When the baby is born blue, but breathing, what does it mean?

[Nosy]

I know blueness is a sign of lack of oxygen, so is it all about the umbilical cord? I am trying to make sense of a traumatic birth experience and putting the pieces together. DS1 was born after a 3 day induction for low fluid & too mature placenta...he came out blue, but breathing (w/0 of 2 on color for his Apgar). After a minute of massage & oxygen he pinked up and was fine. I always thought the blue color was just a sign that he was exhausted after 3 days of contractions. DS2 was born via c-section for FTP/malposition (long horrible story about which I feel pretty bad)...no signs of fetal distress prior to the c-section, but he was sectioned after his drugged mama agreed to the scary OB who said he would never come down (-2 station, posterior, deflexed head, many hours of pushing, water had started leaking 20 hours prior). He pinked up right away as well but had an initial Apgar of 0 for color as well.

I guess I am just trying to understand what level of distress (if any) the color of a newborn indicates. Obviously both babies were breathing, so does the blue color mean much as far as the level of fetal distress the baby encountered during labor? Thanks for any comments.

[pamamidwife]

it takes awhile for some babies to pink up. was he really blue or was he a dusky purple? i have NEVER seen a BLUE baby...though I have seen some seriously oxygen deprived babies and they are more dusky dark purple.

babies when they are born are purple-y. until they take that first breath and start circulating oxygenated blood through their lungs, their color looks different than what we'd expect.

as long as the cord is attached, i usually hold off any serious resuscitation or touching for a minute or so...unless their tone is really, really bad. tone, to me, is a better indicator of how baby is doing at one minute than color.

[hippiemom]

I have attended seminars about, and seen how much it means to a baby to delay cutting that cord, even for 5 minutes! They get some great blood volume and oxygen from that amazing placenta; imagine what this means to a compromised babe. I feel for all babies that delaying the cord cut just helps them with the transition from womb to outside world. For some it makes all the difference! They all look a little on the bluey purple side at first. When you watch closely you can see them turn pink from the chest area out, very cool.

[Charmie981]

All babies undergo some hypoxia during labor and most babies are born a little purpleish gray. As a matter of fact, when I give APGARS, I've never given a 10-10 because I've never seen a baby who was 100% pink at one minute. It usually takes about 5 mintues, minimum, to get them pink to the feet and hands.

Some babies are born more purple than others. I was taught to assess baby's condition during crowning by the color of the scalp: pinkish gray is a-okay, whitish-gray is still okay, purpleish-gray means there's some oxygen deprivation, dusky purple means there's more oxygen deprivation and blackish-purple means baby will probably need some form of resus. Some babies have more difficulties with crowning than others: babies who are malpositioned, babies who descend very quickly, and to a much lesser extent, babies with nuchal cords (around the neck). Babies in those circumstances tend to be a little more purple than others.

The cord clamping and cutting is a big issue. Just because baby is breathing doesn't mean that they are getting 100% of the oxygen they need through their (newly functioning) lungs. Having the placenta still pumping oxygenated blood to the baby helps a lot with oxygen perfusion and babies who have oxygen coming to them from the placenta for longer tend to pink up more quickly than those whose cord is cut immediately.

[Nosy]

Pamela, DS#1 was more of a dusky purple and was given a 0/2. My DH said DS#2 was similar in color to DS1 and was given a 0/2 (I was passed out and didn't get to see DS2 born . ) For DS1, he had a 0/2 on tone, and DS2 had a 1/2 on tone. I guess I was just trying to get a sense of how in distress they were and how much the Apgars really mean.

Thanks!

[Maggi315]

Apgars aren't always reliable, different people give different scores. Before I started doing homebirths, i would never have given a 10 because I never thought the color was great. But now I give them because the babies look great and I expect some discoloration.

Blue is OK, it's the grey/color-drained look that worries me. On the babies that I have seen that were in trouble and need some oxygen or resuscitation, they weren't blue, but a yucky grey color. Blue is normal!!! Babies sometimes need a minute to two to catch up with what is happening and let their systems have a chance to kick in. More and more studies are showing that by giving them low apgars and being aggressive with interventions, we are doing more harm than good. Some hypoxia can even be considered a normal variable.

[mwherbs]

yep that cement gray/drained color worries me.....
APGAR was developed before current resuscitation evaluations were developed- heart rate and respiration is what you would go on as far as the need to actively resuscitate a baby--
could be it just a took a few minutes for the baby to transition into normal- either lungs needed to expand more and fluid be pushed out or just a bit of rapid short breaths ( in a very short time your baby was fine 5 minutes )-- some babies who stay blue longer could have a something else TTN (transient tachypnea of the newborn which is not very serious can last 24-72 hrs, this is where the lungs are still a bit wet and breathing is rapid)