Excerpts from The Childbirth Manual

The Childbirth Manual by Sandra Roberge. All that you will read here on this page is from the book: (You can buy it in PDF Adobe format is you wish.)
Here, on this page are some excellent pictures of birth and pregnancy, be patient, they are worth waiting for!

It’s Your Body and It’s Your Baby - You have rights; don’t let anyone take them away from you. Your health is your own responsibility.

There is a place for the hospital and the medical profession. They should not be rejected or shunned for they do have value. When you have used your own knowledge and abilities and you require more then turn to the medical authorities for more complete information and assistance. If conditions require you to go to the hospital to have your baby then be prepared and meet the experience well educated.

In an abnormal situation many things are impossible to ask for and should be given up but that doesn’t mean that all things must be given up. For example – you may need an intravenous drip but that doesn’t mean you must give up keeping your baby with you after the birth. Even if a caesarean is necessary you can still have the many concessions previously agreed upon. Discussion is necessary. Be aware and ask questions. Have everything explained to you.

l. Find out what hospital your doctor/midwife practices.
2. Who is his/her back up and will s/he allow the same requests as your own doctor?
3. What is your doctor’s understanding of “natural childbirth”?
4. Do you feel comfortable with your doctor? Does s/he explain all the procedures to you adequately?
5. It is wise to be pre-admitted to the hospital where you may need to go or where you plan to deliver.
6. Go on a tour of the maternity ward before your due date.
7. Have your mate, coach or significant other accompany you when you go to appointments, tours and classes. Will they be able to be with you when you need them during your hospital experience?
8. Will you be allowed to have your coach and other people of your choice be with you for the delivery? How many? May your other children, as per your choice, be allowed to be with you also?
9. Does your doctor/midwife have any routines that s/he will insist performing? Discuss the need for these routines.
10. Does the doctor prefer rectal or vaginal examinations during labour?
11. Does the doctor insist on you getting an intravenous drip during labour or delivery? Routinely? Or only if necessary?
12. Will you be urged to take painkillers routinely or only if necessary?
13. What kind of pubic preparation does the doctor prefer you to have (shaving is rarely done anymore, but check!)?
14. Will the doctor do a gentle birth, dim lights, quiet environment?
15. Would your doctor consider letting you deliver on your side if you felt like it? Without putting your legs in stirrups? Or let you deliver in the labour bed if the hospital doesn’t have special rooms set up?
16. If you desire, will you be allowed to touch your baby’s head as it crowns, or help deliver the body?
17. You don’t have to have student doctors, interns or any non-essential people in the delivery room if you don’t want them.
18. Will you get a routine injection of pitocin to make your uterus contract after birth?
19. Does your doctor do an episiotomy (cut of the perineal area) routinely or only if necessary? Will s/he do perineal massage during descent of the head and do perineal support during birth of the head and shoulders? What kind of birth does s/he do?
20. If an episiotomy were necessary would s/he do a midline cut? Do it without freezing so that you can totally feel the birth of the baby’s head if you choose? (The actual cut of the perineum should be done only during a push when the perineum is stretched and therefore numbs the area a little. The cut is quick and you will only feel a brief sting, as much as the sting of a needle and injection of freezing. It would probably hurt as much as a tear of the area.)
21. Will your doctor put your baby directly up onto your tummy after it is born and do any suctioning that is necessary there? Placed on your tummy skin to skin?
22. Will your doctor leave the cord intact until it has completely stopped pulsating and non-functioning?
23. Will you be able to keep your baby with you all the time after the birth? Does the hospital allow “rooming in” or having your baby with you all the time?
24. Is your doctor supportive of breastfeeding? Will you be allowed to breastfeed on the delivery bed?
25. Will you baby be given sugar water in the nursery? – absolutely unacceptable!
26. Do you want your baby to have Vitamin K injection after birth as a preventative against any bleeding disorders? (Rare!)
27. What is the routine of eye care after birth? No silver nitrate, substitute an antibiotic ointment if it is routine.

Demand that all procedures and routines are thoroughly explained to you during your hospital stay. If a caesarean birth is necessary, explanations can still be given, if not to you then your mate or labour coach. One hint: you will get more things if you are not forcibly aggressive with your demands. Be tactful; smile when you say no! Then if this fails go directly to the supervisor or your doctor. Defend your rights if necessary. If you are unable to be aggressive at this fragile time then have your mate, labour coach, doula, and significant other fight for you and protect you – they will be your advocates.

There has been a chart devised that may help you to recognize the need of the baby, called Apgar Score.

Apgar Score Table

Score 0 1 2

1. Heart rate absent slow, below 100 above 100

2. Respiratory effort absent slow, irregular crying good

3. Muscle tone limp some flexion of limbs active

4. Reflexes no response grimace crying

5. Colour blue/white extremities blue body pink

Baby may not cry, may breathe a little irregularly and be a little blue with some but less than the usual amount of muscle tone. If the heartbeat is greater than l00 beats per minute there is no immediate danger. Keep the baby warm at all times. Be sure the airway is clear. Do repeated suctioning with an “ear syringe” by squeezing all air out first and inserting it into the back of the air passage or throat. Try and clear out most of mucous that might obstruct the airway. Make sure that the baby’s head is lower than the rest of the body so that fluid can drain from the chest. Don’t suction for too long at a time or it will interfere in the rhythm of breathing and oxygen intake. Also, it may cause spasms in the airway and swelling of the mucous membranes.

A slightly asphyxiated baby will respond very well to stimulation by touch. Rub your fingertips up the spine on either side, vigorously rub the soles of the feet, stretch the legs out but be reasonably gentle. Too much stress will reduce the baby’s ability to overcome the adjustment difficulty.

Usually the relief of having the birth over may override your logical ability to look objectively at the baby to see its condition. That is why it is good to have an attendant to keep centered on the baby’s physical adjustment. If you are alone you will be forced to keep aware of the progress and condition of the baby at all times.

Apgar rating 4 or less at one minute (Apgar at 5 minutes of 5 or 6 is more serious than at 1 minute!)
No response to stimulation.

What to do - keep the baby warm, body temperature should stay at 32 degrees C or 98.6 degrees F. A cold baby can’t maintain respirations under normal circumstances.
Extras:

Feel - Look - Listen

1. Position baby by placing your hand at the base of the baby’s neck in order to tilt its head back slightly. When the head is in this position with the neck straight the tongue will be free from the airway. Not enough extension will allow the tongue to occlude the passageway, as will too much.

2. Using a small ear syringe suction any fluids out of baby’s nose and mouth. Squeeze syringe first, insert into the passage, release the squeeze. Go to the back of baby’s throat. If this is not clearing the airway then you can use a “De Lee” suction that has a mucous trap and a long rubber catheter, enabling you to suction deeper into the baby’s lungs. The blockage may be deep in the windpipe. Don’t be afraid of causing the gag reflex - which will only assist in clearing the airway.

*At this point the baby may have started breathing on its own. Oxygen by infant facemask may help a lot in establishing a good breathing pattern for the baby and replacing the reduced oxygen to its body. If there is still no response after a couple of minutes then begin resuscitation ...........

1. Hold baby’s head secure in position; place your mouth over the baby’s nose and mouth to create a tight seal. Blow puffs of air from your cheeks, not from your lungs, at a rate of 20 to 24 puffs a minute. As you puff air in you should see baby’s chest rise. (Once every 3 seconds.)

2. After each puff, raise your mouth and turn your head to the side. This allows the air to escape back out of the baby’s lungs and gives you a chance to take a small breath. While your head is turned to the side you will also be able to watch the baby’s chest fall. Be careful not to blow in air while the air is escaping from baby’s lungs. Be sure to make a good seal around the baby’s mouth and nose. Someone can listen to the baby’s chest with a stethoscope to hear the air movement. If the air is not going into the baby’s lungs be sure the baby’s head is tilted far enough, or not too much, or maybe suctioning again would help.

3. Sometimes air will get into the stomach and compress the lungs; moving your hand and placing it over tummy and gently pushing or sitting the baby up for a second should expel it.

4. Observe for signs of baby breathing on its own. Continue until you get some response.

C. Begin cardiac massage - if the baby’s pulse is less than 60 beats per minute.

1. Find out the heart rate. It will slow down if baby hasn’t been getting any oxygen for 1 ½ to 2 minutes. Listen with a stethoscope or feel the femoral (groin) or carotid (neck) pulses. If you can’t feel anything there then put your hand over baby’s chest, you should feel the heart beat easily.

2. Baby should be on a firm surface. (Compression will push baby into bed or down into mom’s soft stomach.) Hold over your arm or put onto the floor or on a table.

4. Place one hand under the baby’s back or put your fingers around the body onto the back.

5. With the tips of the index and middle fingers of the other hand, depress the midsternum about ½ to 2/3 of an inch downwards. Or in the other position, with your thumbs (2 to 3 cm.)

6. Gently but forcefully do this at a rate of twice a second, approximately 120 per minute.

7. Give the baby a puff of air every fifth compression without interrupting the rhythm of the compressions. The breath must be given between compression...puff at the same time that your fingers are coming up.

8. Continue until you get a response or until qualified medical assistance takes over, or until the baby is beyond help, which is extremely difficult to judge, only a qualified medical doctor is able to assess the condition of a baby. CPR for as long as 45 minutes has saved babies lives! Don’t give up.

*Do not hand over resuscitation to anyone unless they can prove that they know the procedure.

(This is true in most places but the law varies. Instead of wondering about the law in the particular area just rely on the fact that only a medical doctor has the authority.)

I would strongly advise anyone involved in childbirth and especially in a home birth situation to learn CPR through a qualified training/educating organization.

“Home Birthing” -
When you have decided to undertake the task of delivering your own baby at home and you have considered all advantages and disadvantages, it is good to have someone helping you who has been through the birth experience before. This person may be a doctor, a nurse, a midwife, a labour guide, a friend, or your mate.
Your attendant should be honest, confident and have a calm, peaceful spirit. They should be sensitive to your needs during labour. They should have a good education in childbirth and have seen many births so they can advise and direct you in the process if you have questions or doubts. They should be able to recognize the normal and abnormal before life threatening difficulties arise. Above all they must be loving!
If you and your mate have decided to do it alone you must be totally prepared spiritually, physically and academically. To choose to give birth alone at home means you have completely accepted this responsibility.
If you have decided to have a midwife or a labour coach (doula) attend you then you should have developed a trusting and comfortable relationship with her before the delivery date. It is your right to know how many births she has been to and whether she can handle most emergencies. You should not perceive her as a doctor, but instead as one who can assist you in your individual task of delivering your own baby. Don’t let your faith and trust in her abilities interfere with your faith in your own ability.
Any birth attendant should be a supplement to your existing knowledge and not a substitute for your education. Your attendant’s knowledge and experience should be available for help and guidance in case you need direction, informing you truthfully of progress or delay and giving you support, working with you throughout your labour and delivery.
A midwife is a person who practices the art of aiding a woman in the delivery of her child. She does not “take care of you” or deliver your baby for you. She may be between your legs to deliver, but the task of giving birth is your own. Remember that home birth is your choice and responsibility; a midwife’s responsibility is to provide the best quality attention, medical knowledge and experience she can offer.
In many parts of the country midwifery is limited to the realm of the physician, unless you are lucky enough to live in an area that has introduced the practice of midwifery in professional facilities and at home. Homebirths have always taken place and will continue to take place because there are those of us who simply feel that this is a normal natural function and home is the best place to give birth. It is not a disease and should not be treated as one. The hospital environment is dedicated to healing the pathology not aiding in the functioning of the normal healthy body. There should be alternatives available for those who feel strongly about the place of birth, and these should be safe alternatives.
One of the main reasons for writing this manual was to aid in parent’s preparation for and to increase their awareness of the birthing process - and more - to help in preparing for a home birth rather than a hospital birth. But before I sound too prejudiced towards homebirths let me clarify how I feel. It is wrong to place all emphasis on the home as being the best and only place for a good birth. It is the principle that I stress, not the place. Babies have been born everywhere, some have been good births, and some have been horror stories. A good birth experience is a matter of individual judgment. What is good for you may be outrageous for another or not good enough for someone else. The important factor is you, what you want and what you perceive is right for you, that which makes you feel happy and satisfied with your accomplishment.
After observing many births, I have seen parents totally contented with deliveries in an ambulance, in a teepee, with a Cesarean birth, or induced forceps delivery! Everyone must decide what is right for him or her. It is not the place of birth but the consciousness of the people involved.
Another factor that you always must honour is the choice of the baby; where to be born, when to be born, and with whom - alone with mom, in a living room by a fireplace with twenty people helping, or in a hospital delivery room attended by strangers. You really don’t have control over your experience, but instead you can plan, choose and then surrender to whatever happens.

John Lennon once said: “ Life is what happens to you
While you’re busy making other plans. "

Growing and creating a new human may be all consuming during the nine months but it should not overwhelm your needs as a woman to express yourself sexually and feel pleasure. The act of sex began the creation and it is all right to continue all throughout your pregnancy, especially when it is an expression of love as well as pleasure.

Sex is one way of focusing on your genitals, feeling comfortable with touch and being open. Either alone or with your partner you may discover some new sensations. Because of increased blood flow to your pelvic area everything feels more intense, more alive. For some, orgasms are easier to reach at this time more than any other time, especially in the first three months. Plus there is the added bonus of no menstruation and no fear of conception or birth control.

Obviously, as you grow, positions will have to be modified and your partner will have to be more sensitive to your comfort. If the regular missionary position becomes uncomfortable then on your side may be better. Don’t be afraid or embarrassed to try something new.

If at anytime you see blood, before, during or after sex stop until you can check with your doctor about possible problems. Extra mucous is normal during pregnancy. You also may be more prone to infections, especially yeast.

Also, it is very dangerous if you get air inside there is a small possibility of it traveling in to your uterus. So warn your partner about that if you enjoy cunnilingus.

You may want to reassure your man that penetration during the last months of pregnancy will not harm the baby’s head. It may bounce the baby but it has room to move around, and there is padding between the penis and the baby - membranes, cervix, mucous plug, bag of waters, and lots of protection.

The chemicals that are released during orgasm and the love shared during making love will be communicated to the baby and baby needs to know all the time that it is loved.

Another bonus to intercourse at your due date or after may be to start labour, by the massage of the cervix and the hormones released during orgasm. But don’t be concerned, it won’t start until everything is ripe and ready.

If your desire dwindles during the last few months of your pregnancy, communicate with your partner of these feelings but understand that your partner should not be ignored. Even if you find it impossible to have an orgasm, just the sensitive sharing of making love will help your partner to be satisfied and not left out or unloved.