Neonatal Resuscitation

7 12 2011

One of the biggest fears when talking about UC (unassisted childbirth) is how to respond to emergency scenarios. A common fear is that the baby will not be breathing or responsive at birth. I believe that having some idea of what you would do in a crisis is extremely important. Not only is it a life saver in the rare event that you face danger, but it’s invaluable for instilling the confidence and peace of mind needed for a truly relaxing birth for you and baby. After all, panic will help no one, even if you are presented with a challenge. Be prepared!

So, here are a few things to remember on the topic of neonatal resuscitation. This is not to be construed as medical advice; please research all subjects independently before making any decisions with regard to the health of you and your baby.

  • Babies are instinctively stimulated by mother. You can read more about how mothers tend to do this to illicit a response here in Emergency Childbirth: A Manual, by Gregory J. White. Lisa Barrett (midwife) also remarks, “Rubbing a baby and gently blowing and talking is usually enough to ensure the baby opens her eyes to look and take a breath. There is usually no rush as with a cord pulsing the baby is normally getting plenty of oxygenation and will come into herself pretty soon.”   Keeping the baby warm and stimulating it are usually more than enough to achieve positive results.
  • There can be a delay in crying, pinking up, or drawing first breath– don’t panic! The two previously quoted sources also support this and provide elaboration.
  • Aggressive tactics for administering oxygen are no longer generally recommended, and are often not even used amongst the medical community/rescue services. The Lisa Barrett link as well as the Emergency Childbirth text will discuss this more, including how utilizing pure O2 has not been proven better for neonate resuscitation compared with blowing shallow breaths for the infant (this too can be instinctive). In fact, these days, using oxygen on a newborn is considered to do more harm than good and so is foregone in favor of the gentler revival techniques. The International Association for Maternal and Neonatal Health (IAMANEH) also state that an oxygen tank is NOT essential for neonatal resuscitation, that the mask and bag are more appropriate (which is equivalent to shallow mouth-mouth), and even warn against routine suctioning of mouth and nose of infants after delivery.
  • Take action first, dial for help afterward. In an infant CPR video, EMT and Captain Nathan McConnell warns that if your baby needs help, your time is best spent attempting to stimulate and resuscitate. He recommends giving at least 2 minutes of care before stopping to call 911. Precious time could be wasted if you choose to dial emergency services first. By the time they respond and arrive, it could be too late, and since every second counts, immediate attention is key. Since life saving resuscitation techniques tend to be the same both at home and in the hospital, knowing how pros handle it will be critical to making sure you’ve done just as they would, and that you’ve done all that you can do.
  •  IAMANEH details the appropriate steps to neonatal resuscitation and speak on it very practically. Basically the steps (see all the links and sources) involve stimulation of the infant, clearing the airways, breathing for the infant, gentle chest compressions, and repeating.
  • Signs the resuscitation was successful include pinking of the tongue (lips alone are not indicative), overall raised APGAR scores, good pulse and good breathing. Resuscitation efforts can go on for up to 10 minutes or more, and 10-20 minutes is usually the period where further attempts would prove futile.
  • Finally, understand that the majority of the time, everything is just fine. The odds of you having to do any of this are slim. Knowledge of neonatal resuscitation techniques can be there for you just in case. You need to learn them, know them, get familiar and comfortable with them, keep cheat sheets, and then put it out of your mind. Don’t dwell on a negative potential… focus your attention on the actual reality and remain calm and optimistic. You have every reason to believe that birth will go smoothly, so don’t worry yourself sick (it only distresses the baby and increases the chances for dilemmas).

Nothing beats taking a class. If you’re like me, you have taken a class several years back and even been certified, but keeping current could be beneficial for both increasing your confidence as well as hearing the updated recommendations (as these change from time to time). Hear what the pros have to say, and if possible, get certified. If you’re unsure of your ability to react quickly in an emergency, do drills. Include everyone you think will be present at the birth. Think of all possible scenarios and outcomes. Have Plans A, B, and C.

Like I usually say– even if you don’t plan on having a UC, being as prepared as you would need to be to have one is such a good idea, because you never know where you’ll find yourself and what will happen. Accidental UC’s happen all the time, and mothers who weren’t expecting it and were not prepared experience worse outcomes than intentional UCs that were thought out in advance. When it comes to birth and nerves, education is key. Never hesitate to transfer to a hospital if you suspect something is amiss with your neonate and they do not appear to be thriving. It’s always better safe than sorry.


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5 responses

8 12 2011
Vanessa

Thanks for this!

8 12 2011
Olivia ♡

The only complaint I have is about this paragraph:

“He recommends giving at least 2 minutes of care before stopping to call 911. Precious time could be wasted if you choose to dial emergency services first. By the time they respond and arrive, it could be too late, and since every second counts, immediate attention is key. Since life saving resuscitation techniques tend to be the same both at home and in the hospital, knowing how pros handle it will be critical to making sure you’ve done just as they would, and that you’ve done all that you can do.”

Unless you are completely alone or in an emergency situation, you generally have someone there already (like your husband/partner, for example). That person can call 911 and you can start the emergency resuscitation or vice versa. If you wait 2 minutes and then the ambulance/paramedics take, say, 10 minutes to get there, that’s 12 minutes or more that your baby may be without oxygen, which can easily be catastrophic in terms of brain damage and/or loss of life.

Also, Lisa Barrett isn’t a midwife anymore, she gave up her license (or let it lapse, whichever) in January and instead is a “doula” (according to her). And of course we all know about the recent legal troubles she is having, so she may not be the best source.

8 12 2011
♥♂►Elizabeth, ISOTP Birth◄♀♥

Thank you Olivia. I agree with your first points.

In regards to Lisa Barrett, that whole situation is so political. She isn’t not a “midwife” for lack of skill. If she isn’t using that label, it’s entirely legally-based. If she’s not a midwife, Amy isn’t a doctor.

8 12 2011
Snorkle

Unfortunately, Lisa Barrett (midwife) has killed several babies in the last 4 years. She has presided over at least 2 deaths this year. It doesn’t look like her neonatal resus technique works.

8 12 2011
♥♂►Elizabeth, ISOTP Birth◄♀♥

Logic fail– she didn’t KILL anyone. She took cases others wouldn’t, that were labeled higher risk. She did it because she believed a mother should have a say in where and with whom she gives birth. She did it knowing her odds of seeing something tragic were higher, because she was more interested in being WITH woman than in being just like everybody else.

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