Oh, my! What a ruckus Rixa’s birth to Inga (“Inga’s birth story, part 1”) has caused these past few days. If you’ve been hiding from blogs or out in space nowhere near a satellite, I’ll give you a very brief synopsis. But, you probably should go watch it first. It’ll help the discussion.
<insert Jeopardy theme music>
So, Rixa had the baby with just her man there… the midwifery assistant came in a few minutes after the birth (Rixa has the exact times noted) and then her midwife got there as Rixa and the baby were being tucked into bed. Her unattended birth was not purposeful despite having had a planned Unassisted Birth (UC) with her first baby. (She had a midwife-attended birth the second time.)
Okay, so watching the birth, you see that Inga had some perking up issues, but Rixa gave her a few mouth-to-mouth puffs and she came around. Yay! Now, around the Net, oh my gosh, the noise is deafening. I won’t even quote the nasties being said, but suffice it to say some people think Rixa was the height of irresponsible and totally ignorant about how to resuscitate a newborn. And that she has a flat affect, which was the most baffling accusation of all, in my opinion.
There’s been on-going discussions in the comments of both the first and second installments of Inga’s birth (“Inga’s birth story, part 2”), including comments from NICU nurses, midwives and others who regularly attend to newborns in trouble. Today, Rixa wrote a post about “Neonatal Resuscitation,” partly as a defense against the cacophony of criticism; it said (and the experts said) much of what I was going to say in this post, so I’ll be briefer than I was going to be in the first place.
If we were to use Inga’s birth video constructively (and respectfully), this is what I’d say to others who might find themselves in a similar situation.
I totally agree that Inga slipped into secondary apnea, which is a place where stimulation no longer works, but some sort of resuscitative efforts must be given (mouth-to-mouth or Positive Pressure Ventilation [PPV]). The question arises, though… if Inga had had more stimulation before she slipped into secondary apnea, would the secondary apnea have been avoided?
Most of those reading this know there’s been a serious push to remember the sanctity of the newborn by not suctioning, not roughing them up like in the hospital, not flicking their heels or sliding your fingers up and down their back so hard their skin peels off on your fingers. So it’s not surprising to me that Rixa was very gentle with the baby. Could/Should she have stimulated her more? Perhaps, but instead of pointing fingers at Rixa, how about mentioning to others who might find themselves in a similar situation to rub the baby more vigorously… run your hand and fingers around the baby’s legs, rub her butt, rub her back. But, you cannot panic and do this or you can really hurt the baby. Talking to the baby is one good way to disperse the energy of concern/worry/fear. “C’mon, baby… time to wake up. Come be with mommy.” Or anything else that comes to mind. The talking can also help parents who have to helplessly sit and wait when others are doing the resuscitation.
Much has been made about the baby (perhaps) experiencing cold stress as Rixa was giving the breaths and waiting for Inga to perk up. Rixa was in the birth pool holding Inga out of the water (right above the water line) and at one point, her husband offers a blanket and Rixa, with total clarity, explains how a wet blanket wicks cold all over the baby, causing a great deal of cold stress. She was absolutely right. We used to put blankets on babies in the water, I’m sure because it was a habit to dry and stimulate the baby with them on land. It didn’t take long for someone (Barbara Harper?) to nip that action in the bud.
I love the article “Neonatal Resuscitation,” eMedicine/Medscape’s detailed explanation of what happens when the newborn stops breathing. In there, when talking about ways the baby can get cold, they reveal that even the most basic assistance can cause the baby enormous stress.
“Another common source of heat loss in the newborn infant undergoing resuscitation is the use of unheated nonhumidified oxygen sources for the bag-valve-mask device. Inspired gasses that are sent to the lungs are subsequently heated and humidified by the infant, thus resulting in massive heat exchange due to evaporative heat losses and insensible water loss.”
Lucky for Inga, her mom used a warmed and humidified oxygen source (Rixa’s own breath!), perhaps even balancing some of the stress she might have had from being held aloft out of the water.
If you birth in the water and your baby needs some help, weighing (as Rixa did) getting out of the pool and drying the baby off versus getting right to the mouth-to-mouth, if you decide to stay in the water, you might try to keep the baby dipped in a little more. However, if it compromises your grasp on the baby, err on the side of standing up, getting a blanket and perhaps having your partner help you hold the baby while you give the breaths. It all sounds like a puzzle piece to remember, but if you play and replay it in your mind, especially if you’re UCing, the replaying can assist in the body memory in case it happens… you’ll have a head start on bringing your baby around.
The last thing I want to address is Rixa’s peacefulness; what others have described as little to no affect.
THE WOMAN JUST GAVE BIRTH!
How anyone can watch and judge that she should have acted <fill in the blank>, must take into account that she’d given birth moments earlier. I, for one, saw a blissed-out mom who was yanked into reality to help her baby come wholly onto the earth. In part 2 of Inga’s story, Rixa says,
“By the next day, the events of the labor and birth were already feeling surreal and dreamlike. Did I really go into labor and have a baby? Obviously yes, since I'm holding her right now! But it seems hard to believe that it really happened and that it's already over.”
Could this have been the delayed reaction to the block of time it took to do the resuscitation and subsequent processing of it? That’s certainly possible. That surreal feeling often hits right after the birth and lingers from a couple of hours to a couple of days, but if Rixa had to set her joyous disbelief aside, I would totally expect the emotion to float back to her once the emergency was over. I love how calm she was during the resuscitation. For goodness sake, panic serves no one, least of all the baby.
As a mother who had a baby in secondary apnea (my UC baby) and who sat immobilized to do anything, I am in awe at the clear-mindedness of Rixa and love the peace she kept as she was the one who kept her baby alive. That she cared enough to share her video with all of us is a testament to her generous spirit of continued birth education, even when she hadn’t planned for that purpose at all.
Thank you, dear Rixa… and I hope your BabyMoon takes a softer glow soon.