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Homebirth "What-If's"
This page has been compiled based on my years of research on the
subject of homebirth. It was created for your information, as a compilation of
many of the questions homebirthers hear, so you can have some quick answers all
at once. It is not, however, to be construed as medical advice. My
recommendation is that you do the research yourself, decide for yourself what the
true facts are and what's really fiction, and draw your own conclusions. But please
be informed - don't be a blind consumer of the medical industry. What if the cord is wrapped around the baby's neck?
This is not a medical emergency. Usually the cord can be gently lifted over the baby's head. Occasionally, the cord is too short for that, in which case there are two options. The first option is to clamp and cut the cord. This is easier, but probably not the best option in most cases, as it will deprive the baby of some blood and oxygen. The other option is to hold the baby snugly against the mom's thigh and allow the newborn to "somersault" out as he's born.
What about placenta previa?
A full placenta previa requires medical intervention, but would be a known factor prior to the birth. With a partial placenta previa, the baby can sometimes still be delivered vaginally, but with very careful monitoring, and a little help to keep it out of the way. (This would be a known factor prior to the birth, and seeking medical help would be an option at that point, even if you had otherwise intended none.)
What if the baby is breech?
Breech babies can almost always be born vaginally, if mom is in an upright position. The standing squat is generally considered to be an ideal position for birthing a breech baby. (If you know your baby is breech and are intending to have a hospital birth, make sure your doctor or midwife is experienced and/or comfortable with vaginal breech births, unless you really want a cesarean.)
What if the baby is transverse (sideways)?
To the best of my knowledge at this time, this is an instance requiring medical intervention, although some believe that, as baby cannot come out transverse, he will turn himself. This (the baby's being transverse) is something you would know going into the birth, giving you the opportunity to go to the hospital if you felt it best.
What if there are twins?
If the mother has been eating well and staying healthy, there is usually no reason twins can't be birthed naturally. See "What if the baby is breech?"
What about Rh incompatibility?
If there is no amniocentesis done during pregnancy, cutting the cord is delayed until it stops pulsing, and the placenta is allowed to deliver naturally, there is very, very little chance of the baby's blood mixing with the mother's. (Although if you have had a miscarriage or abortion, that baby's blood may have had opportunity to mix with yours.) A woman who has a home birth still has opportunity to get Rhogam, though, if she chooses to. (Although Rhogam IS a blood product, and therefore carries it's own risks. Much of it also contains mercury. Be sure to make an informed decision here, as well.) You can be tested for antibodies. You can also be tested for an additional blood factor which, if present, negates the Rh issue. I don't have much information on this at this time, though, as I'm Rh+.
What if the baby goes into distress?
This is extremely rare in a birth with no interventions. Most fetal distress is caused by drugs, fetal monitoring, or poor positioning (flat on one's back). Many doctors will tell you that long labors cause fetal distress, but this is usually not the case. A long labor that results in fetal distress was probably long because of interventions, not because it was naturally long. Often, it is assumed a baby is in distress because the monitor shows that his heart momentarily stopped beating or slowed. This is normal, however, shortly before birth.
What if the baby has trouble breathing after birth?
In an at-term birth, this is not likely to be a problem. Most initial breathing problems are a result of immediate cord-cutting. The birth process is such that the baby should not need to immediately breathe completely on his own, but has a period of transition while he's starting to breathe, but blood (and oxygen) is still being pumped through the cord. Learning infant CPR might be a wise precaution if you're planning a birth with no medical assistance. Newborns don't generally need to be suctioned, either. Turning baby facedown will allow him to cough up any mucus and fluid on his own. Suctioning can actually sometimes force fluids farther into his lungs.
What if the mother hemorrhages?
True maternal hemorrhage is pretty rare if the placenta is left alone and allowed to deliver naturally. Hemorrhaging is usually caused by forcing the placenta to separate before the uterus is ready, by tugging on the cord and/or pushing on the uterus. If there is a lot of blood, nursing the baby will have much the same effect as the pitocin the hospital administers, without the negative effects of drugs. There are herbal remedies for this as well, and placenta can be placed under the tongue (a piece; not the whole thing!) if necessary. And, of course, there is nothing to keep mom from visiting the hospital following the birth if she feels it's necessary.