Friday, August 22, 2008

How to deliver a baby

I was very sorry to hear that a woman went into premature labour on an Air New Zealand flight, and sadly,the baby died. I am sure that the two nurses who looked after the woman did all they could to help her and the baby. And I am sure that they are really gutted at the moment. But the thing that struck me about the news report was that the nurses tied the cord with shoe laces.

What to do with the umbilical cord
What happens to the umbilical cord is a huge issue of concern when you talk to people about what they would do if they are in the situation where they have to deliver a baby. But the truth of the matter is: you are much better leaving the cord well alone, even if the placenta is born still attached to the baby. By leaving the cord alone, the baby continues continues receiving valuable oxygen from his mother. And you could do more harm than good fiddling around with the cord.

'Emergency' birth
The most important things you can do if you are supporting a woman giving birth unexpectedly is reassure mum, dry the baby and put the baby straight to mum's naked chest and keep both mum and baby warm, and out of harm's way.

Have you ever had to be a 'midwife' when you were not expecting it? If you are a midwife, have you had a time when you were 'caught out'?

Image: 'Evan cuts the umbilical cord' Natashalatrasha


Anonymous said...

I was tossed a pair of gloves and told to get ready.
Who said that vbac moms dont' know how to push? That one certainly did!
Second midwife showed up as the shoulders slipped free and babe was born.
*I held babe while mama reorientated herself from hands and knees to meet her little one.
I may be catching the next babe (planned catch this time). We shall see how the mum is feeling when the time comes... which can't be soon enough.
Just got home from chiropractor, lunch and mall laps (pouring rain here!) with mum. Come out baby!!!!

Sarah Stewart said...

As a doula, does the midwife take responsibility for any 'professional' actions you take like catching the baby, hbacmama?

Sora said...

I've been at two births (both for the same friend with speedy labors) which the midwife missed. She's due again in two months, and I'm now apprenticing with the midwife; we'll see if she makes it this time! Both were waterbirths, and planned home births with planned physiological third stage, so nothing like a precipitous airplane birth, though.

The story seems to be missing some critical details. If the baby was actually stillborn, why the need for shoelaces? So they felt the need to cut the cord (which I can understand, for nurses with only hospital experience who have probably never seen things done any other way, and wanting to attempt a resuscitation in the confined space of an airplane, with the placenta probably not out yet.) But if the baby was really stillborn, there would have been no need to tie off the cord before cutting because there would not have been any circulation in it, and that would have been fairly obvious. So did they actually have a depressed premie with a nice chunky pulsing cord and then cut it and botch the resus?

The general public misinformation about 3d stage is mindboggling. I actually saw a news story a few weeks ago about a precipitous side-of-the-road birth in which the dad, explaining to the reporter that they hadn't cut the cord until the EMTs arrived, was quoted as saying, "You have up to an hour to cut it." And then what? The placenta self-destructs? Turns into a pumpkin? At least this dad realized that cutting right away wasn't crucial, I think a lot of people have never really thought about it much but are under the vague impression that the baby can't breathe until the cord is cut.

Anonymous said...

I had to deliver Hugh when he came early. But I don't have much of a sense of the experience. It all hapened very quickly and Dot and I were both on autopilot. She did all the hard work. Dot was wearing a dressing gown and on her hands and knees. I was trying to help her stay calm while we waited for the ambulance, and I thought I'd check to see how far along it was. It is a good job I did as Hugh's head was out. I held his head and the next push had him out. All I knew to do really was to have towels handy so I wrapped him up in towels. I couldn't give Hugh to Dot because it would be too awkward trying to pass Hugh through her legs. The ambulance guys cut the umbilical cord when they arrived, and it had stopped pulsing before then.

Dot and I both posted about the experience on our blog afterwards. (Dot's post

Anonymous said...

One of the three midwives will be right beside me IF I catch.
The other of the 'primary' midwives will be there for baby. The third is a student from our aboriginal program. There may be a fourth there, just for fun as well!
I'm sure if there are ANY issues that arise. I'll be jumping aside to allow for the proper professionals to take over. I assume, ASSUME that the midwives always have an eye on what is going on, as many women and partners want to catch their babies.
With the last birth, the second midwife arrived and assessed blood loss, while the primary did the baby check over. I just held the little one for that brief moment, then to mum and midwife checking things out while little one was curled up on mom. Midwife just wanted to have another set of sterile hands. I was more than happy to comply.

Sarah Stewart said...

@Sora I don't want to get into criticizing the nurses - it must have been a terrible situation for them to have been in. But I found the whole story fascinating, that the media instantly picked up on the cord cutting aspect - as if that action could have saved the baby. I found out about the cord cutting before I heard from another source, one day later, that the baby was stillborn. As you say, Sora, it is the cord that seems to be fixated on. I love your questions about the exploding pumpkin - that's a good illustration to use in lectures - I'll remember that. Meanwhile, I wonder what the media would think about what locus birth devotees do with their babies' placenta and cord?

@Ken - I'd forgotten you guys were in this exact situation. Thank you for linking to your birth story.

I guess it is easy for me, a midwife, to criticize the general public. I guess its our job to get out and educate the public about this issue. We also need to educate the media - you can bet your bottom dollar that in a TV drama account of an unexpected birth, the thing people will be fussing about will be the cord.

Sarah Stewart said...

@hbacmama: good luck at your next birth - have fun. You are going to have to get over here to do your midwifery registration !!! :)

Anonymous said...

That last comment.. ohhhh how I wish. Alas, I'm a little old to be going back to school and I'm a little leary of the 'cross over' with Canadian requirements.
And after this mornings shenanigans... it just makes me ache to do it all the time!

Nichol-Doula said...

As a doula I can say that this is something that I have been trained for thank goodness.
I had a client who had a precipitous home birth with twins. She called me in transition (her voice was shaky and high, the sound of a woman in transition!) and I raced over. Her husband caught baby A, who was a footling breech moments before I arrived. He was a bit blue and took a while to take his first breath, so I passed him under her (she was on hands and knees) so she could talk to him, rub him, and breathe in his face while she rested before her contractions started up again for baby B. Baby B was vertex and came out smoothly into my and her mom's hands.
Passing baby B under my client and putting the twins next to each other wrapped in towels we got a bowl ready for the placentas.
After they were delivered we had to pass babies over each other to untangle their cords, but left them attached and unclamped for the midwife to deal with when she arrived.
I was on the phone off and on with the midwife who was on her way as all this went down.
She arrived to find me sitting next to my client holding baby B to her breast as she help baby A to the other and they were nursing peacefully.
It was a beautiful albeit slightly scary experience.

Sarah Stewart said...

Wow, Nichol, what an amazing story but boy oh boy, a scary one to be in the middle of. My hat goes off to all of you for not panicing...great work :)