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Sunday
May132012

Neonatal Resuscitation: Crucial Skill for Your Midwife

A video of a homebirth neonatal resuscitation (NR) was brought to my attention, being asked what I thought of it. Sharing it here is irrelevant, but the ensuing discussion after my viewing is not. Just know the whole unfolding was horrible to watch as the baby received tactile stimulation instead of Positive Pressure Ventilation (PPV), had wet blankets (and sometimes no blankets) on him and the PPV was done incorrectly.

As the discussion unraveled, commenters noted the assistant didn’t look very skilled in NR, that maybe she was nervous or just forgot some things she should have been doing… namely getting the bag & mask into the midwife’s hand so she didn’t have to do mouth-to-mouth on the baby.

My response to the entire video was one of, not only distress, by intense frustration (and anger?) that such a crucial, life-saving skill wasn’t second nature to the midwifery team.

Your homebirth midwife and her assistant should have NR embedded in their entire being, it being a body memory, able to be tapped into almost in their sleep. I don’t care how nervous anyone is. I don’t care how green the assistant. No professional should be at a birth without exquisite skill at NR.

If you’re reading this and go to births, I hope you’ll schedule a NR practice this week. Encourage your Peer Review to do a NR practice session at every meeting. If you have prenatals during the week, practice there.

Your skill can… and will… save lives.

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Reader Comments (9)

I organize a monthly meeting for our area DEMs and CPMs. We meet for about 6 hours every month for an educational session and peer review. This month (June) we're doing two full days of CPR and next month (July) is neonatal resusc. Some of these mws have been practicing 10 years and haven't had any neonatal resusc training. I'm so excited to organize this class for them.

May 14, 2012 | Unregistered CommenterDanielle Malik

The problem is: you need both the skills and the practical application of them, multiple times, in order to truly feel and be competent in providing emergency resuscitation to a newborn. Which means, you need to have been involved in numerous neonatal codes/resuscitations to feel and be competent. It's truly one thing to do it as a practice scenario with a fake baby, and a totally different ballgame when you do it with a real newborn.

May 14, 2012 | Unregistered Commenteratyourcervix

I agree 100%. I will never forget the 1st time I had to do NNR at a home birth. It was my 2nd home birth & my 1st water birth. I am very methodical in how in how I lay out my instruments & resus kit & lay it out the same whether at a home birth or in hospital. Thank god as now no matter what I do, be it reaching behind me for scissors for an eips or beginning resus, I don't even have to look, I know what my fingers will find. I agree that NNR is one of our most vital skills. Perhaps even in the top 3 (I am thinking controlling PPH & managing shoulder dystocia as the others).

It's nice to see you blogging again Barb xxx

May 14, 2012 | Unregistered CommenterLiz

Yes, yes, yes! It is the worst feeling in the world to catch a newborn baby who is basically lifeless...and for that very reason, it is essential that NRP be completely ingrained into any health care provider so that feelings and emotions don't get in the way of saving a life. There is no room for nerves.

May 14, 2012 | Unregistered CommenterRCPM

I am not a birth practitioner, nor do I feel I have what it takes to be one.

However, I feel very, very strongly that one should not go into midwifery if one does not have what it takes to suppress panic and maintain a grip when things are going wrong. I also don't think one should be the only assistant present at a birth unless one has already satisfactory proven same.

May 14, 2012 | Unregistered CommenterKate

See, the very idea that this is somehow either not mandatory or not a priority for some midwives speaks volumes to me. I can't even imagine such a blatant, murderous oversight.

May 14, 2012 | Unregistered CommenterWhatPaleBlueDot

where could we view this video?

May 15, 2012 | Unregistered CommenterAshley

I'd like to see the video too, but perhaps without seeing it I'm unable to understand why you're upset that tactile stimulation was used before CPAP? It's the normal protocol to attempt manual stimulation of bottoms of feet, etc before moving onto heavier resus. methods, especially since a baby who may start pinking up and increasing heart rate with just stimulation would be at a disadvantage if a provider had skipped this step and gone straight to CPAP (even moreso if they added in blended oxygen since NPR now considers it just as much a drug as medication)

June 15, 2012 | Unregistered Commentercara

The baby received tactile stim from the moment of being born, going through the mother's legs and up into mom's arms. The whole time, s/he was being rubbed up and s/he was completely floppy. There should have been no more waste of time doing stim, but it was clear the baby was in secondary apnea and needed PPV.

June 16, 2012 | Registered CommenterNavelgazing Midwife

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