Being prepared for precipitous labor.

Yesterday I mentioned that commenter Jenny has a history of precipitous labor, and even though she typically gives birth in a hospital, she was interested in hearing suggestions for being ready in case of precipitous labor at home.

Jenny writes,

My general precipitous labor story is thus: my body dilates and effaces without me knowing it, i.e, no painful or regular contractions. My doctor watches the progression over the last few weeks of pregnancy. When I am a dilated to a 6, she schedules an induction for that night or the next day. I arrive at the hospital, have my water broken artificially, and deliver the baby in about an hour. It's a little crazy!

IMO every woman preparing for birth, even in a hospital with an OB practice, should learn at least a little bit about home birth and about how birth unfolds when it's left alone.   It's not that uncommon for babies to come really fast when they decide to come, and once you pass a certain point it's much safer to stay home than to race to the hospital and risk giving birth in the car -- or, as one woman I know did, next to a file cabinet in the fire station in her neighborhood.

Wouldn't it be better to be prepared?

Here's my suggestions.  

 

Emergency Childbirth:  A Manual by Gregory White.     

My midwife would say that childbirth isn't an emergency unless you think it is, but she still recommends this slim handbook for all her birthing families. It was written mainly for people who might be expected to find themselves helping a mother who's giving birth outside the hospital -- police, etc.  It has some advice that's pretty doctor-centric (advising that the mother be on her back, for example) but what it's really good for is telling the difference between normal birth and birth with complications, and how to handle some of the events that might be unnerving, including what to do if something serious happens.

 

 

 

 

 

Double-make your bed.   You'll be glad you did this if your water breaks while you're sleeping.  This is one of the Great Secrets Of Home-Birthers.  It's also useful later if you have a chronically bed-wetting kid or someone's got a vomiting illness.

Have an extra, waterproof mattress cover (a rubber sheet's cheap, but there are more comfortable, breathable options out there now.)   Make your bed once with mattress cover, bottom sheet, and top sheet well tucked in.  Then put the second, waterproof mattress cover on top and make your bed again with another set of sheets and your blankets.   If your water breaks all over everything, or you wind up giving birth squatting on top of your bed, zip!  it all comes off and there's a fresh newly made bed underneath.  You can go to sleep in it (maybe with your baby) and someone can wash the soiled sheets when it's convenient.

 

Got a tub?  Clean it out.  Bathtubs are awesome.  Everybody should have one.  If you keep potted plants in your tub, take them out.  If your tub is gross, have someone clean it.  Or use some of that late pregnancy nesting energy to do it yourself.  There are worse places to give birth than a bathtub, and if you find yourself really WANTING to be in the tub, you'll be glad if it's all ready for you.  Skip the perfumed bubble bath.

 

Have some clean towels.   If you're perpetually behind on the laundry, set some aside.  Three or four big ones should do.  

 

Have a package of Depends-type underpads, a.k.a. "chux pads." This is another one of those magic tips for not having to clean up any mess, and they have utility later.   For the newborn period when I'm still resting a lot in bed and in chairs, I much prefer sitting/sleeping on one of these to wearing those damn postpartum pads.   I have been known to pull them out of my stash when the little one has their first bout of vomiting.

How does the midwife use them?  When the bearing-down starts, someone puts one on the floor (or bed, or whatever -- wherever you're squatting) between your feet.  From my POV, the chux pad magically appeared from nowhere just when I started to push -- really the midwife put it there.  Although frankly, if you're having precipitous labor you might not care very much, it might give your husband something to do.  "Stay right there honey!  I will protect the carpet!"

 

That newborn nose-suctioning bulb thing. 

 

Some kind of heating pad.  For the afterpains.  They suck and you won't want to be without your heating pad.  I like a rice bag, myself.  Here's a fancy one, but you can just use a tube sock tied shut with a knot.

 

Consider putting a flexible "telephone" shower head in your shower.  Well, I give this advice to every woman who is about to have a baby.

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Since you are preparing for the possibility of precipitous labor -- which is by definition fast -- you don't have to do a lot of the things that home birthers prepare for.  Like always having your fridge and pantry stocked with the kind of food you want to eat when you've been in labor for 6 hours.   And you won't bother with a lot of the postpartum care stuff, because if you give birth at home, sooner or later you will probably be (unnecessarily and at great cost) transported to a medical facility where you will experience standard-ish hospital postpartum care.  

I usually buy a custom birth kit put together by In His Hands Birth Supply from a list that my midwife gives them.  It has things like antiseptic, gloves, cord clamps, peri bottles, baby hat, gauze pads, and underpads in it.  In fact, In His Hands sells an emergency birth kit for $12.  They also sell Emergency Childbirth along with some other literature.  

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Add more thoughts in the comments - and if you have a story of precipitous labor of your own, please share!

Comments

[MrsDarwin]

I buy that same birth kit. Definitely second the chux pads and the double-sheeted bed and the hot pad. The tub should probably be cleaned out, just as a matter of protocol, but you may find that you don't want to use it -- I always thought about having a water birth, but in three home births I never ended up in the tub: one was too fast, and the other two I just didn't feel like it. Doing what you feel like doing is pretty key in labor!

Also, lay in a good supply of old towels and little receiving blankets that you don't care about getting stained or ruined. You can buy them on Craigslist even, and give 'em a good hot wash.

None of my homebirths involved the standard lay-flat-and-push position. Gravity is a big aid in pushing -- unless you're worried about tearing. Then a side-lying position can really help. (Worked with #4 -- no stitches, thank God!)

Although you probably will have called 911 and the EMTs will be rushing over, remind your husband that labor isn't over until the placenta is out. You probably won't have to cut the cord yourself with the emergency crews descending, but you will want something in which to put the big bloody placenta so it's not just laying on your carpet or dripping all over the place.

I had a precipitous labor with #3, 1 1/2 hrs from first contractions to birth -- though of course I was planning to stay at home, so I didn't have to worry about getting ready to go out to the hospital. My water broke and we took off the top set of sheets (then remade the bed with another top set). I took a shower. I thought I would die. The midwives got there about five minutes before baby, and immediately had me kneel down at the side of the bed. ("Can you get in bed?" "No, her head is COMING OUT!") I did tear, unfortunately, but she was out like that. They suctioned her out and put me in bed, and that was that.

[Amber]

I buy that birth kit too!

I posted my birth story on my blog - http://flareoflight.blogspot.com/2013/01/justins-birth-story.html if anyone wants to read it. It was amazing to have it all over so fast!

[Bearing]

Good point about the placenta needing a container, Mrs. D! (In case you don't know, whenever some kind of birth attendant gets involved, they will want to examine the placenta. So don't bury it in your garden, dehydrate it, or throw it in your freezer just yet. OTOH If you feel the need to eat some, I will not stop you.)

Add to the list: a plastic dish tub or two.

[Jenny]

This is fantastic! It is like the heavens of knowledge are opening up to me. :)

The double made bed is something I never would have thought about. This is what you need to tell people about homebirth and then they will understand. During the last few weeks, I usually sleep with a towel under me, knowing it would do little good if something big happened. I'm definitely buying the waterproof mattress pad.

I had to laugh about that best position is on your back bit of nonsense. I don't do that anymore, hospital or not. I'm pretty sure I injured my pelvis in that position during my first birth. I had some symptoms of a pelvic injury during the next pregnancy which nobody could identify and again delivered on my back.

The next pregnancy I had severe pain and still my doctor had no idea what might be causing it. I dug through the internet and found information about pelvic separation which they apparently know about in Europe but American doctors are clueless. And one of the aggravating causes is delivering on your back with your legs pulled back, a la the standard US hospital delivery.

After figuring that out, I decided I would never give birth on my back again. The last delivery was so much smoother than the first two because half my pelvis wasn't being smushed into a table. I expected the nurses to give me a hard time about it, but they were surprisingly open and all went well.

I've always had precipitous labors and they seem to be getting faster. Well technically my oldest wasn't precipitous at 4.5 hours, but that includes: nearly an hour of no contractions after my water broke naturally, nearly an hour of waiting for the doctor to get to the hospital after dilating a lot faster than they anticipated--"don't push, don't push"-- and nearly an hour of me trying to learn how to push because I didn't know what the heck I was doing. But with us, the fear is that my first indication of natural labor would be when the baby was on the way out.

[Bearing]

While we're at it, any other "but what do you do at a home birth if...." questions?

The mattress thing is funny -- simple, isn't it? I think it is a good example of -- well, I need a term for it -- when one person who has their head in one sort of paradigm can't see how something could work in a different paradigm. I run into this with homeschooling all the time -- like "oh it would be so exhausting to teach my child for six hours every day" without seeing, for example, that in the home school it doesn't take as long to teach each child, or "my kids would fight every minute they are together" without seeing that, for instance, homeschooled siblings usually have developed strategies for not doing that since they are together so much.

[Jenny]

I do have another question. Usually after birth at the hospital, they give you these heavenly ice packs to sit on for a few hours. Do you know what the home version might be?

[bearing]

My midwife made some for me. I think they were herbal compresses -- wads of gauze or maybe maxi pads soaked in a strong "tea" of comfrey root and then frozen.

But you can buy the hospital kind online. Google "perineal cold pack."

[Amber]

My midwife soaked maxi pads and froze them too. Soaking them in comfrey root tea is an extremely good idea. That stuff is great!

[Amy F]

Those frozen herbal ice packs are the best. With bad tearing with kids 1 and 2, I relied on those and figured out how to make them for my hospital birth too.

I'm willing to guess we had the same midwife given that we had that emergency childbirth book and ordered the same birth kit.

My approach to the ooziness of postpartum time is to buy a pack of Depends (usually the men's large to go over my belly and make me less embarrassed about buying them) and by the time I run out of those, I can wear underwear with a prefold trifolded for a few days. By then, a week or so has gone by and my thicker pads are enough to hold things in. The Depends are great for not worrying about where anything is leaking. And I can stick those herbal packs in easily.

[bearing]

"I'm willing to guess we had the same midwife given that we had that emergency childbirth book and ordered the same birth kit."

AmyF, I think so -- didn't we establish that after my #4 was born?

[Jenny]

Amber,

I read your post and it is very familiar. You go through all the labor stages only at light speed. After they break my water, I generally have 30-60 minutes of strong, regular contractions that I can keep conversation going with breaks for the contraction. Then I have about 10-20 minutes of "the world has stopped and I think I'm going to die" contractions. And then about a twenty minute pushing stage.

Bearing,

Interesting analogy to the fighting siblings. I have found that my kids fight less when my oldest is out of school and they are together most of the time. Also I forgot to mention it above, but thanks for letting me in on the secret of what a "chux" pad is. I've seen the term thrown around and had no idea what this item might actually be. :)

I talked to my husband last night about reading the childbirth book and he is really interested in it. The whole nature of my labors makes him very nervous and I think he would feel better knowing more about what to do.

I have thought of one more question, but it is more about pregnancy than childbirth. Last pregnancy I measured slightly anemic and was prescribed iron supplements. They made me quite sick so I quit taking them. I had spent the better part of 20 weeks throwing up and was over it; hell if I was going to take something on purpose that caused the same problem. Then I spent the third trimester craving and chewing ice.

I didn't realize at the time that ice cravings are a classic symptom of anemia. So if you know of a way to avoid the iron supplements and the anemia, I would be grateful to know.

Thanks for this post! I really do appreciate it.

[mandamum]

Jenny,

Have you tried Floradix for iron? It's a liquid that tastes more or less like molasses (depending on the batch, I think - my first bottle was less, but after that I didn't notice the taste as much) and tends to make many mothers less gassy, etc, than other iron supplements. Otherwise, check with a nutritionist for a list of foods with bioavailable iron? And don't eat them with high-calcium foods :)

You might check that same webpage for the cold postpartum cold packs - one of my midwives had me buy the "shake and crush" kind that turn cold for you. Otherwise, I just did the cold maxipads too....

Ditto on the depends, the (dark) towels, and the chux pads! A chux pad helps too with a sudden bout of bed-wetting, LOL.

--Amanda

[Bearing]

Seconding Amanda on Floradix plus bio available iron. I seem to remember that if hou are eating foods that have lots of not-very-available iron (I.e. plants) you can make some of that iron more available if you consume it with at least a little bit of foods rich in bio available iron (beef, liver.) I've gone anemic in pregnancy before, and always it went back up after adding Floradix and conscientious dietary strategies. Correlation =/= causation but it is probably worth a try.

[mandamum]

Funny - I followed one of your links (the one you quoted from) in the post above this one, and you have an iron tonic in that post :) And in the title too!

http://arlinghaus.typepad.com/blog/2006/01/iron_tonic.html