The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy.
Other excellent resources about avoiding toxins during pregnancy
These are easy to read and understand and are beautifully presented.
Disinfection - A Reference Guide to the Difference Between
& Mirrors? - The Real Story - A good discussion of the
types of hard surface germicides, their relative effectiveness and
for Equipment Used in the Prehospital1 Health-Care Setting
- CDC Guidelines for Sterilization
in the Physician's Office from The
College of Physicians & Surgeons of Ontario
Fun reading about sterilizing
equipment for making beer.
Our sterilizer is breaking down. We are looking at ways to avoid
to sterilize speculums. One place I worked simply cleaned the
and dropped them into a bleach solution overnight, rinsed them in
and used them.
Running specs through a dishwasher with sufficiently hot water and a good detergent would fill the bill, too. When you think about it, your goal is not to make and keep the specs sterile, but to kill pathogens and to meet aesthetic considerations (as well as to satisfy the lawyers, OSHA, etc.)
We have tried plastic spec: the staff loves them (less work),
hate them (they click loudly and pinch, in spite of great care,
and we don't like the expense (you have to buy them, then pay to
of them through your biohazardous trash system). The folks that
supplies love them, too. We do use them for a satellite clinic,
reasons, but have never learned to love them.
We do the bleach method. Scrub the speculum really well and let
in bleach for 20 minutes and rinse it off. Seems to work fine.
When I arrive at a birth, I soak the umbilical scissors,
(for poss emergency epises that never happen) and two cord clamps
re-usable metal ones) in a cold-sterile solution (Amerse). After
I clean the instruments, and the cycle repeats.
I am experimenting with different ways of handling the sterilization of instruments for homebirths, and I'd love to hear how others handle it. Previously, I cleaned them (I use an instrument-cleaning soap followed by a soak in instrument milk), packed in sterilization wrapper and at home, after the birth, baked in oven with a pot of water underneath for a couple hours til the sterilization bar turned brown. I was finding this hard on my instruments to be subjected to the dry heat, and if I had a lull between births, I questioned the sterility of the instruments, the packaging would get little rips in it, the wrappers are expensive to waste.
So lately, I've been doing a cold-sterilization technique taught me by a doctor that feels safer for my instruments and more time-efficient. I'd love feedback anyone has on cold-sterilization methods. I clean the instruments as above. When I arrive at a birth, I soak the umbilical scissors, blunt-sharps (for poss emergency epises that never happen) and two cord clamps (I use re-usable metal ones) in a cold-sterile solution (Amerse). After the birth, I clean the instruments, and the cycle repeats.
Though I am still experimenting with ideas, the cold-sterile
seems more desirable so far, feels like a "fresher"
do the other homebirth midwives do...what do the hospital midwives
about acceptable methods of sterilization for OOH births (no
no pressure cooker)?
Do you consider your instruments contaminated until they have been soaked in Amerse? Do you handle them with gloves?
I have a box of Amerse packets, and it says at a 1:32 dilution it kills "pathogenic bacteria and fungi such as S. aureus, S. choleraesuis, Ps. aeruginosa, M. tuberculosis (effective in 10 minutes at 20 deg. C) and C. albicans. Amerse is virucidal against influenza A2 (Hong Kong) Herpes simplex I and II, Type 2 Adenovirus and Vaccinia on hard, inanimate, surfaces in 10 minutes at 20 deg. C."
What about HIV and hepatitis? This has been my concern about using this product and considering the instruments sterile.
There is a product carried by Cascade called Wavecide that is called a sterilant, however it must be used full strength and is very expensive. It is effective against HIV.
In "Practical Skills Guide for Midwifery" the suggested cold Chemical sterilization method is:
With gloved hands, scrub equip. with soap and rinse. Measure 4 parts water to 1 part Cidex, soak 10 min., rinse and allow to dry, package and label to indicate sterilization and date.
Seems to me the rinse & allow to dry part renders them
Soap and water will kill HIV. Hep is nasty and tough though, and needs heat or chemicals I think.
Yeah, I agree with your concern. Why rinse and air dry?
I like simple heat processing -- if you wrap and sterilize then you never touch the instruments again.
Or -- I can just boil again at birth and IF THE PAN IS KEPT COVERED then the instruments will still be sterile
(don't know how many times I've seen folks boil instruments and
them to sit for hours in an uncovered pan - - - or boil them and
them into a separate container with (usually, nasty old betadine)
let them sit uncovered for hours! If you boil your instruments
let them sit there with the lid on!
Personally, I felt the purchase of a small pressure cooker very worthwhile. It also is capable of creating some delicious meals too!
As far as protecting your wrappers from tears in between births I do the following:
After the pressure cooker, because there is some moisture, I
in a very low temp oven until the pkg is totally dry. Then I
place them into a large zip-lock bag, squeeze all the air out
it. This protects them then from any moisture & tears. I also
found using this method, that instead of purchasing the fancy
wrap paper, I just use brown grocery bags - much cheaper &
just as well. I double layer the wrap just as I did using the real
I have been using Amerse off and on for about 2 years and really like it. I still heat sterilize a set of instruments that I carry around for births where the head is crowning when I get there. I just started having a packet of Amerse added to my kits.
I still use my original set of instruments that I bought in
added to them.....a second set of hemostats and scissors, one of
nifty curved cord cutting scissors and the cord bander. It's hard
the difference between the old hemostats and the ones that are
years old. Buy good stuff, take good care of it and it lasts
I generally don't sterilize instruments at clients home. Often
even use instruments. I have parents purchase scissors in their
and give instructions on sterilizing them. I use sterile plastic
(also in kit) and their scissors to cut the cord. I carry two sets
instruments (steam sterilized)consisting of two curved hem. and
I also carry two sets of suturing instruments (sterile, of
Don't worry about cold sterilization for HIV.....almost anything kills it, even soap and water. What you do need to worry about is HepB (hepatitis) which is a very very hardy virus. It can be cultured off surfaces weeks or months later. This can be taken care of by bleach soaking.
Household bleach 1 part to 10 parts water is effective against the hepatitis virus. This is what we used in the hospital to clean the insides and outsides of the hemodialysis machines.
At our Miami Center we use cold sterilant after a short bleach soak followed by heat sterilization.
Right now I'm really happy with steam sterilization with a
cooker, thanks to all who answered my questions on this list about
We set up all the "important" stuff on a cookie tray, covered by a chux pad. The sterilized instruments go underneath, the bulb syringe, pit, meth, (we hide these because they make the mom nervous) herbs, opened 4 x 4s, some gloves
Use a gardening basket to carry essentials. In the center of the
she keeps gloves and gauze, in the little side pockets all around
bulb syringe, deLee, a squeeze bottle of olive oil, another of
scrub, cord clamps, blood tubes, syringes and needles, and
It has handles and she puts it right in her big bag (a zipper
and it comes out and goes in with minimum trouble. She sits it
the bed next to her, and everything is at hand. Things don't spill
'cause the side pockets have elastic.
I use a Rubbermaid sweater box. I stock it with everything I need
a birth, gloves, gauze, deLee, instruments, etc.
I switched to a large heavy duty plastic box (called action
i can put an enormous amount of "stuff" in it (lots of extras and
needed things), and everything stays where it's put! -- it doesn't
all over inside like the "bags" did -- and anyone opening the box
find things... It has a sturdy, lockable lid -- strong enough to
or sit on. I carry my "essentials" - all the things I (might) need
the actual birth in a medium sized cosmetic-type box (though a
also works well); this fits quite nicely in the big box. The other
advantage to this box is that it's exactly the height for a birth
Found out by accident once (mom wanted something to sit on and the
made birth stool was way too low for comfort) --tossed a chux on
and we were ready!
I recently picked up a portable lap table made for children. It
built in pockets on the sides and a large flat top surface - just
cookie sheet size (which is what I've usually used). It's made of
molded plastic; easy to clean; shaped like a rectangular box with
back and front and the bottom removed. I'm stoked about the side
I have everything necessary for the birth preset in my
box) birth box. The heating pad, towels and hat go on the lid and
for the birth. After the birth I restock my birth box from the
I use four Tupperware boxes to organize my birth bag. One for
run in and catch a baby. Everything you really need to do a birth.
next is all the suturing equipment. The third is the newborn box
scale, tape measure, etc. This is a smaller one. The fourth is
Works really well.
Another trick is to have the heating pad set on warm in a pillow case with the receiving blankets and a cookie sheet in it. This makes for a nice place to work on the baby in case you have to have the baby flat for open airway purposes. If you need to transfer apart from Mom's body for any reason, then just unplug the heating pad, put the baby on top of the pillowcase-cookie sheet setup, wrap with a wool or solar blanket (not too tightly if you think you'll need access to baby's body). Should stay warm for awhile!
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