If the MW does not show in time...

[Electra375]

I have seen the title of a book or pamphlet around, but can't seem to remember where at the moment. It was sort of an ER handbook for birth, neonatal breathing, cord care, placenta birthing, etc.

I'm due in the dead of snow season. There is a possibility that my mw won't make it in time if the weather is bad enough meaning there is enough snow falling fast.

To avoid a panic I'd like to read up on what I need to do if I end up birthing alone. How do I check for a cord around the neck, what do I do if I need to aid my baby in breathing, how long is too long to have the placenta not coming out, I think you can get the idea.

Thanks

[pamamidwife]

Maybe you can print up your own? I've seen the "When The Baby Arrives Before the Midwife" sheet, but I think it might help (and help other mamas!) to have a list of things to remember and do/not do so we can create our own.

You game?

Anyone wanna start?

[Pandora114]

Well, My DH just got done getting first aid re-certified, military pays for it...so I'm pretty confident that he's good to help in the event of a preciptious birth.

What not to do: PANIC. Make sure you and whomever is with you stays calm. Panic is bad mmmkay???

Second: Make sure the Perenium is supported in some way or another, either by water or with hands (CLEAN HANDS!!! wash hands first always!) one hand at 12:00 by the urethra/clitoral region and the other at 9:00 on the perenium/anal region, this above all else can prevent serious tearing.

That's all I can really think of..

[BelgianSheepDog]

If you're up for a lengthier read or something you can skim and refer to later, you might try "Heart and Hands" by Elizabeth Davis. It's aimed at women thinking of becoming midwives, but it has a wealth of information that is just plain good to know or interesting, including herbal and homeopathic remedies it might be nice to have on hand.

[Emilie]

Good for you- every birther should know to do.

[mommaduck]

Ask your midwife for a small birthing kit. Due to the distance, number of children I'd had previously, etc it was considered a real possibility for me. My midwife left me a kit that I kept in the bucket on the dresser with all the other things my midwife requested that I keep on hand. She had also taken hubby aside and gave him a quick once over of what to do as encouragement. That bucket and kit even came with us in the van when we went someplace, just in case!

[Full Heart]

I think its Emergency Childbirth a manual by Gregory White. Its sprial bound.

[texaspeach]

I was thinking of Emergency Childbirth too. It's very easy to follow and is intended as a 'field guide'. it was written a long time ago, but the info is still valid

[mwherbs]

don't panic is a good start but now I am going to define it even more- and that is just be resolute that this is happening now give up what other visions you might be hanging on to about this thing or that thing not getting done .apply yourself to the here and now-
if you are with a woman who is giving birth - listen to her and look at what is happening- what are your surroundings? is it cold? is she telling you to do something? is there realisticly time for you to make a phone call to your midwife? I don't mean leave mom and run down stairs or back into the house while she is in the car- if there is a choice and the phone is too far- stay with mom
something to absorb fluids would be nice to have on the surface she is on if close at hand you can use a blanket or towel to put under her, but don't get caught up in having her move to get something under her- if possible get something there if not thats how it goes- if you have tissues or papertowels at hand they may be useful to wipe away stool one swipe in one direction away from the vagina- then toss that piece -- mom use your own hands to do any support and to catch the baby- you absolutely can do it- after baby is born and someone is on their way do nothing to the cord other than be aware of it and untangel the baby if it is wraped around but don't worry about delivering the placenta- now if mom feels like pushing it out she will but no pulling on the cord or fiddling with the fundus to get the placenta to come - a cord can be cut long after the placenta is born so no need to worry about that detail either
--------------------

[kerikadi]

My last labor was 45 minutes so this is something we do think about. My MW was here for less than 30 minutes with my last 2 births.
When my DH told her he was worried she wouldn't make it she asked him what he would have done he said that he would ask me how I was, encouraged me to nurse the baby and keep us both warm. She said that is exactly what she would have wanted him to do. Unless it is a long amount of time - more than an hour - there is nothing else to worry about as long as Mama and baby seem fine. Keep baby attached via the cord which is something we do for at least 30 minutes after birth anyway.
My DH caught our second homebirth so he already has that part down
My MW feels that when it comes to birth just let the Mama do what feels right to her and take care of her afterwards. That is all she did afterall She has yet to catch one of our babies.

Keri

[rad]

All my births have been fast. So after my 2nd baby, I bought "Emergency Childbirth" by Gregory White and "Heart and Hands" by Elizabeth Davis so DH could look through them and feel more comfrtable about what to do without our midwife there. It did seems ot help him with the last birth just having that extra info. But my midwife did make it just in time. We have recently move further from her, so he actually pulled out those books last month a read through them again. Bascially what the books tell him is just to relax and let birth happen.

[Emmeline II]

Originally Posted by rad

l Bascially what the books tell him is just to relax and let birth happen.

That's what we did. My mw (actally mw's mw friend) didn't arrive until 30 min after the birth.

[caned & able]

Emergency Childbirth, by Dr. Gregory White is the text used by most fire departments, police departments, emergency medical technicians' and taxi drivers' emergency childbirth training in this country. It is an oldie but a goodie.

[MsElle07]

Would anyone call 911 if the baby is coming and the MW hasn't arrived?

This would be one of my nightmares -- having the paramedics intrude on my intimate homebirth. But I can see how this would be my DH's initial reaction -- he would not feel comfortable with me having the baby without the MW there AT ALL.

I'm going to get Emergency Childbirth for him and write up a list: Do NOT call 911 unless: I am unconscious, or close to it, or I specifically tell you to call 911.

[Emmeline II]

Originally Posted by MsElle07

Would anyone call 911 if the baby is coming and the MW hasn't arrived?

This would be one of my nightmares -- having the paramedics intrude on my intimate homebirth. But I can see how this would be my DH's initial reaction -- he would not feel comfortable with me having the baby without the MW there AT ALL.

I'm going to get Emergency Childbirth for him and write up a list: Do NOT call 911 unless: I am unconscious, or close to it, or I specifically tell you to call 911.

You have time to educate yourself and your dh; if possible I would have him attend all your midwife appointments so he can become more comfortable with the concept of hb. The mw's didn't make it to my hb (dc#2), but my dh had a few things in his favor: we took a Bradley class with #1, this was our second birth, and he knew I was educated up the wazoo about home birth. I would make sure your mw has a cell phone and that she answers it , so she can talk your dh through it.



__________________________________________________ __________





Here is the latter half of my homebirth birth story:

I unlock the front door so MIL can get in and ds and I go up to my bedroom. I grab the sports top I was going to use in the birth pool and the light weight "house coat" that I was going to labor in. The ctx were comming stronger and quicker and it was difficult to get out of my pjs and into the sports top. I can't get my pjs to the laundry basket and just leave them in a pile next to the toilet. I get into the bathtub and ds in alternately wandering around the upstairs and playing in the bag I had originally packed for the birth center (before deciding on a home birth 2 weeks earlier). While dealing with ctx I'm trying to keep ds from chewing on a tube of chapstick. Ds wanders off again and as I'm calling for him I hear someone in the house; dh has arrived! The contractions are getting too hard to deal with and are probably 2 minutes apart. Dh sits on the edge of the tube and I have one arm around his thigh, the other is squeezing his hand and my head is pressing into his. Dh is talking me through contractions and pouring water on my back. It is so hot in the bathroom; the house is 79 degrees and the water is warm. I tell him that he should blow up the birth pool after his mother arrives. After 3 contractions his mother arrives; dh tries to get the carseat into her car but can't concentrate. Since the carseat is no longer installed in any car MIL has to stay at our home with ds. Dh returns to the bathroom; I've started using a low moan with the ctx; I think I had one while he was gone. Since I've been in the tub I had been feeling some rectal pressure. I have another ctx and dh asks if he should set up the tub, I respond that there isn't time. The mws call and dh answers; they are driving back. Dh updates them; J says that they are calling another midwife to come to the house. At this point I'm hitting transition -- telling dh to "shut up" and "don't touch me". J tells dh to get me to stop the moaning and take deep breaths. I hear her say it but the ctx are so intense that the moaning offers the only relief, though I try to breathe deeply inbetween ctx. I try to change positions but nothing helps. I end up leaning on my left leg while sitting. Dh is talking to the mws (I think they hang up and call back at least once; I remember the phone ringing a few times after dh comes home) and I hear a "pop" during a contraction. I realize my water broke but cannot verbalize it. Dh hears it also and relays this to the midwives. After the ctx, I say that it is clear, no merconium. During the next contraction the rectal pressure is more intense and (I think) I say that it feels like the baby is trying to come out my butt. During the next ctx J tells dh to have me check for the head; no head. The next contraction I feel the head; I go from just feeling the head to touching the whole top of the bb's head. I say "head", dh tells J that I feel the head, I say "No, HEAD!"

Dh moves from the edge of the tub at one end to the other and cradles the phone on his shoulder so his hands are free. I concentrate on dealing with the next ctx while keeping my hand on the top of the baby's head; I don't even try to push. The burning is intense; the baby's head eases out facing my right thigh (Dh says later that he wanted to get the baby's head out of the water, though he knows that there was no danger). Dh confirms for J that there is no cord around the baby's neck. I hear dh say he sees the shoulders; I feel some more burning and the rest of the baby's body slides out with the next ctx: 1457. Dh lifts up the baby; I take her and ask the sex. At first dh thinks the baby is a boy because he was not aware that a newborn girl has a swollen labia; I wanted to know what name to call her when I talked to her to encourage breathing. After Dh identifies the baby as a girl I have him help me lay back so that I can try and nurse. Though dd came out greyish purple she immediately pinked up though her nose stayed purple for another minute. Dd licks my nipple for a couple of minutes before she starts nursing. It seemed like the "back-up" midwife, A, arrived within 10 min though J said that it was 30min; S had been on the phone with her giving directions. Dh invites MIL up to see dd (thanks dh); I warn that it is a bit "gory" since the water is a reddish brown from my small tear. MIL peers in from the bathroom door, but ds comes in for a closer look. A covers dd with a towel, examines dd, and I think asks if we want to cut the cord. We want to wait until it stops pulsating. I start feeling cramps again; A says I can push with them to deliver the placenta. Dh runs downstairs for a "placenta bowl". After a few cramps I finally start to push a little and the placenta plops out; dh cuts the cord. Dh takes dd so A can help me out of the tub; A first asks me if I want to shower but I just want to get out of the tub after spending over an hour in the water. A puts a chux pad under me and helps me to my bed. Dh is already sitting there with dd, but we make him move because there is no way I'm walking to "my" side of the bed. After I'm on the bed I mention something about hanging out in my "altogether", and MIL gets me a sheet to cover up with. A is in the bathroom examinating my placenta; she exclaims how large it is and asks if I take USANA vitamins since the only placenta she had seen this large the mom was taking USANA vitamins -- and I do! Interesting. She explains to dh what she is looking for in the examination and that everything has come out. I call my mom on dh's cell phone and while we are talking my regular mw's arrive having made the two hour drive from Austin in 52min. A has a client in labor and leaves, S and J take over post partum care.

[Defenestrator]

If a couple has planned a midwife-assisted birth with me we talk about emergency childbirth in our prenatals. I always try to talk the dad into making a plan that has them calling me first.

The way I explain it is that I can talk them through the birth pretty easily on the phone and listen to their descriptions of what is going on (while driving very, very fast to try to get there) and help avoid the craziness of EMTs and the loss of their planned homebirth. If we determine that I am too far to help with a rapidly developing complication then we can either hang up the phone or (even better) have them call on another line to get the EMTs.

I have done one birth this way. It was hilarious! Mom was giving birth on her own in the bathroom. Dad called me and asked what to do. I said, "Go put down the phone and help your wife catch the baby! Pick it back up if you need me!" The next moment I heard the three-year-old big sister yelling "A BABY A BABY! CAN I HOLD IT!" I think that the little one was born just as he was setting the phone down. Mom caught her own baby. He never did pick up the phone again. I felt like a voyeur listening to their first moments in the background through the phone handset -- very sweet. I got there about 15 minutes later and helped the placenta birth -- no blood to speak of. Oh, and hung up the phone!

[xenabyte]

The last two posts just cracked me up, but how sweet and wonderful the two experiences!

I've actually been having dreams my midwives won't be here in time, and my Dh is TOTALLY squeemish about such things, though has been there for me for my first two (hospital births, but with a CNM) and held my hand and rubbed my back and did everything else humanly possible...but he's just squeemish about blood and cord cutting and such....:

So I told him if I am in the bathtub doing it myself, and they are not here yet, for him to just get them (the midwives) on the phone, keep the boys occupied and let me do my thing haha..

I would like to get that "Emergency Birth" book and see if he'd read it and consider catching the baby...but I don't want to deal with a fainting Dh on top of delivering a baby!

It has to really be 'empowering' to have delivered your own baby and WOW the 'big fish' story factor for all those mom friends that freaked out about the fact you are doing it sans meds and hospital...much less to then actually catch your own baby!! I'd almost want to do it for the 'amazed' looks you'd get when you told your birth story to mainstream friends! hehe

[OHmidwife]

Here's the handout I give my clients. It is a combination of other handouts from other midwives and some stuff of my own. Sorry the format is lost by copy & paste, but you get the drift anyhow.
Good luck!
Blayne

When the Baby Arrives Before the Midwife

You've contacted the midwife and she's on the way. Suddenly your partner wants to push or tells you “the baby is coming, now!” What do you do? First of all, believe her! Second, don't panic! Know that most fast births are spontaneous and normal. So relax, and try to follow the instructions below:

1. Move her to a comfortable place - it doesn't need to be a bed. (NOT on the toilet, but the bathroom floor will do if she’s already there.) She can be in almost any position as long as you can reach the baby's head when it is delivering.

2. Get all of the birth supplies within arm's reach. Get a couple big blue chux pads (from the birth kit box) and put them under her hips (plastic side down). Get out several towels or receiving blankets.

3. If you have time, wash your hands. Don't bother if the baby's head is coming fast.

4. Instruct the mom to refrain from pushing hard, if possible. Blowing with her through the contractions will help slow things down.

5. As the baby's head begins to emerge, put your hand on it and gently press the top slightly downward toward your partner's rectum. This is not to hold back the baby's head, but to keep the head flexed and control the speed of delivery.

6. As the baby’s head is emerging, mom may say “it burns!” Try to work with her to blow or puff with contractions to allow the vaginal opening to stretch. Tell her ”little pushes only” till the head is out.

7. If the mom passes some bowel movement, use a washcloth or anything handy to wipe it away or cover it up. This is a normal part of many births, but you want to avoid getting it on your hands or the baby.

8. Continue to use both hands to control the birth of the baby's head and support the mom's perineum as best you can. Once the forehead shows, ease up any pressure that you are using to direct the baby's head toward the rectum and allow the face to be born over the perineum. Don't take away your hands - keep the whole process slow and controlled.

9. Once the baby's head is out, the shoulders and body may follow immediately or there may be a pause for a minute or two. (If the bag of water is still around the baby's face, pinch and tear the membranes away so the baby can take a breath.) If there is a pause, slide a finger along the back of the baby's neck to see if you can feel the umbilical cord.

CORD AROUND THE NECK:
If you feel a cord, pull the loop of cord out gently and slip it over the baby's head. If it won't come that far, DON'T force it - just let the baby be born through it, or, if very tight, somersault the baby out with the cord in place. (After the head rotates to one side, gently press the baby’s face toward the mother’s thigh. As the baby emerges, keep the baby’s face close to the mothers thigh and let the rest of the body “somersault” out.) Then carefully unwrap the cord. It's almost never necessary to cut a baby's umbilical cord before the birth of the body, and can be dangerous.

10. The baby's head will rotate and face one of the mom's legs. With the next contraction, ask the mom to push to deliver the shoulders. If the baby is big, she may need to give a strong push. With one hand on each side of the baby's head, guide it gently downward to help deliver the top shoulder, then upward to deliver the bottom shoulder. Don't pull! Try to keep the baby's arms close to its body as the entire baby delivers, and hold on tight. Babies are very slippery!

HEAD OUT, BODY NOT COMING OUT (“SHOULDER DYSTOCIA”):
If the body does not follow within two or three minutes after the head is out, and/or if the head starts turning a dark purple color, first, if a phone is within reach or if you have anyone else present, call 911. Tell them your partner is giving birth, the head is out, and the shoulders are stuck and you need help. Unless you have a speaker phone or headset, do not stay on the phone with them yourself, as you will need both hands to assist the mother.
Next, tell the mother to flip to hands and knees and to push hard, while you, holding the sides of the baby’s head, put GENTLE pressure upward (hold pressure for the count of ten), then downward (hold gentle pressure for the count of ten).
If the baby has not come yet, have the mother keep changing positions every 30 seconds or so (stand, squat, side lying, hands & knees) and keep pushing, while you continue alternating GENTLE pressure upward and downward, holding the sides of the baby’s head. Once the top shoulder frees and becomes visible, lift upward on the baby's head to help the bottom shoulder come out. The baby's body will follow.

11. Once the baby is completely born, it can be placed on the mother's abdomen immediately, with its head slightly lower than the body. Using a towel, dry the baby completely and briskly - this helps to stimulate the baby to breathe as well as prevents excess heat loss.

BABY NOT BREATHING:
If the baby has not yet taking a breath after 15 seconds or so, use the bulb syringe (from the birth kit box) to clear the back of the baby's mouth and then the nostrils, especially if you noticed meconium- a greenish color in the amniotic fluid. Squeeze the bulb before inserting it in the mouth, then let go after it is in the mouth. Repeat with each nostril. Then continue to stimulate the baby, briskly rubbing its back or flicking the bottoms of its feet.
If the baby still isn't breathing, feel the umbilical cord near the baby's body. If there is a good strong pulse over 100 beats per minute, the baby may just need a few puffs of air. Do mouth-to-mouth using very small breaths (just as much air as is in your cheeks) until you feel the baby start to take some breaths on its own, then go back to skin stimulation. CALL 911 IF THE HEART RATE IS UNDER 100 OR IF YOU HAVE ANY CONCERNS ABOUT THE BABY'S ABILITY TO BREATHE ON ITS OWN!! (It’s a good idea to take a course in infant resuscitation before the birth! Complete CPR instructions are beyond the scope of this handout.)

12. Keep the baby dry and warm at all times. Once the baby is breathing easily and recovered from the birth, s/he may soon be interested in nursing, and it's just fine to encourage that. Baby should be pink and have good muscle tone.

13. Don't worry about cutting the umbilical cord until the midwife arrives.

14. The placenta may deliver within a few minutes after the birth, or may take longer. Encourage her to push whenever she gets a contraction or cramp after the birth.

15. Watch for a sudden gush of blood from the mom's vagina, or a contraction in which you can see more umbilical cord coming from the vagina. If that happens, the placenta is probably ready to deliver. Wrap a gauze pad or a small washcloth around the cord so you can hold it without your fingers slipping. The next time mom feels a cramp, have her push. You can use the cord to gently guide the placenta out into a bowl or pan. DON'T PULL on the cord. The placenta should come with her pushing. If the bleeding seems excessive and the placenta isn't coming, have her get up and squat to push.

16. Once the placenta is out, place your hand on mom's abdomen just below her belly button and rub down in toward her back. You will feel her uterus harden into a ball under your hand - the firmer it is, the less she will bleed. You don't need to use excessive force here - just continue rubbing deeply until you feel that hard ball. It should feel firm like a grapefruit. It is normal to lose up to, but not over, two cups of blood after the birth.

EXCESSIVE BLEEDING:
If the bleeding is continuous and heavy, lie mom flat on her back with her feet elevated about 12 inches, call 911 for assistance, and continue to rub her uterus. Keep her talking, and if possible, have her drink a large glass of water or juice. Have her try to get the baby to nurse, or do nipple stimulation herself.
If bleeding continues to be heavy, squeeze the uterus on either side with both hands firmly, compressing it between your hands. This will be painful to the mother. DON'T LET GO UNTIL BLEEDING STOPS.

17. Place the placenta near mom's side so she continues to have easy access to the baby even though the cord is still attached. You can set the placenta in a bowl or pan, or wrap it in a chux pad if you wish. Put a couple of clean chux pads under mom (have a garbage bag to put the dirty ones in).
Keep the baby in skin-to-skin contact with mom to keep warm. Make sure the baby is covered with dry towels or blankets -find a hat to put on his/her head.
Get a large glass of juice for mom to drink. You may want a drink too.
Take a deep breath and wipe away the sweat. You did it!
Your midwife will be here soon!
These instructions are for a normal “precipitous” (fast!) childbirth, and cannot begin to cover every possible variation in the birth process. If you have any concerns not covered in this handout, call 911. These instructions are in NO WAY implying that individuals should deliver a baby without competent midwifery or medical help.

[caned & able]

WAY OFF TOPIC, but David Lee Roth is a trained EMT, and now that he is not on the radio, maybe he is working as an emt again...

If he arrives at anyone's birth, let us know...that would be a cool homebirth story to tell, although at the time, I am sure, a new mama could care less...

[valeria_vi]

Originally Posted by MsElle07

Would anyone call 911 if the baby is coming and the MW hasn't arrived?

This would be one of my nightmares -- having the paramedics intrude on my intimate homebirth. But I can see how this would be my DH's initial reaction -- he would not feel comfortable with me having the baby without the MW there AT ALL.

I'm going to get Emergency Childbirth for him and write up a list: Do NOT call 911 unless: I am unconscious, or close to it, or I specifically tell you to call 911.

he can call the mw and have her on the phone while the birth is happening.