Home Birth Bags

What the Heck Is In Those Bags?

Hi everyone! I was doing inventory the other day and decided to take some pictures of the contents of our bags (and supply closet, but thats boring) for our own reference. It occurred to me that, since folks always wonder “WHAT DO YOU BRING TO A HOME BIRTH?”, I could share the pictures with you! As you look through these pictures, keep some things in mind:

1) since we share this bag between three midwives, midwives with different habits and histories, we endeavor to keep it simple and streamlined so that it works for everyone. Assistants and nurses also get in to the bag, so it has to be pretty simple.

2) the idea is that this bag is ready to go for two births, and two births only. In my experience, midwives run in to a lot of trouble overstocking bags. Items expire, things get lost, and you can’t find the thing you need. Ideally, immediately after a birth, you re-stock it. These pictures were taken a couple days after a birth.

3) We have all home birth clients order this birth kit. The kits have a lot of stuff that we use at every birth (and plenty of leftovers as most of our clients know).

4) We have standing orders in every chart and nurses to administer meds. More on that in the meds bag section.

Without any further ado:

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Our Bags

This is pretty much it. The large purple home birth bag, the small meds bag, a personal bag (this one is mine - Adrianna and Marinda have witchy baskets - and the postpartum bag. Not pictured: sump pump and antibiotic kit.

The meds bag is separate so that it can easily come inside and never lives in a car even for a few hours. The personal bag holds midwife gear like a computer, change of clothes, toothbrush, chargers, midwifery stuff used by that particular midwife only, etc. Finally, we toss the postpartum bag in the car, usually, because it has some things we don’t have duplicates of like a Massimo pulse oximeter we use for CCHD screening and newborn resuscitation. If anyone out there feels the call to buy us a duplicate, we would not say no!

The Main Bag

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Main Bag

Top pocket is a ziploc “go bag”

This is the Main bag, an Iron Duck medical bag made especially for midwives. The top pocket has a ziplock bag that, say, we arrive at a birth and the baby is coming, we could dump out on a chux pad and have pretty much everything we need.

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Ziploc Go Bag

I like Ziploc bags because we can replace them frequently. I often replace them at births or when doing inventory. I love these large bags from IKEA

contents of the “go bag”

contents of the “go bag”

1) Doppler - for listening to the baby’s heart rate

2) Doppler Gel

3) Bulb Syringe (rarely) used for suctioning baby

4) blood pressure cuff, standard size

5) cord clamps x2

6) stethoscope

7) Sterile OB pack with 2 clamps and 1 scissors

8) sterile gloves, size medium x4

9) sterile gauze x4

10) sterile lubrication

11) flashlight

12) emergency blanket

13) hand sanitizer

14) inventory card

15) single use emergency meds bag

16) thermometer

At every birth we assemble a bowl or tray for our use. From the “go bag” bag we take out the BP cuff, stethoscope, doppler, gel, flashlight, OB pack and thermometer. The rest of the supplies we put in our bowl come from your birth kit. Sometimes we will use the items in the “go bag” at a birth and then replace them with items from your kit. The items we take out get sanitized after a birth before they go back in the bag. The OB pack instruments go back to the birth center to be sterilized. The goal is to keep everything clean, new and in-dates, ready to go.

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Bottom Front Pocket

or, the big, bulky, miscellaneous pocket

please excuse the picture quality change. I came back to the inventory later in the evening so the light is not as good.

please excuse the picture quality change. I came back to the inventory later in the evening so the light is not as good.

The outside bottom pocket is where we keep big, bulky items that we frequently use.

1) Sharps container

2) non-sterile gloves - there are about 50 of these in every birth kit, but sometimes we need more.

3) Fetoscope. When/if dopplers fail we always have this back-up (along with extra batteries)

4) Extra instruments and sterile field

5) Extra gauze and sterile gloves. It feels like there are births where we use none of these items and births where we use everything in your birth kit, plus our extras and start raiding the postpartum bag.

6) Duct tape (see birth tub bloopers)

7) Inventory card

Not numbered for some reason: bag with baby scale and sling

Not pictured: large blood pressure cuff

Opened bag

Opened bag

This is the bag just opened up to the main compartment. The pouches are, from the left:

1) Lab Bag

2) Suture Bag

3) IV start kit

4) packing

5) extra IV supplies

6) Amniotomy and Catheters

Lab bag contents

Lab bag contents

We don’t draw labs often at births, but it happens. Here we have, again in bags that can be replaced frequently (vs plastic boxes or cloth bags):

1) Draw supplies - needles, bandaids, alcohol, etc.

2) specimen bags and 3) paper requisition forms

4) and 5) - supplies for labs like urine cultures, glucose, blood type, CBC etc.



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Suture Kit!

Simple and effective

In my previous partnership in St. Louis, I was always the midwife who sutured, and I enjoy doing it when it is necessary. Over the years I have pared down the suture kit quite a lot, so that it is simple, streamlined and works perfectly, even when I am tired.

1) Suture kit (high quality needle driver, scissors, hemostat and needle puller) and sterile field

2) Sutures - Vicryl CT-1 3.0 x2 and SH 3.0 x2

3) Lidocaine x 2

4) 10ml syringes

5) 1.5” 22g needles

Unnumbered: recticare

And thats it!

What you need to start one IV

What you need to start one IV

This is a basic kit to start an IV. Again, we like to keep it simple so that this bag can be grabbed and, without a lot of thought, an IV can get started. Simplicity is even more important since we have nurses from different situations and everyone is used to different equipment.

1) IV catheters - 22, 18 and 16 gauge

2) IV start kit (1)

3) Bag of LR

4) Extension set x2

5) Administration set

Not pictured (remember I was doing inventory) suresite bandages, large, IV flush

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Extra IV stuff

more is in a separate kit that is used when people want antibiotics for GBS

This is a bunch of extra IV stuff. Not too much, nothing is more irritating than overstocked bags.

1) IV flush x4

2) Extra catheters

3) extra extension sets

4) extra connectors

5) extra suresite bandages

6) extra administration sets

Not pictured - extra LR and D5 (inventory day!)


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super fun stuff

is not located in this pouch


We do not break water very often, and we really don’t use catheters much. This pouch is for items that are long, narrow and sterile. (and there is a lot that needed to be restocked here)

1) self catheter x2

2) Amniohooks x2

3) Straight catheter x2

4) foley catheter x1

Not pictured: amnicators

Under all of the bags and pouches are other compartments where we keep less medical items.

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Tinctures

Adrianna makes many of these

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Little bottles

used occasionally….

Under all of that is a large compartment with resuscitation equipment

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back compartment

folksy heating pad cover

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A cutting board!?

whatever is that for?

I think every home birth midwife has a cutting board in her bag. This is ostensibly for resuscitation, and we set it up at every single birth. Over several hundred births, however, we have only used it once. Maybe twice. Meaning, resuscitation is usually brief and in the parent’s arms. But we have it, and it is set up with the heating pad and warm towels so that it is ready when the baby is born. At the birth center we have a Resus-A-Cradle.

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Newborn Resuscitation

stuff here

These are the things typically used for newborn resuscitation. Everyone at every birth is certified in NRP, though it is rare for low-risk newborns to need more than a couple inflation breaths at birth. We check and assemble items here when we set up for a birth. We make sure the bags and masks are working properly, and check to make sure other emergency items are available.

1) Self-inflating bag masks in various sizes

2) ziploc bag with small resuscitation items (gastric tube, Laryngeal Mask)

3) self inflating bags (these get tossed if we use them)

4) oxygen masks for newborn

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Adult O2

or, when room air is not enough

Stuff for adult oxygen

1) oxygen regulator (this opens the oxygen tank and delivers different amounts of oxygen - not to be confused with an oxygen mixer, which would deliver O2 at different percentages)

2) Medium concentration masks

3) High concentration masks

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A tank of O2

this tank will deliver oxygen for an hour. If we are at a rural location we can bring an extra tank.

That almost concludes the birth-bag tour. There are some additional odds and ends under the oxygen equipment, including some rarely used emergency supplies and rarely used instruments.

The outer back pocket has a file folder with actual paper in it. If clients do not have internet, or our computers die, we have back-up charts in here. We also have some diagrams and flowcharts that can be helpful at certain births.

back up paper

back up paper

Meds

Meds laws are funny in Virginia. With the support of physicians and CNMs, we have standing orders for all meds for every client in every chart. We have a nurse available for every birth to administer meds. We hope these laws change sometime soon, as Virginia is unique in licensing midwives and not allowing them to administer the medications that are in our scope of practice. These are all relatively simple medications and are the standard of care in our community for every birth. The cornerstone of our practice is informed choice - we work hard to offer the standard of care as an option for everyone. Some of these medications are lifesaving and we believe that it would be unethical to attend births without them.

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Behold, the meds bag

Separate from the birth bag so it never sits in a car

I like to hand this bag, pretty side facing out, from a door frame or closet

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Medications are in labeled plastic med bags with lot# and expiry if they are taken out of bottles

Row 1) OTC tylenol PM, OTC Ibuprofen, OTC benadryl

Row 2) Alcohol swabs, bandaids, (under the glare) misoprostol x

Row 3) Pitocin x4 (had just used pit at a previous birth), Methergine

Row 4) filter needles and small needles for vitamin K, Vitamin K

Row 5) 3ml syringes and 22g 1” needles and 1.5” needles

Postpartum Bag

There are some extras in this bag that I suppose we might occasionally use. But mostly we carry this so that the Massimo lives in one place. We take it out and have it with our resuscitation equipment. It goes back in the back for the CCHD screening at the first postpartum visit.

We love you, Rad 5

We love you, Rad 5

And that concludes the tour of our birth bags. If you are a client, student midwife or a doula, we hope this was helpful - now the heavy purple bag is a little less of a mystery. Let us know in comments if you have any questions!


Birth Tub Bloopers

A few months ago I brought you a story of the trials and tribulations of finding a birthtub for the birth center.  If you haven’t checked it out, you can read it here. I am happy to say that we have an Aquatica pre-ordered for the new birth suite. But what about home births?

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What could go wrong?

not much but…..



In Richmond, many folks have had babies at home with Adrianna or Nancy using the horse trough birth tub.

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One option

Horse Trough

The vast majority of folks planning home births in the US, however, use an inflatable tub.  At River City Midwifery we have one of these (big) and two of these (smaller) for our clients to use at home. Sometimes people will plan to use a garden tub they have at home or skip the water birth plan completely. But most of the time, one of these is part of the equation. Inflatable tubs have some advantages over other birthing tub options - they are super comfy, somewhat translucent (better pictures) and, because they deflate, they are portable.  Unlike built-in tubs they are harder to keep warm, sortof a pain to drain, but for the most part they work fine. We’ve been doing this a long time and have a system practically guaranteed for success.

But, over several hundred births there have been a few….. shall we say…. Bloopers.  And I am here today to share them with you.


Birth tub problems

A question on a lot of people’s minds, definitely a question on more Dad Minds than Mom Minds, is the safety and reliability of the old inflatable birth tub. I would call some people (men) Tub Skeptics.  And although Inflatable birth tubs are usually filled, used, drained and deflated with no issues whatsoever, there’s always a little element of truth feeding any skeptic mind.


Filling with Air

If something is inflatable, it will eventually leak.  Balloons, rafts, camping pads and birth tubs. We try to find and fix leaks before labor  - we are there to hold space, not whip out patch kits and kick you out of the tub so we can take over your birthing space with solvents and sandpaper. So, if you ever see a midwife clinging to the side of an inflated tub with a bucket of soapy water (leaks make bubbles) or a stethoscope, try not to laugh. She is just trying to locate a tiny leak.

If you didn’t know, soap is a great way to find a leak in something right before you decide to just throw it away.

If you didn’t know, soap is a great way to find a leak in something right before you decide to just throw it away.


Several years ago I had a run of birth tub problems. It seemed like they leaked air at Every. Single. Birth. I checked them in between births, patched what I could, suffered through slowly leaking tubs during labors and replaced tubs just to have the new ones leak. One tub failed spectacularly. This was baby number two for a lovely family in my neighborhood. Her first labor and birth had been pretty quick and straightforward, so we were surprised that her 2nd labor was harder, longer and more intense. After several hours she decided to get in to the tub. As she stepped in, I heard the familiar hiss of a patch not holding. I found the patch and attempted to re glue it, but the tub was losing air FAST. My client was only getting relief from the tub. So, I did what any reasonable person would do. I called a doula in the neighborhood and paid her to hold the patch on the pool for the duration of her labor. This meant snaking her arm in between the tub and the liner and leaning over the side, practically in the pool herself and applying not-insignificant amounts of pressure on the plastic patch. For 4 hours. Thanks doula!  (have I mentioned how much we love doulas?)

At other births we have had to refill tubs between every contraction.  The mom has her contraction, doing what all laboring people do (moaning, breathing, coping) and also what most don’t (sinking toward the floor).  Then, we turn on the air pump and up she goes, the sidewalls filling and raising her back to position, water sloshing out all the while. So yes, it is not unheard of for birth tubs to lose enough air so that some water sloshes over the side. You will be heartened to know, however, that never, not once, over hundreds of births, has a tub popped completely or lost air quickly enough for the water to flood out.  Has this ever happened to you? Let us know if it has!



Filling with water

When I was a student, 13 years ago, I arrived with my preceptor at a labor on a hot, swampy, July day.  The dad had already helpfully inflated the fishy pool (we used to use these fishy pools almost exclusively back in the old days) with air and as we arrived, he was starting to the run the water.  We busied ourselves with the usual tasks of setting up for a birth - unfolding chux (why? I don’t know), assembling birth supplies, listening to the baby’s heart rate. Eventually I went in to the bedroom to check on the birth tub. Y’all, I have a strong stomach.  Nothing makes me nauseous on sight except maggots and…. this tub. The tub appeared to be full of egg drop soup, which is not something you want or expect, birth tub wise.

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Actual picture of the birth tub

plus onions



The water was yellow and cloudy with long, thin, gelatinous strands of egg-white looking goop throughout. If you’ve ever wondered why I am so adamant about using a NEW hose for filling the birth tub, this is why. In this instance, they had used a very, very long hose that had been sitting in the heat, full of water.  What grew in it was like the SCOBYs (symbiotic culture of yeast and bacteria) you find in your kombucha bottle. Interesting, but not something you want to have a baby in. We sent the dad to the hardware store for a new hose, drained the tub, sanitized it and filled it again.

Sometimes there is not enough hot water to get an entire birth tub full of water warm enough for a birth.  This was always true in apartments in the city, so we started pots and tea kettles boiling when we began filling the tub. A little known fact about me is that while I am patient when it comes to big things - labor, long drives, listening to my kids talk about space, I am REALLY impatient with little things.  Like, it’s extremely annoying how long it takes to pour all the water out of a tea kettle! It takes forever! It is so boring! So, at a birth one chilly April morning, I decided to pour the water out the top of the tea kettle instead of the spout. And this happened.

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I know

It was gross


The birth was imminent, so I gloved up and finished my work, swallowing a handful of ibuprofen when I had the chance. All I remember about the rest of that day is red hot searing pain and an internal dialogue that went something like “you IDIOT!”



Draining the Water

Cats and kittens, this is where we have the real fun. A hundred gallons of bloody, sometimes poopy water. What could go wrong?


Back in the old days - the aughts -  we used to drain birth tubs via gravity siphon. I actually have no idea why we did this because sump pumps are not a new invention.

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not like this!


Nevertheless, this was the apprentice’s task and it went like this:  hook the hose up to an outdoor spigot and run water until it reaches the pool which, ideally, is quite a distance above the spigot. One you hear your helper shout “OKAY, ITS RUNNING” (very relaxing for the new parents, obviously) you rapidly turn off the water, unscrew the hose, and if all goes well, and gravity being a pretty solid theory, it usually did, the water will start to flow out in to the yard. The water runs slowly and it takes a very long time to drain a tub. But it will drain.  Even on a good day this was a ridiculous procedure, often cold, always wet, involving tromping through bushes and mud. A bad day involved poison ivy, rain or snow.

After one cozy winter birth, the kind where you arrive to christmas lights twinkling in the snow and leave as the sun peeks over the horizon, the neighbors got a siphon-related surprise. After tucking in mom and baby, after packing everything up, after pulling the hose back in through the window and winding it up in the bathroom, I got in my car and pulled down the long driveway. Only then did I notice the snow. I had drained the bloody tub on to a hill of snow.  A hill that now appeared to be the site of a massacre or mauling. Sorry neighbors!

 

There are a lot of bloody snow pictures out there….. here is one

There are a lot of bloody snow pictures out there….. here is one

Now, of course, we use sump pumps and with the aid of electricity we pump the dirty water straight in the bottom of the toilet. The sump pumps are powerful and drain the water fast. This is very effective, and also very fun for small people who enjoy hoses and water and don’t know about germs.  As a bloody pool was draining in to the toilet one morning, a wee toddler friend pulled it out and sprayed bloody water all over the bathroom. She did this for several minutes before anyone noticed. Another horror movie scene. We lock doors and supervise now, when there are curious toddlers around.

And here we are at, hopefully, the biggest birth tub bungle of my career (shared with permission). This was another birth in my neighborhood, a lovely first time mom on the second floor of a two family city building.

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Classic STL 2 family

Picture the birth on the 2nd floor there




She labored beautifully, and had her baby in the tub quickly and easily. In fact we had not finished filling it when she had the baby so the end of the hose was still in the tub, and we left it there, busy with other tasks, and maybe a little tired. Since the mom was small, we hadn’t used as much water as usual - it was a pretty concentrated mess as far as birth tub water goes. Baby poop, lots of blood. But normal stuff.

We got her and her sweet baby girl to bed and did the tasks of immediate postpartum: watching, waiting, cleaning. The hose had been screwed in to the kitchen sink faucet and I unscrewed it in order to wash my hands. You probably know where this is going and I am sorry to say you are right. Remember the siphon and the laws of physics?

At some point, the end of the hose was knocked out of the sink and on to the kitchen floor where it proceeded to drain the tub. By the time I made it back in to the kitchen there was two inches of bloody, poopy water on the floor.

This seemed bad. My apprentice and I frantically sopped and mopped, pushing water in to buckets with a broom and dumping it in the bath tub. The water has seeped in to the floor boards and under appliances. It was an endless, multiplying mess the way blood can be. Everywhere. We somehow got it cleaned up, disinfected the floor, and finished our midwifery work and went home. I went home thinking, well, that was bad but, LESSON LEARNED, to always take the hose out of the tub. That night I packed a roll of duct tape in the birth bag, vowing to also always tape the hose to the sink.

Several days later the landlord of the building called me. In the only stroke of luck in this story, he was the client’s father in law.  So it was with sadness and not anger that he told me what had happened.

I googled “bloodbath” so you don’t have to.

I googled “bloodbath” so you don’t have to.


The people who lived downstairs had been on vacation during the birth.

When they came home, they were surprised to find their kitchen ceiling red, brown and crumbling wetly. They were also surprised to find all of their many things in the kitchen, soaked in, and in the cases of dishes and pans, containing, old bloody birth water.  The landlord told me that, not only was the ceiling ruined, but that the people were “sort of hoarders”. They had dozens and dozens of kitchen items that were now, according to any reasonable person, ruined. Also, they were so traumatized, they decided to move.  

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No, it really does not get much worse than this.

I did pay for their items. But, after a small investment in bleach, I also kept some of those items.

So, if you ever come to my house for cookies, know that they were made with love…. and a kitchenaid mixer that was once covered in bloody birth water.

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The end.