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

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#1 of 109 Old 08-24-2007, 09:36 PM - Thread Starter
 
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Or just my "get rid of bulb syringes" evangelism??

Here's my entry from my blog.

What I'm most amazed by is not that hospital-based providers still do this routinely (oy and when you see how vigorously they suction babies after cesareans, you will understand why it gets my goat so bad), but that homebirth midwives and many UCers are doing this, too.

The idea that the bulb syringe is a necessary part of birth is one that is antiquated and must go.

Removing fluid from a baby's mouth is an odd gesture - so they swallow it. Then what? Is that a true risk?? In fact, most of the time when babies are suctioned with bulb syringes, VERY LITTLE to NOTHING is removed. The risk of damage to the nasal passages is high, suctioning deep into the mouth of a newborn can trigger a vagal response, thereby causing low heart tones (and viola! a baby that "needs" help!). Another risk is oral aversion - making initial breastfeeding difficult.

A recent hospital birth I heard about had a nurse that removed "lots" of fluid from a baby's stomach. I'm sorry, but can you tell me why fluid in a baby's stomach can cause problems? Isn't breastmilk and colostrum fluid? I'm not talking fluid in the lungs - I'm talking about when they use a wall-mounted suction catheter and stick it all the way down a baby's throat.

I have never used a bulb syringe...but it took YEARS before I finally took it out of my bag. I think I kept it in there just for "show" - like it's somehow a "staple" of birth supplies.

I remember when I worked at a birth supply house, we'd even get calls from dog and cat breeders wanting deLee suction devices so they can suction newborn animals at birth. Isn't the mother supposed to help with her babies' transition?

We've gotten so far from what is a normal physiological transition for babies. We've introduced them right away to an assault that I find unnecessary and potentially harmful.

Even the so-called evidence for suctioning for meconium does not convince me at all. There is better research coming out to show that it is not helpful. I can only think of one reason why I'd suction a baby: if I was having issues getting an airway for resuscitation. I wouldn't use a bulb syringe, though, I'd use a deLee. I've had the same deLee in my kit for six years!

Why then are we still ok with people doing it?
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#2 of 109 Old 08-24-2007, 09:53 PM
 
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My daughter wasn't suctioned at her home birth, I am sure some midwives would have done it as she wasn't crying or anything. I guess I was lucky, with the next baby I'll make sure to talk about it beforehand if I live somewhere else.

I've only seen it on TV, makes me shudder.
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#3 of 109 Old 08-24-2007, 10:42 PM
 
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My first daughter was a hospital birth and of course they did suction her (it is such an unnecessary routine procedure as with most of the stuff hospitals do) and my second was a home birth, she was not suctioned.

It also makes me shutter to see or think about the babies that get it done.

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#4 of 109 Old 08-24-2007, 10:51 PM
 
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I feel so bad for my poor little ds who was suctioned in the hospital (and all the other ridiculous routine procedures they did to him).

dd was a surprise UC on my bathroom floor. Whenever I tell people the story the 2 most common questions are 1) Oh my gosh! Did you have a suction thing right there? She's ok even though she didn't get suctioned?!? and 2) how did you cut the cord? What do you mean you didn't cut it? Isn't that dangerous?

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#5 of 109 Old 08-24-2007, 10:54 PM
 
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Same here, ds1 got the whole shebang, poor kid:
Ds2 didn't get suctioned per my wish and was fine. Suctioning doesn't get all the fluid out anyways, usually a newborn needs to sneeze and cough a few good times during the first few days.
Are nurses and OBs really THAT bored that they have to come up with all that crap to tease babies and moms with?
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#6 of 109 Old 08-25-2007, 01:46 AM
 
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I dunno that we are OK with it. I think it's "standard procedure", and we just don't tend to question it. As for why it still gets done, I think Robbie Davis-Floyd's analysis tends to be right on (it's part of communicating that the baby is a product of the technocracy, not that it is a perfect biological being). Why midwives do it - it's hard to justify doing nothing. It's the hardest thing about being a homebirth midwife in this technologically obsessed, OBGYN-centric culture. Why UCers - probably same thing. The midwives are doing it, and UCing is about being your own midwife, have to prove you can do everything midwives do... :-/ From what I've seen, though, here at MDC, it does seem to be the exception rather than the rule for UCers.



This seems related in my mind - I've been realizing I don't remember Naked Baby's first breath. I was too focussed on his thereness to pay attention to little things like that. He had no reason to cry, and no one was hovering (and hoovering!), chanting about his breathing, so it just... happened. But I know this only by deduction, 'cause he's surely breathing now.
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#7 of 109 Old 08-25-2007, 05:10 AM
 
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Hear, hear!

Quote:
A recent hospital birth I heard about had a nurse that removed "lots" of fluid from a baby's stomach. I'm sorry, but can you tell me why fluid in a baby's stomach can cause problems? Isn't breastmilk and colostrum fluid? I'm not talking fluid in the lungs - I'm talking about when they use a wall-mounted suction catheter and stick it all the way down a baby's throat.
My second baby had a large amount of amniotic fluid in her stomach, and began vomiting it back up about 12-18 hours after she was born. I was told that it (a) should have been caught (how I'm not sure, but I was transferred to the peds ward shortly after her birth b/c postpartum was overflowing) and (b) they would have put a tube down her throat to drain it and (c) that this possibly contributed to her early reluctance to breastfeed as her stomach was full and possibly upset. I'm not sure what exact conclusion I've come to here. . . I just know what I was told by the nurses at the hospital.

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#8 of 109 Old 08-25-2007, 05:24 AM
 
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The theory is that the inflated stomach is interfering with the full expansion of the lungs, leading to trouble oxygenating (seen as grunting, retractions, central cyanosis).
I do know a midwife that says that babies have trouble digesting blood, so she will suction if the baby is spitting up lots of blood.

It really bothers me to see hospital nurses jamming that bulb in there. They could slow down a little, treat the baby like a human being a little.
I think it would be very tramatic to me to have someone jam a bulb syringe into my mouth like that, and I'm an adult with a much bigger mouth and face.

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#9 of 109 Old 08-25-2007, 05:44 AM
 
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Great post.

None of mine have been suctioned- it isn't done routinely over here, and my midwives always laugh when they see it on my birth plan and tell me they'll get me some more modern midwifery texts DD was a slow starter though, and took some time to uncurl out into the world, wake up, breathe, open her eyes and see what was going on. That's just who she is- her birth, like every other aspect of her, has happened in her way, in her time and she balances her independence very carefully and cautiously.
DS2 was screaming with the birth of his shoulders, and DS1 took his first breath as we lifted the caul away. That's one of the memories that does stick

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#10 of 109 Old 08-25-2007, 02:42 PM
 
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Does anyone have any links to studies that show the effects of routine suctioning?

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#11 of 109 Old 08-25-2007, 03:06 PM
 
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so I am not for routine suctioning at birth and haven't done it for years but- I prefer a bulb syringe to a deelee-- and there are some studies that show that a bulb syringe gets as much out as a deelee-- so I don't know why the deeper suctioning devices are important at all- they are more likely to trigger a vagal response- that is where I am going with this-- normal babies even babies that sound a little juicy- if they are breathing and coughing and sneezing and sputtering- they are clearing their own airways much softer and healthier than I can do it--
and if a baby will nurse- even better because nursing clears airways as well and the viscosity of the colostrum dries out the lungs too--
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#12 of 109 Old 08-25-2007, 03:35 PM
 
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I'm going to make this short as it's off-topic, but don't really feel like I can just ignore it -
Quote:
Originally Posted by Arwyn View Post
UCing is about being your own midwife, have to prove you can do everything midwives do...
Just have to express my strong disagreement with that statement. Maybe for some, although really, I haven't seen this attitude much among UCers. There's no way I would have done any suctioning on my UC baby if she'd been born at home. (At the hospital, she got a tiny bit of totally needless suctioning.) Somehow I just can't imagine reaching for a bulb syringe I didn't even have.
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#13 of 109 Old 08-25-2007, 06:41 PM - Thread Starter
 
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Quote:
Originally Posted by Romana9+2 View Post
I'm going to make this short as it's off-topic, but don't really feel like I can just ignore it -

Just have to express my strong disagreement with that statement. Maybe for some, although really, I haven't seen this attitude much among UCers. There's no way I would have done any suctioning on my UC baby if she'd been born at home. (At the hospital, she got a tiny bit of totally needless suctioning.) Somehow I just can't imagine reaching for a bulb syringe I didn't even have.
well, it may not be true for all, but I have to admit seeing/hearing UC mamas measuring their fundus, dipping their urine, and even suctioning babies - all of which are not evidence-based. the issue is, like with midwives, there are certain rituals we have adopted from obstetrics and there are certain rituals UCers have adopted from midwives. None of that makes any of us right or wrong - it's just a product of trying to make it "friendlier" or "woman centered" when we're still not using evidence-based practices.

seems to me within the midwifery community until there is a study to show it is harmful, midwives will continue to do these rituals and practices because "it's what we've always done".
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#14 of 109 Old 08-25-2007, 07:08 PM
 
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What do you do if a baby is really wet sounding and choking on amniotic fluid? Or has a mouthful of mec?

*These are legitimate questions, I don't disagree with your basic premise that most babies don't need suctioning.*
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#15 of 109 Old 08-25-2007, 07:49 PM - Thread Starter
 
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Let the baby drain - and nursing, by far, is the best thing for "wet sounding" babies. By rolling a baby over on its side, any "choking" it is doing - which is usually just bringing up fluid/mucus, not really choking - can be resolved pretty quickly.

Suctioning won't help wet sounding babies.

A mouthful of meconium? They usually drain it out. But, even with heavy meconium births, I have yet to see a "mouthful of meconium".
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#16 of 109 Old 08-25-2007, 07:55 PM
 
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Something I've never really thought much about until now -

When ds was born, I was in a very strange position - standing up in the water in the fishy pool, leaning forward, my hands on the side of the fishy pool. His head was born - he was anterior - and he just sat there for a bit (crying and kicking at the same time - very very weird feeling ) - so while I waited on another contraction, eventually my mw said something about suctioning him "lightly" because he was face up and something else I honestly can't remember. I'll have to ask someone else who was there. Anyway... since he was already crying and such, doesn't that indicate the suctioning wasn't necessary, even in a paradigm where suctioning is sometimes necessary?

I'll have to think more about this.

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and Brigid Eleanor (11/20/08)
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#17 of 109 Old 08-25-2007, 10:05 PM
 
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Quote:
Originally Posted by 2Bugs View Post
Hear, hear!



My second baby had a large amount of amniotic fluid in her stomach, and began vomiting it back up about 12-18 hours after she was born. I was told that it (a) should have been caught (how I'm not sure, but I was transferred to the peds ward shortly after her birth b/c postpartum was overflowing) and (b) they would have put a tube down her throat to drain it and (c) that this possibly contributed to her early reluctance to breastfeed as her stomach was full and possibly upset. I'm not sure what exact conclusion I've come to here. . . I just know what I was told by the nurses at the hospital.

Jen
Hmm, interesting. My baby was born at the Farm, and I actually can't remember if any suctioning was done or not. I know I would remember it if it had been any more than just a tiny bit, or if it had been rough at all, because I would have objected to that. But about 18 hours after he was born, he had a great big vomit of fluid. (Maybe because he was breech he didn't get the "baby Heimlich" when coming out?)

I never gave it much thought, because he was fine right afterwards. I know it didn't give him any problem with breastfeeding - he always knew exactly what to do. My first thought, though, would be that having fluid in his stomach might help keep him from getting dehydrated while he was waiting for the milk to come in?

nak
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#18 of 109 Old 08-25-2007, 10:25 PM
 
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Not part of my MW's SOP, she said it has been years since she suctioned a baby. None of my girls were suctioned.

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#19 of 109 Old 08-25-2007, 10:50 PM
 
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Great thread.

I've been thinking about this topic a lot lately as I recently heard someone at the LLLI conference talking about it...I never thought about it before hand, I just assumed : that it was something always done in some way - like the reeds talked about in Red Tent for instance.

Now in the process of writing up my birth plans, and this is probably going to be in it.

DS was gently suctioned (thankfully by a non-aggresive mw), but he did have some trouble in the first 24 with gagging, almost like he was trying to get something up, but couldn't. A RN did have to suction him a bit more to remove whatever was stuck in him...and a bunch of fluid - almost mucus-y like did come up.
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#20 of 109 Old 08-25-2007, 11:28 PM
 
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Both of mine were suctioned. This next one won't be. I've been thinking about it and actually, Pam, your thread comes at a good time for me. I'd been meaning to post a thread asking WHY. It just doesn't seem like a good thing. It's rough and imo unnecessary. I'd like for my kids to have a gentle birth and beginning. Jamming some plastic in their throats doesn't seem all that conducive to a gentle beginning.

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#21 of 109 Old 08-26-2007, 01:50 AM
 
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my dd had a tube inserted down her nose to suction her stomach. i had the same thing done after a major car accident to check for internal bleeding...so it really bothered me to see them do it to her, i could feel it going down my own throat. yuck. :

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#22 of 109 Old 08-26-2007, 05:54 AM
 
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Someone asked about studies. I'm copying and pasting a response I put up on another thread. HTH. BTW--if you go to the PubMed studies, they'll usually have links to related studies as well.

Quote:
I just attended a conference (the LLLI conference mentioned above) where Linda Smith, IBCLC spoke. She said that routine suctioning of newborns at birth is not necessary unless there are actual respiratory problems. In her opinion, the baby tongue-thrusting at the aspiration device might create a "muscle memory" that can cause breastfeeding issues later. Some studies she cited:

-Vain et al, Lancet 2004; 364 (9434): 597-602
-Anand, Runeson, Jacobson, J Pediatr 2004; 144: 449-54

And a couple more that I found with a routine PubMed search:
Evidence-based practices for the fetal to newborn transition.

Building evidence for practice: a pilot study of newborn bulb suctioning at birth.

Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial.
Edited to add: Oops, the links didn't come with it You can see the original post here for links to those studies.
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#23 of 109 Old 08-26-2007, 08:45 AM
 
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yep babies cough, sputter, sneeze even throw up- what is the heart rate? is the baby breathing? will the baby nurse?
babies that are wet or seem wet are not remedied by suctioning- we are talking expansion of the aveoli and changes in surface tension on that level in the lungs -- not the little bit that is in the upper passages - when you suction you are changing the circulation and can cause swelling/edema --

try using some suction on yourself- see what your response is - holding your breath and shallow breathing - and the bulb syringe is relatively small for you -- the small bulb is about the size of a baby's fist


now I think that a baby that is not breathing - and is in need of resuscitation then yes I suction first then blow--
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#24 of 109 Old 08-26-2007, 10:56 AM
 
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I have a question about the stomach full of fluid thing...
Do we(they) know that a baby having fluid in their stomach at birth is bad? Is there any specific consequences that are citied for tubing and suctioning this out? It's not like it's a foriegn thing to thier digestive tract.

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#25 of 109 Old 08-26-2007, 11:00 AM
 
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After the baby is born my MW likes the baby to lay on his or her tummy for the first few moments to allow any fluid to come out of the mouth naturally. Of course this is immediately after birth just before nursing.
It just makes sense that if you put a baby on their back right away they are going to swallow and possibly choke on fluid but if you hold them a certain way (rounded back) and place them tummy down on Mama the fluid will come out on it's own.

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#26 of 109 Old 08-26-2007, 11:13 AM
 
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I think it's horrifying. It's also one of those things that childbirth instructors and books don't seem to warn you about...that you should be ready to say "NO SUCTIONING!" when your dear little one is born. Thankfully my first mw didn't do it, but I hadn't known to ask for it not to happen. Second was UC and I knew more so of course I didn't think of suctioning.

I do know that at a nearby freestanding birth center (one that has decent transfer stats), they routinely suction babies. It's so strange, unkind and non-evidence-based.
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#27 of 109 Old 08-26-2007, 11:15 AM
 
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Quote:
Originally Posted by kerikadi View Post
After the baby is born my MW likes the baby to lay on his or her tummy for the first few moments to allow any fluid to come out of the mouth naturally. Of course this is immediately after birth just before nursing.
It just makes sense that if you put a baby on their back right away they are going to swallow and possibly choke on fluid but if you hold them a certain way (rounded back) and place them tummy down on Mama the fluid will come out on it's own.

Keri
Apparently there's a parenting school in Russia that advocates this as well. I found out because I was describing my UC to a friend from Russia and how my baby came out onto the bed herself from a low hands and knees position (no one "catching") and then I picked her up and she said her parenting school says that this is natural and helps fluids drain.
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#28 of 109 Old 08-26-2007, 01:24 PM
 
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Quote:
Originally Posted by mwherbs View Post
so I am not for routine suctioning at birth and haven't done it for years but- I prefer a bulb syringe to a deelee-- and there are some studies that show that a bulb syringe gets as much out as a deelee-- so I don't know why the deeper suctioning devices are important at all- they are more likely to trigger a vagal response- that is where I am going with this-- normal babies even babies that sound a little juicy- if they are breathing and coughing and sneezing and sputtering- they are clearing their own airways much softer and healthier than I can do it--
and if a baby will nurse- even better because nursing clears airways as well and the viscosity of the colostrum dries out the lungs too--
Mwherbs, could you expand on this bolded statement a bit? I've never heard this and it intrigues me.
FWIW-I don't suction babies that are crying unless it is apparent they need help clearing thier airway in respiratory distress.
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#29 of 109 Old 08-26-2007, 01:59 PM
 
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human colostrum immunoglobulin A- a mucin-type glycan holds water/fluid-- as well as forming a healthy mucous membrane surfaces

if I were to give you something that acts similar in the herbal world it would be mallow/marshmallow or corn silk- it is a slicker (mucopolysaccaride) and draws fluids to it as well as being anti-inflammatory at the same time-- and that is just the plant activity- not all the other things/goodies colostrum has--
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#30 of 109 Old 08-26-2007, 02:33 PM
 
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Quote:
Originally Posted by lilylove View Post
I have a question about the stomach full of fluid thing...
Do we(they) know that a baby having fluid in their stomach at birth is bad? Is there any specific consequences that are citied for tubing and suctioning this out? It's not like it's a foriegn thing to thier digestive tract.
I have always heard it is to keep them hydrated until milk comes in and that some babies swallow more than others. DS spit up fluid after he was born and didn't nurse for about 12 hours. This seemed completely normal for him. My MW told me I didn't need a bulb syringe for my birth kit that she doesn't suction babies. I have one for colds and such but it was never used on DS.
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