Tuesday, May 20, 2008


A mother cries over her newborn. He is barely 22 hours old. He has been born for less than a day.

Why is she crying?
Is he sick?

No, thankgoodness.

But, what is that in his arm?
It is an IV access. Since birth, her newborn has travelled by wheeled bassinet to the NICU for IV antibiotics every 6-8 hours. He spends about 30 minutes in the NICU while he receives his dose; depending on the nursing staff he might be brought back sooner. He is receiving these antibiotics prophylactically, just in case. His mom was positive for Group BetaStrep and received only one dose of antibiotics before delivery. She came into the hospital in active labor and simply delivered too quickly to receive the second dose. Her membranes were ruptured less than 6 hours total, her baby was full term, but still; according to hospital protocol, she should have received 2 doses of IV antibiotics before delivery to protect her infant from the possibility of infection.

Well, isn't she silly to cry like that!

The hospital is simply making sure that her baby is safe and doesn't get a serious infection that has a particularly high mortality rate!


Well, she isn't crying about that. She is actually very grateful about her infant being born healthy and she is grateful that he is receiving such excellent medical attention, just in case he were to be at risk for infection, even if the incident of GBS infection in her case is actually very rare.

So, why the Tears?

The Neonatologist says that her baby needs some Formula supplementation! She is suddenly feeling very inadequate and insecure. This is her first baby. During her pregnancy she decided that she wished to breastfeed. She hoped to be able to avoid formula, at least in these early days after birth, when his digestive system is most sensitive.

Well, why does the Neonatologist recommend supplementation?

When the baby was in the NICU receiving his antibiotics, the doctor observed the baby sucking on his fists and acting irritable!

Did he assess a breastfeeding session?
Did he assess the infant's weight loss since birth?
Did he assess the infants wet/stool diaper output?


Does this kind of thing happen everyday in hospitals?


The NICU nurse returned the baby to the room with formula in the bassinet. The NICU nurse tells the mother that the doctor has recommended Formula.

Now this new mother is worried, concerned, scared.
Maybe she doesn't have enough milk? Maybe the baby really IS hungry and unsatisfied? Maybe his IV access hurts when she pulls him in close to nurse.

She has a healthy baby.

now this mother's head is full of Worries.
now she holds her baby in to nurse Tentatively.
now her eyes are full of Tears.

Monday, May 5, 2008

Crash C-sections

I taught childbirth classes for about a year at the end of my L&D nursing career. Mostly it was groups of couples interested in doing the best for their baby, as long as that didn't entail any bit of discomfort for mom. They were very trusting of their doctor's recommendations.

Class after class, these friendly, smiling couples would come and go. They were excited, eager, full of anticipation. They chatted about baby names and nursery decor. They compared due dates and ankle swelling and lower back aches. It really was a lot of fun meeting all these couples on the verge of such an amazing life change. Mostly we covered "Childbirth Basics" and we never went into any real depth about maternity care management in the US. Of course, I maintained a very professional decorum as a hospital childbirth instructor. I would never have endorsed homebirth and would never have mentioned that I had ever had one myself.

On occasion, I did get the "oddball" couple interested in natural childbirth. They were usually the ones with the most interesting questions about interventions and they also usually asked about ways to avoid a C-section.

One time we were talking about the rising C-section rate and the concern was raised about "dinner time" Caesareans. A father-to-be asked me, "How do you know, if the doctor is recommending a C-section, that it is truly necessary?"

I answered, "If the doctor is sitting at the bedside chatting with you, then you have time to ask questions and discuss the matter and it is totally optional at that point.

However, if the room has suddenly filled up with people in nursing uniforms and the monitors are being removed and the doctor is pushing the bed out of the room and starting down the hallway, then there is no time to talk, the C-section is necessary!"

We went through the usual "Lamaze" type questions to ask when an OB recommends a C-section. "What are the risks of having the surgery? What are the risks of not having the surgery? What are the risk of waiting thirty minutes to decide? " I left my class attendees with the idea that, as long as the doctor was standing at the bedside, taking time to discuss the matter with you, then the C-section "option" is just that: optional!!

Also, I made it very clear that if the baby or mother is truly in imminent danger, NO ONE stands around and discusses it! A C-section that is decided in haste is the really, truly necessary one!


A story comes to mind.....

A first time mommy-to-be was brought in for induction. She was induced with Pitocin, an IV uterine muscle stimulant. She was having really strong, Pitocin induced contractions that were difficult to tolerate, so she decided on an epidural. The mother's BP drastically and suddenly lowered after she had received epidural anesthesia. We call this "bottoming out" and while it's not common, it's also not really that unusual post epidural. Mostly it is prevented by getting a large amount of IV fluids in immediately preceding the administration of the epidural anesthesia. When this mother's BP "bottomed out" her OB happened to be in the room. The baby's heart rate started dropping also. Standard procedure when this happens post epidural is to open of the main IV line "wide open" to give a large amount of IV fluids super fast to counteract the sudden drop in BP. As the baby's heart rate dropped, the MD rushed over to the mother's IV stand and opened up one of her IV fluids to run in "wide open." It was soon discovered that the MD had opened up the mother's Pitocin IV line full blast, causing her body to have a sudden, amazing overdose of this potent uterine stimulant. The mother was rushed for an immediate Crash C-section.


And you know, there are actually a few C-section stories like this buzzing around in my brain, but its late and me and my baby are going to snuggle in bed.