Letter Re: Childbirth at Home, by J.C.

Dear Editor:
There are a few errors in J.C.’s article posted 5/19/12. I am a registered nurse that has delivered many babies in hospital and in home and other emergency locations. My comments are in bold type.

J.C. wrote:
Make sure to never pull on the baby’s head. Do apply gentle downward traction while someone pushes firmly down superior to mother’s pubic bone.

This counter pressure is usually only done if there is a problem delivering the shoulders not as a routine intervention.

Once the baby delivers the top shoulder, then release all pressure by everyone and tell mom to push.

It is much easier on Mom and baby to have the mother get on her hands and knees which opens the pelvic area significantly and allows the baby to proceed with the process of being born without interventions.
Some items that I would like to touch on would be minor complications. One such issue is that the “water never broke” or the placenta has not ruptured.

These are two separate conditions that the writer is treating as the same thing and it is not. Placentas should not rupture. Placentas are embedded into the uterine wall at the beginning of the pregnancy and supply via a cord (the umbilical cord) all the nutrients and oxygen that the baby needs during life in the womb. The writer is referring to two different structures that develop throughout the pregnancy, the amniotic fluid sac also called the bag of waters, holds the amniotic fluid within which the infant is cushioned and the placenta which is attached to the uterine wall and provides all the nutrients and oxygen a baby requires. A ruptured placenta is not what the writer means.

“If this is the case, you will have to rupture the placenta”.

You cannot nor should not rupture a placenta which is usually attached higher up the sides of the uterine walls.

Be careful that you do not hurt baby. Try to pull the membrane away from the baby and make a small puncture or incision. Then pull it apart with your fingers.

This statement is a “how- to- do” direction on rupturing the membranes of the amniotic sac, which really should only be done by a professional but it does not relate to the previous statement about the placenta. You want the placenta to be delivered ” intact” or all in one piece if not, retained pieces of placenta will cause problems that even in this day and age can result in the loss of a mother’s life if not addressed quickly.

I am an RN of 38+ years of experience  and have taught graduate nursing school for years so I fee confident in commenting on this subject from both a professional and personal point of view. I have another grandchild to deliver at home in December.

With My Regards, – P.C.

JWR Replies: Thanks for your sharing your expertise. I have already made immediate corrections to J.C.’s article, and re-posted it.