he STRONGLY advises me to try laying on my side for the final pushing so he can ease the baby out.  But, regardless of my position, can a midwife deal with a 4th degree tear at my home?  How about a 3rd, 2nd or 1st?  Would I have been a transfer for stitches?  What does a midwife do if you have a lip and you've been at 9 for quite some time?

5.    Do you have to buy disposable bedding for all over the house?  Who knows where I'll end up walking around to or pushing at...what do they do with the placenta?  Do they bring their own sterile containers and all that or will I have to set everything up.  Gathering all that stuff and keeping track of it (and keeping the one year old away from it) does not sound like my idea of nesting.  I don't think I'd wanna be messing with all of that.

6.  I loved how they just brought me frozen pads at the hosital.  Whatever that stuff was inside of them was heavenly and cushy.  And I will SO miss the warm water of the bidet they offered.  The little bottle they give ya just isn't nearly the same.

Thanks for any insight ladies.  I am so on the fence.

[camprunner]

Originally Posted by Dot-to-Dot 

I am interested in the idea of a home birth...but last time, I had some minor issues and I wonder how these things would go down in the event of a home birth.  Would appreciated any experienced HBer's chiming in.

1.  Well, first of all, as I moved around my hospital room I was dripping blood all over the floor, the bathroom, the bed.  How do you walk around your home dripping like that?  I do NOT want to wear underwear and a pad, that sounds SO annoying while in labor.  And post partum they had to change my sheets because I'd be leaking blood.  I can't imagine just throwing away a few sets of sheets from home.  And going to the bathroom post partum was often messy with blood on the toilet seat or bidet...I don't want my mom or husband (or ME!) to have to clean up blood all over our home.  It almost seems more comfortable to do that in a place where people are periodically coming in to clean and refresh everything for you.

I personally have not dripped blood in labor and that includes that one where my water broke to kick everything off.  However, midwives generally handle all cleanup so I'd think they would clean this up too.  I've read that blood in labor can actually indicate a bigger problem but it sounds like it was normal for you.

2.  I had a lot of trouble with the baby fitting through my hips.  She was large and I guess I am somewhat small in the pelvis.  I have no recollection of uterine contractions once active labor started.  It was blinding, puking, paralyzing pain for about 5 straight hours with no break in between like a contraction would have.  Pure bone crushing pain that overshadowed the uterine contraction.  I'm sure a doula would want me to try different positions...but I could not move and screamed for so many hours that my entire neck and chest were swollen for a week after birth I worry I will scare or wake up my 1yr old).  Seriously..it was so far off from how people explained labor pain.  I didn't want a single intervention last time, including breaking water...but I always wondered if I'd just broke the water would things have gone faster?  Or just harder.  What does a midwife do in the case of a small hipped/big baby woman?  Anything?  :/

A midwife would normally make the same suggestions as your doula made.  Many also have other ways to deal with pain that I'd never heard of before I started interviewing midwives this time.  Most are trained to get a stuck baby unstuck.

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that?  

yes

4.  I progressed to 9 and had a lip - never got to wait for the urge to push.  The doctor asked if I wanted to push and I immediately instructed my husband to hoist me into a squat and pushed that child out so fast that I had a 4th degree tear.  oops.  But I wanted to be DONE and my powers just overcame me when he said I could push.  My doc says he STRONGLY advises me to try laying on my side for the final pushing so he can ease the baby out.  But, regardless of my position, can a midwife deal with a 4th degree tear at my home?  How about a 3rd, 2nd or 1st?  Would I have been a transfer for stitches?  What does a midwife do if you have a lip and you've been at 9 for quite some time?

This depends on the midwife. The one that I am currently seeing is a CNM with lots of experience and seemed to indicate that she could handle this. My last one had a terrible time with my third degree tear and I've heard of ones that don't stitch at all.  Some women transfer to the hospital just for stitching or see their OB later that day.

5.    Do you have to buy disposable bedding for all over the house?  Who knows where I'll end up walking around to or pushing at...what do they do with the placenta?  Do they bring their own sterile containers and all that or will I have to set everything up.  Gathering all that stuff and keeping track of it (and keeping the one year old away from it) does not sound like my idea of nesting.  I don't think I'd wanna be messing with all of that.

They will probably drop chux pads (from your birth kit) whereever you give birth.  You get to decide what to do with the placenta. I'll probably have dh bury under a new tree. You can google things to do with a placenta online.

6.  I loved how they just brought me frozen pads at the hosital.  Whatever that stuff was inside of them was heavenly and cushy.  And I will SO miss the warm water of the bidet they offered.  The little bottle they give ya just isn't nearly the same.

You can actually make the pads at home by pouring witch hazel over post partum pads and freezing them.  This is pretty much the  "warm water bidet" that I was offered in the hospital:  http://www.amazon.com/Duro-Med-Portable-Bidet-Sitz-Bath/dp/B000FHFP76    I did miss that for my homebirth. I may purchase one this time now that I've found it.

Thanks for any insight ladies.  I am so on the fence.

My answers are bolded above and are just from personal experience based on my research and one homebirth. I recommend that if you are interested in homebirth, you interview the midwives in your area. You will get a wide range of answers to these questions. The MOST important question to me is about their ability to stich tears.  In the hospital, they spent 15 minutes stitching a 3rd degree tear.  An inexperienced midwife (who was very nice) spent an hour and a half and then told me she was half way done.  She didn't know how to use the litacain she was using properly (so I felt everything) and I told her she was done at half way!  She was actually a back up midwife so be sure to ask if the midwives backups are also experienced stitchers and if not, what the plan will be.  I am doing another homebirth so I am not by any means being discouraging but it will be important for you to find a midwife experienced in stitching.  The rest of it, I think you will find the midwives have adequate answers for. You might also consider a post partum doula if there is one available in your area.

[laohaire]

Originally Posted by Dot-to-Dot 

I am interested in the idea of a home birth...but last time, I had some minor issues and I wonder how these things would go down in the event of a home birth.  Would appreciated any experienced HBer's chiming in.

1.  Well, first of all, as I moved around my hospital room I was dripping blood all over the floor, the bathroom, the bed.  How do you walk around your home dripping like that?  I do NOT want to wear underwear and a pad, that sounds SO annoying while in labor.  And post partum they had to change my sheets because I'd be leaking blood.  I can't imagine just throwing away a few sets of sheets from home.  And going to the bathroom post partum was often messy with blood on the toilet seat or bidet...I don't want my mom or husband (or ME!) to have to clean up blood all over our home.  It almost seems more comfortable to do that in a place where people are periodically coming in to clean and refresh everything for you.

In my labor, I didn't leak blood. It's probably not rare but it's not standard, I don't think. Unless you mean post-partum? Yeah, I was bleeding, and I did wear a pad. I'm not sure what to suggest on that, I would honestly have a hard time being comfortable bleeding all over the hospital bed and floors and such, especially knowing someone would have to clean up after me and probably throw away the sheets just because I didn't want to wear a pad post-partum. If you meant during labor, I think not wanting to wear a pad is reasonable and can be dealt with by laying down plastic dropcloth (cheap at Walmart). You might also consider renting a birthing tub to spend most of your labor in.

2.  I had a lot of trouble with the baby fitting through my hips.  She was large and I guess I am somewhat small in the pelvis.  I have no recollection of uterine contractions once active labor started.  It was blinding, puking, paralyzing pain for about 5 straight hours with no break in between like a contraction would have.  Pure bone crushing pain that overshadowed the uterine contraction.  I'm sure a doula would want me to try different positions...but I could not move and screamed for so many hours that my entire neck and chest were swollen for a week after birth I worry I will scare or wake up my 1yr old).  Seriously..it was so far off from how people explained labor pain.  I didn't want a single intervention last time, including breaking water...but I always wondered if I'd just broke the water would things have gone faster?  Or just harder.  What does a midwife do in the case of a small hipped/big baby woman?  Anything?  :/

This is really a question for your midwife, but how was your last baby positioned? That makes a huge difference, much more than your size and the baby's size. Also, leaving the bag of waters intact was probably the best choice for both you and baby, since it provides a cushion between your baby's skull (if head down) and your bones.

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that?  

Cord, no problem. Sticky shoulders is also something I would trust a competent midwife to do, in fact more skillfully than an OB - though not to say that true SD isn't scary and dangerous no matter where you are. I don't think every single midwife is extremely competent, so I'd ask her about her experience with sticky shoulders and dystocia. How often does she deal with those? What does she do? Is she skilled with the Gaskin maneuver?

4.  I progressed to 9 and had a lip - never got to wait for the urge to push.  The doctor asked if I wanted to push and I immediately instructed my husband to hoist me into a squat and pushed that child out so fast that I had a 4th degree tear.  oops.  But I wanted to be DONE and my powers just overcame me when he said I could push.  My doc says he STRONGLY advises me to try laying on my side for the final pushing so he can ease the baby out.  But, regardless of my position, can a midwife deal with a 4th degree tear at my home?  How about a 3rd, 2nd or 1st?  Would I have been a transfer for stitches?  What does a midwife do if you have a lip and you've been at 9 for quite some time?

While some midwives can deal with a 4th degree tear (I think), most would probably transfer you to the ER. I had a 3rd degree tear and I went to the ER to be stitched up. While the OB who did the work was a piece of work, the transfer was not a big deal and I would not be afraid of having to do so again. Sometimes midwives manually pull the lip, sometimes they are hands off. However, I personally would listen to my body - no forced pushing, ever. Your body will (almost always) just start pushing when it's ready and there is nothing you can do to stop it. Personally, being told I was a 9 wouldn't mean anything to me, I'd just wait for my body to do its job whenever it was ready.

5.    Do you have to buy disposable bedding for all over the house?  Who knows where I'll end up walking around to or pushing at...what do they do with the placenta?  Do they bring their own sterile containers and all that or will I have to set everything up.  Gathering all that stuff and keeping track of it (and keeping the one year old away from it) does not sound like my idea of nesting.  I don't think I'd wanna be messing with all of that.

Disposable bedding for the whole house? Well, if you bled a lot during your last labor then you might feel good having some drop cloths. I did not. I labored mostly in the birthing tub in the dining room, but also walked through the living room and up the stairs to the bathroom several times. I also did the 3rd stage labor (which was significant - 3 hours) in the bathroom and bedroom. So i was all over the place. No stains, no sweat. Your midwife will give you a list of what you need to buy for the birth, and usually it's as easy as ordering a premade birthing kit. You don't need a sterile container for the placenta - why would you? :) If I recall correctly, I plopped the placenta into a mixing bowl. My midwife examined it, took a print (for fun) and wrapped it up in a brown paper bag and stuck it in my freezer. Which reminds me, I should compost it. You can bury it or whatever you want. It's not nuclear waste, it's a lovely amount of nutrition that can go back to the ground. Gathering up your birth kit doesn't have to be (and really shouldn't be) put off till your nesting period, I had mine all set up around 5 or 6 months. It's not so much stuff, you can just put it in a paper bag and stick it in a closet, up on a shelf, wherever.

6.  I loved how they just brought me frozen pads at the hosital.  Whatever that stuff was inside of them was heavenly and cushy.  And I will SO miss the warm water of the bidet they offered.  The little bottle they give ya just isn't nearly the same.

I've had the pleasure of using a bidet a few times in my life, not postpartum though. Personally I still wouldn't go to the hospital for a bidet :) My midwife made me some frozen pads at home.

Thanks for any insight ladies.  I am so on the fence.

[ShayMarsh]

Originally Posted by Dot-to-Dot 

I am interested in the idea of a home birth...but last time, I had some minor issues and I wonder how these things would go down in the event of a home birth.  Would appreciated any experienced HBer's chiming in.

1.  Well, first of all, as I moved around my hospital room I was dripping blood all over the floor, the bathroom, the bed.  How do you walk around your home dripping like that?  I do NOT want to wear underwear and a pad, that sounds SO annoying while in labor.  And post partum they had to change my sheets because I'd be leaking blood.  I can't imagine just throwing away a few sets of sheets from home.  And going to the bathroom post partum was often messy with blood on the toilet seat or bidet...I don't want my mom or husband (or ME!) to have to clean up blood all over our home.  It almost seems more comfortable to do that in a place where people are periodically coming in to clean and refresh everything for you.

I can't personally speak to the dripping blood issue - until after labor was over and I had to move to the bathroom.  At that time, my midwives helped hold a Chux pad between my legs to catch drips (and go back to clean up any that they didn't catch).  I was also advised to have a number of old towels available to help with any cleanup that needed to be done, be it water from the birth pool or blood that was dripped somewhere it shouldn't have.  Asking family for old towels they didn't want back got me a ton of towels, so I didn't have to spend money on something that I was potentially going to throw away.  Maybe this would be a good idea for you as well - so you have a toweled path that you can walk without concerns.  As far as bedsheets becoming ruined, this did not happen to me.  Midwives are very capable of getting blood stains out of any of the birth linens (my midwives washed all of the birth linens before they left after the birth).  Hydrogen Peroxide does the trick for getting those stains out.  I only needed 2 sets of sheets for my birth - one for during and a clean set for after.  Most of the 'soiling' was done on the disposable Chux pads. 

2.  I had a lot of trouble with the baby fitting through my hips.  She was large and I guess I am somewhat small in the pelvis.  I have no recollection of uterine contractions once active labor started.  It was blinding, puking, paralyzing pain for about 5 straight hours with no break in between like a contraction would have.  Pure bone crushing pain that overshadowed the uterine contraction.  I'm sure a doula would want me to try different positions...but I could not move and screamed for so many hours that my entire neck and chest were swollen for a week after birth I worry I will scare or wake up my 1yr old).  Seriously..it was so far off from how people explained labor pain.  I didn't want a single intervention last time, including breaking water...but I always wondered if I'd just broke the water would things have gone faster?  Or just harder.  What does a midwife do in the case of a small hipped/big baby woman?  Anything?  :/

Breaking the water will do both - make labor harder and faster (and that was certainly my experience).  It's definitely hard to say what a midwife would recommend in that situation - it sounds to me like you would be best talking to midwives in your area and explaining your previous experience to see what their responses are.  I would imagine that some of the things a midwife would try to ease the pain would be hip compressions (pressing the outside of your hips inward to help open and allow the baby's head to come down), water (showers or birth pool - I loved my birth pool and found it was well worth the hassle of setting it up in my bedroom) and possibly herbs or other natural pain relief measures. I think your best bet is to see what the midwives available to you have to say about this concern.

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that?  

The answer to this question should be absolutely.  If your midwives cannot say with 100% certainty that they can handle this situation, then find another midwife.

4.  I progressed to 9 and had a lip - never got to wait for the urge to push.  The doctor asked if I wanted to push and I immediately instructed my husband to hoist me into a squat and pushed that child out so fast that I had a 4th degree tear.  oops.  But I wanted to be DONE and my powers just overcame me when he said I could push.  My doc says he STRONGLY advises me to try laying on my side for the final pushing so he can ease the baby out.  But, regardless of my position, can a midwife deal with a 4th degree tear at my home?  How about a 3rd, 2nd or 1st?  Would I have been a transfer for stitches?  What does a midwife do if you have a lip and you've been at 9 for quite some time?

I also had a lip, and the moment my water broke, I NEEDED to push even though I was also only at 9 cm.  In order to avoid tearing, they had me do controlled pushing while one of them eased the lip out of the way of the baby's head.  It was rather painful (but I can't imagine more painful than a 4th degree tear) and once she did that, I was free to push and baby was out in under 15 minutes. The whole pushing process took 20 minutes, so it didn't take them long to resolve the lip and let me get down to business.  As long as you let them do this, I think you can avoid the tear.  My midwives were also capable of doing stitches if I had needed them.  Luckily, I did not.  This would also be something I would recommend making sure your midwives are very capable of doing and are comfortable with.  If they are not, find someone else who is.

5.    Do you have to buy disposable bedding for all over the house?  Who knows where I'll end up walking around to or pushing at...what do they do with the placenta?  Do they bring their own sterile containers and all that or will I have to set everything up.  Gathering all that stuff and keeping track of it (and keeping the one year old away from it) does not sound like my idea of nesting.  I don't think I'd wanna be messing with all of that.

No need for disposible bedding. And as for walking around, I stayed pretty much in my birth pool or near my bed.  As I mentioned, old towels or even plastic may be the way to go if you think you're going to be all over the place.  As far as the placenta goes - my midwives asked me what I wanted to do with it; if I wanted to keep it, or if I wanted them to dispose of it.  I happily let them do whatever they did with it as I also didn't want to deal with it.  As far as gathering all of the "stuff" you need for a homebirth, my midwives created a birth kit that I could just purchase and it had everything that they tell a mom that they need.  That way I wasn't hunting all over the place for some obscure items that they needed and I didn't know where to get them.  My midwives were excellent and I saw none of the mess - they cleaned everything up while I was busy staring at my baby.

6.  I loved how they just brought me frozen pads at the hosital.  Whatever that stuff was inside of them was heavenly and cushy.  And I will SO miss the warm water of the bidet they offered.  The little bottle they give ya just isn't nearly the same.

There was one of the frozen packs in my birth kit, and I could have purchased more of them.  If you liked them, purchase a bunch and you'll have them whenever you want them.  I never had the bidet, so I guess I don't know what I'm missing there. 

Thanks for any insight ladies.  I am so on the fence.

Some final words on your questions...  Meet with some midwives and ask them lots of questions.  If there are any responses that you get from them that make you uncomfortable or don't put you at ease, then find a midwife who can make you feel better about it.  A midwife should be totally honest with you, too.  If she feels that there is something with your previous experience that puts you at higher risk for complications, they will tell you that they don't feel a home birth is the best option for you.  And also keep in mind that if you start off at home and find that it is not going as you expect, you don't have to stay there - you can always go to the hospital and finish the birth there.   

[GoBecGo]

Originally Posted by Dot-to-Dot 

I am interested in the idea of a home birth...but last time, I had some minor issues and I wonder how these things would go down in the event of a home birth.  Would appreciated any experienced HBer's chiming in.

I've had 2 HB's but i'm in the UK so my access to qualified midwives is easier (every person calling themself "midwife" in this country has to be fully qualified and registered).  I had one NHS homebirth (where i was seen by the community midwife team for my area and attended by the 2 midwives on call when i went into labour) and one independent homebirth (where i chose my own midwife and she did all my care).

1.  Well, first of all, as I moved around my hospital room I was dripping blood all over the floor, the bathroom, the bed.  How do you walk around your home dripping like that?  I do NOT want to wear underwear and a pad, that sounds SO annoying while in labor.  And post partum they had to change my sheets because I'd be leaking blood.  I can't imagine just throwing away a few sets of sheets from home.  And going to the bathroom post partum was often messy with blood on the toilet seat or bidet...I don't want my mom or husband (or ME!) to have to clean up blood all over our home.  It almost seems more comfortable to do that in a place where people are periodically coming in to clean and refresh everything for you.

I didn't drip blood with either of my babies before the birth.  I DID have bloody show, but i was still in underwear at that point.  I have long latent phase, very short active phase and almost non-existent 2nd phase labours, so i tend to be living normal life for a good 6 hours of early labour (and thus am fully clothed still) and eventually i feel like i need to stop and get naked and have a bath (which i find really helps with the sensations) and from then i'm usually in the bathroom or the bedroom BUT i did buy 2 or 3 cheap shower curtains from ikea and throw them down where i was (on on the carpeted hall, one on the bedroom floor over a duvet to make kneeling easier on my knees and one i bought to carry about in case i needed it somewhere else, but which i actually ended up putting on the mattress to protect it in case my waters broke in my sleep (which they did with DD1 but not with DD2).

2.  I had a lot of trouble with the baby fitting through my hips.  She was large and I guess I am somewhat small in the pelvis.  I have no recollection of uterine contractions once active labor started.  It was blinding, puking, paralyzing pain for about 5 straight hours with no break in between like a contraction would have.  Pure bone crushing pain that overshadowed the uterine contraction.  I'm sure a doula would want me to try different positions...but I could not move and screamed for so many hours that my entire neck and chest were swollen for a week after birth I worry I will scare or wake up my 1yr old).  Seriously..it was so far off from how people explained labor pain.  I didn't want a single intervention last time, including breaking water...but I always wondered if I'd just broke the water would things have gone faster?  Or just harder.  What does a midwife do in the case of a small hipped/big baby woman?  Anything?  :/

The fact that she came out so fast and you sustained such a deep tear makes me think her position and NOT your hips were the issue.  I have had pain as you describe it very briefly during my labours and both times it was due to the baby rotating within the pelvis and the back of that bony little head pressing out against the sacrum/hip/pubis is agony.  Though i know it is hard to do movement really does make a huge difference.  Moving from lying down to all-fours can increase the internal dimensions of the pelvis by 20%, and walking/crawling/lunging can change the internal geography for the baby, making moving much easier.  That is a huge huge difference and really can make everything hurt less, but you need to have a mw who can inspire, encourage, motivate and support you to move, not someone who tells you to, yells at you and throws their hands up if you don't feel you can.  She can't FORCE you to do it, but she should have reasonable powers of persuasion!  This is also something that is within your own control, you can commit, inside yourself, ahead of time to giving changing positions a go if you want to.  At my births with DD1 my waters broke at 3am before my contractions began, with DD2 they broke at the start of the 2nd stage, 6mins before she was born.  My MW's (both NHS and independent) would not break waters at a homebirth UNLESS there was a compelling reason (like seeing meconium in the visible bag when a mum was already pushing - it might be done then to speed things up and potentially shorten baby's distress).  In general if there is a positional problem rupturing the membranes rarely fixes and and sometimes makes it harder for the baby to resolve it so it's usually best left.

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that?  

Ask the midwives you interview.  About a fifth of babies have the cord around their necks at birth, RUN from a mw who isn't completely calm about such a possibility, it is very very rarely a problem.  Usually it doesn't need to be touched, sometimes it needs to be unlooped, very occasionally it needs to be cut immediately to get the rest of the baby out (if the cord is short or is looped many times and tight).  Sticky shoulders are quite rare, are usually down to position (of both mama and babe) and you should ask the midwives you interview how many times they have seen this complication and how they usually deal with it.

4.  I progressed to 9 and had a lip - never got to wait for the urge to push.  The doctor asked if I wanted to push and I immediately instructed my husband to hoist me into a squat and pushed that child out so fast that I had a 4th degree tear.  oops.  But I wanted to be DONE and my powers just overcame me when he said I could push.  My doc says he STRONGLY advises me to try laying on my side for the final pushing so he can ease the baby out.  But, regardless of my position, can a midwife deal with a 4th degree tear at my home?  How about a 3rd, 2nd or 1st?  Would I have been a transfer for stitches?  What does a midwife do if you have a lip and you've been at 9 for quite some time?

As i understand a 4th degree involves the full thickness of the anal sphincter and the lining of it (from vagina right through into rectum) and most midwives will transfer you to a gynaecologist/obstetrician to have that level of damage repaired because it is a very complicated injury.  However many can stitch up to a 3rd degree at home - ask.  Ask when they last had to suture a deep tear too - many homebirth midwives stitch less because tears are less common, so be sure they are comfortable dealing with suturing.  I tore to the 2nd degree with dd1 and 1st degree with dd2 but chose not to have stitches either time (i was offered both times).  Did the head or the shoulders tear you?  When her shoulders stuck did the doctor manipulate her to get her unstuck?  Often in those cases a deep tear isn't caused by the baby but by the extra hands inside unsticking the shoulders.  How were the shoulders unstuck? Did he rotate her?  Sweep an arm down?  Push your knees high and press on your pubic bone?  Interventions like that aren't necessary in a straightforward birth so it's likely if those interventions caused the tearing you can avoid it altogether next time.

5.    Do you have to buy disposable bedding for all over the house?  Who knows where I'll end up walking around to or pushing at...what do they do with the placenta?  Do they bring their own sterile containers and all that or will I have to set everything up.  Gathering all that stuff and keeping track of it (and keeping the one year old away from it) does not sound like my idea of nesting.  I don't think I'd wanna be messing with all of that.

I had my shower curtains, and the MW's, despite me having a 5min 2nd stage with dd1 and a 6min one with dd2, had time to get a chux or two under me before the "messy" bit.  We had a small pile of birth things (a bowl, a jug, binliners, old towels, baby's first outfit) and it all fitted very easily into a big carrier bag which i stuck on top of my wardrobe.  Much of the "gathering" took about 90mins one afternoon - i already OWNED a jug and a bowl, i just needed to put them aside.  everything that needed to be sterile they brought with them.  sorry, nak now - they took dd1's placenta to the local hospital and incinerated it.  i opted to keep dd2's and compost it, though tbh it's still in the freezer!

6.  I loved how they just brought me frozen pads at the hosital.  Whatever that stuff was inside of them was heavenly and cushy.  And I will SO miss the warm water of the bidet they offered.  The little bottle they give ya just isn't nearly the same.

I had a peri-gel made by a midwife who was also a qualified aromatherapist with DD1.  It was HEAVENLY for soothing my poor ripped flesh.  With DD2 i made my own witchhazel frozen presses, rather than postnatal pads i used newborn sized eco-type disposable nappies - much bigger, nice and squishy, and absorbent even after the witch-hazel had soaked in so i could bleed on them and not worry i'd leak everywhere.  I sat in a bowl of warm water slotted into the hole in my loo seat a few times a day for soothing too, i guess a bidet might be nice but i'm not sure how it'd be all that different?  My DH and dad were here in the immediate post-partum and waited on me hand and foot, which i liked because it meant i NEVER got a nurse i didn't like :)  ymmv though, depending on who you have available to care for you and how good they are at it.

Thanks for any insight ladies.  I am so on the fence.

I have to say, from the overall tone of your post you don't sound very keen/sold on the idea of a HB.  That's ok!  You don't HAVE to have a homebirth.  It doesn't mean anything about you if you'd rather not.  The most important thing is having real choice and feeling cared for, safe and as comfortable as possible during your births.  If the best place for you to get all that is in hospital that's great.

[allisonrose]

Camprunner shared a link for a sitz bath but you may also find one locally. My nearby Rite Aid carries them for $15 or so. I fully intend to pick one up before my upcoming homebirth.

I've heard that second and more births tend to involve less tearing than the first. I'm hopeful that's true since I had a 3rd degree the first time.

There's definitely nothing wrong with deciding that a homebirth isn't what you want. Each woman should plan their birth for where they feel comfortable. I did the hospital thing the first time around and that reaffirmed that I wanted the homebirth experience. I will miss the food though - not stellar but plenty of it and I didn't have to do a thing to prepare it!

[Dot-to-Dot]

This is all wonderfully helpful!

I should clarify some commonly mentioned points:

Yes, I was referring to bleeding during labor.  Just drips...I assumed it was all part of bloody show and that it wouldn't just suddenly dry up.  Seemed like some drips would be normal.  I guess maybe not, though, huh?! 

I only have ONE CNM available to me.  She just became available and other than that the nearest birth center would be The Farm in Tennessee which is like 4 or more hours away.  So it's this lady...or my wonderful doc at the hospital.  I don't know her yet, but I asked her all of these questions over email and she responded with some impressive and confident answers.  Although I'd have to go to the ER for a 3rd or 4th degree tear.  This is a huge sticking point for me...I would HATE to have to get dressed right after having a baby.  I just want to drape myself in sheets and hold onto the baby.

I'd heard that anything potentially infectious (placenta) had to be dealt with.  I know people plant it...I wasn't asking because I think it's gross.  My last doc invited me to examine my placenta from the first baby and my husband and I marveled at its beauty as the doctor passionately educated us about its amazing properties.  I just didn't know if there were laws or something...I mean up until recently it was apparently against the law to homebirth in my state.  (I've never been able to get my hands on specific laws listed about homebirthing and midwifery in my state but from what I gather they've just expanded the laws to allow it).

For some reason I assumed the doc would have mentioned her position if he thought it'd been a problem, but I'll check with him.  He's not the typical doctor that would overlook it.  He is so great.  He already took time to sit with me and go over my birth notes from last time to see how I felt about it all, questions, changes, etc.

The hospital sent me home with a sitz bath and I thought it was the most ridiculous contraption (after being spoiled by the bidet).  It made me so mad when we got home and I had to always fill it and mess with the tubes and it didn't work with any amount of force that felt like it worked or lasted very long.  I hated messing with it!  I guess I could order one of those toilet seat bidets that screw into your plumbing to offer warm water.

It was mentioned that I don't sound sold..it's true, I want to feel sold, but I'm not.  Yet.  Partly, I don't like our home.  We had to find a place quickly and our only bathroom has no bath, just a shower and it has a terrible sewer smell after the shower runs (we're on a septic system).  The house it old and the bathroom door doesn't even close all the way.  I've never gotten our bedroom set up in a way that it feels like a comfy room where I want to be.  If it were our old home, I'd feel SO comfortable and I know all the spots I'd lay in or go to to relax.  It's a smallish house and with my mom, my midwife and my husband (and 80lb dog) I just envision everybody up in my space.  It's a personal problem...I just have to overcome that one or not. 

But, as far as everything else, your detailed accounts from personal experiences have really helped me begin to visualize this.  Even if it doesn't sound like it...I'm leaning closer and closer to it.

[Marissamom]

I just want to say that I bleed during labor too. during my entire active stage I had gushes of blood with every few contractions. If I had been upright it probably would have dripped. it seems that it's not common, but not a cause for concern. 

[vtamanda]

FWIW, I dripped a fair amount of blood during my labor.  But it was long.  like 20 hours active labor.  I am a little concerned about dripping all over my house, but we have wooden floors, so I am pretty sure it will clean up easily.  I also plan on using a birth pool, so that will contain a great amount of mess.  AND also I am planning on a MUCH faster birth (LOL) so I hope this will mean less bleeding and less drippy mess.

[laohaire]

Originally Posted by Dot-to-Dot 

Although I'd have to go to the ER for a 3rd or 4th degree tear.  This is a huge sticking point for me...I would HATE to have to get dressed right after having a baby.  I just want to drape myself in sheets and hold onto the baby.

Oh, I totally understand that. I was not thrilled to go the ER either. In my case, though, I didn't go right away - I had a few hours to recover a bit. I wanted to sleep and do it in the morning but my midwife said no, but it's not like I gave birth and then was hustled off to the ER. I also went in a nightgown. I'm sure people's comfort on that varies but I didn't care one whit. People come in wearing all sorts of things, you don't always have an emergency in your best clothes. So I just pulled a nightgown over my head, and I probably had underwear and a pad on by then, and that was it. So, that's just my experience just to help your decision either way.

[kawa kamuri]

Maybe ask your MW what she would suggest and do? I bet she's experienced and has a wealth of information. There's no better person to ask than the woman attending your birth! 

[SusannahM]

I bled some during my labor, my cervix had a lot of scar tissue from a prior surgery that caused it...  Anyway, the midwife lay chux pads in a path to wherever I was walking.  I know I still got some on the floor because I saw one of her assistants cleaning it up afterward, but they took care of all of the clean up.  I would have never known I'd dripped at all unless I'd seen someone doing the clean up of it.

[Treeof3]

Originally Posted by Dot-to-Dot 

I am interested in the idea of a home birth...but last time, I had some minor issues and I wonder how these things would go down in the event of a home birth.  Would appreciated any experienced HBer's chiming in.

1.  Well, first of all, as I moved around my hospital room I was dripping blood all over the floor, the bathroom, the bed.  How do you walk around your home dripping like that?  I do NOT want to wear underwear and a pad, that sounds SO annoying while in labor.  And post partum they had to change my sheets because I'd be leaking blood.  I can't imagine just throwing away a few sets of sheets from home.  And going to the bathroom post partum was often messy with blood on the toilet seat or bidet...I don't want my mom or husband (or ME!) to have to clean up blood all over our home.  It almost seems more comfortable to do that in a place where people are periodically coming in to clean and refresh everything for you.

Seems like this is fairly well covered by other posters, but I wanted to add that in planning for our first hb over 6 years ago we scoured yard sales for old sheets that we would feel OK about bleaching and potentially NOT keeping. If they "survived" the birth, we figured we could use them to cover plants in times of freeze etc. so we weren't really wasting. When labor started, we covered the bed this way: mattress, vinyl sheet, mattress pad, sheet, vinyl sheet, sheet. This way when the birth was over we could literally strip the bed and toss the top sheet in the wash, leaving the bottom sheet all made up and ready with no extra work. Plus the vinyl kept the mattress from any leakage. The mattress pad COULD go under the vinyl sheet, but my husband refuses to sleep on "plastic" like that so we have a "junk" mattress pad we use for birthing.  You are also way more worried about blood than you need be. Cleaning up isn't as bad as it seems like it would be and I think by birthing at home in a more relaxed environment, you'll potentially have less "carnage" postpartun than you recollect from the first time.

2.  I had a lot of trouble with the baby fitting through my hips.  She was large and I guess I am somewhat small in the pelvis.  I have no recollection of uterine contractions once active labor started.  It was blinding, puking, paralyzing pain for about 5 straight hours with no break in between like a contraction would have.  Pure bone crushing pain that overshadowed the uterine contraction.  I'm sure a doula would want me to try different positions...but I could not move and screamed for so many hours that my entire neck and chest were swollen for a week after birth I worry I will scare or wake up my 1yr old).  Seriously..it was so far off from how people explained labor pain.  I didn't want a single intervention last time, including breaking water...but I always wondered if I'd just broke the water would things have gone faster?  Or just harder.  What does a midwife do in the case of a small hipped/big baby woman?  Anything?  :/

Ditto the other posters - your mw will help suggest positions and has some pretty nifty tricks up her sleeve. (as would a doula) Simple things like pressing on your hips (who knew?) can really help with that kind of pain. Also laying with your butt in the air and chest on the bed can help with the pain you described. Weird but true. A good doula or mw will know these things and be able to "read" you and help you along, making the entire experience MUCH better for you. Also it sounds like faster is NOT what you need in the future. Time for baby to mold her little head to fit without tearing would be suggested. Coaching for slower pushing and/or not suggesting it at ALL until you insist would be key in the future.

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that?  

Yup - the good ones are prepared. Especially if they expect it to be a possibility. Read up on the Gaskin Maneuver. Most docs don't even know what it is, much less how effective it can be.  Plus something like 1/3 of all babies have the cord wrapped in some way. If it were THAT big of a problem outside of the hospital, you'd hear about it.

4.  I progressed to 9 and had a lip - never got to wait for the urge to push.  The doctor asked if I wanted to push and I immediately instructed my husband to hoist me into a squat and pushed that child out so fast that I had a 4th degree tear.  oops.  But I wanted to be DONE and my powers just overcame me when he said I could push.  My doc says he STRONGLY advises me to try laying on my side for the final pushing so he can ease the baby out.  But, regardless of my position, can a midwife deal with a 4th degree tear at my home?  How about a 3rd, 2nd or 1st?  Would I have been a transfer for stitches?  What does a midwife do if you have a lip and you've been at 9 for quite some time?

Seems the transfer issue has been addressed, but I wanted to add that slow, guided pushing along with preparations of perineal massage and stretching in the months before the birth will cut down on the likelihood of a transfer-worthy tear.

5.    Do you have to buy disposable bedding for all over the house?  Who knows where I'll end up walking around to or pushing at...what do they do with the placenta?  Do they bring their own sterile containers and all that or will I have to set everything up.  Gathering all that stuff and keeping track of it (and keeping the one year old away from it) does not sound like my idea of nesting.  I don't think I'd wanna be messing with all of that.

The placenta... there's lots of options. Its sounds like you don't care about keeping yours or doing anything "ceremonial" with it. My mw brings/supplies a biohazard bag and the placenta goes in there and then she takes it back to her office/birth center. They freeze them and then donate them to a rescue dog training facility. If she didn't donate it, she'd dispose of it as a biohazard just like she does her used needles etc.  Also - I kept all my birth supplies in a plastic container with a lid until birth time. Then the box moved around the house with us. The lid kept my kiddies out of it until it was needed. Last time my oldest was actually handy in fetching it and finding the item we needed (hat, nose sucker, etc). The big waterproof pads were in that container so one could be spread out where I happened to be. My water broke at the start of my last labor and I sat on a chux pad when clothes got on my nerves. I remember I had one on the big exercise/birth ball that I sat on to watch TV for awhile. :)

6.  I loved how they just brought me frozen pads at the hosital.  Whatever that stuff was inside of them was heavenly and cushy.  And I will SO miss the warm water of the bidet they offered.  The little bottle they give ya just isn't nearly the same.

You can totally make those, but I can't help with the bidet. :)  Again though, you may find that there's less "damage" to the region this time around and you won't necessarily miss the bidet as much as you think you will.

Thanks for any insight ladies.  I am so on the fence.

 For what its worth - I am due in January with our 4th child, 3rd homebirth. There is ZERO comparison to the med-free hospital birth I had. Its not even apples to apples where you can weigh the differences, really. Its THAT different of an experience physically and emotionally.  My house is also 1000sft, with one bathroom that has a tub, but its tiny (like too big for me by like 25 wks pg!). With my hubby and kids alone, there's a crowd before you add a mw and close friend for photography. (Luckily neither set of parents care to be there!! Can you imagine?) But when I go into "labor land" everything disappears and the crowd that drives me up a wall on a random Wednesday doesn't even matter to me. I hardly notice them. Last time I remember hearing dh try to quiet the kids(then 6 & 3) and get them to back away from me some and I was thinking that wasn't necessary bc they weren't bothering me, but I couldn't express that. :) I hole up wherever I feel like... bed, couch, birth pool... Which by the way, we disassembled our dining room table and put it in the garage at 38 weeks so that we'd have room for the birth pool. I wound up delivering there last time and it was awesome and totally worth the "picnic" dinners we had the last 2 weeks of my pregnancy!  I am not a huge fan of my house either, but there's nothing I can do about it except embrace the idea that soon 2 of my babies will have been born in it and that certainly diminishes a lot of the issues I have with it!

Also want to add that my dh is terrific and then some. He is the one who emptied the pool last time and he has no issues doing bloody laundry either as needed. Talk to yours and see if the things you think are issues really are for him too. It may be its not that big of a deal - sorta like changing a poopie diaper or cleaning up puke... its really gross when its someone else's kid, but your own kid doesn't seem to bother you as much. The same may be true with the mother of his children, ya know?

Good luck making your decision!
 

[Viola]

OK, my experience:

1.  Blood part: I don't remember this particularly well, other than I got a lot of blood in the bathroom in the hospital, and I didn't want to leave it for other people to clean up, so I was on my hands and knees cleaning it up with toilet paper. I don't know why now. I didn't drip all over the floor of the bedroom part, because I did wear those funky netty underwear with the giant pads in them, and I had some of those same underwear for my homebirth.  I kind of wish they had the old style menstrual belts, but I guess those are a thing of the past.  Anyway, when I was lying in bed at home, I put a chux pad or two on the bed so I wouldn't have to worry so much about the pad.  I also bought a plastic shower curtain liner and a cheap sheet from Wal-Mart to use post partum.

2.  Pain:  I don't have much experience with this.  In the hospital, I had back labor and I felt like something was digging into my back and causing me pain from the outside.  I ended up having an epidural.  I didn't have back labor the second time, and although I remember it as painful, I can't really remember the pain very well.  It all seemed easier after the fact.  

3.  Shoulders getting stuck/cord:  my midwife was equipped to deal with that.  My homebirth baby did get a bit stuck.  Now my only caution with this is that I've read that if you have a dystocia, the chances are likely to have one with the next babies.  I don't know if this is true, but my second baby was a couple pounds larger than my first, and that really surprised me. 

4. I pushed in a side-lying position, then once the head was out, I felt like that was ineffective, so I got on hands and knees and scooted to the edge of the bed.  It was at this point that she was stuck, and the midwife helped get her shoulders out, and I think I rolled over and she pulled her out as I was on my back.  The details are really hazy, although I do have a video of it.  I ripped, probably in part because when it was time to push, and I started being more active about it, it hurt even worse, so I said to heck with it, I'm getting this over with, and I pushed her out pretty quickly.  Then when she got wedged, I guess the midwife had her hand up there too, and at some point I ripped and needed 10 stiches.  I guess it was a second degree.  Yes, she did stich me, so I did not have to transfer for that.  She also had pitocin and methergine to give for bleeding, and I ended up having a dose of angelica root, then a shot of pitocin in one thigh, then a shot of methergine in the other thigh because my midwife wasn't happy with my bleeding, even though I swore I felt fine. 

5. I didn't leave my room, so I don't have experience with this.  I flew my 18 year old nephew out for a month around my due date, so he would help by watching my 4 year old daughter when I went into labor.  I planned to walk around and all that, but when I stepped out of the bedroom, my nephew was downstairs heating up a Boca burger, and the smell made me so ill I had to go back in the room.  Then I labored alone for awhile with my doula in another room, and I basically just moved from shower to bed, and tried sitting on the exercise ball and all that, but I didn't go far.  It was just a few hours, and I tried to lie down and relax as much as I could when things weren't bad.  But if you have the crushing, blinding pain, I don't know how much you need to move to deal with it.  My placenta went onto a chux pad on the floor, and then into a couple of plastic grocery bags and put in the freezer. 

6.  I had the big hospital grade pads in my homebirth kit, and then those kind of pads that are frozen but then when you break them, they get suddenly cold.  But they were like menstrual pads. But I will say that there one of the things that I did kind of miss with my homebirth was the level of care taking I got from the nurses.  I had my baby on a Sunday evening, and didn't leave the hospital until after lunch on Tuesday.  I liked when they came and said encouraging things to me, and brought me witch hazel pads or whatever. Even though the food wasn't great, I liked having it prepared for me and served to me in bed. Right after my homebirth, I was very ecstatic, and my doula came back to visit me that evening and brought up some food for me.  But I was up in my room and my husband was down doing his normal things.  The next day I got up and got dressed, and then came down and lay on the couch, and I got my own food.  My husband went out and ran errands.  I kept going back upstairs every time to go to the bathroom, because that's where all my stuff was, and it just seemed easier to climb the stairs than to move stuff around.  The stitches were painful for a few days, and I kind of wish I could have just stayed in bed and have people check on me or whatever, like I had in the hospital, but I think maybe I have a need for indulgence that goes beyond what I should really expect.  But I kind of liked the fact that it seemed like in the hospital it was all about the fact that I had just had a baby, and I didn't necessarily feel that same thing at home.  

People did bring me dinners, however, and I liked that because I got to see people.  I guess I wanted to have visitors or something.  

Over all, though, the homebirth was a great experience.

[bax]

I've had 2 home births, and for the second the midwife wasn't there in time. I'm pregnant with our third and planning another HB. Here's my two cents.

1. [blood/cleanup]

This was never a problem for us. People put chux pads under you and you just wash the sheets in something like...ammonia. Or hydrogen peroxide. (My husband knows how to do this...I've never had to!)

2.  [baby fitting through hips]

I agree with a pp, this doesn't sound like big baby/small hips to me. Sounds more like position. My first was rotated posterior my whole first labor--she never twisted into the best position with her back against my belly. Labor was 50 hours long and I actively pushed for 5. It was the most horrible, uncomfortable feeling ever. With no rest between contractions (at least during first stage). My second was perfectly aligned and came flying out in a 20 minute second stage. Both were at least 9 lbs. But my midwife with my first knew the best position for pushing out a posterior baby and helped me through 5 hours of pushing. I have no doubt I would have been sectioned in a hospital.

3.  The cord was wrapped around her neck twice and then her shoulders were stuck.  Are midwives totally capable to deal with that? 

My second baby had the cord around her neck. My husband reached in and unlooped it (since the midwife wasn't there yet). Then, because I was afraid of the baby getting stuck, I shifted into position for the Gaskin Manouver, which I'd happened to read about in Ina May's book the night before, and popped the baby out. If DH and I DIYed this, I'm certain a competent midwife could handle it.

4.  [lip/tearing]

Can't really speak to this, although I second pp's suggestions to ask your midwife about their stitching capabilities. I'm going to do the same this time since I tore last time and wasn't too pleased with the results. (Using a different midwife this time.)

5.   [bedding/placenta/supplies]

We just made the bed with old sheets on top, a shower curtain underneath, and regular sheets underneath that. DH did a lot of laundry (the midwives taught him good ways to get stains out), and, honestly, between blood and sweat and then sleeping with our baby and the poop and pee and spit-up and breast milk that get on the sheets...we're just not too concerned with having pristine House Beautiful bedding at this stage of life.

After the birth, I just wore pads and/or had a chux pad underneath me. (And we're supposed to take it easy for at least a couple weeks, so it wasn't too hard for me to just put a chux pad on the couch if I came downstairs in the morning and then just put one on the bed when I went upstairs at night. I wasn't, like, flitting from room to room.)

We put the placentas in a bowl to examine, then double freezer bagged them (the 2-gallon size is good) and put them in the freezer. Later we took them to my mom's house in a cooler (she's out of state) and buried them in the woods. God forbid if they're making laws about our placentas now!

Gathering supplies never posed a problem to me and actually was part of my nesting. I just got a plastic bin with a lid and put everything in there. Most of the things I already have (trash bags, a flash light, etc.), plus the birth kit that I order according to my midwife's specs. My toddler was never interested in prying the lid off the bin and rummaging through it that I recall.

6.  [frozen pads/bidet/peri bottle]

I had frozen pads in my birth kit. I don't have a bidet at my house (but I don't have a lot of other, interventive things either...trade offs?). The peri bottle is kind of lame; the sitz bath also kind of lame. I've found the right temperature of water is key. For my first birth, DH scrubbed out the bathtub every day with bleach so I could sit in there in warm water. Second birth, he warmed the sitz bath for me. It wasn't the lap of luxury or anything, but it was 20 minutes that I got to sit alone in a room and read a book while someone else watched my two kids. I think what is really key is setting up people to help care for you--DH, relatives, friends. And stocking up on tasty, nutritious frozen foods. And just letting yourself be pampered by others.

But ultimately, echoing what others have said, if you're not really feeling the home birth, for pete's sake, don't do it. I love it. But I have friends who couldn't imagine ever doing it. And we're all good moms who love our kids. Good luck with your birth!

[kawa kamuri]

Originally Posted by Treeof3 Also want to add that my dh is terrific and then some. He is the one who emptied the pool last time and he has no issues doing bloody laundry either as needed. Talk to yours and see if the things you think are issues really are for him too. It may be its not that big of a deal - sorta like changing a poopie diaper or cleaning up puke... its really gross when its someone else's kid, but your own kid doesn't seem to bother you as much. The same may be true with the mother of his children, ya know?

My DP was adamant that he was too squeamish for the dirty work of birth. He didn't even want to cut the cord. It made me really nervous leading up to birth. He was the last person I expected would be on his knees wiping blood off of my legs as I exited the birth pool. Draining, scooping and laundering every bit of everything post birth. He even had pneumonia! I asked him about this recently as we're expecting another and he told me the same - it wasn't a big deal, I'm his.