Once you are dilated to ten centimeters, and perhaps even before ten centimeters, your body may begin involuntary pushing efforts. Some women never get this urge to push at all. Whether you do or don’t, it is NOT necessary to add your own pushing efforts to that of your body. By staying totally relaxed and upright, the combination of gravity and the contractions of your uterus can birth the baby.
Women who have heart conditions are not allowed to push to birth their babies because of the strain this puts on their hearts. Yet, their bodies still birth their babies without help.
As the baby makes its way down the birth canal, this is a very intense time. Many women find that they have very primal feelings. They feel the need to make vocalizations, and some even report feeling like wild animals trying to get free. At this point, the intensity of the contractions is calling the shots. The intensity dictates your position, your breathing, everything.
As the baby’s head nears the opening of the birth canal, the perineal tissues will start to bulge. If you have remained upright and allowed gravity to bring the baby down and fan the tissues out naturally, there is very little chance you will tear. However, some women prefer to massage the tissues with oil and warm the tissues with warm, wet washcloths. A good way to keep these hand is to have two crock pots - a small potpourri size pot for the oil and a large one for water and washcloths so they can be ready any time needed. Both should be set on low.
The perineal area is the area below the vaginal opening and above the anus. As this tissue starts to bulge, the birth partner can, at the request of the woman, support the tissue with firm pressure from a hand covered with a warm washcloth. The warmth usually feels very comforting. Pressure against those tissues as the head is emerging can often prevent tearing and can guide the head gently out. However, if you have remained upright, and are giving birth in an upright position, you will probably not have a need for support and there is little chance you will tear. Birthing in the squatting position gives the baby the maximum amount of room available. The position also maximizes the pressure of the diaphragm on the top of the uterus so that the baby is literally propelled down the birth canal without extra pushing. The position pulls the tailbone out of the way so that there is no obstruction of the birth canal. The position normally provides 2 to 3 extra centimeters, which is more than enough room to birth any baby. A standing supported squat also will allow the baby's head to fan out the birthing tissues so that there is no tearing.
As the head emerges, the perineal tissues will be stretched around the largest diameter of the baby’s head. At this point, some women experience a burning sensation that has been termed the “Ring of Fire.” This burning sensation is only momentary and passes as soon as the baby’s head moves past this point and the vaginal opening closes around the baby’s neck. Once the head is out, the body should be born within the next couple of contractions.
Once the head is out, the baby’s body must rotate so that the shoulder is released from under the pubic bone. Once the shoulder is released, the whole body is immediately born.
I encourage the birthing woman to be the one to catch her own baby. Once the head is out, the woman can reach down and guide the baby out as the body is release from the birth canal. If she does not feel able, the birth partner can be the one to “catch” the baby. As soon as the baby is out, he/she should be handed directly to the mother. If the baby does not take a breath immediately, the mother should stroke the baby, rub his/her back, speak softly and gently to him/her, and soon the baby should begin to breath and his/her color should pink up.
Babies born to mothers who have remained upright throughout their labors rarely need to have nose or mouth suctioned because the fact that they have been head down the whole time means mucous has been draining from the nose and mouth throughout the entire delivery. As the baby descends through the birth canal, his chest and lungs are tightly squeezed so that any fluid or mucous is naturally expelled.
Immediately after the baby is born, the baby will be tested using the APGAR scoring system if it is born in the hospital. If the baby is born at home, it is a good idea to perform this assessment yourself to see help you evaluate how the baby is doing. The APGAR test is performed at 1 minute and 5 minutes after birth. Ideally, the scores should improve during the four minutes that elapse between the two tests. A score of 10 is considered a perfect score. The infant is tested on five different indicators of the well-being, and receives a score of 0, 1 or 2. The items tested are:
(response to bulb syringe or lips
A score of 8-10 is excellent, 4-7 is guarded, 0-3 is critical. This lets you know how the baby is doing and if he/she is going to need extra assistance.
The baby should be offered the breast immediately because the sucking stimulates the uterus to contract, expel the placenta, and clamp down to reduce blood flow. If the infant does not want to nurse right away, there is no rush to do anything else unless there is hemorrhaging taking place.
Under no circumstances should the umbilical cord be cut until it has stopped pulsing. Babies whose cords are cut immediately have a tendency to become jaundiced or anemic because they did not receive all the blood from the cord and placenta that they needed.
Some mothers prefer not to cut the umbilical cord at all to separate it from the placenta. After the placenta is expelled, it remains attached until the cord falls off naturally at 5 to 7 days after birth. This is called lotus birth. Mothers who use lotus birth believe that the drying up and falling off of the cord is part of the natural process of birth that they do not want to interfere with. The typical procedure is to rub the placenta with salt and rosemary, store the placenta in some kind of carrier, a small bag of some kind, and it remains attached to the baby until it falls off. The placenta is then disposed of in a variety of ways. Some parents keep the placenta and bury it underneath a young tree planted in honor of the new child. Some parents cook the placenta and eat it as a way of strengthening the new mother physically and symbolically. If you are giving birth in the hospital, you will not be allowed to keep your placenta.
In the hospital, the normal amount of time that is allotted for expulsion of the placenta is 30 minutes. During home births, the time is much more flexible. I have known of women whose placentas were expelled anywhere from one hour after birth to 2 days after birth with no ill effects. There is no reason to necessarily rush the placenta. However, if the placenta is not expelled within the first couple of hours, I would periodically check the mother’s temperature to make sure there is no infection setting in. It would also be a good idea to take 250 mg of vitamin C every hour until the placenta is delivered. This helps to prevent infection.
After the placenta comes out, it will be inspected to make sure all the pieces were expelled. It is a symmetrical piece of material, and all the lobes should match up. If a lobe is missing, a piece of placenta may still be inside the uterus. In the hospital, the doctor will probably administer a shot of pitocin or methergine to cause the uterus to contract and hopefully expel and loose pieces of placenta. If this does not occur, the doctor will go in manually and explore the uterus to find the missing piece of placenta. Home birthers have found that if a piece of placenta is not expelled on the first day, if will often be expelled within the next couple of days as the uterus begins to return to its normal size.
If bleeding continues to be heavy, the herb Shepherd’s Purse is often given in tincture form, and is usually very successful at stopping bleeding. Also, the Homemade Cayenne Tincture, 15 to 20 dropperfuls squirted into the vagina, will stop bleeding in seconds. In the hospital, your uterus will be massaged manually and another shot of pitocin and methergine will be given. However, home birthers have found Shepherd’s Purse to be quite effective. You should also use Positive Belief Suggestions to suggest to yourself that the bleeding should begin to lessen.
If you gave birth in the hospital and you have any tears, they will be repaired surgically. If you had an episiotomy, a surgical procedure to widen the birth canal, this will also be repaired. You would not have had an episiotomy without first having a shot of local anesthesia into the tissues. Or if you had an epidural during your birth, you would not have felt the episiotomy, or the repairs. At home, any minor tears can be repaired with superglue until the tissues grow together. Women with extremely small tears should stay in bed and lie as much as possible with their legs together, and usually any small nicks or tears will heal without any repairs.
Many doctors prefer episiotomy to letting the tissues tear naturally. They feel that a cut heals better than a tear. However, there are no studies or clinical evidence that this is true. In fact, there have been no studies done which show episiotomy to be of no benefit at all during birth, yet it is a routine practice. If you are remaining upright during your labor and delivery, you will not need one, and you will probably not tear either.
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