[rnchrista]

For those of you that do waterbirths, do you just use the regular apgar? or do you do something like this ?http://www.gentlebirth.org/archives/apgarEnning.html
I've also heard it suggested that you do the regular apgar, but at 1 1/2 minutes instead of 1 minute because waterbabies are usually bluer.
Any thoughts?
thanks!

 

[midwifetx]

No, just a regular Apgar. I have noticed that many midwives assign the apgar as soon as the baby is in the mom's arms, and that's a good 55+ seconds before the baby is a minute old. I've noticed slightly lower apgars with waterbirths, but not significant enough to warrent reconsidering when to assign numbers, and I've attended a quite a few waterbirths (150+)

 

[pamamidwife]

I guess for me, when it comes to APGARs, I just notice what is missing - and I do give an allowance for color because of the water. I mostly note tone and respiratory effort since that seems to be the most important.
baby that is not doing well.

Tone is always my main observation when the baby is born. If tone is good - and remains good - then I know I have no need to step in and listen to the heart, lungs, etc.

 

[smeep]

Interesting! I wonder if my midwife used that for my son, he got a 10.

 

[laohaire]

Mine got the regular apgar - 9 and 10. I was happier with the 9, though. It was because she wasn't crying. Maybe she wouldn't have cried at all except I didn't notice the cord was too short, and tried to lift her closer to me/breastfeed, and I pulled on her umbilical cord.

Anyway, she wasn't blue at all, just pale when she came out and very quickly pink.

 

[rnchrista]

Quote:

Originally Posted by pamamidwife Tone is always my main observation when the baby is born. If tone is good - and remains good - then I know I have no need to step in and listen to the heart, lungs, etc.

So, basically, if there arms and legs are drawn up and in, you just leave everything alone, but if they're sprawled out or floppy looking you listen, right?
What about color? If they have central cyanosis, do you get a little agressive then?

 

[pamamidwife]

yeah, if they're tone is good and by one minute they're making respiratory efforts, I leave babe alone. If by one minute they're still not breathing, or if tone is starting to get bad before then after being good, then I suggest the mom talk to the baby and rub him/her a bit. typically, though, most babies really respond to the touching and natural talking moms do.

central cyanosis can be present even up to a minute after the birth - it all depends upon when the baby takes that first breath. because the cord is still somewhat in water (even in mom's arms), there's less of the immediate clamping off that it naturally does when it hits air. I think there's more leeway given to waterborn babies in regards to color than anything else.

hope this helps - and hope I'm explaining it well.

 

[mwherbs]

so what else have i seen - that in hospitals they are far more loose about assigning apgar -- most of the drugged out babies I have seen they still give a 9 to -
yes really wait for 1 minute-
go to some hospital births get a feel for how they assign the numbers- if we are stricter when the stats are collected we look worse because we have lower scores- even if we were in hosptial we would be giving lower numbers to their babies- we are still living with our numbers verses their numbers
apgar use to be more important as part of what you should be doing next like starting some resuscitation efforts- now we have more advanced and immediate assessment that leads to doing resuscitation sooner if need be rather than waiting or deciding to not do anything because the baby has a good heart rate and respiratory efforts.

 

[lorijds]

We always do the APGAR retrospectively, really.

Also, I think of an APGAR as more of a tool for the pediatrician or subsequent care givers. To give them a brief heads up that something wasn't quite right in the beginning--like a babe with a really low one minute, or a moderately low five minute score, or when their initial score was fine, but subsequent ones were lower. Does that make sense?

For the few waterbirths we've had (we dont do them, but occasionally you have an "ooopps"), yeah, those babies seem to take longer to pink up and to cry or vocalize--but their tone and their reflexes are typically as good as a dry lander.

 

[pamamidwife]

I agree with Lori about them being done retrospectively. I'm always like, "umm...what do you think?"

oh, Lori.

 

[mwherbs]

yea we do figure it out when doing the paper work--
although if we have a time keeper in the room we take note at the time- it crosses your mind.

lori also has a good point about usefulness later for the ped- also causes us to watch and see if nursing goes well and if it seems that there could be a blood sugar problem because we did some resuscitation ---

 

[Maggi315]

yeah, I agree with others that I do the Apgar in my head after the fact. Because if there is a problem that would really lower the apgar, I'll be busy dealing with that, listening, whatever.

Before I started homebirths, I would never give an apgar of 10. We just didn't in the hospital, almost always took off for color. But now I happily give out 10's because most of the babies look great.

I guess my waterbirths (and about 1/2 of mine are right now) are bluer, but remember to just wait that minute and not think about color right away. Even if I take off the point, by 5 minutes, they are usually back up.

Blue babies don't bother me, grey and white...now I have a problem...

 

[mwherbs]

Quote:

Originally Posted by Maggi315 Blue babies don't bother me, grey and white...now I have a problem...

yea no love of those colors as either-