Semester 2, Week 1: I'm Back!

Miss me?

Second semester started on Monday and I'm back in the groove. This semester, we're studying pregnancy, birth, newborn, and pediatrics. This is "my" semester! This week we studied the newborn. Newborns are fascinating and adorable and helpless and cute and fussy and difficult and sweet and smell good. To a parent, they will change your life forever.

The newborn period lasts from birth through day 28. At birth, the newborn experiences multiple changes and adjustments, especially as they take their first breath. Every time the mother's uterus contracts, the baby goes into a slight state of hypoxia and hypercarbia (low oxygen and high carbon dioxide). This triggers the medulla in the brain that the person needs to breathe. Because the baby's in the womb still, he/she is unable to take a breath just yet so needs to hang tight for a few more minutes (or hours or days). If the baby is born vaginally, his/her lungs get compressed and the amniotic fluid gets squeezed out of the lungs. This negative pressure should cause the lungs to fill with air once the baby is born. Also, during the last few weeks of pregnancy, the baby creates surfactant, which is a lot like dish detergent, which keeps the lungs from collapsing. (Preemies don't usually have surfactant which is one of the reasons they have so many respiratory problems...Imagine your lungs collapsing every time you take a breath...)

Also, immediately after birth, the umbilical cord senses the cooler air (normally the delivery room is cooler than inside the mom) and a substance called Warton's jelly starts compressing and closing off the two arteries and one vein in the cord. Until this happens (or the placenta detaches from the mother), the umbilical cord keeps pulsing. In the old days, doctors automatically cut the cord immediately after birth for no apparent reason. However, research is starting to show that it's beneficial to the baby to let the umbilical cord finish pulsing before cutting the cord. This can be anywhere from a few seconds to a few minutes.

This is a very striking photo taken a few months ago of twins born a few minutes apart. Baby on the left was born first and had his cord cut immediately. Baby on the right was born next and got to have his cord finish pulsing before being cut. Do you see the difference?

By delaying the cord cutting, the baby receives its full blood volume (otherwise, baby practically goes into hypovolemic shock because it's missing so much of its blood). This gives the baby good hemoglobin levels for the next six months as well as other positive benefits. Otherwise, the baby is anemic, which is not the way one want to start out their life. Frequently in hospitals, the cord is automatically clamped and cut immediately due to doctor's preference and habit.

It absolutely drives me nuts when a doctor says, "Oh, but there's no evidence that delaying cord clamping benefits the baby at all." Excuse me?! 

This article explains the benefits really well: 

http://debrapascalibonaro.com/infant-rights-birth-ibu-robin-lim/

Ok, I'm done with that rant. Just remember, for a normal birth, let the baby's cord finish pulsing before cutting it!

I also wanted to quickly go over the APGAR score. When a baby's born, at one and five minutes after birth, the midwife or doctor assigns the baby a number between 0-10. Zero means the baby is probably dead. Ten means the baby is perfectly healthy and responding well to extrauterine life. Any score less than seven means the baby is in distress and neonatal resuscitation usually needs to be started.

When I worked in the Philippines, most babies received a one minute score of 8 or 9 (take a point off for color and possibly grimace) and by five minutes they were all at 9 or 10 (possibly take one off for color again).

An easy way I was taught to quickly remember the APGAR score is by turning the word APGAR into an acronym. A stands for Appearance (color), P stands for pulse (heartbeat), G stands for grimace, A stands for Activity, and R stands for respirations.

For Appearance, is the baby completely pink? If so, give him two points. Are his extremities still a little white/blue? If so, give him one point. Is he completely white/blue? Give him zero points.

This baby has a pink body but blue hands and feet so he'd only get one point.

The next assessment is pulse. If the heart is beating more than 100 bpm (beats per minute), the baby gets a 2. If the heart is beating less than 100 bpm, baby gets a 1. No heart beat gets a 0. If the baby is crying and responding well to birth, their heart rate is normally perfectly fine and baby scores a 2.

Next is grimace. If you suctioned the baby or messed with him, did he cry and pitch a fit when you suctioned him or did he just grimace or did he remain limp? Crying and gagging and fighting scores a 2. Just grimacing scores a 1 and no response scores a 0.

Next up is activity. To score a 2, the baby has good muscle tone and keeps his/her extremities flexed and close to his/her body and moves actively. A score of 1 means the baby only partly flexes its extremities and isn't really moving. A score of 0 means the baby is completely limp. I've seen a baby with an activity score of 0 and it's pretty scary. The baby is completely limp. The midwife almost dropped him because he was hard to hold. However, he perked up and ended up being just fine.

The last one is respirations. Is baby breathing fine (i.e. screaming with no problem)? That's a 2. Is baby gasping and having problems screaming? That's a 1. Is baby making no breathing attempts at all? That's a 0.

this picture has nothing to do with any of what we just talked about, but it made me laugh so that's why I posted it. :-D

Anyway, the midwife (or doctor) quickly assesses the baby and determines the score at 1 and 5 minutes. If the baby needs resuscitation, that's started almost immediately. And that's all for today, folks! Next week is pregnancy care. (And I'm ridiculously happy about that)

...Until next week!