If a newborn requires resuscitation.....what are the options?

[zjande]

I am researching having a UC because I think my labor is going to be too fast to make it to the hospital.

I learned over in the UC forum that the fold-the-baby-in-half technique described on pages 35-36 of the Emergency Childbirth manual is outdated & NOT the way to go. But also that infant CPR (that I am certified in) is something entirely different from neonatal CPR.

If in the very unlikely case someone like me had a baby emerge that would just not start breathing on its own, what is my best course of action, short of becoming certified in neonatal CPR? Would just calling 911 be it? No matter what should I stay away from the fold-baby-in-half deal & infant CPR? Could those do more harm than good?

Thank you very much for any advice!

[cathicog]

NRP is very similar to infant cpr, but there are interesting differences, and there are differences in the way it is taught by nurses in a hospital setting, and by Karen Strange, who primarily teaches homebirth midwives. It would be worth it to take the NRP, and if you didn't have it, the infant cpr would work. You just have to assess while you are doing the cpr and it is helpful to have someone with you that can assess *you*(for excess bleeding, that is..)

[mothercat]

I am a NNR instructor who teaches OOH midwives. Yes, the fold baby in half thing is definitely a NO,NO. It can cause trauma to the baby and may lacerate the liver. Then you may have a severe problem because the liver is very vascular and will bleed a lot even from a small tear. The covering is rather fragile in a newborn.

The what to do: you could buy the 2005 edition of the NNR book. You can get it from American Academy of Pediatrics (about $50.00). It comes with a CD that shows everything step by step so you can get the rhythm of respirations and chest compressions. I have also seen used copies on Amazon. Just be sure it's the 2005 edition.

The nitty gritty: only about 10 % of babies require any assistance at birth, only about 1 % will need chest compressions, and 0.1% will need meds and continuing support.
But, those percentages includes everything from the wee premies to the severely post term and the very medicated. The actual percentage who require help at term is small, especially in a healthy pregnancy and an unmedicated birth. The single most important thing is respirations. I won't go into all the details because you really should take a class if you think you might need this, but a nonresponsive baby will improve very rapidly with just a puff or two of room air, so mouth to mouth, very gently may work just fine. Oxygen is no longer the necessary starting point, it is only needed if there is no improvement with adequate ventilations with room air.

If a puff or two doesn't improve things, have someone call 911. You can always refuse treatment and transport if the baby is fine by the time they get there.

[mwherbs]

what mothercat has said and to point out the difference that now atleast in adult CPR is not breaths but compressions--- compressions for a newborn is not the priority -- Air is the priority-- or Air and compressions depending on heart rate. the CD is an excellent training device --- look for a class at one of your local hospitals
here is the web site on the right is an instructor locator

http://www.aap.org/nrp/nrpmain.html

[zjande]

Thanks very much for the information! I appreciate it muchly.

[Jane]

The clear difference for me was to learn about primary and secondary apnea (this is covered in the book) - apnea is "not breathing" - so if the baby is not breathing, it could be in primary or secondary apnea. In primary apnea, the baby is a little depressed, and will breathe with stimulation. In secondary apnea, the baby will not have an instinct to breathe, no matter how much stimulation is given.
What's the take home from that? If the baby is all rubbed up, and still isn't breathing after a minute, then mouth-to-mouth is next. More stimulation isn't gonna work. (Baby mouth to mouth, a really small amount of air). That fold-y thing is designed to move the diaphragm. Skip that (it's dangerous, as mentioned) and just directly inflate the lungs.
There's more, lots more, but that's the basic understanding that's different for the neonate than the adult or infant.
Oh, and the latest word is that supplimental oxygen is not good for babies and should only be used as a last resort, so don't feel like not having oxygen is a detriment.
In attending OOH births, I haven't seen nearly 10% need resus - I think I've seen 2%.

[momileigh]

I haven't taken NNR yet, but I've seen a few resusitations. (They have always been after very difficult second stages, never after a fast, easy birth.) What IS the "fold the baby in half" thing???

[pigpokey]

Originally Posted by momileigh

I haven't taken NNR yet, but I've seen a few resusitations. (They have always been after very difficult second stages, never after a fast, easy birth.)

I had a fast, easy birth (second stage about 10 minutes) but my son was white, cord empty at birth and did not respond to being rubbed up so I had to give him MTM, which brought him around quickly. He's fine.

It can happen in many circumstances ... preparation is not a bad thing. My best guess at this point is that his placenta quit around the next to last contraction.

[momileigh]

Oh, I did NOT intend to say that resuscitation is ONLY needed in these situations. I was just saying that every time I've seen it, that was the circumstance. I've seen about 125 births, give or take. I've seen around 5 *real* resuscitations that involved rescue breaths, two of which required chest compressions. All births have been full-term, healthy pregnancies. So, I thought it was valuable to point out that it isn't so common for a fast/easy birth to have this complication, so that it wouldn't give the impression that someone with my limited experience would have a relatively large amount of experience with resuscitation due to a birth that happened normally. All the times I personally have seen or helped with NNR, that mom most likely would have had a c/s in the hospital. I hope that made sense. And I completely agree that everyone who plans to attend a birth, either as an attendent or as a mother, should make an effort to at least be familiar with resuscitation.

[mwherbs]

yep, I would say careful about characterizing things-- fast may mean an abruption, being prepared to do mouth to mouth as a parent is not a bad idea- stimulation, suction and air then compressions if need be--
the fold in half thing was an old attempt to do resuscitation - it is still found in some older books -like emergency childbirth and in Polly's birth book-- it is very dated info because I have been taking classes on how to resuscitate a newborn since the 80's where we had long lists of primary and secondary apnea - and we weren't doing anything like folding a baby-- I couldn't say when that was popular but what I have come across is a few very old country docs in the late 1800's early 1900's who did things similar to mouth to mouth-- some how it just didn't become a wide spread practice for a very long time---

[mothercat]

resuscitating baby

zjande included a link to the pdf for Dr. Gregory White's book about emergency childbirth. The method shown for resuscitation is roughly page 34 of the book.
This book was originally published in 1958 (before we had NNR) and last revised in 1994. I'm not sure if they included revisions to the resus. part of the book at that time.
However, right now the best thing to help baby transition if he/she is having trouble getting started (heart beat 100 or lower, limp, purple, no resp., etc.) is ventilation. Baby may be breathing very quietly or still getting quite a bit of O2 from the cord, so even if no immediate response, color should be becoming pink and baby should have good muscle tone. If not, baby may need help.
May just be primary apnea but always assume it's secondary and that baby will need more than being rubbed up to get started. If just blowing on the baby's face doesn't get a response seriously consider a puff or two of MTM. That little bit will make a huge difference very quickly.

Almost all my births are OOH, so I have seen this go both ways with babies needing a little help at birth. With the long hard labors I expect they may be a little shockey at birth, and I have my equipment nearby, but everything is always ready even for the fast easy ones because sometimes the baby seems to know that a fast exit is in his/her best interest because there is an occult cord or some other problem. And a fast birth can be just as traumatic as a long hard one as far as baby is concerned.

I suppose that's the take home message here. Assume that birth is normal, but be ready in case it isn't.

[momileigh]

Oh, there we go, I found it this time. It looks weird.

[pamamidwife]

the nice thing about fast labors is that they're rarely complicated at all. if that helps at all.

[mothercat]

ACOG and suctioning

pamamidiwfe's siggy:
PLEASE, PLEASE, PLEASE: STOP SUCTIONING BABIES AT BIRTH! THROW THOSE BULB SYRINGES AWAY!

So, I'm adding this:

This month (9/07) ACOG finally issued a statement saying that even with mec, if a baby is vigorous (crying, pink, good muscle tone, good heart tones), they should not be suctioned on the perineum or after birth. Can cause damage to the vocal cords and oral aversion makes breastfeeding more difficult.

AAP in the NNR manuals said this in the newest edition which was 2005.

I know that the national registry exam for EMT's still says every baby must be suctioned at birth, mec or not.

So ACOG and NNR are making progress. Now if we could just get the word out to the people actually assisting at birth.

[pamamidwife]

thanks!

[cfiddlinmama]

OP, this is probably obvious since you are UCing, but leave the cord intact. That is the most important thing we can do. The NRP class I took was for homebirth midwives taught by a CNM. She talked a lot about the science leaving the cord intact. It's the worst thing in the world for a depressed baby to have it's oxygen supply cut off. Just thought I would throw that out there in case you didn't know. My preceptor to be has been a midwife for 30 years. She's only had 2 or 3 resuscitations. The babies all had defects (herniated diaphragm etc.)

Oh and on the fast birth thing, my last two babies were born extremely quickly and both were a little shocky. My last baby was white and limp. I think it's the force of being born quickly or something. Neither required more than stimulation though so it was primary apnea.