The ABC of delivering a baby at home during the lockdown

Scary as it sounds, your partner/friend may find themselves delivering your baby at home during this COVID-19 crisis. Here’s how to be prepared.

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If you’re having an uncomplicated pregnancy, and this is at least your second birth, think about contacting a midwife who can come to your house for the birth of your baby. You may want to avoid going to hospital because nursing resources will be stretched, stock may be in short supply and the risk of contamination may be increased. Women who go to hospital will be sent home early, elective C-sections may not be doable (speak to your health-care provider) and priority will be given to emergency cases.

The ABC of delivering a baby at home:

In an emergency, an open Airway, Breathing and Circulation (ABC) are critical. A newborn needs a clear airway to breathe and must be kept warm.

You will need:

  • Towels – lots of them
  • A bowl for hot water and a face-cloth
  • Black plastic bags, pillows and a blanket
  • Pair of sharp scissors and sewing cotton
  • Big (ideally plastic) bowl
  • Roll of disposable kitchen towelling (for mopping up)
  • Lined bin for disposing towelling
  • Disposable gloves
  • A soft towel wrapped in a hot water bottle to warm and dry baby immediately after the birth
  • Crib with a soft blanket – this can also be kept warm with a hot water bottle or microwave bean-bag
  • An assistant ‘scribe’ who can take notes.

How to prepare

It will be best to do this on the floor. Stack a few pillows for mom’s head, cover these (and a wide area) with black plastic bags. Have towels ready where the baby will be born. You’ll need hot water and a face-cloth to wipe the vaginal area and perineum (area between the vagina and anus) to keep it clean and supple (this will also help to prevent tearing).

Note the time when contractions start, how long they last and when ‘active labour’ begins. This is when mom starts heaving, moving around to find a comfortable position and experiencing really painful contractions that will help her to give birth.

ALSO SEE: Here’s how to time your contractions

Tips

  • Trust your instincts.
  • Stay calm.
  • Listen to the mom in labour.
  • Allow her to move around as much as possible and ‘experiment’ with different positions – both during labour and birth. Let her stand and hang onto your neck, squat or kneel on her hands and knees. With the help of gravity, these positions will help her contractions guide the baby’s head into and through the birth canal. Don’t force her to lie on her back if she doesn’t want to.
  • During the birth, hold your hand over her vaginal area to support the bulging perineum. The baby’s head will take a while to appear. Keep coaxing and reassuring her.
  • There’s no need to actively pull or push the baby out. Leave this to nature. Babies birth on their own.
  • Be patient. This takes time.
  • Encourage her to ‘push’ .
  • Record the date and time of the birth.

ALSO SEE: The ins and outs of squatting births

Once baby is born

  • The cold air, shock of its sudden ‘release’ and noise will make the baby cry.
  • If the baby is ‘floppy’ and not breathing, hold their face down on the palm of your hand so that mucous blocking the airway can drain. The baby will still be attached with the cord to the placenta, and this helps as a useful oxygen backup. Record baby’s reaction to the birth – whether it was a loud, lusty or soft cry.
  • Put the baby skin to skin between mom’s breasts, cover with a towel, and keep mom and baby warm with a blanket. Mom may start shaking – this is delayed shock. Continue reassuring her. Babies are most alert during the first half-hour after birth. Leave the baby to find mom’s nipple and experiment with suckling. This will help the womb to contract so that the afterbirth (or placenta) can come away. This usually takes about 30 minutes to an hour to happen.

More about the afterbirth

  • Don’t forcefully pull it out. Wait until you can see the placenta at the vaginal opening, then ask mom to cough or push while you gently take it out.
  • To separate the baby from the placenta you need to cut the cord. Wait until it stops pulsating. Then, about a thumb’s length away from the baby’s navel, using cotton thread, tightly tie off the cord in two places, about 5cm apart. Use the scissors to cut the cord between these ties
  • Put the placenta into the plastic dish. If possible, weigh it and measure the length of the cord. Record these.
  • Take a picture of the placenta with your cellphone, then bury the placenta outside (unless you’ve called an ambulance. If this is the case, don’t dispose of it).
  • There will be a gush of blood and fluid when the placenta comes away. This is normal.

What now?

  • You’ll need to get mom off the cold, wet, hard and uncomfortable floor. Prepare a warm bath for her. Wrap baby into the warmed blanket and put her into the crib. Leave the creamy white vernix on the skin for 24 hours. This helps to keep baby warm and it acts as a protective barrier cream and nourishes baby’s skin.
  • Help mom in and out of the bath. She’ll be exhausted and will want to sleep. Prepare something nourishing and tasty for her to eat for when she wakes up because then, she’ll be ravenous.

More tips

  • Find out if an ambulance service is able to help. Women are sometimes taken to hospital to make sure there are no underlying problems.
  • In this emergency situation, phone your healthcare provider for guidelines.
  • Complications are rarer than we realise.
  • Don’t attempt a home birth if there are anticipated problems.
  • Breastfeeding is best for baby and mom.
  • Home affairs is open to register births.
  • Take the baby to the clinic to be immunised and recorded. Municipal, private and pharmacy baby clinics, regarded as an essential service, are open. Notes taken during and after the birth will be a useful reference. Take these with you when you go.
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