Problems In The Delivery Room: Why Can’t I Hold My Baby Right Away?
Every mother anticipates the moment after delivery when she first sees her newborn baby. Most of the time, somewhere around 90% of full-term deliveries are uncomplicated. In this case, the baby will be put directly on the mother’s abdomen, gently dried, and evaluated right there.
Sometimes, however, something goes wrong. This might be expected, as would be the case if an ultrasound showed that the fetus had a serious problem. It can be unexpected, when there is a congenital abnormality that was not detected beforehand. It can also be unexpected when there is some stress to the baby during the mother’s labor and its journey through the birth canal. Stress at that point can mean the baby will need some assistance after birth.
Normal Term Infants Can Have Stress During Birth
The transition from fetus to newborn baby is amazing. The baby has to breathe in air for the first time. The umbilical cord is clamped, so there is no more blood or oxygen getting to the baby from his or her mother. The events of delivery, including the first breath and cord clamping cause a whole series of changes in the baby’s circulation. If things go correctly, the baby successfully breathes room air, and all the fluid goes out of the lungs. The circulation in the heart and lungs then changes so that the baby’s oxygenated blood goes out as it should to the rest of the body.
In the approximate 10% of cases in which this transition is not seamless, the baby may need help to breathe. This is often something as little as stimulating the baby as he is warmed under a lamp, giving him more oxygen, or suctioning fluid out of his mouth. Ninety percent of that 10% only need simple interventions that will quickly get them breathing normally. If a baby is not put right on top of the mother’s abdomen and the nurses and/or doctors are helping him, it does not mean there is a serious problem. The mother will probably get to hold the baby very soon. If not, the doctor will explain as soon as possible what is wrong and what they need to do.
When a baby needs help to make the transition from fetus to newborn, the procedures are usually performed away from the mother. The baby may be cared for under a warming light in the room; this is usually what happens when a baby just needs a little help.
Fetuses can pass meconium before they are born. Meconium is a dark green to black sticky substance in fetal intestines that is there before they have ever ingested anything outside the mother’s body. Meconium that is visible in the fluid around the baby (amniotic fluid) usually means that the baby was stressed in some way during labor. This may happen in anywhere from 7% to 20% of deliveries. 2% to 9% of babies who are delivered with meconium-stained fluid may develop meconium aspiration syndrome, which is a problem with the lungs.
If a baby born through meconium-stained fluid is otherwise vigorous and healthy, it is not necessary to try and remove all the meconium. If a baby with meconium is not vigorous or breathing well, suction must be performed to get as much of the meconium as possible out of her mouth and trachea. Trained personnel must do this away from the mother.
Neonatal Resuscitation Teams and the NICU
As mentioned above, 90% of infants who need help after labor will become pink and active after stimulation, and will not need anything else specific.
Babies who do not respond to the above measures may need to have a tube put into their airway (trachea) and have breath delivered to them. They may need heart compressions if their heart is not beating fast or well enough. There are a variety of drugs that may be administered. In most hospitals, a neonatal resuscitation team should give this care. Only 0.2% to 0.3% of delivered infants may go on to have some amount of brain damage from lack of oxygen to the brain.
If there is any reason to expect a difficult delivery, it should take place in a hospital with this kind of team, and the team should be there at delivery. A baby who is not responding normally will go to the NICU, the Neonatal Intensive Care Unit. You might want to visit the hospital you are planning to use early in your pregnancy to make sure it has an NICU, as well as a neonatal resuscitation team. This is extremely important if you have been told your pregnancy is high-risk, or you know of any significant problem with your baby.
Actual Birth Injury
Large babies who are born to small mothers can have actual trauma during delivery. An example of this is shoulder dystocia, in which the baby’s shoulders get stuck after the head has already come through the birth canal. The baby must be delivered, but it is possible to have the collarbones of the baby break, as well as injury to the collection of nerves in the baby’s armpits.
There can also be injury to the head in a difficult birth. Babies born breech can have limb or head injuries, which is why they are usually delivered by C-section.
Babies that are born prematurely are more likely to have trouble making the transition, and more likely to need medical intervention. The more premature, the more possible problems the baby may have.
Twins or other multiple births are also often premature and are at risk not just because of prematurity, but also because of other problems unique to twin births. Multiple births also increase the chance of congenital abnormalities.
Babies born by C-section may also need assistance. These are factors that are known when labor begins or a C-section is started, and there should be a neonatal resuscitation team available.
Significant congenital abnormalities can mean an infant needs more than just resuscitation but also definitive surgical or other care. Many severe birth defects are detected by ultrasound or other tests beforehand, and preparations can be made. Sometimes surgery is even done while the baby is in the uterus.
However, a baby can be born to someone who did not receive prenatal care or who did not want prenatal testing. Some conditions may not be detected. If the baby is known to have a specific birth defect, there may need to be a medical or surgical team ready at delivery. Serious malformations that will need immediate evaluation and special care include:
- Spina bifida with all its variations. The spinal cord can be exposed.
- Anencephaly, which is essentially always incompatible with life because most of the brain is absent.
- Gastroschisis and omphalocele – conditions where defects in the abdominal wall mean that the intestines are outside of the body.
- Diaphragmatic hernia – some of the abdominal contents are in the chest cavity.
- Chromosomal abnormalities – rare ones that cause multiple defects that are usually incompatible with life, such as three copies of chromosome 13 or 18.
- Hydrops fetalis – an abnormal accumulation of fluid in the fetus’ chest and/or abdomen, which can be caused by blood type incompatibility between mother and baby.
- Twin problems in which one twin grows at the expense of the other. Both may need urgent care.
Examples of less severe problems that should be evaluated but will not need any urgent treatment can include other chromosomal abnormalities such as Downs’ syndrome, and congenital conditions such as cleft lip, cleft palate, or club foot. Some congenital heart problems may not be apparent immediately, but are very serious.
If there is any reason for the medical personnel at your delivery to be concerned about your baby, they need to take the time to evaluate and treat problems. By itself, this does not need to be a cause of great concern. Serious problems are rare, especially if you have had good prenatal care and your baby is not born prematurely. Most of the time, a short amount of time is all that is needed to help the baby make the transition to breathing outside of the womb, and most babies can be safely given to their mothers.