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Tuesday, April 6, 2010

Home Childbirth from a Prepper's Point of View, by Ranger Squirrel

I'll discuss bringing someone into the world the old-fashioned way. I realize that as a man I may not be considered by some readers to be the most qualified person to write this post - but hear me out.  I have four kids, all four of which I've helped to deliver, the last two of which were done at home, three of which were assisted by midwives, and one of which was done without any assistance at all.  I’ve also had EMT training, including classes on emergency childbirth.  Nothing in this article, however, is medical advice.  If you need medical assistance, you should seek a doctor.  What I’m trying to do by writing this is help you to prepare for a pregnancy and birth in such a way that you have options.

Essentially, survival is a mindset and prepping is a lifestyle.  Both will be affected by a pregnancy.  This article is meant to be a guide for the father in a prepper household, though others should benefit as well. 

Part I - Pregnancy

The first consideration is pregnancy itself.  You must approach pregnancy from the right perspective.  A normal pregnancy is not an illness.  It's not a disease.  It's a normal process - and a beautiful one at that.  If you can keep this in mind, you'll be a lot better off.

Medical Care During Pregnancy

Do you need a doctor during the pregnancy?  I feel that pre-natal care, if it's available, is a must.  That doesn't, however, automatically require a physician.  If the pregnant woman is otherwise healthy and you have access to a midwife, I think midwives are the better route.  Doctors are trained to treat illnesses, midwives are trained to help grow and birth babies.  Plus, quite frankly, midwives usually know a lot more about pregnancy and childbirth than most doctors.  Besides, you don't go to a mechanic to buy a car; you don't go to a veterinarian to buy a dog - why would you go to a healer to have your baby?  Much of the care given during pregnancy is about alleviating the concerns and fears of the mother.  In the end, midwives are usually better at that part too.

Food Preps

Mommy and baby need good, nutritious foods from wholesome sources.  Whole grains, proteins, vegetables, and fruits.  Dairy isn't a bad option either.  Lots of water.  Eggs, containing everything needed to sustain life, are wonderful things.  A 10-15% increase in your prep supply for all of these things for the pregnant person will be more than sufficient.  You also need a good supply of small, healthy snacks - I've never seen anything that works better for staving off morning sickness than regular, healthy snacking.  A hungry pregnant woman is likely a nauseous and/or cranky pregnant woman.  Pay particular attention to what types of things she's craving - they can indicate where her dietary needs are not being met.

Medical Preps & Supplies

Vitamins: a good supply of pre-natal vitamins and probably an iron supplement.  Get a few different types of morning sickness.  Prenatal vitamins can increase morning sickness, but many women eventually find a brand that doesn’t make them sick.  Most people agree that the benefits of taking a prenatal vitamin make it worth the nausea. The iron will help with a lot of things, not the least of which is slowing the bleeding after the birth.  You need a supply of both sufficient to last her through the duration of the pregnancy.
You also need to go ahead and purchase everything mentioned in the Childbirth section of this article.
Remember, you don't need to worry about the baby - you need to worry about the woman.  Her body will take care of the baby as long as you help her take care of herself.

Books

There are a few books I recommend for the pregnancy.  One is Husband-Coached Childbirth , which is the manual used by the teachers of "The Bradley Method" of childbirth.  The Bradley principle is a sound one and the book is great.  Dr. Bradley was an old farm doctor and he basically said, "Animals know what they're doing during birth, humans are animals, let's imitate animals."  My wife and I took Bradley classes and she later became a Bradley instructor.  It's a method I know and trust and I’ve seen it work four times for my family and countless other times for other families. 

The second book is The Expectant Father.  Most books for Dads-to-be take one of two forms - a) they try to be funny and don't give out much information; or b) they try to be clinical and don't offer much comfort.  This book, on the other hand, is both entertaining and full of information

The third book I recommend is Emergency Childbirth: A Manual.. Yes, I’m aware that book was published in 1958.  Shockingly, the process hasn’t really changed much since then.  Read this book.  Read it again.  Get another copy and keep it in the glove box.  Put the other one with your birthing supplies.

You may want to pick up a book or two that deal with what types of medications and/or herbs can be consumed or should be avoided by a pregnant woman.  I don't have a good source to recommend here - but you can search Amazon.com and find several.  Your midwife or OB can usually recommend a good one too.  As a rule of thumb, if she can avoid taking it, she probably should.  Don’t get sucked in by labels with words like “natural” or “organic.”  That has nothing to do with safety for the baby.  Remember, hemlock is an herb.  That doesn't mean it's safe for baby. 

Clothing

Physical comfort:  From a clothing standpoint, have the mother-to-be spend some time talking to someone at a maternity store about how best to prepare for the changes that are coming.  Every woman is different, every pregnancy is different.  My wife typically looks like she's carrying a basketball by the time she's 4-1/2 months pregnant.  Other women barely show at 9 months.  The tendency, from a male standpoint, is to buy sweats or something similar.  It's practical and cheap.  If the pregnant woman is someone whose moods are adversely affected by wearing “frumpy” clothes, you may want to reconsider this approach.  If she's not, you may still want to reconsider.  Maternity clothing is cheaply made and overpriced as a rule.  That said, the nicer stuff can help her feel beautiful - which, I've learned in 10 years, is extremely important.  This really should be her decision and her opinions are not to be taken lightly.  Of particular importance: bra and underwear. 

Bedding & Other Odds & Ends

  • Pillows.  Lots and lots of pillows. 
  • Some extra sheets. 
  • A waterproof mattress cover. 
  • Many women find a yoga/pilates ball exceptionally comfortable in late pregnancy (and even during labor).
Emotional Comfort:
Your otherwise sane and logical spouse/girlfriend will have moments of completely irrational insanity.  You are never to tell her she is having one of those moments.  Just be reassuring, comforting, and patient.  She needs your support.
Most of the time, she needs you to listen - not to problem solve.  Offer comfort, but don’t jump immediately into finding solutions.  For example, if her problem is fear, the answers could be 1) you need to be her rock; 2) she needs to educate herself; or 3) you need to simply say some soothing words. It could also be all three or none of these things.
So what do you do?  First of all, stop feeling sorry for yourself.  She didn't get this way all alone and you aren't the one whose body is changing so quickly that it's full of aches and pains and whose hormones make it tough to think clearly.  You aren't the one who is about to squeeze something the size of a watermelon through an opening the size of a lemon.  Imagine what she's going through.  Second - listen to what she's saying and watch what she's doing.  If she's talking about fear and clinging to you physically, she needs you to be strong and soothing.  If she's asking lots of questions, she needs you to be strong, soothing, and work with her to educate her (and yourself) about the process.  Common threads: listen, man up and soothe her.  Offer solutions if she's asking.  A foot rub or back rub will go a long way.  If all of that fails, toss her bite size pieces of chocolate and back away slowly.  When safe and practical, grab a beer with the guys and complain – just make sure you’re out of earshot.
Men also tend to get focused on two things during pregnancy: work and money.  This is how we prepare the nest.  That's fine, just realize what you're doing and make sure you're meeting her needs as well.

Sex

I’ve sat through dozens of pregnancy classes with my wife, both as a student and a co-instructor.  This question always comes up, so let me address it.  Yes, you can have sex during pregnancy.  No, it won't hurt the baby.  Yes, it still feels good for you and your partner.  Yes, she's likely to still have a sex drive.  Spooning works best, but you’ll figure that out.

Final Thoughts on Doctors & Pregnancy

I have nothing against medical doctors.  If I get hit by a car, please take me to the emergency room.  But Doctors treat illnesses and injuries.  Pregnancy is neither.
While I strongly recommend against doctors for a normal healthy pregnancy, nothing I've said in this article is a recommendation for unassisted birth or for not getting prenatal care.  I've done births unassisted and assisted, and I much prefer the assisted kind.  Just in case.  Again, pre-natal care, if available is a must in my opinion.
If there are any complications with the pregnancy, involving a doctor where necessary is of course the right thing to do.

Part II - Childbirth

Warning: I'm not embarrassed by bodily functions and I'm not grossed out by birth.  If you are, then stop reading now - unless you're an expectant father - in which case, suck it up you wuss - you need to know this stuff!
Medical Care during Childbirth
First rule: if she wants medical care - you get some. 
Second rule: If the pregnancy has been abnormal, you need medical assistance.
Third rule: Trust Your Gut.  If something seems “wrong” get help.
Other than those three rules, do you need a doctor during the childbirth? If everything is normal, then no.  In fact, when my wife teaches birth classes, I often sit in.  Many of her clients are second time mothers who had a bad experience with their first birth.  The bad experience almost always goes like this - so often that I've coined it a "snowball birth" because one step inevitably leads to the next and the whole mess gets bigger as it rolls downhill.  1) Doctor induces labor for no good reason; 2) Doctor gives an epidural [anesthetic] ; 3) Mother fails to progress to Doctor's satisfaction; 4) Doctor gives mother [pitocin, commonly called "Pit",] a drug to make her contractions stronger; 5) Mother can't push effectively (usually a side effect of the epidural); 6) Doctor tells Mother she needs a C-section; 7) Doctor performs major surgery without proper emotional support or mental preparation for the mother; and 8) Mother feels like a failure and Doctor leaves for his golf game.
What everyone fails to see is that this whole process happens because the baby isn't ready to come yet.  If the Doctor hadn’t induced labor, there would have been no problem in the first place.  [In most cases] the baby will come when it’s time.


Pain Management

Most mothers who have had a "modern" birth - those with epidurals and doctors - will tell you how much it hurt despite the epidural and often have complaints about the doctor being rough or rude or even threatening...e.g., "if you don't push, I'll need to use suction."
When you talk to a woman who had a natural and uneventful childbirth - no drugs and a midwife, they rarely talk about pain. They use the word "pressure".  There are medical reasons for this involving hormones released after pregnancy that affect memory.  Do you remember "The Flashy Thing" in the movie Men in Black, that erases memory?  The body has a hormone that does the same thing for pain memories.  If you have an epidural, it often doesn't triggered and you will remember the pain. If you're normal and healthy and you have the option - go with a midwife.

But what if …

Let’s say it's an emergency.  The baby is coming, it’s going to happen at home and no one can come and help ... the pregnancy, up to this point has been normal and healthy.  Now what?  Do you call 911?
Some of you may be tempted to tune out right now because you aren’t planning on having a home birth without assistance.  Well, guess what? Even if you aren't planning to deliver unassisted at home - remember that the baby may not have gotten that memo.

Supplies for the actual birth:
  1. You need something to clamp or tie-off the cord.  I've used dental floss and cord clamps.  I highly recommend the cord clamps.  You can buy them here.  You'll want to order those ahead of time.  You need at least two.  People have used clean, unopened packages of shoelaces as well. Again, I recommend the clamps.
  2. You need lots and lots of clean towels.  We used beach towels.  How many do you have? You need more.
  3. You need a large deep bowl to catch the placenta in.  It will likely come out with a good amount of force.  If the bowl is shallow, it will slide right back out and land on you.
  4. You need tissues.  It's quite possible she's going to poop during labor.  If she does, she most likely didn't intend to and she probably won't even realize it happened.  It won't be very much.  Just grab it with a tissue and put it somewhere out of the way.  You don't want it touching the baby and there is no need to embarrass mommy.
  5. You need a sharp pair of scissors and a way to sterilize them.  Alcohol works.  Just have it handy.  There will be no hurry for the scissors.
  6. Hydrogen peroxide is good at getting stains out of carpet.  I told you that you needed to get more towels, but you didn’t listen.
The Birth Process
She'll have contractions.  They may be fast coming, or not.  They may be hard or not.  They may be regular or not.  I know the movies say that they'll be regular, fast coming, and painful.  They're movies and neither the baby nor the mother’s uterus has seen them.  On a related note, the water may not break until well into the process of birth.  Occasionally, in fact, babies are born with the water in tact.  Don't count on the water breaking to be a sign - that's also just in the movies.
First things first: what's your job?  You are whatever mama wants and needs.  You make mama comfortable and hydrated.  You do not complain about your problems and you don't share your fears with mama.  You are strong when she is not.  You are soothing when she needs to be soothed.  You just need to help get mama to the point where her body and instincts take over, then you catch.
If you need to time the contractions, that's fine.  Do it discreetly, and don't give mama reports.  Above all, don't tell mama she's having a contraction or when one is about to happen.  It's fairly likely that she already knows.
Watch mama...she's likely to go through some telltale stages (these can last for more than 24 hours or be over in less than an hour):
Nervousness, insecurity, a sense of "I'm not ready" - I'm still talking about mama here, not you - focus!  These are all signs of early labor when they're coupled with contractions.  She'll likely be talking to you through her contractions...that's because they're still mild.  Have her rest, use the bathroom, and drink water.  Maybe eat something.  If that doesn't stop the contractions, this is probably the real thing.  It could be 24 hours or 20 minutes.  It's up to baby.  Keep mama as calm as possible, comfortable, moving, and hydrated.  Help her walk around, walking helps labor progress.  Close the blinds, lower the lights - if she wants soothing music, now is the time, wash your hands very well.  Gather your supplies - especially the towels.

There is also a period of emotional swings, if contractions were regular before, they may get irregular during this period.  That's normal.  This is a transition period.  Contractions will get more intense.  She'll likely stop talking during the contractions - you should too.

Unless she tells you otherwise, keep touching her - gently, soothingly.  Look for areas that are tense and help her relax them.  Tell her she's doing great.  Tell her you love her.  Tell her you find her amazing. Comments like: "you're hardcore," "you're a trooper," and "no pain, no gain," are probably ill-advised. When the contractions get to the point that she wouldn't move out of the way of oncoming traffic when she's having one - you're in the real deal.

At some point around this time, she's going to shed her modestly - and likely her clothes too.  That's why I had you shut the blinds earlier.  Keep her drinking water between contractions.
Now you should be watching/listening for a few things: 1) grunting; 2) clenched muscles during contractions ... the same ones you clench when you're trying to have a bowel movement (if you’re behind her and she’s removed her clothes, watch her sides just above her hips – when that area tenses, she’s pushing); and 3) her saying "I feel like I need to poop."  All of these are signs baby will be arriving very soon.

Then you'll go into the final stage - and men tend to want to say "PUSH!"  She won't have a choice but to push.  Pushing makes things feel better.  Her body will compel her to push.  This is not a 30 second process.  Our first child required more than four hours of pushing.  Keep her hydrated and comfortable.

In the movies (and at hospitals) they put mama on her back with her legs up.  They are idiots.  Nothing could be less helpful to mama and baby.  That position is only helpful for the Doctor, and the Doctor isn’t here.  This position is unhelpful because it doesn't use gravity to help and it makes the opening narrower.  It’s like trying to swallow food while standing on your head.  You can do it, but it doesn’t make the process easier.  Instead, have her get on all fours, or better yet in a standing squat.  This opens the birth canal and helps baby come.  True, it makes it harder for you to "catch," but this isn’t about you.   Keep your hands properly positioned, because babies can come out fast and you don't want the baby's introduction to the world to be a thump onto the floor.

The water will break at some point if it hasn't already - look at it.  If it's dark or brown, you may have a problem - but you already know that because you read the Emergency Childbirth manual, right?  Normal is slightly less than clear with flecks of white stuff that looks and feels like lotion floating around in it.
If you see anything other than a head coming out first, then call 911.

Crowning - the part where the head is coming out of the opening - can be a tough time for mom.  For dad, it's tough to look at - but get over yourself...she needs you now more than ever.  Believe me, everything will go back to normal after a few weeks.  Try to help her push baby out gently - too fast and you could have a serious tear.  In the end, the baby will come out however it wants.  But you can try.
Follow the book's directions on clearing the mouth and checking the cord.
After the head comes out, the rest will follow quickly.  Catch!  Your baby is slippery, small, and may come out with surprising force.  Don't drop it. Don't pull it out and don't yank on the cord, the placenta (which the cord is still attached to) will come out in a few minutes.
Put baby on mama's belly, cover it with towels or blankets and get ready to catch the placenta.  Mama will feel it coming.  She can be on her back for this part.
Keep your hand up and keep the bowl in place.  This can take up to 30 minutes, but when it happens it will go quickly.   This is the messy part.  It's also the gross part.  Catch the placenta in the bowl.
You should expect about a cup of blood during this process.  That's easy to say because a cup doesn't sound like much.  It looks a lot worse than it sounds when it comes from someone you love.
Once the cord has stopped pulsing and goes limp, clamp the cord about an inch or two away from baby's navel and then about an inch further than that.
Sterilize your scissors and make the cut between the two clamps.

Part III – Caring for Mama & Baby Post-Partum

Baby is easy.  Keep it warm and in contact with Mama’s skin.  Mama should be trying to nurse as soon as she feels up to it.
Mama will be shocky.  That means she'll be pale and shaky and may alternate between being hot and cold....make her warm and comfortable.  Hydrate her.  Orange Juice is good (and a Bradley Method tradition).   Keep her warm.  She'll still be leaking blood for awhile.  Don't make her move until she's ready - that could be hours.  Be ready for her to faint - you need to have hands on her at all times if she's walking.
At some point, she'll need to pee.  That can be really difficult for a newly un-pregnant mama.  Something that makes it easier is a thing called a peri-bottle.  Basically, it's a little bottle that you can fill with warm water and mama can use it to clean herself after peeing. 

Big, thick pads for her nether regions are important here.  She'll still have some blood coming out.  These look like giant maxi pads and she'll know what to do with them - you are still actually speaking to her aren't you?  She's a human being after all!  Some people even soak them in various herbal solutions and freeze them beforehand to use them as cold compresses - just beware of freezing the skin.  Or you could buy perineal cold-compresses.

Seek medical care if available at this point.  Unless something seems wrong, there's no real hurry here.  We didn't even go to a midwife until four hours after our third child was born and that wasn't really even necessary.  Consider it a wise precaution. The main concerns are baby's breathing (usually indicated by color), overall health, and whether mama is doing alright post-partum.
Again, nothing I've said here is to be construed as medical advice.  You need to consult a professional if possible.  These are just tips from my experience with my kids - all of whom were born healthy and without any serious complications.  I'm very lucky in that way.

As a father – the time after baby is born is the easiest part.  You take care of mama and the other household members and she'll take care of baby.  Taking care of mama sometimes means changing diapers and cleaning up spit-up.  It means sometimes holding the baby.  It may even mean cooking and doing laundry.  I said this part was easy, but it sounds like a lot of work, right?  It’s easy because your role is well defined.  The process works like this:  Ask yourself what needs to be done.  Then, compare the answer to that question with this sentence - "Feed the baby with my breast."  If the two answers are not identical - then it's your job.  Simple, right?
Let's try one:  What needs to be done?  Someone needs to drink a beer.  Okay - does "someone needs to drink a beer" equal "Feed the baby with my breast?"  No?  Then you have to do it.
One more: What needs to be done? Dinner.  Does dinner equal feed the baby with your breast? No.  You make or otherwise acquire dinner.
What kind of food does baby need? - None.  Mama will handle that.  Breast milk is the best possible thing for baby.  Your only role here is not getting jealous.

Diapers - disposable or cloth.  We use cloth.  From a prepper standpoint there is no other option.  We can buy all the cloth diapers we need for three years for about $600-$1,200.  That doesn't even cover the first year for disposables.  Storage room is minimal.  It takes a shelf.

Other things you'll need - gentle shampoos, onesies and/or baby clothes. If you're buying in advance think about seasonal weather. Grandparents are famous for buying cute little shorts and t-shirts for babies born in November. You'll also need soft blankets.

We co-sleep [with our babies], so we don't even need a crib - but if you'd like a crib, get one.  If you drink or use drugs (including prescription ones) or if you are obese or have a disorder like narcolepsy, then please don't co-sleep. If you breastfeed and co-sleep, then babies are much easier.  Most rarely cry or get colicky.

Now, if you're about to get upset over my views on co-sleeping, save it.  I know the arguments better than you do.  Bottom line: humans have co-slept with babies for millennia.  When was the last time you rolled out of your bed in the middle of the night?  Exactly.  You're equally likely to roll on top of a baby.

Now on to mama - what does mama need?  She needs you to check on her and make sure she's okay.  She needs moral support.  She may need help or counseling with regard to nursing - there are specialists for that called Lactation Consultants - there is also La Leche League.

She's likely to be bored and tired.  She needs your companionship.  She needs to rest.  You may have to force that one on her or she may love it.  She needs your companionship.  She needs food and water.  She needs to urinate regularly.  She needs your companionship.

When the doctor or midwife follow up they're going to seem oddly interested in bodily functions.  There's good reason - they are indicators of overall health.  She'll want to know if mama is peeing normally.  She'll want to know how often the baby is peeing and/or pooping.

For the first day at least you'll want to keep an absorbent pad under mama in bed.  She'll be oozing blood.  The big perineal pads will catch most of it, but more protection never hurts.

Oh, one more tip: the first few baby poops will be black and tarry.  That's normal.  They're a pain to clean off of the baby unless you put a little olive oil in the baby’s crack.  I know it sounds silly, but this first poop is called meconium and it's nasty and sticky.  The oil keeps it from sticking to the baby.

I hope this has been helpful.  Enjoy your baby, they grow fast! - Ranger Squirrel