Home Childbirth — A Midwife’s View, by No Place Like Home

Our society today views childbirth as a sickness that can only be managed by “professionals” in the hospital.  Babies that might come out blue and unresponsive, possible hemorrhaging, and babies that get stuck in the birth canal are all things that deter families from having births at home.  These are real issues and should not be ignored, but they make up only a small percentage of birth outcomes.  The vast majority of women in the world can and do give birth safely at home.   As fellow survivalists, we understand that the government and media either hide statistics or distort them.  The fact is that the U.S. is ranked 24th in infant mortality following such countries as Cuba, Portugal, and Singapore.  When one looks at the countries with the lowest mortality rates, at least 70% of the births are attended by midwives.  At the turn of the 20th century, that same statistic was true for our country.  Now home births account for less than 3% of all births.  In fact, in some of our major cities, nearly 50% of births are performed by a major surgical procedure known as Caesarean. When one investigates the facts concerning the safety and reasons for home birth, it is not hard to see that it is a better way to birth.  Regardless of opinion and inclinations during normal and peaceful times, in a survival situation caused by economic collapse or natural disaster, childbirth will have to be dealt in possibly less than ideal conditions.  I believe that in such a situation, midwives will be an invaluable and precious asset.  In preparing your family for a TEOTWAWKI situation, you might consider making contacts with midwives in your area if you are expecting a child or plan to have some in the future. There is no substitute for experience and knowledge, so please consider the care of a midwife if you are pregnant. If your situation does not allow you to have a midwife, then here are some good suggestions to ease the process of labor and birth.

If you and your family have had children before, then you know something about the process and how things progress.  Still, having a baby at home can be intimidating when traveling is dangerous and help is miles away.  One thing to remember is that the mother knows her body and will, almost unconsciously, facilitate an easy entrance for the baby if she is left to herself.  Once labor has started, you should contact any help you planned on having, whether it is an ambulance or a midwife.  The best way to help Mom is to encourage her in her efforts and provide as much food and drink as she wants; labor is a very strenuous activity.  Help her to go to the bathroom often, as this will help relax her muscles and speeds the descent of the baby.  Childbirth can be painful, but the pain is most often caused by a poor position of the mother that forces the baby on the pelvis or against the spine.  A good overall position is standing up or squatting.    

Squatting opens the pelvic cavity 30% more than lying down.  If the mother is lying on her back, her body weight is compressing an artery in the back and preventing good blood flow to the baby; it is also a very uncomfortable position.  When the mother wishes to lie down, she may prefer laying on her side or sitting up part way.  A hands and knees position may also be preferable, especially when a baby is posterior (its back bone is against the mother’s spine). This position drops the baby off Mom’s spine and gives some relief.

We know that Mom can push this baby out, but what do Dad/ Sister/Friend do as the baby comes out?  You may want to gather some supplies for the birth.  This would include a bowl to catch the placenta, plenty of towels or other absorbent material to clean up blood and amniotic fluid, sterile scissors (boil for 10 min.), and towels for baby (warm in low oven, dryer, or over a wood stove).  As the newborn arrives, have Mom pant through her contractions to slow the descent of the baby and prevent tears in the perineum.  Supporting the head as it comes out will also minimize tears.  Also, the infant has been in the mother’s belly for approximately 40 weeks, floating in warm, cozy liquid.  Unless careful consideration is taken to keep the temperature slightly warmer than body temperature, the baby arrives into a colder environment.  You might think that the baby should immediately be wrapped in a towel, but the best place for a newborn is on the mother’s bare chest with a blanket on top.  God designed the mother to be able to adjust her body temperature to warm or cool the baby.  Fathers are also able to warm up a baby. Placing the infant on Mom’s chest also allows it to smell her and the nipple area so the baby will be calm and ready to nurse.

As the baby comes out, careful checking of the umbilical cord should assure the birth partner that it is not wrapped around the infant’s neck and cutting off blood flow.  If it is wrapped around the neck, it can usually be slipped off easily.  In the instance where it is too tight to free the neck, tie two strings or shoelaces to the cord and cut between them, otherwise the baby could lose a lot of blood.  In a preferable situation, the cord is left intact and is only cut after it has stopped pulsing.  This allows a maximum amount of blood and nutrients to flow into the baby that will help the baby prepare for life outside the womb.  Before cutting the cord, be sure to sterilize your string and scissors in boiling water.

As well as checking the cord, the father/birth partner should check the baby for breathing and responsiveness.  Obviously, if it is crying, there’s no worry.  But sometimes fluid or meconium (baby’s first bowel movement) can get into the nasal and mouth area and possibly aspirate into the lungs, causing breathing problems.  This is usually not a serious problem, as the baby’s crying and coughing will bring it out; suctioning the mouth and nose with a bulb syringe will help.  If the baby is unresponsive, place on Mom’s chest and rub vigorously with a towel and this will usually trigger a response. If the baby is still not coming around, try giving it oxygen through a face mask, otherwise start CPR immediately.  As part of preparedness, CPR training would be good knowledge to have.

When the baby is born, everyone is absorbed with the infant and the extraordinary event that just took place.  However, there is still a placenta that has been providing nutrients and blood flow to the baby.  At no time should the umbilical cord be tugged on to facilitate its release from the uterine wall, which will cause hemorrhaging.  During the birth process, hormones and chemicals are telling the body what to do and when.  If the baby is born naturally with no drug inhibition (always the situation in home birth), the body will usually tell the placenta to detach. The mother may or may not feel some more contractions and the placenta will be pushed out; standing will help this process.  Remember that the best place for the newborn was the mother’s chest.  When a baby starts to nurse, it causes oxytocin in the mother which produces contractions and helps to release the placenta from the womb.  If the baby will not suck, manual stimulation of the nipple will suffice.  Be sure to watch for excess bleeding, in which case, more stimulation of the nipple is needed and/or vigorous massage of the abdominal area to cause the uterus to shrink up and stop the bleeding.

Another situation that may be cause for concern is if the baby becomes stuck in the pelvis.  The pelvis is shaped somewhat like an oval with the narrow portion extending from side to side of the woman.  As the baby is being born it rotates slightly to pass this narrow part so the shoulders can come out.  Sometimes this does not happen; maybe the baby is very large, its arm has come out with the head, or some other similar situation. Whatever the cause, its shoulders cannot get past the narrow part.  If the mother is lying down or only slightly sitting up, help her get on her hands and knees to help open the pelvic cavity.  This may drop the baby down and back in slightly and get it in a better position to come out.  In a very difficult situation, the dad may have to reach a couple fingers in alongside the baby’s head to the shoulders and try to pull one shoulder past the ischial spines (the narrow part of pelvis).  The important thing to remember if a baby gets stuck is that the umbilical cord may be getting pinched as the infant comes out.  If the baby’s head is out, it may start to breath on its own, but acting quickly is very important.  Encourage the mother to help pull her baby out, move, and swing her hips to get the baby to move down. This will solve most problems instantly.

Again, knowledge is power and researching the means and/or possibility of a home birth will give both parents some ease about the process and confidence in a TEOTWAWKI situation.

A few recommended books to have on hand would be:
• “Spiritual Midwifery” by Ina May Gaskin (wonderful collection of home birth stories, very focused on spiritual and emotional care of woman, as well as info regarding medical care of labor and birth),
• “The Birth Partner” by Penny Simkin (more for father/birth partner, gives info on best birthing positions, encouraging mother, hospital practices, items to have on hand for birth, stages of labor),
• and “Heart and Hands” by Elizabeth Davis (midwifery-oriented, lots of info for midwife on care for pregnancy and birth).
These books offer a wonderful collection of knowledge for both mother and father and would be invaluable for the birth at home.

About The Author: “No Place Like Home” is the pen name of a doula who is pursuing DONA-certification. She is an advocate for home birth and believes that women are strong enough to birth on their own and should be given that opportunity.