Question for OB/MW

[Maggirayne]

I have a question for an obstetrician, midwife or other person experienced with post-delivery baby issues. I know you can't answer exactly, having not been there, but am curious what info I can find. Thanks.

My baby's heartrate dropped during contractions and stayed low between (ETA: talking w/my dr. later, they weren't staying low) them, so I was put on oxygen. She was purple when she was born, and they took her and immediately gave her oxygen. I got to hold her for only a couple minutes before she was taken to the nursery to be put under an oxygen dome and on a monitor. She was on the oxygen for close to an hour and then weaned off in the hour following.

The nurses were telling me not to push because the doctor wasn't there (10-15 minutes of not-pushing). I was put on the oxygen during that time. Would having her sooner, pushing when my body was ready have made a difference in her oxygen levels and heartrate?

Also, there was a little bit of meconium present in the amniotic fluid, wouldn't that have made not pushing not good for her? They did have a pediatrician present for that reason.

They cut the umbilical cord as soon as she came out. Then while she was in the nursery, they were monitoring her and told my husband that her blood sugar/fluid volume was low, and they might need to give her an IV--they didn't. Would not cutting the umbilical cord immediately have made a difference in her oxygen level and/or the blood sugar/fluid volume?

Would it have been possible to have let me hold her and put an oxygen mask on her? Wouldn't the skin-to-skin contact helped her her heartrate even out/oxygen levels stabilize, etc?

I will discuss this with my doctor, but when I last saw her, I hadn't developed my thoughts. I would like any thoughts before I see her. Thank you for any input.

[sarahn4639]

I'm not a midwife, sorry. I do fully believe that all of your suspicions are true. Pushing when your body was ready, not cutting the cord immediately, and being in skin contact with you are all thing that would have been benificial and preventative for the problems you (your baby) encountered. I'd be suprised if your OB agrees since they would be be saying they messed up and endangered your baby. I'm glad all is well now and you can be more empowered next time.

[snugglebug14]

cutting the cord immediately makes a HUGE difference. Assuming that there was no true knot in the cord or other reason for the cord blood flow to be obstructed then you baby would have continued to receive oxygenated blood from your placenta for as long as the cord was attached and the placenta was attached to you. It's so frustrating how hospitals deprive the baby's who are most in need of their full placental transfusion. That's important and valuable blood for any baby but most importantly for those baby's who are low on oxygen or blood volume. so sorry to hear this happened to you.

[Maggirayne]

Thank you. I did a lot of reading on labour and how to avoid complications, good positions, etc., but didn't do my research on stuff for her. I had told them I didn't want the cord cut right away, but hospitals. . .

I didn't get to hold her until they had done all the initial check stuff--in the room--but I wanted to get to hold her and feed her immediately and look at her and find out she was a she, ourselves, etc. They did let me hold her, but not more than a couple of minutes. I want to have the next one at home. DH says I had good delivery, which is true; I had no IVs, moved around the whole time except for the very last bit, had two really supportive nurses (one did the perineal massage for me) no cutting or tearing(obviously no need to cut), no meds, so why do I want to have a homebirth? It was good, yes, but-BUT-the point was to have my baby, not have her taken to the nursery and not get to hold her for FOUR hours. I sent him to get her--they had to clean her up. At least he did go with her initially, and later when they cleaned her, he got to put lotion on her. Fortunately, when they did bring her, she took right to nursing like she'd always done it--but I was worried.

Sorry to just vent. I just feel like no one really understands where I am. I mean, "She's healthy, is doing fine, why should I let it bother me?" is the feeling I get when I try to talk about it.

[ndakkitten]

I am not a midwife, but I am a nursing student and have also done tons of research during my 3 pregnancies while preparing my birth plans. I can understand your frustration. Indeed, cutting the cord too soon can affect the baby's oxygen levels. While that cord is still pulsing, it is still providing oxygenated blood to the baby as well as increasing the volume of blood in their body.

Also, if you are having decels between contractions during the pushing stage, it is definitely more important to get the baby out faster. I can't believe they weren't letting you push in that situation. You should push when your body tells you to, NOT when someone is hollering at you to push... And I think one of my biggest peeves is people telling you not to push just because the doc isn't there. Bah, nurses can deliver if needed. It's happened many times. I don't believe in docs that show up just to catch. This is why I prefer midwives. During my two labors with my midwives, they were there over half of my labor.

However, for my last birth, my OB was there for the last two hours of my labor. There was no shouting, no telling me to push or not push. In fact, when I was complete, my OB just said "You can push if you want, or you can wait till you feel the urge, I'll leave it up to you."

My three suggestions for you (for your next delivery if you have one) would be to:
1) Write a very detailed birth plan that not only covers labor, but newborn care, sick baby care, c-section care, etc. My last birth plan was five or six pages I think. I went over it with DH, my OB and the nurses at the hospital. I made sure they all had copies. Make sure your DH understands not only the content of your birth plan, but your reasons behind your wishes.

2) Have a doula. A doula will support you and your wishes the entire time. If you aren't in a condition to speak up for yourself, the doula can say something

3) Find a provider and facility that is willing to respect your wishes and give you the kind of birth you want. Remember, the provider is working for you...if you don't like the way things are going, you can switch providers. Also, it is important to find out what the policies of the facility are, as these may not always jive with your wishes and what your provider tells you. Prime example...I was a VBAC for my last labor and my OB had ok'd the provision of my birth plan that said I wanted to eat and drink. Hospital said I was supposed to stay NPO. Of course, DH and I brought our own snack food and I ate anways....what were they gonna do? Kick me out?

Sounds like you do need to discuss this with your provider. You may have had a good delivery, but it wasn't a great delivery. At least you can use this as a learning experience and be better prepared next time.

[birthgreeter]

You are right to question what happened.
here are some links to help you with your research.


http://www.cordclamping.com/morley1.htm
http://www.cordclamping.com
http://www.lotusbirth.com
http://www.cochrane.org/reviews/en/ab003248.html
http://www.cordclamp.com
http://www.ICPA4kids.org/research/pr.../umbilical.htm

Here are some articles you can look up also. (if interested)

**Two patterns of perinatal brain damage and their conditions of occurrence (Myers RE. American Journal of Obstetrics and Gynecology 1972; 112: 246-276.)
**Cord Closure; Can Hasty Clamping Injure the Newborn? -By George Malcolm Morley, MB, ChB, FACOG, July 1998, OBG Management.
**Early clamping of the Umbilical Cord; Cutting the Ties That Bind-By Cory Mermer, Townsend Letter for Doctors and patients.
**Lost Causes and Side Effects; The Neurological Damage Caused by Immediate Cord Clamping is Irreversible By George malcolm Morley, MB, ChB, FACOG
**Cerebral Palsy and Cord Blood Gases by Dr. George malcolm Morley- A letter to the Editor of the British medical Journal
**A Randomized Controlled Trial of Delayed Cord Clamping in Very Low Birth Weight Preterm Infants (Eur J Pediatr 2000 Oct; 159 (10): 775-7)
**Delayed Clamping of the Umbilical Cord Improves Hematologic Status of Guatemalan Infants at 2 Months of Age (Am J Clin Nutr 1997 Feb;65(2):425-31)

[1stimestar]

Originally Posted by Maggirayne

Sorry to just vent. I just feel like no one really understand where I am. I mean, she's healthy is doing fine, why should I let it bother me? is the feeling I get when I try to talk about it.

You are NOT alone in your feelings. They ARE valid. Yes, you have a happy, healthy baby. Most of your labor went the way you had envisioned it. But that is not the whole of the equation. People do not always realize this. They just don't get it. Don't worry, some of us do get it. Hugs.

[Maggirayne]

Thanks!

Thank you each so much. It is so encouraging to know I'm not just out in left field. I did do a lot of research, thanks for the links and articles, birthgreeter, but not enough on post-birth things. Will definitely be better prepared next time.

Kick you out if the hospital indeed!

[birthgreeter]

That is the best we can do in this world, grow, and learn and make changes as we do. learning all you can empowers you -for the next baby! best to you and this little one now!

[Maggirayne]

Well, I did get to talk to my dr, saw her for my postpartum PAP (how fun! :P). My DH said they had me not push because I wasn't ready--I'd asked him couple weeks ago, wanted to see what he remembered). I was pretty sure that was not so, but some things aren't really clear (when I delivered the placenta, did I have to push it out, I just don't remember, I know it came fast--dr said it was already unattaching from my uterus), and I felt defensive with him. But, I asked the dr, and she rather airily said, "Oh, we like to have the dr there for the actual delivery." My uncle who is a PA said anyone can catch a baby--I sent him my original post.

Me: Um, so what about the dropping heartrate?
Dr said, "They weren't that bad--bad is 60's. They were around 80's-90's and were coming back up between contractions."
Me: So why was she on oxygen???
Dr: "To get the lungs expanded. I know you wanted her up on your tummy. It might not have been necessary, but it was so she didn't get fluid in there and end up with an infection and be in NICU for 7-14 days."

When I asked about the fluid/blood volume she didn't really answer what was low or why it was needed, "Oh, she didn't need the IV after all."
Me: I want to know for the future.
Dr: It likely won't happen next time.

My thought: I WANT to KNOW!

[DoomaYula]

It sounds like your doc was really blowing you off re: giving specific answers to specific questions. I'd think about a different provider if you have another baby.

[Nicole B]

Not an OB/MW either but your post made me think about my second delivery...
I know now that there are certain things you do have "some" control of in a hospital setting but say your baby is taking just a bit longer to get used to life on this side of the womb...dr's have to do what THEY think is best for the baby no matter what you might know is best...
Like my birth for example, dd was pink and alert but had a little bit of chest sucking with her breaths but otherwise she seemed just fine...
So not even an hr after birth they stuck her under an oxygen hood with 100% O2 and of course she got rather dependant on that flood of oxygen...went into a nasty spiral of having her O2 stats drop every time they tried wiening her and this terrible cycle lasted for over 5 days before she finally was well enough in their eyes to bf at 5 DAYS OLD!
Even then I knew in my heart that 100% O2 was not supportive of good lung developement (she didnt' even have to use but a fraction of her lungs to suck in adequate oxygen so anyone aught to know that isn't helpful to a baby who needs to learn to breath our 30% oxygen AIR!!!)
Well anyway there wasn't much I could have done I'm sure because of "hospital protocol" in these situations...
That's one of the many reasons I am taking charge of my own body/pg/delivery/baby by staying home and avoiding all the BS that comes with a hospital delivery!
And if baby does end up needing more help that I can offer I have a wonderful mw who's attended situations similar to mine who can suggest what might need to happen next!

Anyway...novel there I'm sorry, LOL
But I feel for ya moma!
At least we know better for next time though right?

<<<<<<big hugs!>>>>>

[SublimeBirthGirl]

All of those things would probably have made a difference, but your doctor will never tell you so no matter how much you talk to her about it. They have their policies and even though many do more harm than good, when you give birth in a hospital you mostly have to accept them for what they are, unfortunately.

[Maggirayne]

Next Time. . .

Originally Posted by Nicole B

So not even an hr after birth they stuck her under an oxygen hood with 100% O2 and of course she got rather dependant on that flood of oxygen...went into a nasty spiral of having her O2 stats drop every time they tried wiening her and this terrible cycle lasted for over 5 days before she finally was well enough in their eyes to bf at 5 DAYS OLD!

Oh my, I would be so mad if that had happened. I am so sorry.

I hate how you think of what to say, what to ask after the event. I realized I could/will ask how she would get fluid in her lungs if they'd suctioned her, which I watched them do right after I'd pushed her head out. And how does she (the dr) know something like this won't happen again?

Originally Posted by Nicole B

That's one of the many reasons I am taking charge of my own body/pg/delivery/baby by staying home and avoiding all the BS that comes with a hospital delivery!

Hear, hear. Now to convince DH for HB. I said all through this last pregnancy that I was going to see how my first delivery went, and if it was good have the rest at home. Now I have all the more reason, although he thinks it was fine with the hospital. I guess I'm not convinced drs. and hospital policy are omniscient--not that I am either, but I know how I want things certain ways. And I want to have a bunch of kids--especially since it was easy--she came out with two pushes, (when they finally let me push): .

I hadn't thought of making up 'contingency' birth plans for any situation. If I can't convince him to do HB, I'll definitely do that, well, will do anyhow for any contingency with HB/MW, etc, right! Hmm, I don't have to wait until I'm pregnant to start it either, hehe.

Funny thing is, my parents are okay with HB. My mom even joked we could go for a 'long drive' when I get close to delivering. I don't think I'm ready for a UC, and I know DH isn't!

The info about cord clamping was, well, shocking, to say the least. Referring to the Lotusbirth website, that was mostly referring to Canada, but is it possible to write a "hands off contract" for the US?

I want to go natural/unmedicated even if I have breech or multiples. That was the one really great thing with this delivery, It was all unmedicated, and the nurses were wonderful, very supportive, did not push meds/IV on me, even suggested I get in the tub instead of giving me Stadol when I asked (I felt I was getting panicky and having a hard time relaxing through the CXs). And one did perineal massage for me, DH didn't want to in front of people, I can understand that!

[Maggirayne]

Well, back at dr's for well baby, weight, etc, checkup. DH went with me, and I asked again about why might she have needed an IV. And my dr gave me much clearer answers.

Dr: When they're on oxygen, they get dried out, the blood volume can be lower.
Me: So she would have had glucose inthe IV?
Dr: And saline.

Me: Why exactly was she on oxygen?
Dr: When they have trouble breathing like that--did I say last time her heartrate was dropping between contractions?
Me: Yes.
Dr: We like to put them on oxygen just so it's easier for them. Was it absolutely necessary? Maybe not. In the old days, you would have had her and never known there was a problem. When they come so fast--her head wasn't even squished-looking--they're just kind of in shock and they weren't in the birth canal long enough to get the fluid squeezed out.

So I rather surprised at her admission that it might not have been necessary, and pleased that I got some more definitive answers, but annoyed thatt I had to push for them. I wondered how much of the clear answers were b/c DH was with me, too.

I do like my dr, so am really torn about changing. She is very supportive of breastfeeding, has been good about answering questions, doesn't routinely do episiotomies, is easy to talk to, so I kinda wonder, am I just overreacting because I didn't get things the way I would have liked when my baby was born? But even while I was pregnant (almost every time I went in) I had questions, and she was pretty good about answering me, although a few time I remember getting home and looking at them and thinking, "She didn't really answer _____." So I'd ask again or see if I really wanted to know and drop it. So I just don't know. *sigh*

[rachelagain]

I have worked w/ hb and hospital births-- hospitals just take the baby- mws usually just leave baby on mom.
I had my first 3 at home, and it was wonderful- no one is in a hurry and I help them as long as I wanted-- it was normally 20 minutes or more before the mw would ask to weigh/measure, etc. She would check heart, breathing, etc. while babe was in my arms. (this is what I have seen at the other home births I have attended as well.)
Now, I was at the hosp. w/ my last because of marginal placenta previa. I have a good Dr. and birth was ok, but they were really bothered when my baby didn't scream-- she was breathing, and alert and doing good, but you could tell all the nurses/dr was really nervous and were trying to stimulate her to cry- rubbing her foot *way too hard*, etc. but baby was fine-- (her heartrate had been down like yours) but my mw was doula-ing for me and she checked the heartrate and baby was fine w/ that as well. (BTW, she is still a calm baby and doesn't cry much) So they took her and worked her over, etc. before giving her back.
The thing is, drs. have only been to births at the hospital, they have only been to births were they take baby right away and do 'what they need to'. To them, it's normal and it was a good delivery, etc. Because it probably was, compared to the medicated births that they see most of the time. But to have the time to bond w/ your baby, I've only seen it happen at home.

[Maggirayne]

What colour are babies typically when they first emerge from the birth canal or are lifted out at a C-section?

[MsBlack]

When they come out from Csec, they can be quite pink, or *maybe* bluish--assuming a more or less healthy infant. When born vaginaly, most babies are light blue or lavender at birth, and soon get rosy/pink (if cord is still pulsing and/or they start to breathe right away.). This can be observed even in baby's of color, tho of course 'pink' or 'blue' means something a bit different in a white baby than darker skinned baby.

Vag born babies get a little oxygen deprived during the final part of labor as they are being squeezed through the passage, which accounts for the blue color. Now, if the baby is very dark blue/purple, that is a sign of pretty intense oxygen deprivation==but still, blue means the heart is beating, just less circulating 02 than usual at that moment. FOR WHICH HEALTHY INFANTS HAVE COMPENSATING MECHANISMS! So don't go thinking that 'low oxygen' means the same thing for a neonate as it would for a baby days after birth, or for you, cuz it doesn't. Sometimes, a baby will look light blue with head on the perineum, which starts to get darker blue as seconds pass to next push. Then body is born, and it's not as dark, and instantly the color evens out as that less oxygenated blood is able to pass out of baby's head and into the body again. This can be a little scary to observe, that darkening of the head, if you don't know what you're seeing.

But almost all healthy normal babies are vaginally born blue or lavender, and some take a few minutes to pink up thoroughly tho some will pink up very rapidly.

I always have to kinda laugh when I hear people say "my baby was born blue, it was an emergency!" Because usually, blue is normal! And even a really dusky baby will most likely get to the right color soon, most often with little help of any kind, right there on mom w/cord intact. The only color you DON'T want to see is pale/colorless/white--because that usually indicates a heart that has stopped, or is barely beating at all.

[Nicole B]

What a great responce M
Thank you

Maggiryan- I'm glad you got better answers from your doc this go round

Thanks for your words to me earlier
I still get mad sometimes just thinking of the needless seperation the hospital/dr put between me and my baby's bonding tme:
I agree with msblack that your dr only done what his training has taught him to be as best
I hope your next birth is wonderful and intervention free ...work on that husband of yours

[mwherbs]

I think having you wait when you needed to push was a bad choice of the nurses-- and that is something to consider when looking at your doctor- your doctor is not who will be there to manage your labor the on shift nurses will- and even with standing orders they are the labor sitters and basically the first line of decision making when you are in labor-- did you know in other countries they don't have nurses (who have less training in birth) do labor sitting but midwives , even if a doctor does the delivery a midwife staffs the labor ward -- now there may be some nurses who have worked years at it but no guarantee that you will get a well seasoned nurse, and then of course she/he may not have gotten much training as to why you do a certain action, mostly how to do an action- a birth educator has many more hours training about birth than your typical nurse. so no surprise that they could make a mistake on having you wait to push
as for dusky babies- many babies have funny color and the assessment for needing to resuscitate has to do with heart rate and breathing- this would be right away then one minute after birth is when you do an apgar- and then the next apgar is at 5 minutes--
a baby is born with a fairly low oxygen status- at sea level it is about 61% at altitude it is about 45% -- by 15 minutes there is usually a gradual 20-30% increase in oxygen saturation -

we delay clamping because a baby does better to transition into breathing, it may be that your baby did need a bit of resuscitation efforts or it could have been that there were some poor tracings before birth- and then some panic on everyone's part about what could be wrong with your actually perfectly healthy baby that took a bit to recover from waiting to be born-- if you rub your finger across a fontanel it changes a baby's heart rate - when they drop into the birth canal close to birth there is often a drop in heart rate- has to do with different nerve centers being stimulated in a baby-- since this happens so often in birth I can't help but think it is normal- how low and for how long is what becomes a concern--the nurses probably saw a drop and then got scared and didn't want to be the only ones in the room catching a baby that might need resuscitation- not realizing that their actions makes for a bigger problem--
the rest is just the time it took for everyone to recover from the birth events as they unfolded- if I were to guess I would say that maybe your baby was breathing a little fast. just what is typical postpartum recovery at the hospital you gave birth at? many places like to take babies to the nursery so that they can keep the staff numbers lower (this is how profits are made) - more babies looked after by a few- instead of 1 on 1 that would be necessary if the baby were to stay with you-- also they try to keep the numbers low on OB staff as well - so if anyone else was in labor they may have wanted your nurse to labor sit someone else or do postpartum for you and another mom and it could have been purely an adminstrative choice in how you and your baby were cared for--