Can we talk about routine suctioning of babies at birth? - Page 4 - Mothering Forums

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#91 of 109 Old 09-02-2007, 11:38 PM
 
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to add more to this thread I thought I had read something from LLL on oral aversion -- here is a pretty good article- with some older references, but an interesting read none the less

http://www.llli.org/ba/Aug00.html


this is an excerpt from the article--
"One of the most common practices newborns encounter immediately following delivery is suctioning of the airway. NICU nurses have identified suctioning as noxious and possibly painful because it involves potential tissue damage and often elicits responses that resemble pain. 7 In one study of low birthweight babies, 75 percent of infants displayed all 4 of the specified signs of pain when suctioned, and 100 percent of the infants displayed 3 of 4 signs of pain.7 In newborns, any oral discomfort may cause an aversion to subsequent stimuli touching the mouth or lips, possibly causing more pain.6"
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#92 of 109 Old 09-02-2007, 11:53 PM
 
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and here is another that talks about pain- but includes suctioning as a painful procedure--

1: Arch Pediatr Adolesc Med. 2003 Nov;157(11):1058-64.

Comment in:
Arch Pediatr Adolesc Med. 2004 Jun;158(6):600; author reply 600.

Do we still hurt newborn babies? A prospective study of procedural pain and
analgesia in neonates.

Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D.
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital,
Rotterdam, the Netherlands.

BACKGROUND: Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and long-term detrimental effects. OBJECTIVE: To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population. METHODS: For 151 neonates, we prospectively recorded all painful procedures, including the number of attempts required, and analgesic therapy used during the first 14 days of neonatal intensive care unit admission. These data were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians. RESULTS: On average, each neonate was subjected to a mean +/- SD of 14 +/- 4 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6%) consisted of suctioning. Many procedures (26 of 31 listed on a questionnaire) were estimated to be painful (pain scores >4 on a 10-point scale). Preemptive analgesic therapy was provided to fewer than 35% of neonates per study
day, while 39.7% of the neonates did not receive any analgesic therapy in the neonatal intensive care unit. CONCLUSIONS: Clinicians estimated that most neonatal intensive care unit procedures are painful, but only a third of the neonates received appropriate analgesic therapy. Despite the accumulating evidence that neonatal procedural pain is harmful, analgesic treatment for painful procedures is limited. Systematic approaches are required to reduce the occurrence of pain and to improve the analgesic treatment of repetitive pain in neonates.

PMID: 14609893 [PubMed - indexed for MEDLINE]
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#93 of 109 Old 09-03-2007, 12:50 PM
 
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Since there are so many knowledgeable people on this thread, I was hoping you could give me your opinions on my situation.

Synopsis: Planned a homebirth with a midwife. Water broke for 48 hours without a single contraction. Baby's movements went way down. Midwife suggested going to the hospital for Pitocin. I accepted (shamefully) a single dose of Fentanyl as I was unprepared for the Pitocin ctx's. Labor was an hour and 43 minutes. Although I did not have a fever or elevated white count or an odor of the amniotic fluid when we went in, several hours after a lengthy 'hunt for the cervix' session I developed a fever.

By the time my daughter was born she and the fluid smelled very strongly of infection. We told them that we didn't want the cord cut before it was done pulsing. She was only out for 10 seconds before they said 'she's not breathing' and stole her away from be to put her of the baby exam table. They rubbed her and she cried immediately, but they said she had the infected water in her lungs so they deep suctioned her 4 times. I was barely aware of what was going on and couldn't get any words out to stop it. Her Apgars were 8 and 9 for color.

Several weeks later I asked the hospital midwife why she had done it that way instead of respecting our wishes and she said that because of the infection it wasn't standard of care to let her try to breathe while still getting oxygen from her cord. I asked why they had to suction her 4 times, and got the same answer (very defensive I would like to add). "Well it's better than *not* breathing, isn't it" she asked me twice - but my answer that she was, was lost on her.

So my question is this: Was this a time that suctioning was necessary to prevent something worse? I can't feel in my heart that it was, and I am so full of rage about what happened.
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#94 of 109 Old 09-05-2007, 09:03 PM
 
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I haven't read the whole thread yet but will.

DD1 was suctioned. She was born overdosed and then suctioned and stuck on oxygen (as was I...cold enough to make my nose raw). She had trouble nursing. She just didn't want to do it...she was tired and burnt out!

DD2 was a UC waterbirth and we didn't suction (though my SIL wanted too but kept it to herself ) and there is such a difference in how she nurses! She was "wet" sounding but honestly she just came from a WET environment where she spent 9 months. We didn't expect her to sound dry! She sneezed a lot in those first couple days and then stopped sounding "wet". If we have any more we won't be suctioning them either.

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#95 of 109 Old 09-05-2007, 09:11 PM - Thread Starter
 
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OMnM, you bring up a good point. Oxygen to "dry out" a baby's lungs is horrible on the baby. It's very cold and if you've ever had cold air stuck down your nose/throat, you can realize how uncomfortable it is.

Nursing a baby will help clear things out just fine. I think the idea that we need to "dry out" a baby's lungs - again - is counterintuitive to how we're designed?

Oh, how did we survive without suction devices, cord clamps and oxygen? Egads. For normal birth, none of these are necessary.
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#96 of 109 Old 09-06-2007, 10:36 AM
 
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Mine was suctioned when he was born. He gave me a hard time for nursing from the beginning. I figured it was due to the suctioning. I spent hours at a time gently persuading him to give it a try. When he would latch on, it didn't hurt and fit the descriptions I had read of how to do it correctly, so I thought everything was fine. But, on day 3 he had no dirty diapers at all. Turned out he was tongue-tied. When we counted how many sucks to a swallow, instead of being around 2 like it should be, it was more like 20 or 30. He was not interested in the breast because in his experience nothing was coming out of it. On the 5th day, we had his frenulum clipped, and within minutes he was sucking perfectly.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#97 of 109 Old 09-07-2007, 02:00 AM
 
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Please see comments made on the thread
Suctioning baby after birth??? (sorry, don't know how to link to that thread)
I have posted info regarding AAP and ACOG statements for suctioning at birth. It's message #16.

Wife, mother, midwife, triathlete
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#98 of 109 Old 09-07-2007, 04:30 PM
 
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it took me a while to find mothercat's post.... in homebirtht

here it is: http://www.mothering.com/discussions...5&postcount=16

Jessica

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#99 of 109 Old 09-07-2007, 05:33 PM
 
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First do no harm. Love it Thanks so much for sharing the information, mothercat...and Jessica for finding it

I have retired from administration work, so if you have a question about anything MDC-related, please contact Cynthia Mosher. Thanks!
 
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#100 of 109 Old 09-07-2007, 09:33 PM
 
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Based on that, my baby didn't need suctioning after all.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#101 of 109 Old 09-08-2007, 12:46 AM
 
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Hmmmmm, just chiming in... a little late. Anyhoo, I don't suction routinely at cesarean births. It isn't really supported in the literature. Anyway, hasn't anyone here ever heard of a perforated stomach? It is really fun to look at an xray with a feeding tube as soft as a usual suction catheter heading down towards the liver, hmmm!

Now, as far as the bulb, If there are copious secretions from a c/birth baby, I find that placing baby on the side, allowing fluid to collect in the cheek pocket and then gently suctioning the cheek pocket, avoiding the back of the tongue. As far as delee, I only do this if the infant is having a lot of difficulty clearing the upper airway and even then usually only pass down one side and not all the way to the stomach. That leaves one nare not all congested from suctioning and doesn't empty the stomach unnecessarily. I have seen many providers roughly bulb suction the hypopharynx of babies and this can cause delay in breastfeeding.
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#102 of 109 Old 09-08-2007, 02:11 PM
 
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Quote:
Originally Posted by rowantreeinak View Post
She was only out for 10 seconds before they said 'she's not breathing' and stole her away from be to put her of the baby exam table. They rubbed her and she cried immediately, but they said she had the infected water in her lungs so they deep suctioned her 4 times. I was barely aware of what was going on and couldn't get any words out to stop it. Her Apgars were 8 and 9 for color.

Several weeks later I asked the hospital midwife why she had done it that way instead of respecting our wishes and she said that because of the infection it wasn't standard of care to let her try to breathe while still getting oxygen from her cord. I asked why they had to suction her 4 times, and got the same answer (very defensive I would like to add). "Well it's better than *not* breathing, isn't it" she asked me twice - but my answer that she was, was lost on her.
While I understand the concern about infected fluid being in the lungs, I'm wondering why she thought it would interfere with breathing. Maybe someone else can weigh in on this.

The bolded part makes absolutely no sense. If it looks like a baby should have fluid removed, they should be doing it while the baby is still attached, because obviously any difficulties breathing would be ameliorated by the fact that the baby is still receiving oxygen through the cord. It is just counter to reason to prematurely sever a baby from its most efficient life support system in order to treat it, and logically to do so would in some cases create or exacerbate problems. I assume then that they do it because it's more efficient for the birth attendants. If the situation worsens so that they have to move the baby, well, the baby is already separated from the mother so they don't have to take that extra step. As well, the baby team isn't in the mama team's space, so if the mother is hemorrhaging, for instance, they're not getting in each other's way. Understandable, but the mistake that is made is to assume that it should be routine standard of care, in other words, that the possibility that it will be a real benefit (not just a convenience) to not have the baby and mother in the same space, always outweighs any other considerations.
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#103 of 109 Old 09-11-2007, 07:10 PM
 
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The other thread going on recently about this: http://www.mothering.com/discussions...d.php?t=742856
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#104 of 109 Old 10-08-2007, 03:20 PM
 
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My midwife at our consultation meeting said that she has to suction babies that are born in a water birth more than babies not born in water.

Will the baby have problems if not suctioned when born in water? Or would it be fine just like in a regular birth as you all have been saying in this thread?
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#105 of 109 Old 10-08-2007, 04:17 PM - Thread Starter
 
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Originally Posted by hippiekaren View Post
My midwife at our consultation meeting said that she has to suction babies that are born in a water birth more than babies not born in water.

Will the baby have problems if not suctioned when born in water? Or would it be fine just like in a regular birth as you all have been saying in this thread?
This is a common misconception. Water born babies do not have to be suctioned - what are we suctioning? Goop in the mouth? Again, it's not necessary and potentially harmful. We overestimate the benefit of things like this simply because we hear babies that are 'gurgly' or 'wet'. Once babies continue to breathe and open their lungs and nurse things clear up. Midwives need to learn to just trust the process and sit on their hands. It all is a perfect design!

If you need to discuss this more with her and she still carries this belief, please have her contact Barbara Harper at Waterbirth Intl.

All hands should be off that baby unless it needs resusciation for at least the first 15 minutes to a half hour - including the routine of putting on hats and towels. Nobody touches that baby but the mom/dad!
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#106 of 109 Old 10-08-2007, 07:51 PM
 
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Because it keeps them busy. Because it's something they can control. Probably because some babies who have snot/fluid in their head/gut gag on it. So they treat them all. KInd of like they treat all babies for chlamydia and gonnorhea (I know I prob. spelled that wrong) even though a tiny population are actually affected by it. Because they can.
That´s exactly why. Ugh. Seriously I have plenty of things to do to ¨keep me busy¨ than jam things down babies throats that don´t need it, just to piss parents off and exert my ¨control¨ over them.

When I attend deliveries as the nurse for the baby, I personally do not suction unless the baby needs it. And I define ¨need¨ by the baby actively spitting up huge gobs of stuff...gagging on it, turning blue...obviously blocking the air way. When this happens I turn the baby on its side and gently use the bulb syringe or the Delee to gently suction the oral cavity. I don´t cause the baby to gag and I have never had to go all the way down.

I have had to suction endotracheally on a baby that aspirtated meconium, but the baby NEEDED it. The baby was blue, limp and NOT breathing.

This is me personally...I do still see a few nurses and old school doctors that still deep suction. I know the new NRP guidelines do not recommend routine deep suctioning. For wet sounding babies I find that some gentle CPT helps break up secretions. And really sounding wet shortly after birth really isn´t a big deal...itś normal, the baby was swimming around in fluid for 9 months.
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#107 of 109 Old 10-08-2007, 10:04 PM
 
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I come from the training that believes bulb syringes are useless-that if you have to suction, it makes the must sense to use the delee. Not to mention most bulb syringes are sterilized with that awful carcinogenic stuff.
Funny story: I was at a birth where the granny to be was an ob nurse. This was a primip, had a beautiful, fast labor with a hard, long 2nd stage requiring lots of position changing for a nuchal hand. We break the water to see if that will help the baby come faster- and there is mec. Not much at all. So, the Granny is holding the mama on the birth stool, the baby finally comes out. he's a little stunned, but fine and the Granny FREAKS out, BEGS for this bulb syringe (which is always on the tray to be PC)and goes to town on this baby! Oh it was horrible and shocking and funny all at once!
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#108 of 109 Old 10-25-2007, 02:19 AM
 
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For the midwives who do not suction: I would hope that you discuss this with your clients before the birth, and warn them that there may be some or a lot of gagging, choking, crying at first. My midwife did not use the bulb suction, and my baby cried a lot after birth. We were worried there was something wrong, and after a few hours of crying right after birth, I began to feel distant and resentful of my baby. The crying was a result of mucous.
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#109 of 109 Old 10-25-2007, 04:43 PM
 
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Originally Posted by janellesmommy View Post
For the midwives who do not suction: I would hope that you discuss this with your clients before the birth, and warn them that there may be some or a lot of gagging, choking, crying at first. My midwife did not use the bulb suction, and my baby cried a lot after birth. We were worried there was something wrong, and after a few hours of crying right after birth, I began to feel distant and resentful of my baby. The crying was a result of mucous.
Yes, we let them know what is normal and what isn't normal regrading breathing. And that sneezing the goopies out is good, etc.

Lying the baby across your lap with the head slightly down for a couple of minutes will help stuff drain.
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