1.30.2010

Immediate Breathing At Birth


Jenna, this one is for you.

I was recently at a birth where baby didn't pink up and start yollering right away. Now, someone who has been at a great number of births can start to tell when it is normal flaccidity that will ebb with a little attention and patience and when baby needs a little help starting up.

But, one of the main concerns I have is how this is managed at the hospital...
This babe was quite shell shocked from a rather severe case of shoulder dystocia and a little tired from the hard work he and mama had done. He was born with no tone, bad color, and no breathing. He was one of those babies that needed a little help. Doc gave him 40 seconds to become responsive and, with vigorous rubbing, sole thumping, and mama and daddy calling him earth bound, pronounced him 'needing more work' and clamped and cut the cord, whisked him away to a nearby table, and continued what they were already doing previously on mama's tummy.

Only now, his oxygen line was gone.

In this study, it is shown, in part, how the presence of oxygen, as well as decreased blood flow in the umbilical cord, help to stimulate a babies first breathe. The downside is, if you are worried about baby showing stimulated response, independent breathing, and coming 'earth side', WHY THE HECK WOULD YOU CUT OFF THEIR ONLY SOURCE OF OXYGEN in hopes that they will start respiration? It is exasperating an already possibly problematic situation.

They rubbed him down... coulda continued to do that while he was still attached. They thumped his heels... coulda continued doing that while he was still attached. They ran the oxygen under his nose... coulda done that while he was still attached.

As it was, he took his first breath, independently, about a minute and 45 seconds after he was born... 45 seconds after he was deprived of his oxygen source. seconds from being intubated. They were literally prepping the line to intubate him when he took his first shaky breath. He began crying lustily and everyone cheered, me included... but they could have avoided that emergently necessary first breath by leaving him attached. The placenta detached 30 minutes later.

I have seen homebirths where baby was born equally shell shocked and the midwife was equally diligent at getting babies first breath initiated... while leaving the cord intact. The difference is that one babe will have to be 'bagged' when the placenta detaches or umbilical cord stops pulsing (generally within 2-5 minutes) vs. baby having to be bagged within 1-2 minutes postpartum. Giving baby that extra cushion can be the difference between an 'emergency' and the emergent first breath.

Most homebirth midwives carry oxygen, the same as hospitals, but usually let nature, and baby, determine when they need to intervene, not before, which reduces risk by default.

.. sigh, I was planning on posting the birthstory of Tres this evening, but this is what you got instead. I have it written down on pen and paper (I know, what is that) and promise to get it up by week ending. I know Mama M and Daddy M are getting anxious to see it, and the pictures - BREATHTAKING (no pun intended).

1 comment:

Spot On Your Pants said...

This just gave me the chills. I can't imagine. Poor guy, but it is comforting to read about the back-up plan.

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