What’s So Great About Home Birth?

Moving her hips helped Noah dilate faster. Copyright image courtesy Joanna Boles Whitlow, used with permission. All rights reserved.

Moving her hips on the birthing ball helped Noah dilate faster. Copyright image courtesy Joanna Boles Whitlow, used with permission. All rights reserved.

When Noah  found out she was pregnant with her first baby at 21 years old, she was afraid to tell her mom. It hadn’t been easy since she left home to live with Aaron, her artist boyfriend. Noah was a talented artist too, and moderately successful with her own tie-dye business.

A baby was going to bring some big changes. To prepare, Aaron got a job in a woodshop and asked his family to help pay for a home birth, since it wasn’t covered by their insurance.

Home Birth With a Midwife Equals Individual Care and the Freedom to Move

Noah went to an obstetrician to confirm the pregnancy. She didn’t like the abrupt visit and the way her due date was changed to match an ultrasound, even though she positively knew the exact date that her last period began— she and Aaron had been participating in a local art show.

Prenatal Visits With a Midwife Last an Average of 45 Minutes

Noah decided to confide in her aunt, who put her in touch with me, a licensed midwife. I have a small home birth practice and also work in a Comprehensive Perinatal Care (CPSP) clinic; I saw Noah there.

Noah’s prenatal care with me followed a routine schedule, but at each visit there was plenty of time to ask questions or discuss concerns. Noah made some nutritional changes based on my advice; we went over how she could increase mineral rich, high-protein, high fiber foods and healthy fats.


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We talked about what tests Noah needed to undergo and why they were an important part of prenatal care, along with any drawbacks they might have for her or her baby. Noah’s blood pressure and her weight gain were normal, and she continued with a reasonable fitness program. At 33 weeks the baby was positioned butt first, or breech.

The Mother’s Pelvis is Roomier than the Top of Her Uterus

The majority of babies turn head down by 34 weeks; it is more comfortable for them. Noah had weekly ultrasounds and her little one was still in a breech position at 35 weeks. Although this presentation is up and down, or longitudinal, and therefore may be considered a variation of normal, problems can occur and it is not within my current scope of practice for home birth. If the baby did not turn, Noah’s birth plans would need to change.

Noah, Aaron and I reviewed some strategies that some think will encourage breech babies to turn, such as lying head down on a slantboard or doing handstands in a swimming pool to move baby’s bottom out of the pelvis to facilitate turning.

Visits to a chiropractor, hypnotherapist or acupuncturist experienced in treating pregnancy complaints are all associated with improved outcomes, according to a research review conducted by J.S. Cohain and published in 2007 by MIDIRS Midwifery Digest.

Aaron painted this portrait of his son in a head down position. Copyright image courtesy of Aaron Hansen, used with permission. All rights reserved.

Aaron painted this portrait of his son in a head down position. Copyright image courtesy of Aaron Hansen, used with permission. All rights reserved.

Communicating With the Baby May Be Key

Playing music or a placing a flashlight near Noah’s lower stomach might encourage movement in that direction. Another traditional remedy involves having the mother look at diagrams of head-down babies until her unborn gets the message.

I felt Noah might be interested in trying that method, but it was Aaron who ran with the idea! He painted a beautiful portrait of his infant son in a head-down position, using an ultrasound for reference. The painting hung where Noah would see it often – and at 36 weeks, the baby did turn!

When I interviewed Aaron for this article, he told me, “The idea to do this painting was after you had suggested we have a photo of a baby upside down. Noah and the baby took a nap and I painted this, I think them being in the state of sleep helped us all communicate this message to each other. You also suggested choosing a name for him and we gave the name “Yeshua” to our son and said if you like it turn head down, if not we will try again. The following ultrasound he was head down!”

There was only one remaining problem: Noah’s baby was facing forward. While not a block to home birth, posterior or “sunnyside up,” presentation may cause a long, drawn out labor and persistent backache, especially for first time moms.

Aaron with Noah laboring on the birth ball. Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

Aaron with Noah laboring on the birth ball. Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

Mothers Can Handle the Contractions But May Get Very, Very Tired

The best remedy is for Mom to assume forward leaning postures to encourage the baby’s heavier backbone to come around front. I advised Noah to get down on her hands and knees to scrub the floors or crawl around with the pets. Swimming laps is another option, as is prenatal yoga. Noah needed to avoid recliner chairs and bucket seats found in many cars.

Contractions Work to Turn These Babies More Readily if Mom Can be Upright and Move Her Hips in Labor

Many hospitals do encourage walking in early labor but switch to confinement to bed as labor becomes more active. Noah wanted the freedom of movement throughout labor and delivery that a home birth allowed.

One week after her original due date, at 3:00 pm, Noah began having contractions every 15 minutes. They lasted 30 to 45 seconds. She walked, climbed onto her bed or sat and swayed on a yoga ball.

By 7:00 pm Noah was in active labor, with contractions lasting 60 seconds and coming regularly two minutes apart. She drank red raspberry leaf herbal tea, a pregnancy and labor tonic that I recommend, and emptied her bladder every hour. By 10:30 she had dilated to 4 to 5 centimeters. Fetal heart tones monitored at regular intervals indicated her baby was doing well.

At 11:00pm Noah was walking outside with Aaron to view the starry night. Noah said she felt the breeze caress her and felt her oneness with nature. She was confident and relaxed between contractions. During pains she sometimes used long, slow, deep breaths and moved her hips. Other times she pumped her knees up and down or even jogged through contractions. She said moving definitely helped her handle the pain. Aaron had a tough time keeping up with her!

Around midnight Noah let her doula, or professional labor coach, help her climb into a jacuzzi tub. With the  jets turned off, it gave her some welcome relief.

Warm Water Aids Relaxation

Relaxation allows for faster progress in labor with less pain. Similar to the effects of narcotic drugs, warm water can even slow down or stop contractions when used too early, before labor is well established.

At 2 am Noah was walking again, and at 3am her water broke. The liquid was clear and the baby’s heartbeat showed no signs of distress.

Noah relaxes in the tub. Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

Noah relaxes in the tub. Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

At 5 am Noah was dilated to 7 centimeters. She was on and off the kingsized bed, in and out the door, swaying in Aaron’s arms or jogging down the driveway. She was working hard, resting well between contractions, but no longer making much conversation. At 6am she vomited, an event that I think is nature’s way of moving the baby downward when labor is nearing transition.

It was 7am when Noah got back into the tub of warm water. Fetal heart tones were assessed using my underwater doppler. Even though her I had been frequently monitoring for any signs of trouble, Noah barely noticed the intrusion.

By 8am Noah’s own body was providing her with an endorphin, or natural pain killer, effect. She was falling asleep between contractions. Aaron and the doula whispered encouragement to Noah each time the pain roused her. At 8:20 I checked and found Noah’s cervix completely dilated. At 8:33 she started pushing her son into the world.

 Birth In The Squatting Position Makes Physiological Sense

Pushing hard for an hour or more is not unusual for first time moms, especially if the baby still needs to rotate. But Noah’s constant activity had done the trick; she was now squatting, relying on gravity, warm water and her own efforts. Squatting increases the diameter of the pelvis 28%, or 1 cm, according to textbooks such as Maternal, Fetal, & Neonatal Physiology by Susan Blackburn.

Eight and a half pound baby boy Yeshua arrived and was greeted by his parents at 8:47pm. Noah had been in active labor for approximately 13 hours, considerably less than the 16 to 24 hour average for first time moms. Yeshua was nursing well within minutes.

Just Waiting Five or Ten Minutes to Clamp the Cord has Benefits for Babies

Noah"s baby is still receiving oxygen from the cord. Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

Noah”s baby is still receiving oxygen from the cord. Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

Umbilical cord clamping was delayed until 9:10am and the placenta delivered spontaneously ten minutes later. A Cochran Review conducted in 2013 found that infants who had their umbilical cord clamped early, within seconds after birth, were more than twice as likely to have iron deficiency at three to six months of age than newborns whose cord clamping was delayed.

 Encapsulation Includes Steaming, Drying and Grinding the Afterbirth

Noah and Aaron admired their infant during the newborn exam and I showed them the placenta, which their doula took for encapsulation. The hormone-rich organ will be powdered and put into capsules. Although the FDA has not evaluated any claims and there are no scientifically controlled studies, mothers use placenta pills as a traditional remedy to prevent post partum depression.

I gave the baby vitamin k by mouth since the Aaron and Noah chose this administration method over an injection. We had discussed possible risks and benefits much earlier in their  pregnancy. Noah also declined to have me put antibiotic medicine in the baby’s eyes, a routine in hospitals. I carry the ointment but most of my home birth parents exercise their right to refuse it.

It's an eight pound eight ounce boy! Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

It’s an eight pound eight ounce boy! Copyright image courtesy of Joanna Boles Whitlow, used with permission. All rights reserved.

Noah had a lot of support from her aunt, her doula and me, her midwife. She was as successful at breastfeeding as she was at giving birth.

Yeshua gained weight rapidly. The couple is still doing well and they keep in touch with me. Being part of so many young families’ lives is my favorite part of being a midwife.

Home Birth Was Best For This Family

Noah believed a home birth was best for her and her family. Her decision led her to acquire information about comfort measures including warm water and position changes that would facilitate her goal of an effective, unmedicated labor.

Noah and Aaron then made more informed choices regarding the care of their newborn; they are becoming confident parents who have developed a wide network of support.

 

Resources:

Cohain, JS. Turning Breech Babies after 34 weeks: a review. (2007).  Midwifery Today Int Midwife. Accessed on February 01, 2015

Simpson, M, et al. Raspberry leaf in pregnancy: its safety and efficacy in labor. (2001). J Midwifery Womens Health. Accessed on February 01, 2015

Blackburn, Susan. Maternal, Fetal, & Neonatal Physiology. (2014). Elsevier Health Sciences. Accessed on February 01, 2015

McDonald, SJ. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. (2013). Cochrane Database Syst Rev. . Accessed on February 01, 2015

© Copyright 2015 Mary Earhart: Pregnancy, Childbirth, All rights Reserved. Written For: Decoded Pregnancy
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