It didn’t happen on purpose. Not exactly, anyway.
This was child #3, during my stint in Appalachia with the National Health Service Corps. Though I lived in the biggest town around (with a grand 5,000 population), no doctor was willing to allow a VBAC birth (vaginal birth after Caesarean). Mind you, I’d already had one without incident. Child #1 was C-section for failure to progress, but Child #2 was a normal labor and delivery. So what was the big deal? I never received an answer.
Instead I found an OB/gyn in a larger town an hour and a half away, who was willing to accommodate my request. I made regular monthly, then weekly visits, throughout my normal pregnancy. I figured I’d have plenty of time to reach the hospital. I’d been in labor nearly 24 hours with each of the first two babies.
Turns out, I was wrong – fortunately. I called my husband, who was out-of-state, at 6 a.m., asking him to hurry home. He was less than six hours away (five, at 80 mph), and should be back in plenty of time.
It was a warm day in May, the kids were out of school, so my daughter was able to watch her younger brother (who was cooperating for some reason). When the contractions grew stronger, I took refuge in our over-size bathtub, which was large enough to float in. This was far more relaxing than a hospital bed, surrounded by strangers.
Was it the environment or the baby? I’ll never know. But labor progressed more quickly than expected. After about 6 hours I started growing irritable – angry, really. Why wasn’t he home yet? I’m not sure I recognized this as transition labor, but I knew I wasn’t going to any hospital.
Suddenly, he burst through the door. “I’m calling an ambulance,” he cried, heading for the phone.
“I’m not going anywhere,” I retorted. “Get over here and help me.”
Between contractions I managed to make it to my bed. Ten minutes later, my precious daughter was born. Though he would never have chosen to, my husband was delighted to help deliver the baby. He even videotaped the placenta.
My friend, Dr. Steve, stopped by a few hours later and placed a few stitches (though I’m not sure I really needed them). By then everything was cleaned up and the baby was happily nursing. It felt odd to resume life so immediately, without the hullabaloo of the hospital.
It also seemed strange that when I filed for a birth certificate, the health department said they hadn’t heard of a home birth in years – and this deep in Appalachia. I still find it hard to believe.
That experience convinced me that a home birth was far preferable to a hospital delivery, at least for a healthy mother and child. I would have repeated the experience with my fourth, but things didn’t go as smoothly. His big head got stuck and I’m not sure he would ever have delivered without another C-section.
In retrospect, 31 years after the first delivery, I think child #1 would have delivered, had we waited a little longer, and maybe had circumstances been more relaxed. Child #2 and #3 clearly were home-deliverable. However, without intervention, I wonder if trying to deliver child #4 might have killed us both.
The topics of prenatal care, labor, and delivery have not yet been addressed in Armageddon Medicine. I need more hours in the day to get everything done. I know we have some obstetricians and midwives on board, and hope they’ll be willing to help out, maybe write an article or two . . . perhaps while waiting for the next child to be born.
Copyright © 2011 Cynthia J. Koelker, MD
Within a few years post-apocalypse, as modern birth control wears out and isn’t replaced, maternal mortality rates (maternal death rates during or shortly following delivery) will probably return to historic (and, for non-modern countries, current) rates of around 2%. Since the average woman will eventually be having 5 children, the cumulative risk for a woman of dying in childbirth will be 10%.
This means, 1 in 50 women will die during any single episode of childbirth. 1 in 10 will die during their lifetime from their multiple childbirths.
My suggestion? Find yourself a skilled, well trained midwife or obstetrician – someone who can handle medical complications of pregnancy, and is willing to perform operative vaginal delivery. Work on being able to provide anesthesia. Have a surgeon or obstetrician (or, again, a highly skilled midwife) who is willing to perform Caesarean delivery. Figure out a way to provide blood. Figure out how to diagnose and manage ectopic pregnancy (the leading causes of maternal death during early pregnancy, and, without modern lab and ultrasound, quite difficult to diagnose reliably, until she is dying).
Anecdotes about “how I survived a home delivery”, while cute, and perhaps inspirational, do not address the frightening reality of pregnancy without modern medicine…