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:
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
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.
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
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
7) Sterile OB pack with 2 clamps and 1 scissors
8) sterile gloves, size medium x4
9) sterile gauze x4
10) sterile lubrication
12) emergency blanket
13) hand sanitizer
14) inventory card
15) single use emergency meds bag
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.
Bottom Front Pocket
or, the big, bulky, miscellaneous pocket
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
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
5) extra IV supplies
6) Amniotomy and Catheters
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.
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
And thats it!
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
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!)
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.
Adrianna makes many of these
Under all of that is a large compartment with resuscitation equipment
folksy heating pad cover
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.
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
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
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.
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.
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
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
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.
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!