WHY homebirth anyway

LABOUR Physical signs:What birth companion can do to help Some thinning out (effacement), ripening and possible dilation of the cervix. Anticipation. How you may feel: Exhilaration, like you want to tidy everything, nervousness. How you can help yourself:Prepare everything needed for birth. Make sure you can be reached easily at all times. Physical signs:Increased and stronger Braxton-Hicks contractions. Some self-doubt likely: am I able to cope? Get regular rest and sleep. Take over some household tasks. Baby's head may engage in pelvis. How you may feel: Surge of energy - "nesting". How you can help yourself: Take exercise. Give emotional support. Physical signs:May have "show" - like beginning of period. * How you can help yourself: Gentle massage of nipples will help cervix ripen. If a woman likes it, stoke and play with one nipple at a time to help ripening of the cervix. Physical signs:May have loose bowel motions. May have low backache Physical signs: What birth companion can do to help Cervix is being drawn up and thinned out. Excited. How you may feel: Confident How you can help yourself : Have light meal - e.g., soup., omelette, bread and honey, banana, grapes. If things start slowly, have meal together in relaxing setting (e.g. in garden) or picnic in the country, go out to restaurant or invite friends in. Physical signs: 1-5cm dilation. "Show" if have not had it before.* How you can help yourself: Relax in bath. Choose distracting activity together - e.g., watch film or do light gardening or cooking, invite friends round or go out and visit friends, play Scrabble or cards, walk in country. Physical signs: Contractions get longer, stronger and are at regular intervals, 5 minutes or more apart. They may be like indigestion, cramps, period pains or band of elastic pulling in round lower abdomen. How you can help yourself Alternate rest and activity if daytime. Get some sleep if night time or if you need it. Help her relax. Physical signs: Waters may break with slow leak, or pop so that water streams out. How you can help yourself : Do some cooking which takes a long time - e.g. bread, meringues, slow casserole. What birth companion can do to help: Stay calm, confident, loving. How you can help yourself : Empty bladder every 11/2 hours. Make sure any phone numbers needed are handy, there is money to make calls, and if using car there is petrol in tank. If not sure that this is labour, try completely different activity - e.g., if in bed, get up, and do something,: if up, have rest or watch TV. Help with household tasks. If contractions are big enough not to be able to talk through them, start slow, full breathing. Rub her back or stroke her abdomen. Relax. Physical signs 5-8cm dilation. General sense of everything getting faster and more intense. Go to hospital or birth room if not already there. Help her relax. Contractions get stronger, longer, closer together, till every 2-3 minutes and lasting 60 seconds or more. Feel you want to concentrate on labour. Discuss birth plan with midwife. Use touch, stoking, firm holding, or massage. Waters may go. Get more serious. Focus concentration during contractions. Put cold cloth on her forehead between contractions. How you may feel May become apprehensive, discouraged, impatient, irritated. Drop shoulders and relax as each one starts. How you can help yourself: Rest warm cloth or hot water bottle against lower abdomen, between thighs, over lower back. Physical signs : May feel tired. Welcome each contraction with slow breath out. Offer iced water and ice-chips. How you may feel: May feel trapped. Breathe more lightly if you need to over peak of contraction. Breathe with her if this helps. May vomit. Give long breath out as contraction finishes. For backache: use strong counter-pressure, ice-wrapped in cloth, or hot towel. Help her change position to leaning forward. Doze between contractions and relax completely. Help her move and walk around. Use aerosol water-spray or small plant spray to freshen up. Move around and change position as often as wished. Empty bladder every 11/2 hours. Suck ice-chips, sip liquid or suck on sponge. For backache, hands and knees position, walking, side-lying, kneeling or sitting forward. Late first stage Physical signs: 5-8cm dilation. General sense of everything getting faster and more intense. Go to hospital or birth room if not already there. What birth companion can do to help :Help her relax. Physical signs: Contractions get stronger, longer, closer together, till every 2-3 minutes and lasting 60 seconds or more. Feel you want to concentrate on labour. How you can help yourself : Discuss birth plan with midwife. Use touch, stoking, firm holding, or massage. Waters may go. Get more serious. Focus concentration during contractions. What birth companion can do to help :Put cold cloth on her forehead between contractions. How you may feel :May become apprehensive, discouraged, impatient, irritated. How you can help yourself: Drop shoulders and relax as each one starts. Rest warm cloth or hot water bottle against lower abdomen, between thighs, over lower back. How you may feel :May feel tired. Welcome each contraction with slow breath out. Offer iced water and ice-chips. May feel trapped. Breathe more lightly if you need to over peak of contraction. What birth companion can do to help :Breathe with her if this helps. Physical signs: May vomit. Give long breath out as contraction finishes. For backache: use strong counter-pressure, ice-wrapped in cloth, or hot towel. What birth companion can do to help :Help her change position to leaning forward. How you can help yourself : Doze between contractions and relax completely. What birth companion can do to help :Help her move and walk around. Use aerosol water-spray or small plant spray to freshen up. Move around and change position as often as wished. Empty bladder every 11/2 hours. Suck ice-chips, sip liquid or suck on sponge. For backache, hands and knees position, walking, side-lying, kneeling or sitting forward. Transition: bridge between first and second stages Physical signs How you may feel How you can help yourself What birth companion can do to help 8-10 cm dilated. As if tossed in a storm at sea. Welcome each contraction with a long, slow breath out. Then breathe as lightly and quickly as you want to. Stay with her. You are an anchor in a stormy sea. Contractions powerful, every 11/2 - 2 minutes and lasting 90 seconds, or almost continuous. Restless, increased irritability, sense of time lost. Concentrate on one contraction at a time. That particular one will never come back again. Remind her that transition though intense, is short. Some contractions may have double peaks. May not want to be touched. Relax buttocks and pelvic floor like heavy hammock. Give her information. Remind her of baby, signs of progress, "not long now." Concentrated pain around cervix as final tissue is pulled up over baby's head and baby is pressed down through cervix. Relax buttocks and pelvic floor like heavy hammock. Walk around, change position for comfort. Encourage and reassure her. Cramp in legs. May be forgetful and even forget you are having a baby. Use any rest times for complete relaxation. Speak simply and clearly. Feel hot -then cold -then hot. Find it difficult to relax completely and keep breathing rhythms. Blow out if feel urge to push and attendant says not to push. Be responsive to her mood. Cold feet. May want to give up. Breathe with her if this helps. Drowsiness. May be frightened because everything is overwhelming. Maintain peaceful atmosphere. Shaking. May feel urge to push. Give hot water bottle between legs, at feet, in small of back, or she may prefer ice in towel for back pain. Flushed face. May fall asleep between contractions Help her change position. She may get stuck and uncomfortable in one position. Hiccups, catch in throat, belching, involuntarily holding breath, grunting, groaning on breath out at end of contraction - all signs of pushing urge. She may appreciate massage, stroking, firm holding, having her back rubbed. If she is shaking, firm massage of inner thighs may help. Use whole palm of hand, fingers pointing down, and massage form tops of inside legs to knees, stoking back lightly over tops of legs, keeping continuous rhythmic movement. Waters may go if they have not gone before. Offer sips of iced water and ice-chips, Vaseline or lip salve for lips. May begin to feel pressure against rectum. She may like a sponge-down with cool water. "Rest and be thankful" interval Physical signs How you may feel How you can help yourself What birth companion can do to help Full dilation. Sense of peace. Rest. Relax. Contractions often become weak or fade away for about 20 minutes, sometimes longer. Anxiety because no contractions felt if told to start pushing. Close eyes. Enjoy lull. Wait patiently. Brush her hair back from her face, offer cologne, and freshen her up for pushing. Reassure her that all is well. Give encouragement. Play soft, relaxing music. A shower may feel good. Second stage Physical signs How you may feel How you can help yourself What birth companion can do to help Urge to push gets stronger as the baby comes lower. Contractions may be further apart. Degree and timing of pushing urge may vary with contraction. Cheerful, excited. Right time to push is when you want to; you should push only as and when your body tells you to; hold breathe only as long as you need to. Encourage her by saying, "Open up, " and " Good, " - not "Push, " - with contractions. 1-4 urges, coming in waves, during each contraction. Amazed at power of pushing urge, as if you are being pushed rather than pushing. Do whatever you feel like doing. Rest hot cloth over anus and perineum if she finds it helps her relax pelvic floor muscles. A little blood may appear when pushing: may have small bowel movement. May feel very tired and doze between contractions. Completely absorbed in what you are doing and not concerned about surroundings. Change position often for comfort; try kneeling, crouching, squatting, on all fours supported standing, squat. Help her change position so that upper part of body is well raised. Position in which she is most comfortable is right. Feels as if grapefruit in anus - then this changes to tingling, stretching, heat around vagina as head presses against perineum. Renewed determination as you see and feel baby's head. Burst of energy. Relax perineum, buttocks, legs. If progress is slow, help her squat. Support her physically in different positions: standing, kneeling, or sitting behind her so that her back is supported. Crowning. Feeling of heat builds up until it is like "ring of fire" around baby's head. Touch top of baby's head before it is born. Sponge her with cold water between contractions; offer ice-chips. Birth of baby's head - then whole body slips out. Interest turns to baby. Breathe out baby. Remind her to open eyes to see birth. Feel cannot stretch any more without popping. Put hands down to feel whole head when it has slid out. Tell her when head can be seen. Relief - astonishment - joy

Fact Sheet: The Safety of Homebirth Myth: Home birth is so dangerous that it should be considered child abuse. Reality: "There is no evidence to support the claim that the safest policy is for all women to give birth in the hospital...There is some evidence ...that morbidity is higher amongst mothers and babies delivered and cared for in institutional facilities in general and ... obstetric units in particular. -- Campbell and Macfarlane 1986 "Raw data, such as birth certificates, give an inaccurate picture of the risks of home birth because they include a large proportion of unplanned home births and births without a trained attendant, both situations carrying extremely high risk." (Goer) 6,8,10,12,13 "No study of planned home births of a screened population of women with a trained attendant taking proper precautions has shown excess risk." (Goer) 1-25 "Because unexpected problems arise even within a screened population, those planning home birth should have appropriate backup arrangements with an obstetrician and a hospital. Home birth attendants should have the skills to monitor the labor and the baby and the skills, equipment, and medication to manage or stabilize emergencies such as a baby who does not breathe spontaneously or a mother who hemorrhages after birth." (Goer) 1,2,4,6,8,11 "Home birth becomes dangerous only when doctors and hospitals fail to provide backup services." (Goer) 1,2,3-6 "Excellent outcomes with much lower intervention rates are achieved at home births. This may be because the overuse of interventions in hospital births introduces risks or the home environment promotes problem-free labors." (Goer) 1-11 "To prevent unnecessary postpartum hospital transfers, the attendant should be able to repair perineal lacerations and to perform and repair an episiotomy." (Goer) 4 REFERENCES Treffers PE and Laan R. Regional perinatal mortality and regional hospitalization at delivery in the Netherlands. Br J Obstet Gynaecol 1986; 93(7):690-693. Ford C et al. Outcome of planned home births in an inner city practice. BMJ 1991; 303(6816):1517-1519. Mehl L et al. Outcomes of elective home births: a series of 1146 cases. J Reprod Med 19(5):281-290. 1977. Sullivan DA, Beeman R. Four years' experience with home birth by licensed midwives in Arizona. Am J Public Health 73(6):641-645. 1983. Koehler N et al. Outcomes of a rural Sonoma County home birth practice: 1976-1982. Birth 11(3):165-169, 1984. Hinds MW et al. Neonatal outcome on planned vs. unplanned out-of-hospital births in Kentucky. JAMA 253(11):1578-82, 1985. Janssen PA et al. Licensed midwife-attended, out-of-hospital births in Washington State: are they safe? Birth 1994; 21(3):141-8. Burnett CA et al. Home delivery and neonatal mortality in North Carolina. JAMA 244(24):2741-2745. 1980. Durand AM. The safety of home birth: the Farm study. Am J Public Health 1992; 82(3):450-3. Schramm WF et al. Neonatal mortality in Missouri home births. Am J Public Health 1987; 77(8):930-935. Tyson H. Outcomes of 1001 Midwife-attended home births in Toronto, 1983-1988. Birth 1991; 18(1):14-19. Campbell R and MacFarlane A. Place of delivery: a review. Br J Obstet Gynaecol 1986; 93(7):675-683. Murphy JF et al. Planned and unplanned deliveries at home: implications of a changing ratio. Br Med J 1984; 288(6428):1429-1431. Goer H. Obstetric Myths Versus Research Realities. Bergin-Garvey, 1995. Eskes TK. Home deliveries in the Netherlands -- perinatal mortality and morbidity. Int J Gynaecol Obstet 1992; 38(3): 161-169. Tew M. Place of birth and perinatal mortality. J R Coll Gen Pract 1985; 35(277):390-394. Campbell R et al. Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery. Br Med J 1984; 289(6447):721 -724. Damstra-Wijmenga SM. Home confinement: the positive results in Holland. J R Coll Gen Pract 1984; 34(265):425-430. Wood LAC. Obstetric retrospect. J R Coll Gen Pract 1981; 31:80-90. Shearer JM. Five year prospective survey of risk of booking for a home birth in Essex. Br Med J 1985; 291(6507): 1478-1480. Howe KA. Home births in south-west Australia. Med J Aust 1988; 149(6):296-302. Crotty M et al. Planned homebirths in South Australia, 1976-1987. Med J Aust 1990; 153:664-671. Woodcock HC et al. Planned homebirths in western Australia 1981-1987: a descriptive study. Med J Aust 1990; 153:672-678. Anderson R and Greener D. A descriptive analysis of home births attended by CNMs in two nurse-midwifery services. J Nurse Midwifery 1991; 36(2):95-103.