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Friday
Nov192010

Comment for "Home Birth Plan"

Note: As I am set to publish this, Emma sounds like she might be in labor. She’s having a breech homebirth, so I’m eager to watch along her process. Much of this post becomes irrelevant for her and wasn’t a critique at all of her birth plan, but I wanted to offer other thoughts and ideas; now they can sit out there for others to read. 

Sending love, Emma! 

I read “Home Birth Plan” on the Ramblings of a kajira blog today and wanted to make a few comments. Blogger has been irking me no end not automatically allowing Name/URL as a commenter’s option, so I’ll just chat with Emma here in my blog! 

Emma, the author of the blog, is a kajira… a slave in the Gorean style of Dominance/submission, what many would classify as kink, but others find it a lifestyle choice instead. Her D/s world is irrelevant to her birth plan (on the outside, anyway), but when you go to her site, you’ll have questions; thought I’d give you a head start. Oh, and lowercase “i”s instead of the capital I is a sign of submission, not a typo. 

Emma! I’m so excited for you having a homebirth. I love that you have Jake as such a vital part of your needs and desires. That speaks well for your relationship. 

There’re a couple of things I wanted to mention about your birth plan, clarifications, really. I know you have a midwife and she’s obviously guiding you along nicely, but thought I’d point out a couple of things that caught my eye. 

- I'll need antibiotics for GBS. Once the series is done, i'd like the IB removed.

When antibiotics are given in labor, they are given every 4-6 hours (depending on the antibiotic) until delivery. But, inbetween infusion times, the tubing can all be set aside and you capped off with a saline lock. You’ll still have the IV threaded in your vein (no needle, of course), but you will be able to move around fine, shower and such without a problem. 

Have you talked to your midwife about doing the Hibiclens wash instead of the IV antibiotics? It is what many homebirth clients do and is what most of my clients choose to do as well. It is easy and the research is very positive about the efficacy of its treating/”washing” GBS so the baby isn’t infected as s/he goes over the perineum. If you want the list of studies and my protocol for the Hibiclens, email me and I’ll send it right over. (Navel gazing Mid wife at g mail dot com)

- No episiotomy, i'd prefer natural tearing. - and if a tear does happen, PLEASE use a topical numbing agent to stitch it.

It is extremely rare for a midwife to do an episiotomy. I’ve done two in 15 years! (and might not even do those again if it were today) Hopefully, that will ease your mind. And not sure why you are asking for a topical numbing agent. Instead of injectable lidocaine? Many of us will put the topical on for a minute or two, letting it numb the area a little and then use the injectable lidocaine to really numb the area. I cannot imagine suturing with just the topical lidocaine. Owie, zowie! 

There are midwives that suture without meds, but they almost always will suture immediately after the birth when the birth hormones are raging high and the perineum is still pretty numb from pushing. It’s a philosophical discussion about when to suture, but I find that suturing that close to the birth doesn’t allow mom and baby an uninterrupted time to see and feel and smell each other. When moms are being sutured, it isn’t unusual for her to be so distracted she cannot hold the baby or, if she can hold the baby, have a difficult time nursing. I’d rather wait awhile (45-60 min or so) and let mom and baby settle in before suturing. 

Each midwife does have her own style and preferences, though, so this is a great question for your own midwife. 

- Regarding being told what to do versus listening to your own body as well as Jake, I think you’re going to find that exactly as you picture it. When everything is going great, the usually tact is to be gently encouraging. It is when guidance is needed that a midwife will step in. (It’s what you’re hiring her for, right?)

- Vitamin K shot is not needed, but eye drops after a couple hours are fine if required due to the GBS positive factor. I want that bonding period first though, and if eye drops aren't required, i'd like to skip them.

Actually, there are times the Vitamin K shot is needed (in my and others’ opinion). If there is bruising at birth or if there’s been some trauma to the baby as s/he is being born… shoulder dystocia for example… or if there is a caput (neither of which a breech baby will have). However, it is very common for a breech baby to have bruising on the butt, swelling and/or bruising on the genitals or if any manipulations need to be done, on that body part. As a midwife, I would encourage my clients to seriously consider getting the Vitamin K shot for a breech birth. 

Regarding the Erythromycin eye ointment, it is given for chlamydia and gonorrhea, not GBS, if that helps your decision. 

According to the 2005 Sanford Guide to Antimicrobial Therapy, the ophthalmic ointment is indicated for use in all newborns for the prevention of a bacterial eye infection known as ophthalmia neonatorum due to Neisseria gonorrhoeae and Chlamydia trachomatis."

- Baby will need hep B vaccine AND hbig immuglobulin at birth with in 12 hours of delivery....

It’s so interesting you don’t want the Vitamin K or the erythromycin, but you do want the HepB injection. If moms pick and choose, it is very often the other way around. If, however, you are in a high-risk category, ignore this comment.

- Mom will need Rhogham. She's RH negative - baby is most likely positive. 

Not sure why you think the baby is most likely positive, but care providers almost always (should!!) test the baby right after the birth and then you can get the RhoGam® (aka Anti-D) if the baby is positive. (And yes, readers, I am aware not all mothers choose the RhoGam® even if their babies are negative.) Even in a homebirth, labs can come get the blood stat and let the midwife know so she can get you the RhoGam® before 72 hours postpartum. There are even home tests to determine what type the baby has. 

I’ve poked around and can’t find a percentage of babies that are positive to moms who are negative; do you have a site I can check out? I did find that 85% of Caucasians have Rh positive blood, so maybe that’s what you are going by? 

And do you know if the dad is Rh positive or negative? If he’s negative, then you don’t need a shot at all! 

(For the geeks in us, I came across this interesting (cool!) site that scientifically explains the Rh factors in more depth –and reminds us providers it isn’t just a case of positive and negative, but there are variations on the negatives we need to be aware of. Plus, MoonDragon has a great explanation of the variants of Rh negatives [Kell, Duffy, etc.])

I really do look forward to your upcoming birth, Emma. I know there are now many of us sending you birth vibes and anticipate seeing your precious baby. Thank you for being so out there.