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#1 of 11 Old 08-31-2013, 05:44 PM - Thread Starter
 
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I'm post-partum but wondering about the next baby. I had a hospital birth which was absolutely natural, but was forced (physically at one point) to birth on my back.  My doctor decided that after ~30 minutes of pushing (my husband said that the baby's head was almost out) to pull my baby out by her head, then by her shoulders.  My husband said that she was purple, and now I understand that she may have been trying to avoid birth hypoxia by interfering with the birth.

 

Anyway, I guess I'm kind of crunchy.  I'm aware that oxytocin released by the mother essentially shuts down the infant's brain during birth, but I'm wondering if that involves a purple baby?  Is this a normal occurence? And is there any way to know during birth if hypoxia is happening? Is "breathing the baby down" a smart idea, then? How long should the baby be in the birth canal maximum?

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#2 of 11 Old 08-31-2013, 06:18 PM
 
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I am not sure of the answers to your questions but I just wanted to reach out and give you a :Hug for what sounds like a very challenging birth. Did someone really force you to lay down? YOu must be such a jumble of emotions!


 
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#3 of 11 Old 08-31-2013, 09:19 PM
 
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Quote:
Originally Posted by treeonastring View Post

Anyway, I guess I'm kind of crunchy.  I'm aware that oxytocin released by the mother essentially shuts down the infant's brain during birth, but I'm wondering if that involves a purple baby?  Could you explain a bit more what you mean by this?

Is this a normal occurence? It is within the range of normal for there to be some discolouration of the baby's head both during the birth and for a period of time afterwards. However I'm not sure what you mean by the term "purple baby" so I'm not sure if this is what you're referring to.

And is there any way to know during birth if hypoxia is happening? Yes there are some ways but it isnt an exact science. A CTG can sometimes give you an indication but it is not super reliable. A sample of blood taken from the baby's head can be tested to see what the pH is (scalp pH) which can also give some imdication of whether the baby is hypoxic. It is more reliable than a CTG but also more invasive and can only be performed when mum's cervix is dilated enough to allow access to the baby's scalp.

Is breathing the baby down" a smart idea, then? In most cases breathing the baby down is fine. if there were clear signs of distress and birth seemed imminent it may be better to encourage active pushing.


How long should the baby be in the birth canal maximum? There is no maximum time. It all depends on how mum and baby are coping.

I'm sorry you had such a bad experience. I'm happy to try to provide more answers for you if you want to share anymore information.

Mother of two spectacular girls, born mid-2010 and late 2012  mdcblog5.gif

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#4 of 11 Old 09-01-2013, 07:41 PM
 
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Well I'll say one thing that we learned in prenatal classes, babies don't come out of the birth canal looking all pink and pretty like those on TV! I was glad she mentioned that cause I would have thought something was wrong with DD.

 

Did your baby have any trouble breathing once she came out?

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#5 of 11 Old 09-02-2013, 11:37 AM
 
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Were you on any kind of monitor of the baby's heartbeat?  Did the baby have trouble breathing?  Have you had a chance to talk to your doctor or see your records and go over them together?  It might be useful for you to come up with a list of questions for your doctor.  You can ask her, and perhaps also see if you can talk to another doctor to see if they agree about the decisions that were made.  That might  help you figure out what you think of the whole situation.

 

I'm not a professional, so I'm just talking as a mom who has spent a lot of time processing my own births and traumas.  I had a child who had birth asphyxia.  The trouble with things like hypoxia is that if the doctor was worried about hypoxia and did pull your baby out to prevent that, you may never be able know whether or not it was "necessary" in the sense that your baby would have had brain damage had she waited.  Hypoxia isn't one of those things anyone wants to wait around for.  You can only know that it was a concern and the doctor acted on that concern.  You probably can't know what the outcome would have been had she not.  Your baby might have been fine, or might not have been.  It might be very difficult to determine if it was a legitimate concern or not.  I understand though the urge to try and figure out... what really happened there?  It's frustrating because sometimes it can be very hard to know.  

 

I'm sorry that you were made to lie on your back to labor.  That must have been scary and uncomfortable for you.  It was probably scary for you to have your baby pulled out like that.

 

In my first birth, I pushed for close to three hours before my daughter was born, healthy but a little blue.  She needed a little help but pinked right up.  I used to wonder if it was really necessary for them to take her off to the warming table.  But after my second birth, I have peace about that.  I understand that I can't ever know if she would have been fine or not without the warming table, but with it, she was fine.  My second labor my pushing stage was only half an hour and we, unfortunately, had no access to anyone or anything that could have helped speed it up.  This is my baby who had birth asphyxia.  You can look in my signature to see what happened.  Every birth and baby is different, and depends on a variety of factors.  Sometimes a long pushing or breathing down stage is fine for babies and moms and sometimes anything over 8 minutes is too long.  I can't say for sure what could have happened to my daughter in different circumstances.  I only know what happened in the circumstances we had. Most of the time, we can really only know if a birth was "normal" by looking back on it, and then, so often we can only say, "This is what happened," not "This is what could have happened."

 

 

 

I hope you're able to get answers to your questions that satisfy you.  

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#6 of 11 Old 09-02-2013, 11:42 AM
 
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Also, it sounds like one of your big questions is if it would be safe for you to breathe a baby down again?  This is a good thing to discuss with your care provider.  Careful heart rate monitoring during the pushing stage might give you some peace of mind.

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#7 of 11 Old 09-02-2013, 11:11 PM
 
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Purple is not a good color...that is, for any human to be.  It is the visual sign that the amount of oxygen in the blood is low, (technically speaking, the amount of oxygen bound to hemoglobin in the red blood cells is depleted).  Blood testing can give an idea of the amount of oxygen actually in the blood, but the most immediate way to estimate this is by looking at the oxygen saturations that are seen on the pulse oximeter once the baby is being assessed.  Usually, cyanosis correlates to oxygen saturations less than 80 to 85%.

 

It isn't uncommon for neonates to be blue or purple at birth, though often it is primarily the extremities that are most affected.  When central cyanosis is present (head and trunk are also blue), it is more concerning in that it suggests a more significant degree of oxygen depletion.  As you know, the greatest worry is that the brain (as well as the heart and kidneys, other organs very sensitive to lack of oxygen) may be hurt as a result of insufficient oxygen.

 

However, shortly after drawing those first breaths, most babies will pink up nicely.  This is why APGARS are so important!  A baby that is really "down" from lack of oxygen will take longer to breathe, may have a low heartbeat, may have poor tone and responsiveness, and may stay blue longer.  A low one minute APGAR should prompt appropriate resuscitation, and most babies respond well.  However, a low five minute APGAR is very alarming, and is strongly correlated to poor outcomes.

 

So, in your case, it would seem that your OB astutely observed the blue head/trunk, and promptly got your baby out where oxygen and resuscitation could be started.  Given the risks of prolonged hypoxia, (look up hypoxic ischemic encephalopathy, HIE), my hunch is that it was the right thing to do.  I'm assuming your baby's APGARS were fine and your little one is healthy and well?

 

Oh, and as to the cause of the hypoxia, it can be very difficult to determine and is sometimes multifactorial.  Cord compression or occlusion (from a variety of reasons--compression in the birth canal, nuchal cord around the neck, knotted cord, clot in the cord, etc.), placental insufficiency, decreased blood flow due to uterine contractions, high maternal blood pressure are all possible reasons, though there are many others.  I wouldn't assume that the same situation will happen during subsequent pregnancies, (assuming you don't have an underlying diagnosis that you know of that could have contributed, such as high blood pressure, a clotting disorder, etc.).

 

Anyway, I'm sorry the experience wasn't what you had hoped it would be.  But, a big hug and congratulations on the best role of your life:  being a mother!

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#8 of 11 Old 09-02-2013, 11:21 PM
 
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Oh, and just to add:  totally agree with katelove's explanation of intrauterine monitoring of oxygen levels of the baby, which can be very difficult to do.  Again, if your doc actually saw a blue baby, I think most would agree the prudent thing is to expedite delivery.  Fetal heart rate monitoring can provide some information, in that a prolonged period of bradycardia (low heart rate), or certain patterns of bradycardia with contractions (called decelerations) can correlate with oxygen deprivation to the baby.

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#9 of 11 Old 09-02-2013, 11:38 PM
 
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What are your questions about the next baby in terms of home birth? 


Midwife (CPM, LDM) and homeschooling mama to:
13yo ds   10yo dd  8yo ds and 6yo ds and 1yo ds  
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#10 of 11 Old 09-03-2013, 01:44 AM
 
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The only thing I find a bit odd though is that a partially born baby can be a purplish colour quite normally. Definitely a problem if they don't pink up quickly after birth but I've never seen a delivery expedited based on colour of the baby.

OP, I assume someone was doing foetal heart checks every couple of minutes while you we're pushing? Could it be that the baby's heart rate dropped and that is what prompted your Dr to take the action he did?

Mother of two spectacular girls, born mid-2010 and late 2012  mdcblog5.gif

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#11 of 11 Old 09-19-2013, 08:26 AM
 
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Originally Posted by treeonastring View Post
 

I'm post-partum but wondering about the next baby. I had a hospital birth which was absolutely natural, but was forced (physically at one point) to birth on my back.  My doctor decided that after ~30 minutes of pushing (my husband said that the baby's head was almost out) to pull my baby out by her head, then by her shoulders.  My husband said that she was purple, and now I understand that she may have been trying to avoid birth hypoxia by interfering with the birth.

 

Anyway, I guess I'm kind of crunchy.  I'm aware that oxytocin released by the mother essentially shuts down the infant's brain during birth, but I'm wondering if that involves a purple baby?  Is this a normal occurence? And is there any way to know during birth if hypoxia is happening? Is "breathing the baby down" a smart idea, then? How long should the baby be in the birth canal maximum?

 

They check for hypoxia by testing the infant's blood gas concentration.  Usually this is done after birth using the cord blood, but I have heard of them doing it with a nick to the scalp during birth too, perhaps if they can't get the heart rate.  Most commonly, they follow the baby's heart rate.  Babies who have a normal heart tracing are almost always fine.  Babies with an abnormal heart tracing in a particular pattern called late decelerations are at risk for hypoxia.  A certain percentage will experience brain damage or death without intervention.  Others will be fine.  There is no way in the moment to know which babies will be fine and which will be injured or killed (absent something obvious like a visible cord or pouring blood), so the standard of care is to intervene for all of them.  If your doctor was monitoring your baby's heart rate and there were late decels, that would have been an indication for intervention.

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