Birth professionals often make a big fuss over keeping things "sterile" during birth. Hands must be washed and gloved, instruments must be baked in special ovens (autoclaves) and wrapped and often sealed to protect them from germs. Stacks of disposable pads are placed under the birthing area and whisked away as soon as they are soiled. It can all seem very imposing when first thinking of recreating the scene at home. But do we really need to?
Hospitals promote themselves as clean, sterile, safe places to birth babies but the facts lead me to believe otherwise. The reason doctors wash their hands today is directly related to the 1847 observations of Hungarian doctor Ignaz Semmelweis that women birthing outside of hospitals were less likely to die of infections than women birthing in hospitals. In 2001, a Boston based study on postpartum infections for women birthing in hospitals ends with the observation that:
"In conclusion, our results indicate that postpartum infections requiring medical attention are common and that most postpartum infections occur after hospital discharge, so that use of routine inpatient surveillance methods alone will lead to underestimation of postpartum infection rates."
I would imagine that if a study was done on home-birthing populations today Dr. Semmelweis would be hard pressed to discern much progress in the past 150 years. The midwife email loop archives contain no significant heading for postpartum infections leading me to believe that "postpartum infections requiring medical attention are common" but they are hardly normal.
The number of antibiotic resistant "super germs" is rising and the highest concentrations of these bugs are camped out in hospitals around the world. I don't see hospitals as "sterile" anymore. I see them as places where people have to work very, very hard in order to keep all the germs that live there from infecting people. They are becoming progressively less and less able to prevent these infections from occurring. As a result of the "germ warfare" taking place in these hospitals, I feel much more "sterile" birthing in my own home.
Judith writes:
There's some dissent about just how much "sterile" stuff you'll need but assuming for the sake of discussion that you want some things sterile...
I use the term "aseptic technique" rather than "sterile" because... well, take an agar plate, hold it up in the air exposed (with the cover off) for ten minutes in any hospital, then culture at body temp or room temp for 3 days if you dare. If you don't get plenty of potential pathogens going, there's probably something wrong with your culture medium (or it's got some super-mycin growing on it!) there's nothing sterile about the environment it a place where all kinds of people with all kinds of pathogens come for treatment etc.
If you want things sterile, don't go anywhere. That being said, a few baked sheets, clean or sterilized things that might touch you, etc., aren't a bad idea if they increase your peace of mind.
You don't "buy" sterile scissors...you make them sterile, or rather aseptic (true absence of all organisms is unlikely, anywhere). Boil them in ordinary clean water on the stove for 10 minutes, then wrap in clean paper that has been baked in an oven around 250 F, and keep them in a clean, dry place...re-do in a month or so if not used. Don't let paper get hotter than that, and watch sheets and towels carefully if baked for more than 40 minutes even at that temp...they do scorch and tear along the scorch lines.
The baking-in-the oven method works well for sheets, towels, and other cloth items...I don't like to use it for metal stuff like scissors that need to be kept sharp too much. There are some things that can be disinfected in a solution or unscented household chlorine (or peroxide, if you're really sensitive to airborne chlorine) bleach, about 1 part bleach to 10 parts water.
Remember, your skin is not sterile and shouldn't be, and the baby should be colonized with the bacteria and other healthy microorganisms that live on YOUR skin (not some hospital worker's and not the ambient and often virulent strains of stuff that live where sick people go.). Your milk should be sterile, but your nipples aren't, and that's where the baby's mouth is going. The baby will develop favorable digestive flora from the stuff he or she gets from your nipples and skin. Your womb should be sterile, but your vagina definitely is not, and the baby's coming through there.
The ritual of getting things baked and boiled and packed up for the birth can be psychologically soothing, which I think is its best value. "Clean" is a good idea, "sterile" is neither possible nor all that desirable (unless maybe you are like the Bubble Boy of no-immunity fame, in which case the possibility that you are pregnant is pretty remote).
Kaire writes:
Another thing you can do for sterilizing the scissors, if that is such a major concern, is ask your doctor, (if you have one) about having them put in their autoclave. Luckily, I work in a tattoo studio and have full access to an autoclave, if I choose to unabirth. Their are a couple of options of places you can go and it shouldn't cost you more then maybe $5-10, if they charge you at all. The process takes about 45 minutes to an hour and they are good to go, they are wrapped in a sealed sterile bag and put in and then nothing can get to it till you open it.
Bill writes:
I agree with Kaire about the autoclave. Also note that boiling scissors in an open position, in a large pot of water longer than 15 minutes is usually sufficient enough. It will not remove any spores, but will take care of most bacteria and viruses. Try a pressure cooker with water if you feel that boiling is not enough. Please make sure the scissors are all metal, or if they have plastic handles, they are medical ones that can take the heat. Usually those scissors have an imprint on the side that indicates the temp to autoclave. Time in the pressure cooker is about 10 to 15 minutes. Basically, that will do the same as an autoclave.
Use shoe strings, cord clamps, regular scissors, surgical scissors, whatever you want. I would think the more important thoughts and questions to be: "Are the items not necessarily sterile, but clean? Is my environment relaxing? Am I relaxed?" If you think about it, sterilization has been around for over 50 years. How long has the human race been around? 10,000 years + ???
This is not easy for me to say, as I am still attempting to overcome my own personal issues with homebirth. I can say this. My wife and I will be doing birth at home, and I will worry about things being clean, not being sterile.
Silverhawke writes:
You can buy sterile cord clamps at midwifery supply sites, as well as scissors and a whole host of other items. All of them, while making some feel prepared, are (IMO) expensive and unnecessary. I was attending hospital births, so I was able on occasion to end up with the stray sterile gloves or cord clamp, but we used a brand new pair of sewing scissors, and sterile cord clamps from one of the hospitals I attended a birth at for our UC.
We tried to get the towels for the baby into the dryer, to heat up, but he came too fast and while they were warm, hadn't been in there long enough to be thoroughly sanitized by heat. He was fine.
A Christian mama writes:
If God himself decided that a stable was sterile enough for the birth of his only son, my bedroom has got to be sterile enough for the births of my babies.
