In European countries most babies are delivered at home. Until recent years in the United States, the same custom was true. Among idealistic college youth, natural living enthusiasts, and those with no insurance, home delivery still holds an attraction. Midwives and occasionally physicians usually attend these patients. Husbands, wives, nurses, and family physicians should
all become acquainted with the techniques of a home delivery. Either through planning or in an emergency, this knowledge may prove most useful.
First in importance is the recognition of labor. For several weeks prior to delivery there may be painless, irregularly spaced contractions. These so - called Braxton—Hicks contractions serve to firm up the uterus and, as it were, “prime” it for the main event. The baby typically “drops” several weeks before labor is to begin, as the head descends into the pelvis, creating a “lightening” sensation. Slight cervical dilation then follows, with increased secretion of mucus—like discharge.
When labor actually ensues, however, one of three changes heralds its onset. The loss of the mucus plug, at times coated with blood (bloody show), may coincide with the onset of labor. Second, the cervix begins to thin (called effacement) and dilate. Regular contractions then commence, usually coming every eight to ten minutes, lasting at least sixty seconds. They then increase in frequency, becoming quite intense. Labor contractions located in the low back may be extremely painful. They are commonly associated with an “occiput posterior” delivery. In this more challenging type of labor, the back of the head orients toward the mother’ s back, making passage through the birth canal during labor more difficult. The “bag of waters” (amniotic sac) may burst, causing a sudden flood of warm clear fluid. Occasionally, the escape of urine or a vaginal discharge may mimic the breaking of the water. This must be tested with pH paper (litmus or nitrazine). The amniotic fluid is always alkaline, turning nitrazine paper blue. When labor initiates itself by the breaking “bag of water,” it normally proceeds faster. In fact, it is important for the delivery to be accomplished within twenty-four hours after the water breaks, to lessen any risk of infection in the mother’s womb.
Labor usually progresses steadily through three distinct stages. The first stage consists of progressive cervical dilation and thinning (effacement). When the cervix is completely dilated, the opening is 10 cm. in diameter, the average diameter of a baby’s head. The second stage of labor begins when the head passes through the completely dilated cervix, and descends into the birth canal (vagina). The first appearance of the baby’ s head between the labia is called crowning. Progressive dilation of the vulva then occurs, requiring special self-control on the part of the mother. Periodic panting with each contraction, helps to avoid pushing the baby out too fast, thus preventing laceration of either vagina or cervix. If all goes smoothly at this point, the baby enters the world into the waiting hands of an attendant midwife or physician.
Your first maneuver, after the baby’ s head emerges, should be to clear its mouth and nose of mucus. A rubber suction bulb works excellently for this purpose. Clearing the airway of mucus should be performed thoroughly, with the baby’s head in a downward position (for a normal ‘‘face down” delivery).
Quickly check the baby’s neck for the umbilical cord. If a loop of the cord is discovered, slip it gently over the head to make the delivery of the shoulders and trunk easier. This helps prevent its strangling the baby, or accidentally tearing the cord. A hemorrhage would then result, depleting the baby of its precious blood. The upper shoulder of the infant is usually delivered first, followed by the lower. Finally, the rest of the body slips out easily. Continue holding the baby in a head down position, and suction the mouth and nose again. Wait “patiently” for the first cry and a few deep breaths that ventilate the lungs and bring a healthy pink color to the newborn body. The pulsing umbilical cord should be left alone for a minute or two, to allow further blood flow from the placenta into the baby. This acts as a mild “transfusion” to give the baby some of its own blood, which would otherwise be lost. “Stripping” the cord of its blood in this fashion retards the later development of anemia, commonly seen in babies a few months old. When the cord quits pulsating, it can be tied or clamped. In a normal home-like setting it is convenient to boil a clean white shoelace, and use this to tie the cord. About ¼ to ½ inch from the skin of the navel, tie the cord securely, with care taken to avoid pulling or traumatizing the umbilicus. Place two ties about an inch apart, the second one being further from the baby than the first tie. Then use a pair of sterilized scissors to cut between the cord ties. The third stage of labor involves the delivery of the placenta. The “afterbirth” follows within five to forty five minutes, and usually separates on its own accord with no manipulation required. If necessary, use your hand to gently massage the uterus. Another “push” on the mother’s part, and the placenta comes easily.
The uterus should again be massaged carefully. The baby can be positioned to nurse at mother’s breast. This enables both hormonal and neural mechanisms to contract the uterus and lessen the likelihood of hemorrhage. Periodically, for the next hour massage the uterus to keep it firm and
minimize bleeding. If there has been a laceration of the perineum during the delivery, it should be carefully inspected. If the tear is extremely small and not bleeding, it may be allowed to seal by merely lying still with the mother’s legs together for a few hours. All deeper lacerations, particularly those involving the muscle of the rectal sphincter should be sutured. Even if this means a trip to the emergency room or doctor’s office, it should be repaired, so complete healing
will occur. Then the rectum and birth canal will not lose their normal anatomic relationships, leading to incontinence or discharge. One most important qualification for a successful nurse-midwife is the ability to remain calm under pressure. The delivery of a baby is an exciting
time. All the attendants should continually remain alert, interested, and composed. Encouragement to the mother during the strenuous pushing stage can make all the difference between a successful home delivery and one that needs obstetrical assistance in a hospital. The use of forceps can often be avoided if mothers receive the proper coaching and encouragement during this labor stage. Patience in waiting for the placenta will likewise be rewarded. Although excited viewers may request to take pictures, it is much more important to attend to the physical needs of the newborn than obtain a few precious snapshots.
all become acquainted with the techniques of a home delivery. Either through planning or in an emergency, this knowledge may prove most useful.
First in importance is the recognition of labor. For several weeks prior to delivery there may be painless, irregularly spaced contractions. These so - called Braxton—Hicks contractions serve to firm up the uterus and, as it were, “prime” it for the main event. The baby typically “drops” several weeks before labor is to begin, as the head descends into the pelvis, creating a “lightening” sensation. Slight cervical dilation then follows, with increased secretion of mucus—like discharge.
When labor actually ensues, however, one of three changes heralds its onset. The loss of the mucus plug, at times coated with blood (bloody show), may coincide with the onset of labor. Second, the cervix begins to thin (called effacement) and dilate. Regular contractions then commence, usually coming every eight to ten minutes, lasting at least sixty seconds. They then increase in frequency, becoming quite intense. Labor contractions located in the low back may be extremely painful. They are commonly associated with an “occiput posterior” delivery. In this more challenging type of labor, the back of the head orients toward the mother’ s back, making passage through the birth canal during labor more difficult. The “bag of waters” (amniotic sac) may burst, causing a sudden flood of warm clear fluid. Occasionally, the escape of urine or a vaginal discharge may mimic the breaking of the water. This must be tested with pH paper (litmus or nitrazine). The amniotic fluid is always alkaline, turning nitrazine paper blue. When labor initiates itself by the breaking “bag of water,” it normally proceeds faster. In fact, it is important for the delivery to be accomplished within twenty-four hours after the water breaks, to lessen any risk of infection in the mother’s womb.
Labor usually progresses steadily through three distinct stages. The first stage consists of progressive cervical dilation and thinning (effacement). When the cervix is completely dilated, the opening is 10 cm. in diameter, the average diameter of a baby’s head. The second stage of labor begins when the head passes through the completely dilated cervix, and descends into the birth canal (vagina). The first appearance of the baby’ s head between the labia is called crowning. Progressive dilation of the vulva then occurs, requiring special self-control on the part of the mother. Periodic panting with each contraction, helps to avoid pushing the baby out too fast, thus preventing laceration of either vagina or cervix. If all goes smoothly at this point, the baby enters the world into the waiting hands of an attendant midwife or physician.
Your first maneuver, after the baby’ s head emerges, should be to clear its mouth and nose of mucus. A rubber suction bulb works excellently for this purpose. Clearing the airway of mucus should be performed thoroughly, with the baby’s head in a downward position (for a normal ‘‘face down” delivery).
Quickly check the baby’s neck for the umbilical cord. If a loop of the cord is discovered, slip it gently over the head to make the delivery of the shoulders and trunk easier. This helps prevent its strangling the baby, or accidentally tearing the cord. A hemorrhage would then result, depleting the baby of its precious blood. The upper shoulder of the infant is usually delivered first, followed by the lower. Finally, the rest of the body slips out easily. Continue holding the baby in a head down position, and suction the mouth and nose again. Wait “patiently” for the first cry and a few deep breaths that ventilate the lungs and bring a healthy pink color to the newborn body. The pulsing umbilical cord should be left alone for a minute or two, to allow further blood flow from the placenta into the baby. This acts as a mild “transfusion” to give the baby some of its own blood, which would otherwise be lost. “Stripping” the cord of its blood in this fashion retards the later development of anemia, commonly seen in babies a few months old. When the cord quits pulsating, it can be tied or clamped. In a normal home-like setting it is convenient to boil a clean white shoelace, and use this to tie the cord. About ¼ to ½ inch from the skin of the navel, tie the cord securely, with care taken to avoid pulling or traumatizing the umbilicus. Place two ties about an inch apart, the second one being further from the baby than the first tie. Then use a pair of sterilized scissors to cut between the cord ties. The third stage of labor involves the delivery of the placenta. The “afterbirth” follows within five to forty five minutes, and usually separates on its own accord with no manipulation required. If necessary, use your hand to gently massage the uterus. Another “push” on the mother’s part, and the placenta comes easily.
The uterus should again be massaged carefully. The baby can be positioned to nurse at mother’s breast. This enables both hormonal and neural mechanisms to contract the uterus and lessen the likelihood of hemorrhage. Periodically, for the next hour massage the uterus to keep it firm and
minimize bleeding. If there has been a laceration of the perineum during the delivery, it should be carefully inspected. If the tear is extremely small and not bleeding, it may be allowed to seal by merely lying still with the mother’s legs together for a few hours. All deeper lacerations, particularly those involving the muscle of the rectal sphincter should be sutured. Even if this means a trip to the emergency room or doctor’s office, it should be repaired, so complete healing
will occur. Then the rectum and birth canal will not lose their normal anatomic relationships, leading to incontinence or discharge. One most important qualification for a successful nurse-midwife is the ability to remain calm under pressure. The delivery of a baby is an exciting
time. All the attendants should continually remain alert, interested, and composed. Encouragement to the mother during the strenuous pushing stage can make all the difference between a successful home delivery and one that needs obstetrical assistance in a hospital. The use of forceps can often be avoided if mothers receive the proper coaching and encouragement during this labor stage. Patience in waiting for the placenta will likewise be rewarded. Although excited viewers may request to take pictures, it is much more important to attend to the physical needs of the newborn than obtain a few precious snapshots.
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