Baby resuscitation?

[Quickening]

So I heard from pamamidwife that in her opinion, blow by blow oxygen doesn't do much and may interfere with the establishment of the baby's breathing. Cold O2 being blown into the babys face stimulates the breath holding reflex.

She suggested quick mouth to mouth blow. How would you go about doing that? I imagine it would have to be done really really gently? How much do you know to blow? Do you just breathe out gently?

When does lack of breathing become a cause for concern for you guys, and what steps do you take?

[mwherbs]

go to a cpr class and try it out on the mannequins you need to be able to fill the lungs but you don't want to blow too hard and cause damage- this is one reason an ambu bag is useful because you use it with a pop-off valve and a gauge so you can control yourself better. When a baby isn't breathing and you have some adrenaline pumping you really need to have practiced mouth to mouth or NNR because your senses can be very altered, depending on how you personally cope with stress- your breathing may be too rapid or shallow or too hard so I really encourage you to practice.

[rainbowmoon]

mwherbs- what's an ambu bag?

I think the cpr class is a great idea for a UC btw! I think that would make my DH feel much more confident!

[mwherbs]

so infant cpr= mouth to mouth resuscitation with chest compressions go to classes and practice on a mannequin

Neonatal resuscitation (NNR) is what is done by medical professionals most of the time including EMTs it is done with a bag and mask (ambu bag) as well as chest compressions and possibly drugs depending on location or care provider. This is also taught via a class and is renewed every 2 years. you use either a self-inflating bag with a cushioned mask that fits on baby's face this can be used with or without oxygen hooked up to it or a inflatable bag with mask that is dependent on an oxygen tank/source to inflate- you place the mask on the baby's face and squeeze the bag you look for chest inflation same as with mouth to mouth the first puff on un-inflated lungs is usually a harder puff then softer puffs - you practice in pairs and another person is doing the chest compressions and counts also practices on a mannequin-

It is important to remember this is done for very few babies about 10% will need some kind of help and about 1% will need drugs or additional care.

[cottonwood]

Let's remember though that those stats are based on managed births (in which most the umbilical cord is cut too soon,) most of which take place in the hospital.

Quickening, you asked how much to blow -- it's done with the air that is in the mouth. In other words, don't blow with your lungs, that could rupture the baby's lungs.

Dr. Gregory White (in the book Emergency Childbirth) has a good gentle resusitation technique to try before mouth-to-mouth that involves a kind of cradling the baby with airway open and folding the body into and out of a 'V' shape.

If baby is not breathing but color and body tone is good (baby may be purplish but should begin to pink up quickly, grey is bad, totally limp is bad) don't worry. It can take even a few minutes for the breathing reflex to kick in, but if the baby is still connected to the cord, it should be receiving blood and oxygen, in other words, no brain damage is going to happen because of not breathing. Talk to the baby, gently rub its back, and turn tummy-down to help drain any fluids.

[mwherbs]

The folding the baby into and out of a V shape was an old attempt at NNR since then they figured out what worked better- remember this was done when even homebirths were very medicalized including ether masks to knock mom out- the V movement went to direct chest compression and stimulation of the lungs by breath or ambu bag which is physiologically closer to what we are trying to achieve- a beating heart and breathing lungs- I have a very old autobiography by a doctor Mc Cartney and he actually did a form of mouth-to-mouth resuscitation in the 1870's so far ahead of his time-there were probably other doctors just like this and with better communication and studies is how we have the system we have to day.
Dr. White was just giving you medical information current for the times when he first wrote the book. If your child were to drown in a pool would you rather use the folding technique or mouth to mouth resuscitation? Actually the folding of a baby/person who already has air in the lungs would work somewhat like a Himlich manuver the first time but for un- inflated lungs it does little and is too low to stimulate the heart much.
As for the 10% I think it is pretty close- no matter what the setting care provider or no.

[cottonwood]

Originally Posted by mwherbs

Dr. White was just giving you medical information current for the times when he first wrote the book.

Yes, but that does not in itself make it wrong. Nor am I saying it is the last word on the issue. But if I were concerned about the amount of time that it was taking my baby to breathe (assuming baby is not limp and lifeless and is still attached to placenta,) I would personally try to stimulate first with gentle movements of the body.

If your child were to drown in a pool would you rather use the folding technique or mouth to mouth resuscitation?

Of course you are right. I should have clarified -- if baby is seriously in distress, CPR should be initiated and continued until further medical help becomes available.

As for the 10% I think it is pretty close- no matter what the setting care provider or no.

What evidence do you have for this? As you know, statistics do not cover planned unassisted births, or differentiate between levels of disturbance in low-intervention attended births. And common sense (as well as the current scientific understanding of the hormonal process of labor) tells me that the more the process is fiddled with and the more the mother is stressed or distracted, the more likely problems are to develop, including with the infant immediately after the birth. Setting most certainly does matter.

If I believed that 10% of babies needed help at birth (under ideal circumstances in which the mother is healthy and the birth process is not disturbed,) I would feel the risks outweighed the benefits and I think I would have a hard time supporting the choice to have a planned unassisted birth. I have to ask, what is your position on this?

[cottonwood]

Originally Posted by mwherbs

The folding the baby into and out of a V shape was an old attempt at NNR since then they figured out what worked better- [...] I have a very old autobiography by a doctor Mc Cartney and he actually did a form of mouth-to-mouth resuscitation in the 1870's so far ahead of his time-there were probably other doctors just like this and with better communication and studies is how we have the system we have to day.

Dr. White does mention mouth-to-mouth which he calls "suitable if the attendant is trained" and oxygen from a mask which the EMTs would use, so apparently those were the medically-accepted system for NNR then. Of course this is a book about emergency childbirth in which there is no oxygen tank and possibly no knowledge of CPR. Although he does have this to say: "The methods described will in the majority of cases not be found wanting. In the occassional case where the baby fails to rally, other methods would not be more likely to produce success." In any case, whether or not he is right about this, I would think to do that first with a non-distressed baby.

[mwherbs]

the movements to make with a new not breathing baby that has a still pulsing attached placenta would be to bring them up to you and dry them off- this is stimulation- if the placenta delivers it is not providing oxygen- many many babies are born and take a minute or so to really breathe. if they are limp and not breathing, heart rate is lower than 90 stimulate by rubbing if no change I would recommend mouth to mouth-you might want to suck the first time to clear the airways then puff- practice is probably teh easiest way to know how much and how hard you want the chest to rise but you don't want to damage the lungs

[pamamidwife]

I just have to say that if we're talking anecdotally or statistically, I don't think 10% of babies need assistance "getting started".

Sharon, I'm curious if that's your experience. Do 10% of your clients babies need help getting started?

[mwherbs]

so all women I have seen birthing at home or not 10% of the babies needing something yep, a few puffs mostly- stuff I have done at births that stayed at home probably closer to 3-5%, nothing like your heart in your throat when they look blank--I am mostly reassured by a look in the eye that babies who are going to be fine have. I think moms on antidepressants have brought about a new twist- but I have no proof- the LMs I work with currently would probably clearly say yes to 10% "healthy mom" is a very broad and ill-defined term. I was thinking through resus stuff and one of the most profound ones was when the baby had dystocia and it wasn't just shoulder it was a tight squeeze to the knees, mom had portwine birth mark over 1/2 of her body and in labor it swelled up everywhere baby was 13# came out , limp, grey as cement, and no attempt to breathe- mom says you'll just have to save her in a very calm and matter of fact way- mouth-to-mouth- baby was fine ---- hard to say what all was going on (long story unfolded later).
But with all this said the take home point is that nearly all babies are going to try and breathe on their own, time at birth can become very distorted if you have a cord that is still functioning to an attached placenta you have time to really love a baby up, dry them off and talk to them-

[pamamidwife]

I think I understand your clarification (though I have to admit sometimes your posts are a little hard to understand, as they go in different directions).

So, in a NORMAL labor at home, in one without provider induced directions and distress (forced pushing, positioning based on what a provider wants vs what a woman wants, labor sped up through artificial means - herbs, AROM, etc) you would only see babies that need help maybe 3% of the time.

I think that in the hospital, it could be closer to 10% only because I believe the hospital overreacts to babies getting started and cuts their cord (major insult), whisks them away and gags them with suctioning, etc. This doesn't even count for the fact the women in the hospital that are drugged or have epidurals.

I just wanted to clear up that 10% of homeborn babies do NOT need resuscitation efforts.

[Quickening]

Thank goodness for the clarification I thought that 10 percent was definitely too high for homebirth settings and I think its too low for hospitals but thats just me : )

I just wanted to add that I read a birth story the other day and it had the woman describe how her husband helped her lie her baby on their belly on her leg, with their head towards her feet so the baby was upside down and she rubbed on his back.

That was really great visual imagery for me. I had been wondering how I would manage to hold a baby upside down in a more gentle way then they do on tv with the drs holding the baby by their feet : That just doesn't feel right for me!