How to Recognize True Emergencies & Handle Complication
This is the number one question people ask about unassisted birth. Even those who are planning one worry about this. The truth is that 90% of labors will be complication-free. For every 1,000 live births, only 6.50 infants will die in the first year of life. This includes SIDS, accidents, adverse reactions to vaccines, preemies, etc. The chances of your infant dying are very low. The stillbirth rate in the US is 1 in 115 births, a little less than 1%. The main causes are infection, defects, retarded growth, gestational diabetes, preeclampsia, maternal drug use, postdate pregnancy, physical trauma, placental abruption, radiation poisoning, Rh disease, and umbilical cord accidents. Few deaths occur due to problems during labor & delivery.
Many people assume that if a woman's baby dies during an unassisted birth, it is her fault for not having had a doctor on hand. This is completely untrue. Most infants that die at home would have died in the hospital anyway. The vast majority of stillbirths occur in utero before labor begins. Many are related to problems that can't be treated, only managed--or that can't be managed at all. Even prenatal care will not save an infant from dying in utero. A doctor is likely to recommend preterm birth if an infant's life seems to be in danger during the pregnancy, which is usually equally dangerous for the infant.
There are times when probably arise during labor that can threaten the life of the child. Some of these can be handled at home, and some will need hospital treatment. Mothers learn to recognize these conditions, handle them, and know when to go to the hospital. These labor complications are just as likely to cause death in a hospital as they are in the home, so long as the mother has done her research. Most problems can be handled by a mother simply following her instincts. Rarely does a death occur because of the mother's actions, but because of things that are out of her (or anyone else's) control.
In the hospital, the only sign that a fetus is in danger is discolored amniotic fluid or decelerations in the fetal heart rate. These signs can be recognized at home, too. A mother is perfectly capable of telling if her amniotic fluid is green. She can listen with a Doppler or fetoscope, and if something seems wrong, she can go to the hospital--calling ahead to warn them. It usually takes 15 minutes to prepare for a C-section in the hospital. If they are preparing while the mother is on her way, they can C-section her as soon just moments after her arrival. Sometimes, it will be too late--but this could happen even if she were in the hospital. Some mothers will not attempt an unassisted birth if the hospital is too far away for this reason.
One sign that something is wrong is excess bleeding during or after labor. This could mean problems with the placenta, such as placenta accreta or placental abruption, which puts the child in danger of oxygen deprivation and the mother in danger of hemorrhage. It could also mean that the mother is already hemorrhaging and could bleed to death. If it occurs during labor, a mother should go to the hospital. She should not take any blood thinning medication for pain. There are herbs that can be used to help manage the bleeding. If it occurs after birth, the mother may be hemorrhaging. Many cases can be handled, again, with herbs and maternal rest. If the bleeding is severe or continues, if the mother begins to seizure or feel faint, she should be taken to the emergency room immediately.
Placenta previa is a condition in which the placenta covers the cervix, blocking the baby's exit. The mother can usually feel during labor that the baby is not coming out. She can often feel the placenta during a vaginal check. Spotting during pregnancy can be a sign that the placenta is covering the cervix. This can also be spotted by listening with a Doppler or fetoscope. A mother can learn to differentiate between heartbeat, cord sounds, and placental sounds. She can also palpitate her stomach to feel the location of the placenta. Most of the time the mother will be aware of this condition before labor begins. This is a condition that will require a C-section. It affects about 0.5% of all labors and is not an emergency. Mothers are more likely to hemorrhage with this condition, but usually the baby is delivered fine by C-section.
Another labor emergency is cord prolapse, when the cord is presenting before the infant. If the mother can feel the cord at her cervix, or if it drops into the birth canal before the baby, she is going to need a C-section. The cord can become compressed, cutting off the oxygen supply to the infant. She should try to push the umbilical cord back inside her. An ambulance should be called. She should lay back on her elbows, with her legs and backside elevated as far as possible. This position will utilize gravity to keep the baby from pressing down on the cord. If birth is imminent, and the baby is coming out, she should continue delivering. Otherwise, she needs to wait for the ambulance and go to the hospital for a C-section.
Shoulder dystocia occurs when the baby becomes stuck in the birth canal, his shoulders refusing to come past the pelvis. The baby is at risk of fetal distress, because the cord may become compressed and deprive the child of oxygen. This should be handled as quickly as possible but is no reason to panic. Many times the baby can be dislodged if the mother changes position: squats, rolls around a little, stands up, gets on her hands and knees, or just moves her body sharply. She can lay on her back and flex her legs to her shoulders, which widens the pelvis. If this does not work, someone can attempt to gently dislodge the baby. Hands should be placed on the shoulders, and the baby should be turned gently--sort of corkscrewed out. Another method is to try to dislodge one shoulder, then the next. The attendant can also squeeze the shoulders trying to make them a little smaller. If this fails, someone should call 911 while the mother continues trying to deliver. This is usually resolved without need of a C-section, but it can become an emergency--even in the hospital.
Another common question asked is: What if the baby isn't breathing? If the baby is purple, red, or pink, or pale, keep the child warm. Hold him skin to skin. Talk to her. Rub his back to stimulate him. Lay her face down over her thigh with her bum higher than her head to facilitate mucous drainage. Give her a moment. If she doesn't perk up, begin administering CPR if she does not start breathing. Flicking the feet, applying a cayenne tincture on the lips, or even giving the baby a good hard slap can help her breath. If the baby is pale blue, white, limp, or seems almost dead, suction the nose, start CPR, and call 911. Many mothers rent an oxygen tank so they can give the child oxygen if necessary.
An inverted uterus is rare. It occurs when the uterus inverts and comes down the birth canal after the baby. This can be solved by balling your hand up into a fish, gently sticking it into the vagina, and pushing the uterus back up past the cervix. This is very painful. Inverted uterus increases the mother's risk of hemorrhage. Mothers suffering this complication should go to the hospital.
If there is meconium in the water or if the water is discolored, your baby is at an increased risk of infection. However, this is not a guarantee that anything is wrong. The baby should be born and washed up. If he seems to need medical attention, take him to a clinic right away. This is not a complication or emergency. With treatment after birth, the baby should be fine even if he did inhale a little meconium.
Most people are afraid that the cord will be around the baby's neck. This is not an emergency, and it's not uncommon! The cord is around the neck about 30% of the time. Usually it causes no damage and is loose enough that the mother can simply unwind it, or somersault the baby out of the cord as he emerges. If it is tight enough, it may be cutting off the baby's oxygen supply. In this situation the parents would cut the cord and then push the baby out as quickly as possible. Many unassisted birth stories include the mother mentioning that she had to unwind the cord from around the child's neck. My own son was born with his cord loosely around his neck. The doctor simply cut it, and that was it! The cord shouldn't be cut unless necessary though, as it keeps providing oxygen to the infant.
Tearing is less common at home in the hospital but can occur anyway. Most tearing is mild and will heal on its own. Many mothers handle severe tearing by holding the skin together and applying superglue. However, some mothers do have severe tearing that heals all on its own. The mother can go to the hospital for stitches if she likes, but this is no reason to panic.
Many things we perceive as complications are just normal events that aren't extremely common. Many events during the labor can be handled by a mother on her own, and she can even learn to evaluate her risks of complications. Most mothers will solve these problems using what they've learned by researching and by relying on their instincts. Many times, if a mother's actions cannot save the child's life, neither would the doctors except in rare situations (birth defects, premature birth, etc). There are true emergencies that do require hospital and even C-section delivery. Mothers planning an unassisted birth learn to recognize these emergencies and know how to handle them. They also know when they should and should not attempt to deliver their baby at home. The simple answer to the question "What if something goes wrong?" is "The birthing couple will be prepared to handle it."
