True emergencies, and fear

[FeralFox]

How do you handle them at home?  I mean things like meconium, prolapsed cord, footling breech, 4th degree tears, etc.  is there some kind of a guide for dealing with any of these?

I'm not pregnant yet, and due to several factors our out birth choice will influence out ttc timing, so we kind of need to decide now whether we're going to UC or not.  I have a few reasons to worry - for one thing, labor with my son was extremely long (two days of hard labor at home, only getting me to 1cm, at which point we transfered) and I ended up with an epidural, pitocin, decels, vacuum extraction, and a huge episiotomy.  If I were at home, one or both of us might not be here right now.  He was under 7 pounds, but still too big for me to push out.  My ex-husband was small, my current husband is huge - I can pretty much count on having a bigger baby this time, and even slightly bigger is very scary for me.

I really want to UC.  I really, really want to UC.  But I'm also a health care worker.  Right now I work in a NICU, and I have also worked in mother/baby.  I know what can go wrong.  I'm well educated on how interventions cause things to go wrong, but I also know that shit happens and lots of things go wrong that are not caused by interventions.  I'll be getting prenatal care either way, but I worry that something unexpected could happen during the birth itself.  I also worry that my fear of something happening could make me freeze up and not be able to birth at home.  My husband very much wants us to UC, and is rejecting any suggestion that we go to a hospital or even a birth center.  I agree with him, but...the fear.

So, how do you prepare for what can go wrong, without focusing on those things to the point that you're expecting something to go wrong?  And where do you learn to deal with the true emergencies that can happen?

[Almi]

Meconium is usually no cause for concern in a natural, unhindered birth.  In fact it has been proven that suctioning of the baby (or siphoning of the stomach) after birth when meconium was present does not keep it from getting infected and is only stressful on the baby.  However, cutting the cord too early and not allowing the baby skin-to-skin contact with its mother directly after birth can increase the baby's chance of having a problem (meconium aspiration).

Prolapsed cord warrants an immediate hospital transfer.  However, this is extremely rare and typically happens in one of two situations: 1) The membranes are artificially ruptured before the baby's head is engaged in the pelvis, and 2) identical twins, particularly when the twins share an amniotic sac.  So this is not likely to happen in UC.

Footling breech babies can be delivered vaginally with no problems.  It is a good idea to birth in the position that feels best to you, particularly a standing or squatting position, because then gravity helps the baby descend with minimal pushing.  It is up to you if you want to touch the baby as it is being born, but it is important to NOT pull on or try to maneuver the baby in any way as it is being born.

I just read a birth story the other day of a UC mama that had some fear and anxiety during her birth (along with a history of birth trauma), and she tore all the way into her anus when she birthed her 10 pound baby (which, I might add, she pushed out very quickly due to fear).  However, instead of getting stitched up, she opted to sit at home with her legs together, and she healed that way.  She does have some rectal problems, I believe, that she is working on healing.

Generally, if you are unafraid of the birth process and let your tissues stretch slowly (and deliver in an upright or squatting position, or on all fours, so that it puts less pressure on your perineum), you are unlikely to tear (very much if at all), even with a very large baby.  Tears can be repaired with liquid bandage or super glue, or you may opt to be sewn up at the hospital.  It all depends on the tear and what you are comfortable with.

Here is a good website for handling other variations of normal:

http://www.unhinderedliving.com/variations.html

Decide what you are comfortable with handling at home and what warrants a hospital transfer for you, and remember that, due to lack of interventions (among other factors), complications rarely happen in unassisted childbirth.

I have heard of plenty of ladies being in labor for days and then giving birth unassisted.  The fact that you weren't dilated doesn't mean much, as it is possible to dilate from 1 to 10 quite quickly, when the time comes.  Remember that every labor is different, so what happened with your last baby might not happen the next time.  

Unless you have some sort of medical problem with your pelvis, I highly doubt you are unable to fit a baby that YOUR body made through it.  See this:  http://www.glorialemay.com/blog/?p=466

The reason you were unable to push your baby out probably started with the pitocin.  Pitocin-induced contractions not only cause fetal distress (heart decelerations), but the contractions are too painful for mom, too, and because of the fact that she must be monitored while on pitocin (and therefore can't move around and change positions at will) makes it even worse, so she asks for an epidural.  An epidural (and laying on your back) can make it so you are unable to push your baby out (requiring forceps and episiotomy).  I highly doubt that your body is inadequate, because, by the way, your baby's size at birth is usually dependent on YOUR body, not your husband's.

You need to birth where and with whom you are comfortable.  Which is worse for you, hospital or homebirth?  Maybe you want a midwife?

"How do you prepare for what can go wrong, without focusing on those things to the point that you're expecting something to go wrong?"  

You have to accept the fact that something might go wrong.  Even if you give birth in the hospital.  Birth does not come without risks, just like driving does not come without risks.  In fact I believe it is riskier to drive down the street than to give birth.  This is my opinion.  The thing is, the better and more educated of a "driver" you are, the less chance you have of getting in an "accident."  Educate yourself on "complications" and what to do about them (with the link I provided earlier listing each complication).  Very few of them cannot be handled at home, and the ones that can't very rarely happen, particularly with a healthy momma and full term baby.  Above all, visualize your perfect birth and believe that nothing will go wrong.  The more confident you are about the birth, the better chances you have of having the best outcome possible.  If you go into the birth process fearfully, you increase your chances of complication.

So that's my advice to you.  Research, research, research.  Read birth stories.  Watch birth videos.  The more you know the facts and the more comfortable you are with taking responsibility for your birth, the less afraid you will be, and the more likely you are to have a good birth experience.

[lia_joy]

From everything I've read (and experienced) size has a lot less to do with ease pushing out a baby than the POSITION of the baby.  A medium-large baby in a good position is actually more likely to go easily because the baby pressing down helps you dilate.  sometimes even a slight misalignment of the head can cause labor to stall or not get started.  my second baby was posterior and the labor was a lot longer & more painful than either of the others even though his size was right in the middle.  My 3rd labor, I went from 4cm to pushing in 10min -- so yeah, you can't always tell how long you have left based on cm. and you can't always know what to expect from on labor to the next.

Besides researching & determining what you'd be comfortable dealing with at home and having a transfer plan for emergencies, I think the fear is best addressed within.  Once you have all the information, you can kind of over-think it because you have no way of knowing if you'll be that one in a 1000 or one in a 10000 that faces whichever complication you fear most, and you can only be so prepared... But I think if you can quiet the mind and listen within you have a better chance of figuring out if that fear is coming from an intuitive place (telling you you're better off birthing with some kind of support) or just an over-anxious, worst case scenerio place.  I like to do this when i'm falling asleep at night because it's the best quiet time & my mind is more likely to be relaxed.  sometimes, I project a question into my dream to get a sense of if it's a real concern or just a worry. it sounds kind of woo-woo, but studies show that the subconscious mind is actually better at making complex decisions than the conscious mind so defering to intuition is backed up by science :) 

People often say to me "I could never UC because if something bad happened, I'd never be able to forgive myself."  But that's exactly how I feel about hospital birth.  If I went there against what everything inside me says is right for me & my baby, and something bad happened, I'd never be able to forgive myself for not listening to my heart.  the moment i realized that forever changed my confidence going forward.

[Almi]

Originally Posted by lia_joy 

People often say to me "I could never UC because if something bad happened, I'd never be able to forgive myself."  But that's exactly how I feel about hospital birth.  If I went there against what everything inside me says is right for me & my baby, and something bad happened, I'd never be able to forgive myself for not listening to my heart.  the moment i realized that forever changed my confidence going forward.

I totally agree with this.  No one seems to get that.  They're like, "Oh, you're SO brave!  I could never do that."  I'm honest with them and tell them that THEY'RE brave for having their baby in a hospital.  Hospitals and doctors alone don't scare me.  But possibly having to fight them off when I'm in labor and giving birth?  Very scary.

[BaileyB]

Originally Posted by lia_joy 

From everything I've read (and experienced) size has a lot less to do with ease pushing out a baby than the POSITION of the baby.  A medium-large baby in a good position is actually more likely to go easily because the baby pressing down helps you dilate.  sometimes even a slight misalignment of the head can cause labor to stall or not get started. 

I'm TTCing and just lurking but wanted to add that my second baby was 7 lb. 14 oz. but was stuck for a few hours because she was facing my hip bone which was caused by me laying in a hospital bed for 12 hours. I had had an epidural and when she got stuck they were like, "We need you to get on your hands and knees." I was like HELLO!!! I HAD AN EPIDURAL!! Finally I made the bed sit me all the way up and tried to position myself to sit/squat and she turned and came right out.

[Almi]

Originally Posted by BaileyB 

I'm TTCing and just lurking but wanted to add that my second baby was 7 lb. 14 oz. but was stuck for a few hours because she was facing my hip bone which was caused by me laying in a hospital bed for 12 hours. I had had an epidural and when she got stuck they were like, "We need you to get on your hands and knees." I was like HELLO!!! I HAD AN EPIDURAL!! Finally I made the bed sit me all the way up and tried to position myself to sit/squat and she turned and came right out.

Most hospital staff wouldn't have even suggested that.  They would have tried to force the baby out of you with forceps, vacuum, or c-section.  You're one lucky mama to have hospital staff with common sense. :)