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By Root 699 0

is dilated less than four centimeters and contractions are relatively mild and spaced further apart (seven to eight minutes), as well as a late phase, when the contractions are much harder and closer together. The early phase varies in length—from maybe two hours in multiparous women (having had previous pregnancies) to as much as twenty-four hours in prima gravis (first pregnancy). Late first phase tends to be more regular, with the average woman dilating about one centimeter per hour. Women will usually want to get up out of bed, especially in the late phase. Encourage it, as lying in a bed during labor is a bad habit that is really only necessary in hospitals due to the use of epidurals and intravenous (IV) narcotics. I have found that squatting really does help speed the progression as well as minimize labor pains. In a hospital birth a woman’s cervix is checked frequently; I would urge strongly against this practice at home. In the hospital setting, a woman who is not progressing may get a dosage of the labor hormone Pitocin or may even go for a cesarean section, neither of which you will be doing at home. In addition, hospitals have a limitless supply of sterile gloves, so the risk of introducing infection into the birth canal is relatively low. In home deliveries, in which labor without Pitocin (the synthetic version of the hormone oxytocin) tends to take longer, infection prevention is crucial. You will have a pretty good idea how things are progressing just by monitoring the frequency of contractions and the look on her face.

Speaking of infection, now would be a good time to discuss an infection called Group B Strep. Group B Strep (GBS) is a bacteria that roughly 30 percent of women carry in the birth canal. While passing through the canal about 60 percent of children will be colonized if the mom has GBS. Even in modern medicine, about one in two hundred newborns will develop severe complications such as pneumonia, meningitis, or sepsis (blood poisoning). All women are currently screened for GBS at about thirty-seven weeks and treated with IV antibiotics prior to beginning labor. This has been shown pretty conclusively to reduce the amount of GBS in the canal, lowering the rates of colonization of babies. In addition, penicillin-based antibiotics readily cross the placenta and afford the baby some protection even if he or she is colonized.

Since I don’t imagine people will be getting screened for GBS WTSHTF, I would recommend every woman start taking an antibiotic about ten to fourteen days prior to their due date. While IV antibiotics are currently recommended, oral were used pretty regularly until about ten years ago. Ampicillin is probably best; any -cillin or cephalosporin (medications with ceph or cef in the name, such as cephalexin [Keflex], Ceftin, Cefazolin, Rocephin, etc.) is good. You could probably use -mycin-based antibiotics in a pinch or for seriously penicillin-allergic patients. Do not use -cyclines or anything with floxin in the generic name, as these are both toxic to young children.

After getting through the first phase, the woman will begin to feel the need to push or the sensation of needing to have a bowel movement, from the baby’s head pushing on the pelvis and bowel. I generally recommend getting back into bed at this point, though some midwives keep them up. Now is the time to clean the entire pelvic area with Betadine, iodine, or high-proof alcohol, including one-half to one inch inside the vagina itself. Begin working on stretching the back wall of the vagina using KY lubricant or oil. Looking at the vagina, take the areas at about seven o’clock and five o’clock between your thumbs and forefingers and stretch sideways and outward. Start gently but work up in force. Trust me, no amount of force you apply is going to equal the stretching from the head.

As the child begins to crown, assuming that you have clean or sterile gloves, work your fingers up around the neck to make sure the cord isn’t wrapped around it. If it is, you can usually pull on the stretchy cord while pushing