Processing Birth Attended Yesterday @ a Hospital as a Doula...questions....

[holly6737]

I attended a moderately wonderful birth yesterday (moderately wonderful because there wasn't an instrumental delivery or a c/s, an episiotomy, the placenta wasn't ripped out of her, etc.) at a local hospital. I'm a volunteer doula, so I don't meet the birthing women beforehand and don't have any say in their birth plans or whatnot. Anyway, it was an interesting birth for me because the mother only spoke spanish and I only speak english (I've got to learn spanish!! ), but she knew enough to grab my arm and tell me "thank you!" when I was about to leave, and that, of course, made my heart melt. Anyway, I have some questions....

1) She was preterm. 34.5 weeks. They had her on tons of Penicillin. I asked why and the nurse said because she was early. Is there really an increase in infection because she was early? Her waters spontaneously ruptured. Were they thinking maybe her waters ruptured because of a uterine infection?
2) She was on continuous EFM for a bit, but then they switched to internal after they started to notice baby's hr dropping with contractions. Before then I also had her on the birth ball, standing, etc. and after that she had to stay in bed. Every birth I've attended (except the home birth) the baby's hr eventually becomes an issue. Is this the monitor, does the baby's hr fluctuate naturally or could it be because of the pitocin? Because her waters were already ruptured? It's just so hard for me to know when they're being how they are and when it really is an emergency.
3) They did an amnio-infusion because of the baby's hr. Is this a common practice? I've never seen it done before.

And then I just want to vent about the cord being cut. The baby was born and let out a little cry, but you could tell he was having a bit of trouble transitioning. So they immediately cut the cord. It just made no sense at all. I mean, it was like an emergency to cut the cord, the speed at which the doctor moved. I'm guessing it was to get him over to the NICU people, but doesn't it make sense because he was still receiving O2 from the placenta, so what could the NICU have done for those first couple of minutes that the placenta couldn't have??

I'd really appreciate any insight from more experienced doulas or midwives. Thanks!

[homebirthing]

So they immediately cut the cord.

Unfortunately, most hospital care providers don't see the mother/baby dyad. The two are not connected, and so they wouldn't even begin to see the benefits of oxygenated blood from the placenta until babe learns to breath for the very first time in his life. There is so much more I could say, but this is one thing about hospital birth that makes me want to cry.

[CEG]

I asked the same question when I attended the Neonatal Rescusitation class (I'm an RN). I was told that it is too hard for a neonatal team to perform around mom and the cord. I think in some cases this is true- babe needs more than the cord can provide, but obviously in the majority of cases babe would benefit more from the cord.

Also, as far as oxygenation, fetal hemoglobin carries much more oxygen, but oxygen saturation of the fetus is only 30-40% (if I remember correctly) while in a "born person" we would expect 95-100%. So there is a big change from fetal circulation requirements versus infant requirements and sometimes the amount of oxygen provided by the placenta is considered to small to meet the needs of the baby.

Editing because I typed "ases" instead of "cases." I guess I was thinking of the docs and my mind wanted to type "as_es"

[SublimeBirthGirl]

THey always immediately cut the cord if a baby's not transitioning well. It's completely stupid and ridiculous but standard.

I hardly ever hear about a hospital birth where there aren't heartrate issues. There was a study/experiment/whatever done once where 20 or so docs were given an EFM strip and asked to interpret it. Every doc had a different interpretation. Some period of time later they gave the docs the same strip again. Not only did they all interpret it differently, they all interpreted it differently from their own first interpretations. The fact is, they don't know why babies' hearts do what they do, what it means, or anything else. It's a crapshoot, which is why CFM increases the cesarean rate w/out improving outcomes.

[Ironica]

Originally Posted by holly6737

1) She was preterm. 34.5 weeks. They had her on tons of Penicillin. I asked why and the nurse said because she was early. Is there really an increase in infection because she was early? Her waters spontaneously ruptured. Were they thinking maybe her waters ruptured because of a uterine infection?

Not a birth professional, but having read a TON about GBS... the GBS culture is normally done at 37 weeks. If you're preterm, you haven't had a culture, *and* your baby is at greater risk of developing an infection if you're a carrier, so the ACOG guidelines are to pump you full of penicillin. They give you an IV penicillin infusion every 4 hours while you're in labor, or starting when the membrane ruptures even if you haven't gone into active labor yet. It's the same routine if you have a positive culture at 37 weeks. Also, they want to give you at least two doses before baby is born, so they're quite cross with you if you don't come to the hospital at least five or six hours before your baby is born.

[Banana731]

They will do an amino infusion if the HR is dropping to try to "float" the cord off of wherever it's being compressed enough to cause the flow of O2 to be interupted.

[happyartmama]

Very interested to learn from this post as well.

SublimeBirthGirl, any idea where to find or reference the study you mentioned? I would like to take a look at it and possible reference in my CBE classes.

[mommyminer]

"1) She was preterm. 34.5 weeks. They had her on tons of Penicillin. I asked why and the nurse said because she was early. Is there really an increase in infection because she was early? Her waters spontaneously ruptured. Were they thinking maybe her waters ruptured because of a uterine infection?"

Besides the GBS issue, an infection can cause PTL. That's another reason they give antibiotics just in case there is an infection.

[BugMacGee]

Besides the GBS issue, an infection can cause PTL. That's another reason they give antibiotics just in case there is an infection.

:

[BugMacGee]

Unfortunately, most hospital care providers don't see the mother/baby dyad.

I work in a high-risk area and this is certainly true. L&D is in charge of mom, NICU of baby. It gets awkward when the baby has a serious defect/ is very premature that we know about and need to prepare for (eg. have code meds ready for the birth, extra staff) To them, it's just another mom having a baby.

The two are not connected, and so they wouldn't even begin to see the benefits of oxygenated blood from the placenta until babe learns to breath for the very first time in his life.

At some point, the baby does need to transition to extra uterine existence. Especially a preemie, remaining connected isn't going to help with any respiratory difficulties they may have. That's due to lack of surfactant.

There are benefits to delayed clamping, but some babies need other kinds of support that the placenta isn't going to provide.

[BetsyS]

Originally Posted by Ironica

If you're preterm, you haven't had a culture, *and* your baby is at greater risk of developing an infection if you're a carrier, so the ACOG guidelines are to pump you full of penicillin.

It's actually CDC guidelines that provide this protocol. Not everyone follows the exact CDC recommendations, but they are the most researched and evidence based ones out there.

[Ruthe]

[quote/]At some point, the baby does need to transition to extra uterine existence. Especially a preemie, remaining connected isn't going to help with any respiratory difficulties they may have. That's due to lack of surfactant.

There are benefits to delayed clamping, but some babies need other kinds of support that the placenta isn't going to provide.[/QUOTE]

And the baby should remain attached to it's built-in support (cord and placenta) until extra-uterine aide is established. It's only common sense to do it bedside and not deprive the baby of the oxygen that IS available for several minutes or longer.
It's also been shown that delaying for as little as 2 minutes can significantly reduce anemia in babies 3 months -6 months after birth. Anemia is a big concern for preemies who didn't get extra iron stores in the last months of pregnancy, like a full-termer would. Immediately slashing the cord causes nothing but harm.
Read about this procedure:
http://www.checkbiotech.org/orphan_N...spx?infoId=715
Does it really seem imperitive to you that the treatments done to help preemies get oxygen must be done accross the room and not at bedside while the baby is supported as long as possible by oxygen from the still-functioning placenta?

[BugMacGee]

And the baby should remain attached to it's built-in support (cord and placenta) until extra-uterine aide is established.

I'm sorry. I'm not quite sure what you mean by this. I'm adressing comments like the cord should be kept intact until the baby learns to breathe. At 34.5 weeks, it's not necessarily an issue of learning to breathe. It's likely a surfactant deficiency that causes respiratory distress (if there is any, sometimes 34 weekers don't have any) Until the placenta can produce surfactant-which, to my knowledge, it cannot, you can keep the cord intact as long as you want but it's not likely to help with the respiratory issues that many preemies have. At some point, the placenta stops being the baby's lifeline and they need to transition. Preemies are still going to have preemie problems with or without the placenta attached.

I'm all for delayed clamping, but it's not going to solve all neonatal problems. All I'm sayin'.