Archive | March 2012

Rethinking the medical care provided to Premies

Every time I look at premature babies isolated in incubators, my mind screams out, “Let the mom hold it!!!” For years I wondered if I was the only person who felt that way. I know premies need to be kept warm, away from germs and with little stimulation, but separating them from their moms seems counterproductive.

Then I learnt about the options with cutting the umbilical cord – immediate cutting or letting the blood continue to flow from the placenta to the baby until it stops pulsing by itself. The common medical practice in many places is to cut the cord immediately, especially when baby needs medical help. The irony is that if a baby is not breathing, or is premature and needs medical help, they are more in need of the extra flow of blood, oxygen and nutrients from the placenta, and yet these are the ones who are more often separated from the source of that which can help them.

It was heartwarming to read of the recent story in the National newspaper in New Zealand, of a very tiny premie, who was born in an ambulance before the mom and midwife could reach the hospital. Because they were not in a hospital, they had to resort to basic techniques to help the baby. Two of the things they did was to leave the cord intact to allow blood and oxygen to continue flowing, and put it on its mothers chest. The baby did surprisingly well.

The baby girl was born at 10.50am weighing just 907grams, but she was pink and breathing by herself.

“I was so relieved and impressed that this tiny little thing was fighting so hard to breathe.” While midwife, Ras, was monitoring the baby’s oxygen and caring for her mother, James and Reesink were organising a helicopter with a paediatric team from Whangarei.

Ras, who specialises in natural birth, says: “In an emergency like this, with no immediate hospital back-up, you go back to the basics: all babies need air (oxygen), warmth, food and love. On mother’s chest, close to her heart, connected to the placenta and oxygen near her mouth – this was the best we could offer her for the first hour. We made a little hat of Gladwrap and a Gladwrap blanket over her body so she wouldn’t lose heat or fluids through her very thin skin.

“Babies who are born this early can’t suck or swallow so we could only hope the paediatrician would come soon to put a drip up with glucose and the necessary medication.” The ambulance moved to the Kerikeri Domain to be ready for the emergency helicopter. Every time the mother moved, the baby made little noises like a bird, Ras says.

The temperature in the ambulance was up to about 30 degrees C when the paediatric team, including a doctor and a specialised nurse, arrived by helicopter from Whangarei.

“They were surprised that little Cynthia Jane was still pink and breathing and her blood sugar level was pretty good. It was an amazing team effort with five people in an ambulance on the Kerikeri Domain, fighting for the life of such a small baby, who even in a tertiary hospital might not survive.”

You can read the full story at http://www.stuff.co.nz/national/health/6109172/Tiny-babys-dramatic-delivery.

 

Could it be that the baby did so well because of the basic things the caregivers did, which would not have been done had it been born in a hospital with more high tech stuff? Of course this is just one story. One story is not proof. But it does beg the question. I had a friend whose premie baby died despite all medical efforts to save him. Looking at the details of his particular situation, I can’t help but wonder if he died because of all the medical efforts to save him. There was one point in which they could have waited to see, instead of intervening. But we will never know. The doctors were just trying to do their best with what they knew.

One of the most painful memory my friend had was that in the months he was in the incubator, she did not touch him or hold him. She just wished she could have held him. It would seem to me that, as much as the mom has an overwhelming need to hold her baby, the baby has an overwhelming need to be held. I was thrilled to come across clear and evidence-based information about Kangaroo care for premies, and I imagine, lots of it is useful for sick babies and normal babies as well.

Dr Nils Bergman and his wife, Jill Bergman, from South Africa, have worked on the figuring out the best care for premies. Their website,  http://www.kangaroomothercare.com/ , features an all-rounded approach to this insanely stressful time for parents of premies, the medical team caring for them, and the best health practices for the premies themselves. Their video on you tube describes the book written especially for parents to understand the medical stuff so they can feel empowered to make decisions together with the medical team. http://www.youtube.com/watch?v=_O0w8Lhekb0

It is my hope that medical care for premies and sick babies continue to improve and continue to take into account the emotional as well as physical needs of the babies and their parents. Until then, I hope that parents who have a premie can use this information to help them negotiate and discuss the care plan for their babies with the doctors and nurses, and also get support for their emotional health needs.

 

If you need to talk to someone about your emotional health surrounding any pregnancy, birth or parenting issue, now or in the past, you may call Kaurina at 1 – 604 809 3288.