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.

Why One Midwife Doesn’t Want You to Learn Neonatal Resuscitation Skills

7 12 2011

My article on Neonatal Resuscitation was removed from The Birthing Site because one midwife took issue.

Her argument is that laypeople cannot learn neonatal resuscitation.

Cannot, or should not?

I knew when I discussed with TBS about potentially writing for this subject that this particular topic was touchy. I asked them first. I let them know my intentions. I knew I was too much for people, not for everyone’s palate, and I knew that there could even be some concerns about liability surrounding this. Yet, I was enthusiastically received, published, and was praised both by them and other sites and members for writing a great article. People said it was helpful. It only took one professional to say “Nuh uh uh!” to have the information hurriedly snatched back, amidst apologies and thanks for their expert valid opinion.

Well, I’m not sorry. I did nothing wrong. I won’t apologize for writing it, and I won’t keep it from you. I will publish it again here. Look for the follow up to this piece.

Things in life sometimes ARE complicated. Our digestive system is complicated, yet we eat every day. Our nervous system is intricate, yet most of us move daily. Most things in life are a paradox, both simple and complex. Birth is one of those things. Neonatal resuscitation can be one of those things. There are probably 1 million and 1 things to know and learn about it, yet birth and resuscitation happens every day all over the world and largely without fuss. We need to find the balance between the intricate and the simple. The confidence to flow with the simplicity of nature, and appreciation for the complexity — we re-educate ourselves in an effort to regain the confidence stolen from us by the established businesses who hold authority over our heads. With it, they control our very life and death. I don’t know about you, but I’d like a little knowledge and a little say in that.

You can’t censor information. You can’t burn books, even if you’re afraid of what the commoners might think they’ve learned from it all. People in authority think information is dangerous. That’s the story of humanity. Choices and freedom are still for us to have. No one can “let” you do anything. You have the right to birth your way, and you have the right to read my article. What you do with that will always be your final choice. You are in control.

The facts are this:  Most mothers who feel the need to stimulate a response from baby achieve this naturally and with ease, unless someone has given them fears to hold, fears that they won’t know what to do, that they aren’t good enough to handle it on their own. That panic leads to death. Not being calm, irrational hesitation on your part leads to death. Not knowing when to call for outside help leads to death. Letting their fears contaminate your mental space is a graver danger than birthing without assistance.

Take back your power, think for yourself, and live.

I was the "liker" there, btw.

Now she's talking about breathing tubes? These are not a normal aspect of neonatal resuscitation. This woman is a midwife. I was not aware that midwives were trained and skilled with intubation. It is not recommended that people utllize intubation who are not skilled at doing it very regularly, since it can injure the throat (especially so for a neonate!). She is not making a case against UC, she is making a case against home birth.

I’ve read Samantha’s comments again and had this to add:  so much of what she is saying to do to stimulate the newborn is exactly what I am talking about (for example, rubbing). She and I are on the same page there. I am not sure how her info there is better or contrary to mine… it’s not. It’s in harmony with mine.

It terms of some things I found insulting… looks like a copy paste job? No, I wrote it all. I wrote it myself. That’s pretty inflammatory. That sounds accusatory. These are MY words. Never held a life in my hands? What on earth does that mean? I’ve been responsible for three newborn lives in my lifetime, the last of which was MY own UC. Of course I’ve held the life of a newborn in my hands! I would argue that every mother has.

So, I stand by my work, my good intentions, etc. Samantha having “UCers best interests at heart”? She is discouraging learning more. I am advocating it. She sympathizes with UCers. I am one. She’s a midwife who believes she is necessary. I believe you can DIY. I don’t think having their best interests at heart quite fits.


And this, my dears, is how one single person with a title after their name can silence others using fear.