While some advocates of freebirthing stand by the idea that it is as safe as--if not more safe than--a hospital delivery, many critics strongly disagree, citing the drastically higher rates of infant and maternal mortality during and after unassisted deliveries. The World Health Organization released a statement in 2005 warning against voluntarily unassisted births, based on global statistics. However, should you find yourself faced with the surprise of attending a birth without a doctor or midwife present, there is good news: the odds are strongly in favor of both the mother and the baby doing just fine.
In reality, most families go to the hospital or call the midwife too soon, not too late. It is unlikely that a mother will be saddled with an unexpected home delivery unless she waits far beyond the typical recommendations. Less than one percent of births occur with very little advance warning, and even fewer of them end in a full delivery before the arrival of a midwife or medic.
Even still, it is a good idea for all expectant parents to be prepared for the possibility of an unexpected home birth. To be fully prepared for the remote possibility that you may have to do this alone, have a kit of sterile instruments ready. The kit can be fully sterilized by wrapping it in heavy paper, tying it with a string, and placing it for two hours in a 250-degree oven. A shallow pan of water in the bottom of the oven can keep the paper from scorching. Have this kit prepared by week 36 of pregnancy and re-sterilize it once a week to avoid contamination.Your kit should include many towels, a heat-retentive blanket, several small flannel cloths, and a few receiving blankets.
If, of course, you have not pre-sterilized these items and the baby's birth is imminent, it is okay to use clean substitutes (this is better than simply doing without them). There is no need to prepare anything to use for cutting the cord or disposing of the placenta; all of these things can wait until help arrives. It is also a good idea to have a bottle of medical-grade personal lubricant (K-Y is fine) and a new-in-package, sterile bulb syringe. Medics may be able to instruct you on their use.
In the rare case that a birth is imminent and you have no time to go to the hospital, one of the first and most important things that you need to do is to reassure the mother that she will be okay. When a woman is in the very late stages of labor, it can be very difficult for her to trust that she and the baby will be alright, even in a very secure setting. Even if you have to feign confidence--and even if you have to lie--tell the mother with certainty that she and the baby will be fine. The mother's faith in her body is one of the single most important factors in insuring a healthy delivery.
Instruct the mother to "blow out the candle" through her mouth when she feels a contraction, and tell her not to push if she can in any way avoid it. Panting can help a woman in late labor to keep from pushing until help arrives. It is very difficult and painful to try not to push during the final contractions, but it is one of the only ways to slow down the labor when birth is imminent. Have her lie on her side to slow the labor.
When the mother is calm enough that you can leave her side just for a moment (between contractions, that is) call 9-1-1 immediately. Be very quick in your communications, and do not become nervous or hysterical. Tell them the mother's age and blood type if you know it. Also inform them of how far along the pregnancy is (in weeks, not months), and roughly where she is in labor (How long are the contractions? Is the baby crowning? Does she feel a strong urge to push?)
Wash your hands while you are on the phone with emergency services, if you can leave the mother's side long enough to do so. It will be important that your hands are as clean as possible in case you need to make the delivery. The emergency personnel may want you to stay on the phone until they arrive.
Layer several towels and sheets underneath the mother's body to soak up any fluids that might be expelled. There is no need to wash or throw away any of them, simply place a new one under the mother if they become saturated. Keep at least one of the sterile towels dry so you can use it to dry the baby if it arrives before help does. If the mother is already pushing, she may defecate on the sterile towels; if this happens, simply use the sterile flannel cloths to clean her.
If the mother's urge to push is too strong and she is not able to prevent herself from pushing, the baby may be born before help arrives. Do not blame the mother if this happens: pushing is an instinct that is difficult--and for many women, impossible--to override. As the baby is born, guide him out as gently as possible. Do not try to hold him in, do not pull him out, and do not try to do anything to keep the mother from tearing. All of these, unless done by a medical professional, can be seriously damaging.
If the baby's cord is wrapped around his neck, gently ease it over his head, but do not pull it tightly. If this is impossible, you may be able to form a loop to allow the rest of his body to slip through. Do not cut or pull on the cord. Leave it attached to the baby and the placenta until help arrives.
Place the baby on his mother's abdomen and quickly cover them with a warm blanket or towel, but be careful not to cover the baby's head. If he is not crying immediately, rub his back to stimulate breathing. Try to ease mucus or amniotic fluid out of the baby's nose by rubbing the side of his nostrils. Over the phone, emergency service personnel may instruct you on infant CPR or explain to you how to use a bulb syringe.
It is likely that the mother will continue to bleed somewhat large amounts if the placenta is still attached, but you must not attempt to pull it out. Encourage her to try to get the baby to nurse as quickly as possible. This will help to release the hormone oxytocin, which will cause her uterus to contract, expel the placenta, and control the bleeding. If the cord is too short to do this without stretching it, have her manually massage her nipples; the stimulation will have a similar effect. Encourage her to continue to do this even after the placenta is out, since it will help to contract her uterus and control the bleeding.
If help still has not arrived, try to keep both the mother and the baby calm and warm until someone is there to assist you. Do not cut the umbilical cord, move the mother, or handle the baby until a professional has arrived.
While this article may help you to be prepared in the event of an unexpected home birth, it is not intended to substitute the advice or assistance of a midwife, doctor, or medic. Always follow the instructions given to you in person, even if they contradict the recommendations of this article. If at all possible, births should always be attended by a qualified midwife or physician.