Do midwives carry medications that would prevent me from bleeding too much?
The definition of a hemorrhage during a normal vaginal birth, is blood loss of more than 2 cups in the first few hours after birth, or more than 4 cups within the first 24 hours afterwards.
This is a good question to ask a midwife you want to hire because the answer is, it depends.
The definition of a hemorrhage during a normal vaginal birth, is blood loss of more than 2 cups in the first few hours after birth, or more than 4 cups within the first 24 hours afterwards.
There are the 3 types of medications typically used for postpartum hemorrhage in out-of-hospital settings. These are:
Synthetic oxytocin AKA pitocin.
Pitocin can be administrated in IV form or intramuscularly, as a shot in the thigh. In out-of-hospital settings pitocin is more often given via a shot. Pitocin works quickly to control bleeding but does not last longer than 10 minutes, so it may have to be repeated, if the bleeding is not controlled by then. It doesn’t have significant negative side effects, although there have been some studies that show it slightly delays milk production, and is correlated with slightly increased rates of postpartum mood disorders.
Misoprostol AKA cytotec
Cytotec works really well to cause contractions of the uterus to slow a hemorrhage. It also has the negative side effect of causing a potential fever and loose stools. It comes in pill form and is either given to the mom orally to chew up and put in her cheek or under her tongue, or it is administered rectally.
Methylergonovine Maleate AKA Methergine
Methergine cannot be given to women who have high blood pressure. It is administered orally in pill form, or intramuscularly via a shot in the leg. It works well to contract the lower segment of the uterus. Methergine has several negative side effects, including loose stools, lowered breastmilk production, changes in blood pressure, and nausea.
Choosing the right medication:
For most midwives I know who carry medications, they choose to use pitocin first as a medication during a postpartum hemorrhage. If the pitocin doesn’t work, they will usually repeat with a second dose of pitocin, or administer cytotec, or both, depending upon the severity. Midwives usually use methergine for too much bleeding that occurs several hours after birth or if the mother doesn’t respond well to other therapies.
So ask your midwife, does she carry medications to prevent too much bleeding? If so, which ones? What is her usual guideline for controlling and preventing too much bleeding? The answer depends upon the individual midwife and the locality she practices in.
What to do and what NOT to do if you're exploring home birth as a first time mom!
Women who come from families where natural birth is the norm tend to have straightforward natural births. Why? Because they’ve been thinking about birth as normal their entire lives. Some of us have to work hard during pregnancy to undo all the subtle messages we’ve been told-that our bodies don’t work well or we just aren’t strong enough.
So you’re interested in having a home birth, but not sure if it’s a good idea since you haven’t had a baby before? Trying to decide if you’re crazy, dumb, or doing the right thing?
How do you decide?
First of all, you’re courageous to ask questions and seek out answers! You could have just signed up with the local ob group at your closest hospital, not knowing anything about them. But you are brave, you educate yourself about your options.
Here’s some things to keep in mind as you decide what’s best for you and your family:
-Remember you Remember
Your birth story will be with you for the rest of your life (Simpkin, 1991)! Set yourself up for a good one. Think about where you feel safe and who you feel safe with. What things do you like? What makes you feel comfortable? How do you want to remember your experience?
Sometimes finances come into play when deciding who to use as a care provider. Keep the long term in mind as you decide who to hire. If you really want to have a home birth, but aren’t sure you want to spend the money on it, think, “What would I think of this decision I made 10 years from now?” You won’t regret spending money on the experience you want!
-Discover your overarching goal
Planning a home birth means you have a high chance of having a natural vaginal delivery and a low chance of having a cesarean. You have a low rate of interventions and a high rate of breastfeeding success. For a first time mom planning a home birth, compared to a mom who has had babies before, you have a higher chance of deciding to go in for pain relief or needing to go to the hospital for better monitoring or IV fluids. Research transfer rates for first time moms (or ask midwives). Compare cesarean rates for first time moms at local hospitals. Many hospitals have a first time mom cesarean rate close to 50%!!!
What’s your overarching goal? Is it breastfeeding success? A natural or vaginal delivery with as few interventions as possible? To give birth in a place you feel safe? Is it worth the risk to plan a home birth and know you may transfer to a hospital? Is it worth it to plan for a natural hospital delivery, and know you may have a much higher chance of having a cesarean? These are questions you can only answer for yourself, but keeping in mind you will remember it, and surrounding yourself with positive people will help guide you.
-Don’t be Afraid to Change Plans
The process of pregnancy, birth, and parenting, is a journey. At the beginning of your pregnancy you may want your best friends, mom, husband, and doula there. As things get closer to your due date, you may realize you just want it to be your partner and doula. It’s okay to change plans last minute! It’s better to switch care providers at the end than to stay with one who is going to push unnecessary interventions upon you.
When women get close to giving birth, they enter a deeply primal state. They crave darkness, warmth, quiet, and a place of safety. These are necessary for the cascade of hormones that promote physiological birth. They are harder to create in certain environments. At the end of pregnancy and in labor, women become instinctual. Listen to that instinct.
-Pursue Positive People
My biggest piece of advice to first time parents who want to have a natural birth is to surround yourself with positive birth stories. Women who come from families where natural birth is the norm tend to have straightforward natural births. Why? Because they’ve been thinking about birth as normal their entire lives. Some of us have to work hard during pregnancy to undo all the subtle messages we’ve been told-that our bodies don’t work well or we just aren’t strong enough.
“Ina May’s Guide to Childbirth”, “Spiritual Midwifery”, “Everyday Birth Magazine”, and “Birth Without Fear” are some great resources for good stories. Find your friends and family who have had natural or positive births and listen to their stories. Go to a local ICAN meeting or find a local home birth support group. In Cincinnati we have both the Home Birth Circle group on Facebook and the Home Birth Collaborative (http://cincinnatihomebirthcollaborative.com/) . The Home Birth Collaborative holds monthly meetings where home birth families share experiences with potential home birthers.
Stay clear of naysayers. I’m talking about care providers too! If your care provider is speaking negatively to you about your ability to give birth, or says that you should be induced because your baby might be too big, run! “There’s such thing as induction police!”
References:
Simkin, P (1991). Just another day in a woman’s life? Women’s long term perceptions of their
first birth, pt 1. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/1764149
5 Things You Didn’t Know You Need for Home Birth
“Dehydration and electrolyte imbalance can cause uncoordinated uterine contractions and lead to a longer, more painful labor. “
Utility bill
A copy of your ID and proof of address
1. Copy of your ID and proof of address.
When midwives go to file the birth certificate, the health department needs to see a proof of residence. If you move late in pregnancy, it may be a good idea to visit the Bureau of Motor Vehicles to update your license before you have the baby.
2. Depends.
Did you know they now make them in a variety of fun colors? They used to only be available in peach or lavender. Depends are great for the first 24 to 48 hours when your lochia (that’s the word for the normal postpartum bleeding that occurs as the endometrium sheds and the placental site heals) is like a heavy period. The great thing about Depends is you don’t have to worry about extra laundry. Plus, depends have better back protection than heavy duty pads so you don’t have to worry about soiling your sheets when you are snuggling in bed with your baby.
Toilet paper…
3. Extra toilet paper.
If you’re having a home birth, chances are good you’ve hired a midwife and her team, who will be with you in your house from when you go into active labor, until a few hours after the baby is born. Your body will also be making room for a baby to come out, so trips to the bathroom are frequent. It’s important to have extra toilet paper on hand!
Epsom salts or liquid calcium magnesium.
Dehydration and electrolyte imbalance can cause uncoordinated uterine contractions and lead to a longer, more painful labor.
4. Epsom Salts or Liquid Calcium Magnesium.
Magnesium deficiency can cause leg cramps and lots of Braxton Hicks contractions. It’s helpful to have epsom salts on hand for a soak in the tub if you aren’t sure whether you’re really in labor. You can find epsom salts in the pharmacy section of the grocery store or in any pharmacy. It’s also helpful to have liquid calcium-magnesium around at the end of pregnancy, in case you have leg cramps or are having a lot of uncomfortable contractions which are making it difficult to sleep. My favorite brand of liquid calcium-magnesium is Integrative Therapeutics, which you can find on Amazon
5. A Sense of humor
Whether it’s because you are trying to prevent your four-year-old from drinking the birth pool water, or need to laugh as you put on the “one-size-fits-none-victoria’s-secret-special” stretchy panties, this part is crucial. Humor is also a great way to encourage labor and can help you cope when you’re past your due date and not sure if you are EVER going to have the baby.
Need an idea for some laughs? Check out Jim Gaffigan’s Mr Universe here
What items did you find unexpectedly helpful for your home birth?
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