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Old 03-13-2011, 12:39 PM   #1
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UCers? how to prepare

I've read several birth stories and found a few UCers here. I'm still on the fence. I need to come up with 2 grand for my midwife in the next 18 weeks, or no homebirth with a midwife. Because if I can't have a midwife, I'm doing UC.

Background story: I was full time at the hospital I work. When I became pregnant, my boss called me in, preceded to break me down by "making fun" of how many kids I have, and then insist I go prn (as needed staff). I went to HR and while they hand slapped and poo pooed her for how she spoke to me, they wouldn't let me go back full time, she said she didn't have a ft position. I lost my benefits. Since then I went and applied for the medical card for the kids and I, and was denied because of what I had in savings. And when that was all gone I applied again. (waiting for results, but don't want to go to hospital and use card for birth, if I get it)

I had planned, before all this, to have a home birth. And thats what I want. Midwife or not.


So, what should I be doing to prepare? I've read up on the mechanics of birth. I've read every birth book I could find. My husband is behind me, though not experienced. I have no IRL close friends who believe in natural birth, let alone homebirth.......so it will be just me. and maybe my doula. if she can make it.

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Old 03-13-2011, 01:52 PM   #2
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Re: UCers? how to prepare

I read and listen to my intuition. I also pray.
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Old 03-14-2011, 07:30 AM   #3
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Re: UCers? how to prepare

I don't know where you live but in FL midwives will accept medicaid. I've not had a UC before but I was secretly hoping last time no one would make it in time and it would be just DH and I. I say read read read everything you can get your hands on. Also you might want to research infant CPR just in case you were to need it. You probably won't need it but it would make you and DH feel more comfortable if you new you were prepared to handle an emergency. There was a discovery channel program about the "Unassisted Childbirth" lady Laura somebody that was really interesting. You could probably watch it online for free somewhere. Just educate yourself and DH as much as you possible can in the next 18 weeks so that you both feel confident in your abilities. Good luck mama!
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Old 03-14-2011, 08:51 AM   #4
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Re: UCers? how to prepare

I wrote up this "tutorial" for an online group I run(Birth Is Normal over at CafeMom), hope it helps.

Unassisted birth is an option for most women. We do a lot of talking about it and some strongly encourage women to UC. But we don't do enough talking about HOW to prepare for an UC, what are some of the basic things you need to know and where do you go to find that information.

About 60% of the women in BIN who UC transfer, 98% of those transfers are probably preventable and unnecessary. Sometimes having a midwife present to prevent a transfer can be a wonderful thing.

You can't prepare for an UC by simply reading Shanley's Born Free forums, her book, reading birth stories and watching videos on youtube. While trusting the birth process is crucial, its not enough. We need to be realistic, not idealistic. Preparing to UC isn't something that should be done in a fly by the seat of your pants manor, it should be approached with the utmost respect and seriousness.

Here are some tips/resources/etc to help you prepare, but you should NOT stop here. Hopefully other women that have had an UC can share tips how they prepared and if they transferred what they think they could've done differently to prevent a transfer if it wasn't necessary.

If you feel you are not capable or are not willing to make the commitment to learn the essential basics in preparing for an unassisted birth - you should hire a midwife.

Books for Birth
Hearts and Hands by Davis
Birth Emergency Skills Training by Gruenburg
Shoulder Dystocia Handbook by Midwifery Today
The Hemorrhage Handbook by Midwifery Today
The Second Stage Handbook by Midwifery Today
Prolonged Labor Handbook by Midwifery Today
Tear Prevention and Treatment Handbook by Midwifery Today

Books for Baby
Neonatal Resuscitation Textbook by Kattwinkel

Essential things you should know
*How to identify and cope with maternal exhaustion
*How to identify an obstructed 2nd stage
*How to identify hemorrhage, on "land" and in water.
*What is normal blood loss(CC's) and clots
*Newborn CPR & Resuscitation
*Meconium
*How to treat hemorrhage (herbs, homeopathy, etc)
*How to identify and treat shoulder dystocia
*Retained placenta, normal time for it to expel and what to do
*Newborn respirations, normal and abnormal
*When to call 911
*When to transfer during labor

Communication
If you are UCing, it prudent you communicate with family/friends/spouse (whomever is to be at your birth), what is normal during labor, what is abnormal and when they need to call 911.

Maternal Exhaustion
Maternal exhaustion and prolonged labors make for a higher blood loss. The longer the labor, the more CC's a woman will lose.
Encourage rest. Stimulate labor only when appropriate. Allow food and liquids.
Homeopathy: Carbo Veg

Prolonged Labor
Up to 800CC's is to be expected if blood loss.

Blood Loss Tips
Waterbirth Tip: If you are in water when you give birth, if you can't see the bottom of the pool because of the amount of blood dispersed in the water you have lost about 500cc's.

TIP: Get fake blood or blood from your local butcher, measure out 200CC's. Pour it into water, on a chux pad and on a sheet. Notice how it looks, absorbs into material and disperses into water. Do this again with 500CC's and with 700CC's in water, chux pad and a sheet or blanket.

Following are the most common factors that occur before a diagnosis of failure to progress is made.

Possible cephalopelvic disproportion (CPD): Although this is a possible condition, I believe it is relatively rare. I have seen only three true cases of CPD in my career.

Malpresentations of the fetal head most often result from the woman having an adequate to ample pelvis anda smaller baby who can move around freely.

Ascynclitismiagnosed with the suture lines of the fetal skull are not felt to be aligned exactly halfway between the symphysis pubis and the sacrum. If the baby's head is tilted up toward the pubic bone, it is called anterior ascynclitism; if it is tilted toward the mother's sacrum, it is a posterior ascynclitism.

Posterior labor: It is my experience that with appropriate diagnosis and minimal intervention this condition can be corrected by assisting the baby to rotate as soon as it is diagnosed. Many times the position is not diagnosed until labor is advanced and progress arrested. At the onset of labor, it is important for the midwife to assess the position. It is relatively simple to assist the rotation of the baby when the mother is in early labor and very difficult once labor becomes advanced.

Brow presentation:These are extremely rare, occurring less than 1% of the time. Passage of a brow through the pelvis is slower, harder, and more traumatic to the mother than any other presentation. Perineal laceration is inevitable andmay extend high into the vaginal fornicesor into the rectum because of the large diameter offered to the outlet. The brow may be adjusted with little effort if found in early or at the beginning of active labor. At this point the adjustment is made manually and is not painful for the mother.

Face presentation: While traumatic, the face presentation may be delivered safely as long as the position is anterior. The posterior face presentation-baby's body toward mother's back-is very difficult if not impossible because the baby's head is forced back upon its shoulders, and the head cannot come into the pelvic outlet. Early diagnosis is imperative to ensure the best outcome. I encountered four face presentations in twenty years of practice.

Uterine atony:If a malpresentation is not discovered or other factors contribute to a long, nonprogressing labor, the uterus resumes with a good outcome if the mother is allowed to rest and labor is not forced to proceed. There have been cases of stalled labors that have been oxytocin augmented without remedying the cause, and they have resulted in uterine rupture. If there is neither malpresentation nor any other contributing factor (or they have been resolved) and the fetus is in no distress, the mother should be allowed to rest as long as necessary. She should be encouraged to eat and drink high carbohydrate, nourishing foods. If she is dehydrated and an IV is not available (or permissible), try giving potassium and electrolyte fluids both orally and by rectum, per enema bag. To stimulate contractions before mother is well rested will only lead to further complications such as the development of constriction rings, fetal distress and third stage difficulties.

Incoordinate uterine action:This phenomenon is rare and difficult to diagnose and is often mistaken for failure to progress or assumed to be false labor. Incoordinate uterine action presents as painful, frequent though irregular contractions that do not cause either effacement or dilation. When this condition is suspected, it is very important for malpresentation or posterior presentation to be ruled out. The diagnosis may be confirmed by the attendant touching the cervix during a contraction and noting no tension of the cervix. The only effective treatment is to stop the contractions and rest the mother for a period of time. When contractions resume spontaneously the condition will be resolved and labor will progress normally.

Maternal exhaustion: It is important that the mother be encouraged to rest and sleep as much as possible in very early labor. If exhaustion has occurred, labor will slow down and inertia and constriction rings may lead to operative intervention.

Maternal hypoglycemia:Hypoglycemia is probably the most frequent cause for slow progress in labor and increasing maternal irritability and difficulty in dealing with contractions. Because of the increased stress of labor, the mother's stores of blood sugar diminish rapidly. It is important for the mother to be fed during labor. Giving fruit juices during labor is not recommended because they may cause hyperacidity, leading to heartburn and vomiting, which will heighten the problem.

Cervical dystocia:Simple failure of the cervix to efface and dilate or abnormal rigidity of the cervix and cervical conglutination are the pathological reasons for cervical dystocia. It may also be caused by scarring from a previous birth or from artificial cervical opening, or from injury to the cervix from operative intervention. It has been shown that nulliparas who have been on the pill for some time may have a rigid cervix.

Cervical adhesions:It is not unusual to find hard spots on the cervix. If the woman does not have condylomas, most often what you are feeling are small cervical scars from previous births or gynecological procedures. The use of instruments for dilating the cervix or delivering the baby often cause small tears to occur, as does pushing babies out prematurely. These adhesions most often will break down during the active phase of labor.

Psychological factors: If there are significant psychological problems that may negatively impact labor and birth, it is important that they are discovered and acted upon before the time of birth. If the mother needs counseling or psychiatric help, the time to get it is before labor begins.

Tight nuchal or short cord:A nuchal cord is present in about one third of all deliveries and usually presents no problems. The issue, therefore, is whether it is able to function in its delivery of blood and oxygen to the fetus during labor and delivery. When there is a deceleration of the fetal heartbeat at about 6 or 7 centimeters, I immediately suspect a tight or short nuchal cord. First, change the mother's position to either hands and knees or to the left-side lie. Nothing should be done to accelerate labor at this point. The cord will stretch if given enough time.

If the cord is not nuchal or shortened, it may be compressed. A good rule with bradycardia is that three separate episodes of decelerations of the fetal heartbeat are definitive of persistent, recurring bradycardia, and if this is the case, the woman should be transported to the hospital.

Compound or nuchal arm:this occurs so frequently that it is considered fairly normal. When all other causes for hang-ups of labor have been eliminated, compound or nuchalarm is likely the cause. The problem may not be discovered until the mother is approaching second stage, and is one reason for her not feeling a pushing urge. She may say she has supra-pubic pain while pushing.

Thoroughly familiarizing yourself with a variety of circumstances that could lead to prolonged labor not only helps you diagnose a condition when it presents, but may make it possible to avoid transport to the hospital. Once we get beyond the standard pronouncement that there is failure to progress, we can take deliberate steps to facilitate a safe, successful delivery without medical intervention.
Source

Postpartum Hemorrhage
The three main keys to avoiding its occurrence are 1) good nutrition and supplements as needed; 2) knowing the mother; and 3) not rushing the delivery of the placenta.

Identifying Hemorrhage
Yawning
Cant catch breathe
Thirsty
Nausea
Pale/Sweaty
Fainting
Respirations rapid and shallow
Collapse & twitching

Treating Hemorrhage
Salt Water
Food
Massage belly open hand with Clary Sage EO
Ice pack on feet
Raise feet above heart
Thumb nail size of maternal side of placenta in mouth, under tongue or cheek
Shepherds Purse *Tincture*

Blood Loss
200-550CC's is normal, 800CC's for prolonged labor.
1 cup = 250CC. C - 1 C normal blood loss
Fainting is not shock, blood loss is individual.
Pulse good gage for PPH, 100
TIP: Get fake blood, measure out 200CC's. Pour it into water, on a chux pad and on a sheet.

More info on PPH
Three Keys to Avoiding Postpartum Hemorrhage
http://midwiferytoday.com/enews/enews0821.asp#main
http://midwiferytoday.com/enews/enews0346.asp
http://midwiferytoday.com/enews/enews0711.asp#main

Newborn CPR & Resuscitation

Surprise Breech

Shoulder Dystocia
Primary risk is brachial plexus injury. Clavicle or radius injury generally heal without a problem.

Risk Factors:
- Large Baby, but most SD occurs in babies under 8 lbs.
- Baby more than 2lbs larger than previous baby
- Diabetic Baby untreated
- Abnormal proportions: malformation, goiter, anencephaly, etc
- History of previous SD is NOT a significant association

Risk Factors NOT associated with SD:
- Obesity
- Post-dates

Associated Risk Factors:
- Malpresentation
- OP
- Maternal Position

Signs of Classic SD:
- Slow descent, (two steps forward, one step back)
- Unusually Slow Crowning
- Mother complain of Symphis Pubis

After Birth of Head:
- Head recoil, cheeks push back into perineum(turtling), or face jams into mom's thighs.
- Failure of restitution

Reasons for Shouder Delay:
- Normal lull in cntx after birth of head
- Weak cntx or weak maternal pushing effort or big baby needing strong pushing effort
- Shoulders have not yet rotated into AP diameter of the outlet. Shoulders have become impacted by provider traction or by uterus malrotation of shoulders at inlet; anterior shoulder trapped. < this is classic shoulder dystocia

Take a BREATH
- Breathe: Stay calm. Panic is dangerous and scares away cntxs (a uterine cntx after cures SD)
- Reassure: Everyone the baby will come in just a moment
- Examine: Where are the arms? Shoulders?
- Asses: Which way must you move the baby?
- Turn: Baby or mother to correct position
- Help: the baby out with gentle correct guidance or traction

Retained Placenta
Normally the placenta will detach within about 20mins, but it may take up to 2hrs.
Herbal Tinctures: Placenta Out
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Old 03-14-2011, 08:58 AM   #5
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Re: UCers? how to prepare

Yeah, we just read and read and read. Lots of Ina May Gaskin and I bought a few midwifery textbooks through Amazon. There are several places online that sell birthing kits, but we didn't use anything in them except the chux pads for after. We never tried checking my dilation or anything. My husband just put on gloves and caught when it was time (though, surprise! Julian was a frank breach).

That said, I am lucky cause my hubby is a paramedic, and I did see an OB through the pregnancy. We just conveniently forgot to show up for the birth. Good thing though, cause we would have had to have a c-section (of course, if my OB had ever bothered to palpate my stomach, she would have known the baby was breach... duh). I had no problem pushing him out, but as soon as my hubby realized what was going on, he asked me to keep pushing even without contractions so we could get him out fast. I still had no tears (thank you, hands and knees position) and LO was just fine, except for some bruising on his hip.
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Old 03-14-2011, 09:37 AM   #6
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Re: UCers? how to prepare

I highly highly highly recommend reading Emergency Childbirth by Dr. Gregory White. Actually, I recommend owning it as well, because it is a great reference to have on hand during the birth in the even that you would need it.

It is written for emergency personnel (like firefighters, police, EMTs, etc) for some basic training in case they need to attend a birth during a natural disaster or riot or whatever. It does a great job of covering all the basics of what to expect and what could go wrong (obviously not every rare obscure thing, but the major things (shoulder dystocia, breech presentation, baby needing resuscitation, hemorrhage, etc.).

It's basic approach is that birth USUALLY takes care of itself, and the best thing for an "attendant" to do is to keep everyone calm and to let the mom's body do its job, only intervening if a problem actually arises.

I also really like The Power of Pleasurable Birth by Laurie Annis Morgan.

The Unnasisted Childbirth book is by Laura Shanley.
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Old 03-14-2011, 03:52 PM   #7
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Re: UCers? how to prepare

*head in hands* I'm screwed. Dh is not a "medical person" and he's my only support. I'm the medical person, having done some nursing classes and working in a hospital, dealing with blood, respiratory issues, etc.
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Old 03-14-2011, 04:23 PM   #8
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Re: UCers? how to prepare

Quote:
Originally Posted by findingstrength View Post
*head in hands* I'm screwed. Dh is not a "medical person" and he's my only support. I'm the medical person, having done some nursing classes and working in a hospital, dealing with blood, respiratory issues, etc.

My dh is not medical at all, I am and the researcher. He has been my support through 7 UC's and will be through our 8th UC in June. He has done brilliantly and he doesn't have to do much. It is less complicated than people think.
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Old 03-14-2011, 08:39 PM   #9
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Re: UCers? how to prepare

This thread has really got me thinking... honestly I've always thought it was CRAZY to UC. Like, seriously nutty. But. The more I read and the more I think about it, the less crazy it seems to me. I just told dh I'm feeling half way tempted to just not back it to the hospital in time.

I wish I had words of advice for you, but I don't! So good luck in doing your research and making your decision. In Oregon, if you're in the third trimester or something crazy like that then a homebirth with a CPM is covered. But if you get your medical card before that, it's not covered. Which is really goofy and crazy and makes no sense.
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Old 03-14-2011, 09:05 PM   #10
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Re: UCers? how to prepare

in illinois homebirth is not covered by a medical card. MW at hospital are....but they are subject to hospital protocol too. i had a MW with #3 because I thought it would be so different.....and it wasn't. she wasn't hands on, she wasn't there with me til after 6pm.....she didn't stay in the room> my HB midwife will be whatever I want, she will be my doula.MW or just witness my process.
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