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Resuscitating a just born baby - Page 2

post #21 of 28
Buzzbuzz - I don't know anyone who is trained in NRP who thinks that simply keeping the cord intact is sufficient to treat a baby who needs help after birth. That may be a layperson's interpretation of delayed cord clamping, but it's certainly not the professionals'.

Maybe it would help to explain the rationale of the midwifery approach to resuscitation. Keeping the cord intact and the baby on the mother is the norm and the standard, evolutionarily speaking. Thousands of years of refinement in the process of transition to extra-uterine life have resulted in a process that works well most of the time. Throughout this refining process, women and their attendants were NOT clamping the cord within 30 seconds of birth. I would have been at least several minutes before that was done. Immediate cord clamping is what needs to be justified, not maintaining the normal physiological process that is supposed to occur after birth. Up to 30% of the baby's (oxygenated) blood volume is transfused from the placenta to the baby in the first three minutes after birth. Unless there is good evidence presented that immediate cord clamping provides some benefit that exceeds the benefit of the infant receiving the full blood volume (and this blood IS oxygenated), then we don't do it. There are no steps to the NRP that cannot be done equally well with the cord attached as long as the provider is comfortable with the process. To hospital providers, who are trained and accustomed to doing NRP away from the mother on a warmer, in that particular environment, it must seem that it can't be done any other way effectively, but it certainly can. In a waterbirth, the baby can certainly be warmed and dried on the mother if needed, or other methods of stimulation such as the mother talking to and rubbing her baby can be done to counteract primary apnea, if present. If the baby is in secondary apnea, all the warming and drying in the world will not work, and you proceed to PPV and chest compressions (if needed), which can be done with no problem on or near the mother. If positioning for PPV is a problem, we use a pre-prepared firm surface with a shoulder roll, which is always nearby at the time of birth and can be used wherever the mother happens to give birth.

Furthermore, keeping the baby on the mother or near the mother during resuscitation is respecting the baby as a sentient human being having their own experience. That baby expects to be born and be in contact with the mother. Physically, skin-to-skin stabilizes the baby's temperature, blood sugar, blood pressure, etc. Psychologically, it's where the baby belongs and I believe it reduces stress. It's also respecting the mother as a vital part of the resuscitation process, in that she and the baby are a "unit", if you will, when the baby is born. Her role in speaking to the baby and touching the baby is an important one. Furthermore, it keeps the mother calm, reduces her adrenalin and keeps her oxytocin levels high, which helps the uterus clamp down appropriately.

To address the level of experience with NRP that most CPMs have - yes, it is definitely lower than someone who works in a high-volume hospital setting. However, I would invite you to compare the number of births a CPM attends per year with the number of births an average nurse, who would be responsible for for NRP, in a rural hospital might attend. I would guess they are pretty statistically similar and no one is calling for women not to give birth at smaller rural hospitals and instead force all low-risk women to travel however far to a large, urban hospital setting due to their increased experience with NRP. NRP is wonderful, but it's not rocket science. It's actually a pretty simple series of actions which, granted, the more you do, the better you will be at it. That's why the midwives I know handle their equipment regularly and have "practice runs" on a regular basis, not just the certification class every 2 years.
Edited by womenswisdom - 3/29/13 at 11:52am
post #22 of 28
Thread Starter 
To be clear, this birth took place at a small hospital with no NICU and no pediatrician at te birth.

I cant remember his first APGAR score. I want to say it was a 2? Does that sound about right? The second score was normal. He is a healhy 2.5 year old now.
post #23 of 28
Quote:
Originally Posted by Ambivalent Dreams View Post

To be clear, this birth took place at a small hospital with no NICU and no pediatrician at te birth.

I cant remember his first APGAR score. I want to say it was a 2? Does that sound about right? The second score was normal. He is a healhy 2.5 year old now.

Two is a very low Apgar. It is certainly possible to have a two at one minute and the an eight or above at five minutes but that baby will require active resuscitation in between. Best case scenario for a two, IMO, would be a baby who had a good heart rate but poor colour and tone and no respiratory effort. Some stimulation and oxygen can improve things by five minutes. I personally would be worried that it took so long to come up and i would be watching very carefully for milestones but i would be resssured if he is fine at 2.5yo.
post #24 of 28
Well, we don't really know how long it took to come up. It could have been an 8 at two minutes but the apgar still would be done at five minutes. Just because the one minute was a 2 and the five minute was a 7 or more doesn't tell us how long the resuscitation actually took. I wouldn't assume it took the entire five minutes. Also, it's the five minute score that is associated with long term prognosis.
post #25 of 28
Quote:
Originally Posted by womenswisdom View Post

Well, we don't really know how long it took to come up. It could have been an 8 at two minutes but the apgar still would be done at five minutes. Just because the one minute was a 2 and the five minute was a 7 or more doesn't tell us how long the resuscitation actually took. I wouldn't assume it took the entire five minutes. Also, it's the five minute score that is associated with long term prognosis.

Yeah I know, I actually meant that I would be concerned that it was so low at one minute not that I thought it took 4 minutes of resuscitation to come good. He should have had resuscitation before one minute so to have only a two by then would make me personally (as both a parent and a midwife) concerned even if he was an 8 by two minutes. I would still wonder what had happened to cause such depression. As I said though, I probably would have relaxed my eagle eye on milestones by 2.5yo.
post #26 of 28
Thread Starter 
I was a little scared at first but he is sharp as a tack. He counts to 10 in English and Spanish, knows all the letters and the sounds associated with more than half of the letters. He speaks clearly, runs, and tells me he loves me. He really seems fine. My concern is really more at being prepared in case this happens at my next birth.
post #27 of 28
Thread Starter 
And Katelove, I too wonder what made him limp and blue when he was born. It was a sad, scary, surreal few minutes. In my mind I told myself he HAD to be okay and could not fully entertain any alternative outcomes. But, a small part of me was horrified that I might have killed my baby by not having an elective c-section. After such a long labor and a previous c-section, the doc would have done it on a heartbeat. She told me later though that with all that meconium he could have easily been born blue with a c-section. That made me feel a little better. But, honestly, I think I am only now realizing how serious this really was.
post #28 of 28

I thought this article was pertinent. Long but interesting, written by a care provider. Covers the normal transition to breathing with lungs. It really gave me a new perspective on the whole thing!
 

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