# Can we talk about routine suctioning of babies at birth?



## pamamidwife (May 7, 2003)

Or just my "get rid of bulb syringes" evangelism??

Here's my entry from my blog.

What I'm most amazed by is not that hospital-based providers still do this routinely (oy and when you see how vigorously they suction babies after cesareans, you will understand why it gets my goat so bad), but that homebirth midwives and many UCers are doing this, too.

The idea that the bulb syringe is a necessary part of birth is one that is antiquated and must go.

Removing fluid from a baby's mouth is an odd gesture - so they swallow it. Then what? Is that a true risk?? In fact, most of the time when babies are suctioned with bulb syringes, VERY LITTLE to NOTHING is removed. The risk of damage to the nasal passages is high, suctioning deep into the mouth of a newborn can trigger a vagal response, thereby causing low heart tones (and viola! a baby that "needs" help!). Another risk is oral aversion - making initial breastfeeding difficult.

A recent hospital birth I heard about had a nurse that removed "lots" of fluid from a baby's stomach. I'm sorry, but can you tell me why fluid in a baby's stomach can cause problems? Isn't breastmilk and colostrum fluid? I'm not talking fluid in the lungs - I'm talking about when they use a wall-mounted suction catheter and stick it all the way down a baby's throat.

I have never used a bulb syringe...but it took YEARS before I finally took it out of my bag. I think I kept it in there just for "show" - like it's somehow a "staple" of birth supplies.

I remember when I worked at a birth supply house, we'd even get calls from dog and cat breeders wanting deLee suction devices so they can suction newborn animals at birth. Isn't the mother supposed to help with her babies' transition?

We've gotten so far from what is a normal physiological transition for babies. We've introduced them right away to an assault that I find unnecessary and potentially harmful.

Even the so-called evidence for suctioning for meconium does not convince me at all. There is better research coming out to show that it is not helpful. I can only think of one reason why I'd suction a baby: if I was having issues getting an airway for resuscitation. I wouldn't use a bulb syringe, though, I'd use a deLee. I've had the same deLee in my kit for six years!

Why then are we still ok with people doing it?


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## huggerwocky (Jun 21, 2004)

My daughter wasn't suctioned at her home birth, I am sure some midwives would have done it as she wasn't crying or anything. I guess I was lucky, with the next baby I'll make sure to talk about it beforehand if I live somewhere else.

I've only seen it on TV, makes me shudder.


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## lachingona1 (May 16, 2007)

My first daughter was a hospital birth and of course they did suction her (it is such an unnecessary routine procedure as with most of the stuff hospitals do) and my second was a home birth, she was not suctioned.

It also makes me shutter to see or think about the babies that get it done.


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## Shelsi (Apr 4, 2005)

I feel so bad for my poor little ds who was suctioned in the hospital (and all the other ridiculous routine procedures they did to him).

dd was a surprise UC on my bathroom floor. Whenever I tell people the story the 2 most common questions are 1) Oh my gosh! Did you have a suction thing right there? She's ok even though she didn't get suctioned?!? and 2) how did you cut the cord? What do you mean you didn't cut it? Isn't that dangerous?


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## mittendrin (Nov 5, 2003)

Same here, ds1 got the whole shebang, poor kid







:
Ds2 didn't get suctioned per my wish and was fine. Suctioning doesn't get all the fluid out anyways, usually a newborn needs to sneeze and cough a few good times during the first few days.
Are nurses and OBs really THAT bored that they have to come up with all that crap to tease babies and moms with?


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## Arwyn (Sep 9, 2004)

I dunno that we _are_ OK with it. I think it's "standard procedure", and we just don't tend to question it. As for why it still gets done, I think Robbie Davis-Floyd's analysis tends to be right on (it's part of communicating that the baby is a product of the technocracy, not that it is a perfect biological being). Why midwives do it - it's hard to justify doing nothing. It's the hardest thing about being a homebirth midwife in this technologically obsessed, OBGYN-centric culture. Why UCers - probably same thing. The midwives are doing it, and UCing is about being your own midwife, have to prove you can do everything midwives do... :-/ From what I've seen, though, here at MDC, it does seem to be the exception rather than the rule for UCers.

This seems related in my mind - I've been realizing I don't remember Naked Baby's first breath. I was too focussed on his _thereness_ to pay attention to little things like that. He had no reason to cry, and no one was hovering (and hoovering!), chanting about his breathing, so it just... happened. But I know this only by deduction, 'cause he's surely breathing now.


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## LemonPie (Sep 18, 2006)

Hear, hear!

Quote:

A recent hospital birth I heard about had a nurse that removed "lots" of fluid from a baby's stomach. I'm sorry, but can you tell me why fluid in a baby's stomach can cause problems? Isn't breastmilk and colostrum fluid? I'm not talking fluid in the lungs - I'm talking about when they use a wall-mounted suction catheter and stick it all the way down a baby's throat.
My second baby had a large amount of amniotic fluid in her stomach, and began vomiting it back up about 12-18 hours after she was born. I was told that it (a) should have been caught (how I'm not sure, but I was transferred to the peds ward shortly after her birth b/c postpartum was overflowing) and (b) they would have put a tube down her throat to drain it and (c) that this possibly contributed to her early reluctance to breastfeed as her stomach was full and possibly upset. I'm not sure what exact conclusion I've come to here. . . I just know what I was told by the nurses at the hospital.

Jen


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## Jane (May 15, 2002)

The theory is that the inflated stomach is interfering with the full expansion of the lungs, leading to trouble oxygenating (seen as grunting, retractions, central cyanosis).
I do know a midwife that says that babies have trouble digesting blood, so she will suction if the baby is spitting up lots of blood.

It really bothers me to see hospital nurses jamming that bulb in there. They could slow down a little, treat the baby like a human being a little.
I think it would be very tramatic to me to have someone jam a bulb syringe into my mouth like that, and I'm an adult with a much bigger mouth and face.


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## flapjack (Mar 15, 2005)

Great post.

None of mine have been suctioned- it isn't done routinely over here, and my midwives always laugh when they see it on my birth plan and tell me they'll get me some more modern midwifery texts







DD was a slow starter though, and took some time to uncurl out into the world, wake up, breathe, open her eyes and see what was going on. That's just who she is- her birth, like every other aspect of her, has happened in her way, in her time and she balances her independence very carefully and cautiously.
DS2 was screaming with the birth of his shoulders, and DS1 took his first breath as we lifted the caul away. That's one of the memories that does stick


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## danotoyou2 (Jan 19, 2007)

Does anyone have any links to studies that show the effects of routine suctioning?


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## mwherbs (Oct 24, 2004)

so I am not for routine suctioning at birth and haven't done it for years but- I prefer a bulb syringe to a deelee-- and there are some studies that show that a bulb syringe gets as much out as a deelee-- so I don't know why the deeper suctioning devices are important at all- they are more likely to trigger a vagal response- that is where I am going with this-- normal babies even babies that sound a little juicy- if they are breathing and coughing and sneezing and sputtering- they are clearing their own airways much softer and healthier than I can do it--
and if a baby will nurse- even better because nursing clears airways as well and the viscosity of the colostrum dries out the lungs too--


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## Romana (Mar 3, 2006)

I'm going to make this short as it's off-topic, but don't really feel like I can just ignore it -

Quote:


Originally Posted by *Arwyn* 
UCing is about being your own midwife, have to prove you can do everything midwives do...

Just have to express my strong disagreement with that statement. Maybe for some, although really, I haven't seen this attitude much among UCers. There's no way I would have done any suctioning on my UC baby if she'd been born at home. (At the hospital, she got a tiny bit of totally needless suctioning.) Somehow I just can't imagine reaching for a bulb syringe I didn't even have.


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *Romana9+2* 
I'm going to make this short as it's off-topic, but don't really feel like I can just ignore it -

Just have to express my strong disagreement with that statement. Maybe for some, although really, I haven't seen this attitude much among UCers. There's no way I would have done any suctioning on my UC baby if she'd been born at home. (At the hospital, she got a tiny bit of totally needless suctioning.) Somehow I just can't imagine reaching for a bulb syringe I didn't even have.









well, it may not be true for all, but I have to admit seeing/hearing UC mamas measuring their fundus, dipping their urine, and even suctioning babies - all of which are not evidence-based. the issue is, like with midwives, there are certain rituals we have adopted from obstetrics and there are certain rituals UCers have adopted from midwives. None of that makes any of us right or wrong - it's just a product of trying to make it "friendlier" or "woman centered" when we're still not using evidence-based practices.

seems to me within the midwifery community until there is a study to show it is harmful, midwives will continue to do these rituals and practices because "it's what we've always done".


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## MsElle07 (Jul 14, 2006)

What do you do if a baby is really wet sounding and choking on amniotic fluid? Or has a mouthful of mec?

*These are legitimate questions, I don't disagree with your basic premise that most babies don't need suctioning.*


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## pamamidwife (May 7, 2003)

Let the baby drain - and nursing, by far, is the best thing for "wet sounding" babies. By rolling a baby over on its side, any "choking" it is doing - which is usually just bringing up fluid/mucus, not really choking - can be resolved pretty quickly.

Suctioning won't help wet sounding babies.

A mouthful of meconium? They usually drain it out. But, even with heavy meconium births, I have yet to see a "mouthful of meconium".


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## Patchfire (Dec 11, 2001)

Something I've never really thought much about until now -

When ds was born, I was in a very strange position - standing up in the water in the fishy pool, leaning forward, my hands on the side of the fishy pool. His head was born - he was anterior - and he just sat there for a bit (crying and kicking at the same time - very very weird feeling







) - so while I waited on another contraction, eventually my mw said something about suctioning him "lightly" because he was face up and something else I honestly can't remember. I'll have to ask someone else who was there. Anyway... since he was already crying and such, doesn't that indicate the suctioning wasn't necessary, even in a paradigm where suctioning is sometimes necessary?

I'll have to think more about this.


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## hapersmion (Jan 5, 2007)

Quote:


Originally Posted by *2Bugs* 
Hear, hear!

My second baby had a large amount of amniotic fluid in her stomach, and began vomiting it back up about 12-18 hours after she was born. I was told that it (a) should have been caught (how I'm not sure, but I was transferred to the peds ward shortly after her birth b/c postpartum was overflowing) and (b) they would have put a tube down her throat to drain it and (c) that this possibly contributed to her early reluctance to breastfeed as her stomach was full and possibly upset. I'm not sure what exact conclusion I've come to here. . . I just know what I was told by the nurses at the hospital.

Jen

Hmm, interesting. My baby was born at the Farm, and I actually can't remember if any suctioning was done or not. I know I would remember it if it had been any more than just a tiny bit, or if it had been rough at all, because I would have objected to that. But about 18 hours after he was born, he had a great big vomit of fluid. (Maybe because he was breech he didn't get the "baby Heimlich" when coming out?)

I never gave it much thought, because he was fine right afterwards. I know it didn't give him any problem with breastfeeding - he always knew exactly what to do. My first thought, though, would be that having fluid in his stomach might help keep him from getting dehydrated while he was waiting for the milk to come in?

nak
hapersmion


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## kerikadi (Nov 22, 2001)

Not part of my MW's SOP, she said it has been years since she suctioned a baby. None of my girls were suctioned.

Keri


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## monocyte (Jun 17, 2004)

Great thread.

I've been thinking about this topic a lot lately as I recently heard someone at the LLLI conference talking about it...I never thought about it before hand, I just assumed







: that it was something always done in some way - like the reeds talked about in Red Tent for instance.

Now in the process of writing up my birth plans, and this is probably going to be in it.

DS was gently suctioned (thankfully by a non-aggresive mw), but he did have some trouble in the first 24 with gagging, almost like he was trying to get something up, but couldn't. A RN did have to suction him a bit more to remove whatever was stuck in him...and a bunch of fluid - almost mucus-y like did come up.


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## HarperRose (Feb 22, 2007)

Both of mine were suctioned. This next one won't be. I've been thinking about it and actually, Pam, your thread comes at a good time for me. I'd been meaning to post a thread asking WHY. It just doesn't seem like a good thing. It's rough and imo unnecessary. I'd like for my kids to have a gentle birth and beginning. Jamming some plastic in their throats doesn't seem all that conducive to a gentle beginning.


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## the elyse (Apr 15, 2006)

my dd had a tube inserted down her nose to suction her stomach. i had the same thing done after a major car accident to check for internal bleeding...so it really bothered me to see them do it to her, i could feel it going down my own throat. yuck.







:


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## LemonPie (Sep 18, 2006)

Someone asked about studies. I'm copying and pasting a response I put up on another thread. HTH. BTW--if you go to the PubMed studies, they'll usually have links to related studies as well.

Quote:

I just attended a conference (the LLLI conference mentioned above) where Linda Smith, IBCLC spoke. She said that routine suctioning of newborns at birth is not necessary unless there are actual respiratory problems. In her opinion, the baby tongue-thrusting at the aspiration device might create a "muscle memory" that can cause breastfeeding issues later. Some studies she cited:

-Vain et al, Lancet 2004; 364 (9434): 597-602
-Anand, Runeson, Jacobson, J Pediatr 2004; 144: 449-54

And a couple more that I found with a routine PubMed search:
Evidence-based practices for the fetal to newborn transition.

Building evidence for practice: a pilot study of newborn bulb suctioning at birth.

Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial.
Edited to add: Oops, the links didn't come with it







You can see the original post here for links to those studies.
Jen


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## mwherbs (Oct 24, 2004)

yep babies cough, sputter, sneeze even throw up- what is the heart rate? is the baby breathing? will the baby nurse?
babies that are wet or seem wet are not remedied by suctioning- we are talking expansion of the aveoli and changes in surface tension on that level in the lungs -- not the little bit that is in the upper passages - when you suction you are changing the circulation and can cause swelling/edema --

try using some suction on yourself- see what your response is - holding your breath and shallow breathing - and the bulb syringe is relatively small for you -- the small bulb is about the size of a baby's fist

now I think that a baby that is not breathing - and is in need of resuscitation then yes I suction first then blow--


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## lilylove (Apr 10, 2003)

I have a question about the stomach full of fluid thing...
Do we(they) _know_ that a baby having fluid in their stomach at birth is bad? Is there any specific consequences that are citied for tubing and suctioning this out? It's not like it's a foriegn thing to thier digestive tract.


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## kerikadi (Nov 22, 2001)

After the baby is born my MW likes the baby to lay on his or her tummy for the first few moments to allow any fluid to come out of the mouth naturally. Of course this is immediately after birth just before nursing.
It just makes sense that if you put a baby on their back right away they are going to swallow and possibly choke on fluid but if you hold them a certain way (rounded back) and place them tummy down on Mama the fluid will come out on it's own.

Keri


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## Nan'sMom (May 23, 2005)

I think it's horrifying. It's also one of those things that childbirth instructors and books don't seem to warn you about...that you should be ready to say "NO SUCTIONING!" when your dear little one is born. Thankfully my first mw didn't do it, but I hadn't known to ask for it not to happen. Second was UC and I knew more so of course I didn't think of suctioning.

I do know that at a nearby freestanding birth center (one that has decent transfer stats), they routinely suction babies. It's so strange, unkind and non-evidence-based.


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## Nan'sMom (May 23, 2005)

Quote:


Originally Posted by *kerikadi* 
After the baby is born my MW likes the baby to lay on his or her tummy for the first few moments to allow any fluid to come out of the mouth naturally. Of course this is immediately after birth just before nursing.
It just makes sense that if you put a baby on their back right away they are going to swallow and possibly choke on fluid but if you hold them a certain way (rounded back) and place them tummy down on Mama the fluid will come out on it's own.

Keri

Apparently there's a parenting school in Russia that advocates this as well. I found out because I was describing my UC to a friend from Russia and how my baby came out onto the bed herself from a low hands and knees position (no one "catching") and then I picked her up and she said her parenting school says that this is natural and helps fluids drain.


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## BugMacGee (Aug 18, 2006)

Quote:


Originally Posted by *mwherbs* 
so I am not for routine suctioning at birth and haven't done it for years but- I prefer a bulb syringe to a deelee-- and there are some studies that show that a bulb syringe gets as much out as a deelee-- so I don't know why the deeper suctioning devices are important at all- they are more likely to trigger a vagal response- that is where I am going with this-- normal babies even babies that sound a little juicy- if they are breathing and coughing and sneezing and sputtering- they are clearing their own airways much softer and healthier than I can do it--
and if a baby will nurse- *even better because nursing clears airways as well and the viscosity of the colostrum dries out the lungs too*--

Mwherbs, could you expand on this bolded statement a bit? I've never heard this and it intrigues me.
FWIW-I don't suction babies that are crying unless it is apparent they need help clearing thier airway in respiratory distress.


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## mwherbs (Oct 24, 2004)

human colostrum immunoglobulin A- a mucin-type glycan holds water/fluid-- as well as forming a healthy mucous membrane surfaces

if I were to give you something that acts similar in the herbal world it would be mallow/marshmallow or corn silk- it is a slicker (mucopolysaccaride) and draws fluids to it as well as being anti-inflammatory at the same time-- and that is just the plant activity- not all the other things/goodies colostrum has--


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## lyttlewon (Mar 7, 2006)

Quote:


Originally Posted by *lilylove* 
I have a question about the stomach full of fluid thing...
Do we(they) _know_ that a baby having fluid in their stomach at birth is bad? Is there any specific consequences that are citied for tubing and suctioning this out? It's not like it's a foriegn thing to thier digestive tract.

I have always heard it is to keep them hydrated until milk comes in and that some babies swallow more than others. DS spit up fluid after he was born and didn't nurse for about 12 hours. This seemed completely normal for him. My MW told me I didn't need a bulb syringe for my birth kit that she doesn't suction babies. I have one for colds and such but it was never used on DS.


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## Magali (Jun 8, 2007)

I just never thought about the suctioning before. I am glad i have you ladies to fill me in though!


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## Arwyn (Sep 9, 2004)

Quote:


Originally Posted by *Romana9+2* 
I'm going to make this short as it's off-topic, but don't really feel like I can just ignore it -

Just have to express my strong disagreement with that statement. Maybe for some, although really, I haven't seen this attitude much among UCers. There's no way I would have done any suctioning on my UC baby if she'd been born at home. (At the hospital, she got a tiny bit of totally needless suctioning.) Somehow I just can't imagine reaching for a bulb syringe I didn't even have.









just responding to this before i finish the thread -
I'm sorry I wasn't clear - I certainly did not mean that this is a good or accurate description of UCers or what UC is supposed to be. I only meant that _when_ UCers suction routinely with bulbs (or do any of the other mostly pointless things too many midwives do), it is reflecting that (unfortunate) idea about UC, rather than the birth/body/self trust that makes UC such a powerful and safe birth option.

Sorry that wasn't clearer.


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## courtenay_e (Sep 1, 2005)

Just attended a hospital birth of twins today. First was vaginal and non-medicated, second was single footling breech for whom they tried a version FOUR times before the heartrate went up to about 220 and they decided to section him, used a fast acting spinal...but they really tried before they went to surgery. The boys were 38 weeks, seven pounds and six and a half pounds, placenta was beautiful and healthy, babies apgars were 9 and 9 for both...and the nicu nurses deep suctioned them all the way down to their bellies, simply because they were twins. *WHAT!?* It made me sick. The babies were quiet and peaceful after their initial birth cries, nice and pink, breathing beautifully, and they took them away and suctioned them. *sigh* This mama had a great doc (known for supporting the homebirth midwives in the area, and VERY supportive of this mama and her wishes), and got so much of what she wanted in a birth that she didn't complain too much when they did this...but it made me sick to watch it. They were _screaming_ by the end...poor babies!


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## lilylove (Apr 10, 2003)

Quote:


Originally Posted by *lyttlewon* 
I have always heard it is to keep them hydrated until milk comes in and that some babies swallow more than others.

This seems to make sense.
What reason do docs and nurses cite for doing it though? I mean are they just guessing it's bad because some babies spit up some fluid? I just don't understand why something as drastic as suctioning a baby's tummy is done for something that they have been swallowing all along


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## courtenay_e (Sep 1, 2005)

Because it keeps them busy. Because it's something they can control. Probably because some babies who have snot/fluid in their head/gut gag on it. So they treat them all. KInd of like they treat all babies for chlamydia and gonnorhea (I know I prob. spelled that wrong) even though a tiny population are actually affected by it. Because they can.


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## Romana (Mar 3, 2006)

Quote:


Originally Posted by *Arwyn* 
I certainly did not mean that this is a good or accurate description of UCers or what UC is supposed to be. I only meant that _when_ UCers suction routinely with bulbs (or do any of the other mostly pointless things too many midwives do), it is reflecting that (unfortunate) idea about UC, rather than the birth/body/self trust that makes UC such a powerful and safe birth option.

Oh, okay.







Thanks for clarifying - I didn't catch that you meant it that way.


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## LiLStar (Jul 7, 2006)

i cringe at what dd was put through







I don't even know what all of it was, because I could only hear it. hb transferred to a c/s.. records say they used the delee upon delivery of the head. i remember hearing a very strong loud cry, but who knows if that was before or after the delee. then they took her over to the warmer for some nice dramatic extra suctioning, because when my water broke there was very very light mec staining. pffft. my records said they didn't find any though. great, confirm that it wasnt necessary! after that she was wrapped up and dh held her by my face.. wrapped up so that all i could see was her eye brows to her chin! she was breathing kinda loud and sounding wet, and dh was kind of concerned about that and i kept telling him she's fine, its normal. then they took her back to mess with her some more and i didn't see what happened but i heard a smacking sound







dh said it was gentle but it sounded awful. i could do nothing! and i was too drugged and loopy to yell at them to stop. i hate that they were hitting her for no reason. then they did a cbc and it came back with one number high, possibly indicating infection "but sometimes its high due to stress"..GEEZ! Unceremoniously rip her out of me, orally assault her, smack her, then repeatedly stab her in the heal..I imagine that would be a wee bit upsetting







So then they poke her precious little baby foot again. after she'd gotten to snuggle and nurse a bit. shocker: it was normal that time.


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## Softheart (Jul 20, 2002)

Thanks so much all! I am adding this to my birth plan!


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## jennica (Aug 10, 2005)

When ds was born he would not nurse for hours. They were all really concerned about this and kept informing us that his blood sugar was going down and if he didn't nurse soon then they would have to give him formula. They wanted to give him formula within about 5 hours after birth, but I held out until that night (he was born at 7:00 am). By that time he was breathing fast and they told me his blood sugar was low and they had to give him formula. I finally consented because I didn't know what else to do and I had already been through so much with the birth anyway that I wasn't myself by that point. Well, dh accompanied ds to the nursery where they were to finger feed him formula and then return him to me. When they came back dh told me how they put a tube down his throat and suctioned a bunch of mucous out of his stomach. No one ever bothered to ask me or dh if this was okay or anything, but they weren't really big on informed consent there anyway I guess







: Anyway, they told dh that the mucous makes them sick to their stomach and then they wont nurse, so they have to suction it out. Is this true? It didn't seem to do anything, he didn't start nursing well until we got home and we both relaxed. And I figured out his breathing would slow down if I just layed him face to face with me and I breathed slowly and deeply. I think the breathing thing was just because he was seperated from me too much after the birth. Oh, and I later found that is blood sugar was not "low", it was just getting lower, so what I now think happened is that the last ped was about to go off shift and wanted to suction him before she left, so seeing how reluctant I was, she told me his blood sugar was low so that I woud let him go off with her, and she then took that oppertunity to shove a tube down his throat. Poor baby


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## Softheart (Jul 20, 2002)

Oh, and not to hijjack the thread, but you all seem uncommonly (to me) knowledgable on this subject--like I'd never heard of not suctioning and now I am so grateful to be on the way to a gentler birth for ds, so does the OP or anyone else just have a brief list of other procedures/practices you would refuse for your newborn (we will be in birth center w/mix of docs and midwives)? I know to refuse circ, Vit K, vaccines, eye drops, cord cutting before its ready, formula, being taken away to nursery...Do you think there is more to refuse? Weighing to soon when it should be bonding time?, bath?, other stuff I don't know about...? Just briefly, someone, and then I can go research it all...THANKS!


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## MsElle07 (Jul 14, 2006)

*Thanks for answering my questions before, Pam.*

Two of my babies were suctioned, one because of light mec before the birth, although heartrate was good. She was heavily suctioned at the perineum, and went on to have fast resps for 3-4 hours. Fortunately, I wasn't in the hospital, or I'm sure she would've been brought to the special care nursery, when all she needed was some skin to skin and some nursing.

Someone asked why people are doing it if there's no evidence it helps. Aside from the fact that the medical establishment does all sorts of things that aren't evidence based (as we all know), I also think it's a CYA thing. Providers want to give evidence that they did everything they could in case of a bad outcome. Like the saying, "The only C-section you're sued for is the one you don't perform," you're less likely to be sued when the family sees that you're "earning your money" "taking precautions to ensure the health and well being of the baby," etc.

This idea is so ingrained in us. At my most recent birth, my MW's assistant didn't do much of anything during labor. There was really nothing for her to do, I wanted to be by myself or just with my DH, and was handling things fine. She helped clean up after the birth, listened to FHT, and did charting. The rest of the time, she sat in the other room talking to the MW and reading a book.

This bothered my DH enormously. He felt she needed to be doing something. He couldn't understand why we would pay her (cash, not covered by insurance) to sit and read a book. Even 5.5 months later, when we talk about DD's birth, he brings it up. So, if it's true of my DH, who leans towards the crunchy side, I can see how the idea of DOING SOMETHING is extremely important to most people. It's probably subconscious for a lot of us, but it's definitely there.


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## MsBlack (Apr 10, 2007)

MsElle07--

Healthy newborns come with quite well-functioning reflexes, including the ability to cough, gag, sneeze, cry. All of these things do work to clear the airway, mouth and nose of fluids/meconium--they work really well, and tho it can be a little worrisome to watch a baby do these things at birth or in the days following, it is actually better (in great majority of cases) to support these functions without interfering. That work not only clears the passages, but since it's 'work', it helps the baby gain strength and good oxygenization.

Like most mws, I learned early that routine suctioning is 'good'...and like many mws, I've spent this era of my practice trying to unlearn the silly medical things I learned early! So at first, it was hard for me to do nothing when baby was born--at least, hard when baby clearly had a good amount of fluids in there. But I learned to breathe out the nervousness and sit on my hands--and have been rewarded with the sight of babies taking care of the fluid business on their own, or with parents' gentle help wiping stuff away and giving touch and verbal encouragement. And further rewarded with a deeper trust in birth, mothers and babies and the way it was all meant to work.

A few times I've gotten calls from frantic parents in the early postbirth days: 'my baby just had this choking fit, got all blue in the face and had a hard time getting something out of her throat! Should I call an ambulance, or go to ER?' And on further questioning, this had already passed, baby was nice and pink again and breathing fine. Parents had generally done what comes naturally--putting baby on belly and patting her back, or holding baby close during this episode, wiping away what emerged (to name the 2 most popular responses by far). Anyway--it can be scary to watch the baby struggle this way, especially if baby gets a bit blue in the process. But those reflexes do work, and healthy babies are not harmed by a few moments of 02 deprivation.

Remember that in Heimlich choking instructions, the first rule is: if person is coughing or gagging, do nothing (let them try to work it out before interfering). ONLY if there is no airway at all, do you move in to help, because moving in too soon to help can only cause more problems. This goes for babies, too. I have seen some really really wet sounding but vigourous babies work out a lot of fluid! A lot--and sometimes the parents are saying 'aren't you going to suction him?'....but we just wait a minute, and see how the babes DO work it out--and are soon quite rosy for the aerobic work they've just been doing with clearing their own airways. This goes for meconium, too--and with mec present, you especially don't want to risk abrading those tender mucous membranes with suction devices, since mec is caustic to those tissues. That caustic effect can't help but have a greater chance of doing harm ('chemical pneumonia'), on tissues that have been scraped open by hard plastic suction tools of any kind. Sometimes I wonder if the hospitals see a lot more babies in need of help for mec aspiration syndrome BECAUSE they do that deep suctioning--and thus make things worse for baby in the long run not only by abrading mucous membranes, but by shoving some of the mec even deeper into the airway than it was in the first place. I know one doc who says definitively that this is the case, who has advised me in no uncertain terms NOT to transport any baby who can breathe, as long as signs continue to improve over the first 24hrs: NO! Don't transport--those idiots will just make things worse! (gotta love that man)

One thing I will do for a very fluidy or mec baby is to wipe away what emerges--if you have a mouth or nose dripping w/stuff, seems better to me to remove it by wiping than leaving it, just to prevent it being sucked back in on the next inhale.

Only on a couple of occasions have I stayed around far longer than usual after the birth, to do--and teach--respiratory therapies for baby that can help if a baby seems to have a lot of fluid/mec still inside that is causing less than optimum breathing/oxygenization. (steam, warm water immersion, back percussion).


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## BugMacGee (Aug 18, 2006)

Quote:


Originally Posted by *MsBlack* 
MsElle07--

Healthy newborns come with quite well-functioning reflexes, including the ability to cough, gag, sneeze, cry. All of these things do work to clear the airway, mouth and nose of fluids/meconium--they work really well, and tho it can be a little worrisome to watch a baby do these things at birth or in the days following, it is actually better (in great majority of cases) to support these functions without interfering. That work not only clears the passages, but since it's 'work', it helps the baby gain strength and good oxygenization.

Like most mws, I learned early that routine suctioning is 'good'...and like many mws, I've spent this era of my practice trying to unlearn the silly medical things I learned early! So at first, it was hard for me to do nothing when baby was born--at least, hard when baby clearly had a good amount of fluids in there. But I learned to breathe out the nervousness and sit on my hands--and have been rewarded with the sight of babies taking care of the fluid business on their own, or with parents' gentle help wiping stuff away and giving touch and verbal encouragement. And further rewarded with a deeper trust in birth, mothers and babies and the way it was all meant to work.

A few times I've gotten calls from frantic parents in the early postbirth days: 'my baby just had this choking fit, got all blue in the face and had a hard time getting something out of her throat! Should I call an ambulance, or go to ER?' And on further questioning, this had already passed, baby was nice and pink again and breathing fine. Parents had generally done what comes naturally--putting baby on belly and patting her back, or holding baby close during this episode, wiping away what emerged (to name the 2 most popular responses by far). Anyway--it can be scary to watch the baby struggle this way, especially if baby gets a bit blue in the process. But those reflexes do work, and healthy babies are not harmed by a few moments of 02 deprivation.

Remember that in Heimlich choking instructions, the first rule is: if person is coughing or gagging, do nothing (let them try to work it out before interfering). ONLY if there is no airway at all, do you move in to help, because moving in too soon to help can only cause more problems. This goes for babies, too. I have seen some really really wet sounding but vigourous babies work out a lot of fluid! A lot--and sometimes the parents are saying 'aren't you going to suction him?'....but we just wait a minute, and see how the babes DO work it out--and are soon quite rosy for the aerobic work they've just been doing with clearing their own airways. This goes for meconium, too--and with mec present, you especially don't want to risk abrading those tender mucous membranes with suction devices, since mec is caustic to those tissues. That caustic effect can't help but have a greater chance of doing harm ('chemical pneumonia'), on tissues that have been scraped open by hard plastic suction tools of any kind. Sometimes I wonder if the hospitals see a lot more babies in need of help for mec aspiration syndrome BECAUSE they do that deep suctioning--and thus make things worse for baby in the long run not only by abrading mucous membranes, but by shoving some of the mec even deeper into the airway than it was in the first place. I know one doc who says definitively that this is the case, who has advised me in no uncertain terms NOT to transport any baby who can breathe, as long as signs continue to improve over the first 24hrs: NO! Don't transport--those idiots will just make things worse! (gotta love that man)

One thing I will do for a very fluidy or mec baby is to wipe away what emerges--if you have a mouth or nose dripping w/stuff, seems better to me to remove it by wiping than leaving it, just to prevent it being sucked back in on the next inhale.

Only on a couple of occasions have I stayed around far longer than usual after the birth, to do--and teach--respiratory therapies for baby that can help if a baby seems to have a lot of fluid/mec still inside that is causing less than optimum breathing/oxygenization. (steam, warm water immersion, back percussion).

But with bulb suction, you are not abrading any tissue that is required for ventilation/oxygenation. Even with deep suction you are not entering the lungs.

Not transferring a baby in respiratory distress??? Remind me to take that doc off my list of recommended peds!







:


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## Jane (May 15, 2002)

So, here's what was on my mind last night - boobs. We regularly present the baby with a breast or two that dwarf their own head-size. Tickle their throat with a nipple until their suck reflex is triggered. Is it the mother's love that makes it different? Maybe a little, but I think babies are more reslient than imagined.

I haven't seen babies cry when being delee'd down to the stomach. But I've only seen it 3 or 4 times. They look a little surprised. They do breastfeed better afterwards.

There are some enzymes in colostrum that thin out secretions. If the baby will nurse, that helps a lot.

Sometimes it helps to demonstrate that "grrrrr.ahem" noise that we adults use to clear our throats. Babies can't do that, yet. So they splutter and sneeze and push up mucus. Totally normal, but it sure sounds bad. If I was doing that, it would be because it was sooooo bad the normal stuff didn't work. I'd be in real distress before I resorted to those tactics. Perhaps that's why it's so distressing.

Or it's part of a little OCD - not wanting there to be mucus in/on a perfect newborn. Like an extension of the "picking tribe" - the "suctioning tribe" of birth workers.

I am always suprised at the variety seen in normal healthy babies. After telling dozens of moms that "It's fine, I'm sure the baby is breathing just fine even though it looks like he's squished. He wouldn't keep nursing if he couldn't breathe well, he'd pop off and readjust."
Yeah...then I met the baby that would rather nurse than breathe. His mama really did need to hold that little dip of airspace for him. I love babies.


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## mwherbs (Oct 24, 2004)

as far as routines and evidence the evidence has only recently swayed back to not suctioning on the perineum with mec present-- the thought was to prevent meconium aspiration syndrome (MAS)-- and when a baby has this it is serious very serious because meconium is inflammatory and corosive to the airways and the surfactant that helps lungs function and it changes the normally antiseptic properties of amniotic fluid and supports rapid growth of bacteria- so looking to prevent this wasn't a bad idea but what the studies have shown about use of routine suctioning was no real change in incidence of MAS- so the problems caused by breathing in mec most likely occurs before birth, long before birth is the current theory , I want to add that mec is present far more often than MAS occurs most babies are fine despite it's presence at some point before labor babies stop doing the little practice breathing movements they do so they aren't breathing in amniotic fluid just before labor (one more thing that makes induction questionable) so if mec is there unless there is deep gasping it isn't going into the lungs-- the routines on this have really only changed in the last 2 years and since the resuscitation class certification is every 2 years there may be some providers who are only now getting this info--of course they may still be thinking that they have prevented a problem by their actions in the past- because they saw mec suctioned and the baby didn't get sick-- studies are one thing experience is quite another- since most babies with mec won't get sick suctioned or not then it will seem like suctioning did something to prevent this problem and I certainly understand why people want to prevent a problem if possible- routine suctioning just isn't the answer-- I don't know anything about what should be done post c-section


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## cottonwood (Nov 20, 2001)

Thanks, Pam. So many good points made here, a lot of information (some new to me.)

I know someone who gave birth recently whose baby had fluids suctioned from the stomach (god, that *can't* be pleasant) and she believes it was necessary for the reason that Apricot mentioned, that it's interfering with the lungs expanding. It's just a strange concept to me... babies swallow fluid when they're in utero, you can't they be *expected* to have fluid in their stomach? Why would nature have devised a system whereby a full stomach would interfere with breathing.







Maybe someone can explain this better for me, but I just don't get it.

Quote:


Originally Posted by *Apricot*
It really bothers me to see hospital nurses jamming that bulb in there. They could slow down a little, treat the baby like a human being a little.

Yeah, like it's some big emergency. Almost all the hospital videos on youtube, that's what they're doing, while the baby is screaming away. Even some homebirths.







The episodes I've seen of House of Babies, they're doing the same damn thing. Argh.

Quote:


Originally Posted by *pamamidwife*
well, it may not be true for all, but I have to admit seeing/hearing UC mamas measuring their fundus, dipping their urine, and even suctioning babies - all of which are not evidence-based. the issue is, like with midwives, there are certain rituals we have adopted from obstetrics and there are certain rituals UCers have adopted from midwives.

Yep, I see it a lot. Drives me bonkers.

Quote:


Originally Posted by *Apricot*
So, here's what was on my mind last night - boobs. We regularly present the baby with a breast or two that dwarf their own head-size. Tickle their throat with a nipple until their suck reflex is triggered. Is it the mother's love that makes it different? Maybe a little, but I think babies are more reslient than imagined.

Babies are *very* resilient. That doesn't mean it doesn't matter.

I think the difference is in taking something into your mouth voluntarily, because of an instinctive urge, versus having something jammed around in your mouth and at the back of your throat. I just stuck my finger in mouth to suck on it... fine. No problem. I know, however, that if someone were to stick something in there (worse yet, with no warning) I would have a very different reaction.

Quote:


Originally Posted by *Apricot*
I haven't seen babies cry when being delee'd down to the stomach. But I've only seen it 3 or 4 times. They look a little surprised. They do breastfeed better afterwards.

But why not just wait for the urge to suckle to present once the stomach has emptied?

Quote:


Originally Posted by *Apricot*
Or it's part of a little OCD - not wanting there to be mucus in/on a perfect newborn. Like an extension of the "picking tribe" - the "suctioning tribe" of birth workers.

No doubt.


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## MsBlack (Apr 10, 2007)

Apricot--

The doc in question was a pathologist, as a matter of fact, not a peds. And had seen enough in his 40yrs of practice (both as path. and general pract.) that I had lots of reasons to believe he knew what he was talking about. Besides being an avid researcher all his life, and a doc whose mind was never subsumed into the 'medical religion'--after all those years, he could still see, rather than having his sight and thoughts all directed by medical beliefs.

And I have to say that I have seen no evidence that what the hospital does for mild-to-moderate RDS is any better for babies than what can be done at home (can't comment on severe RDS/MAS due to lack of experience there). When I say 'less than optimal oxygenization', I don't mean serious distress--just breathing that isn't perfect, needs some support, and does improve with non-invasive measures fairly rapidly. It took that doc, on the phone after a thick-mec birth, telling me to stay home with that baby, to prove to me that this is true--he helped inspire my confidence in staying home where I saw the evidence with my own eyes. I once was afraid of mec aspiration and RDS, as a matter of training to the medical religious beliefs about it. First belief being 'the med ppl know and do best--so when in doubt, hand it to them'. And with RDS/MAS, all other beliefs springing off of that primary one "deleeing is best care", "antibiotics round is best care", "oxygen is good", isolation from mother is good, etc. These are beliefs only, not truths, and in my pov, since they are beliefs that grow out of the mechanistic approach to the human body and life, they are not exactly to be relied upon. My way is to see the whole picture, in any event, as best I can. All too easy to be distracted by retractions for instance--and to miss the baby's actual color, ability to bf, etc. Working to see the whole picture helps dispell the fear that is based on those medically inspired beliefs, and can lead to calm, sane responses to a situation rather than too-hasty over-reaction.

No, bulb syringe is not entering lungs--but it sure can reach into back of throat. Both syringe and delee can push mec deeper. Both can cause abrasion, without much by way of proven good being done. Abrasion can lead to swelling, even a small degree in those tiny throats/tracheas can't be a good thing. I, too, have only seen delee used a few times. Twice on essentially dead babies, who were full in lungs and abdomen of thick mec that was a result of other issues--they did not cry because they were never going to. Three times on live, healthy babies, one with some mec and two with none but very wet lungs post csec. All 3screamed their heads off, as soon as suctioning started tho all emerged peacefully enough before suctioning commenced--screamed, that is, between choking on the tube going down their throats. So, our individual experiences have probably colored our opinions on that.

Not sure what you mean when you say 'breastfeeding went better' after deleeing. can you clarify this? Was there poor bfing prior to suctioning? Was there a way to know whether it was the suctioning that helped improve bfing, or could it have been coincidental? Was deleeing the thing that 'helped' in some physiological way--creating hunger, for instance, by emptying the baby's belly--or after being assaulted w/delee, was baby just greatly in need of the comfort of the breast? Again, this is an area where I think we need to be aware of the mere beliefs in action, beliefs strong enough to cloud the truths of the situation (and I am not saying I 'know' the truths of it--I merely insist on questioning this because it is only by questioning the med model have people been able to take back their bodies, babies, births...). Remember that not all trauma produces agitation--some trauma produces passivity--but this does not prove that an action was non traumatic or in any way helpful for a baby. Seeing 'improved bfing' might feel helpful to careproviders, because it eases their fear--but is there a way to know if it was actually helpful to the baby?

Also, I'm with 4 littlebirds--can we not wait until baby wants to suck? Many babies seem to want that breast very soon after emergence. Many others want it in a 1/2hr to an hour or so after birth. And some just aren't that interested in the first day or 2--and with a healthy, vigorous infant, can we be sure that this slower approach to bfing is a problem? Again, I want to be able to see the whole picture, not react out of fear based beliefs and 'knowledge' that is seen through the smoky glass of those beliefs about babies/the body that just ain't necessarily true.

Finally--yes, babies are very resilient, for the most part. Does this mean it's ok to do things to them that they will probably 'survive', if those things are not evidence based and may be harmful in ways we cannot measure? They are also, so very vulnerable on all levels.


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## BugMacGee (Aug 18, 2006)

I just had to add here that e-coli thrives on the bile salts in mec.

*And I have to say that I have seen no evidence that what the hospital does for mild-to-moderate RDS is any better for babies than what can be done at home (can't comment on severe RDS/MAS due to lack of experience there). When I say 'less than optimal oxygenization', I don't mean serious distress--just breathing that isn't perfect, needs some support, and does improve with non-invasive measures fairly rapidly. It took that doc, on the phone after a thick-mec birth, telling me to stay home with that baby, to prove to me that this is true--he helped inspire my confidence in staying home where I saw the evidence with my own eyes. I once was afraid of mec aspiration and RDS, as a matter of training to the medical religious beliefs about it. First belief being 'the med ppl know and do best--so when in doubt, hand it to them'. And with RDS/MAS, all other beliefs springing off of that primary one "deleeing is best care", "antibiotics round is best care", "oxygen is good", isolation from mother is good, etc. These are beliefs only, not truths, and in my pov, since they are beliefs that grow out of the mechanistic approach to the human body and life, they are not exactly to be relied upon. My way is to see the whole picture, in any event, as best I can. All too easy to be distracted by retractions for instance--and to miss the baby's actual color, ability to bf, etc. Working to see the whole picture helps dispell the fear that is based on those medically inspired beliefs, and can lead to calm, sane responses to a situation rather than too-hasty over-reaction.*

Sorry Mrs. Black, I totally disagree. I've seen babies go down the tubes faster than you can sneeze. There is a reason for "over reaction" as you call it. We know the difference between slow to transition and distress.

A pathologist doesn't see live people so I'm not sure what expertise he could claim on this subject.


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## BugMacGee (Aug 18, 2006)

The other thing I have to say about this is that I've seen countless ex-preemies/ sick term kids, who've spent days/weeks intubated and experiencing other noxious oral stim., go on to sucessfully breastfeed.
I have a hard time believing that a couple seconds of suctioning has any effect (unless those babies aren't that resilient after all)

But as I said before, I don't suction unless babies need it.

And a bulb syringe you're using is the size of a baby's head, you have the wrong brand!


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## cottonwood (Nov 20, 2001)

Quote:


Originally Posted by *BugMacGee* 
I have a hard time believing that a couple seconds of suctioning has any effect (unless those babies aren't that resilient after all)

So you think everything said here about the possible negative effects is completely untrue? Irritation of the nasal passages? Vagal response? Oral aversion? That it doesn't prevent MAS?

Quote:

But as I said before, I don't suction unless babies need it.
Of course not. But everyone defines "need" differently, and how you define it depends partly on what assumptions you've made based on previous experiences with it. This is how all myths in obstetrics stay alive.

Quote:

And a bulb syringe you're using is the size of a baby's head, you have the wrong brand!
Actually said: "...and the bulb syringe is relatively small for you -- the small bulb is about the size of a baby's fist"


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## BugMacGee (Aug 18, 2006)

SOmeone was talking about making a paper mache bulb syringe roughly the size of a baby's head.

With gentle bulb suctioning, i don't think you are going to get irritation of the nasal passages (I think leaving mec in there would be considerably MORE irritating as it does contain digestive enzymes)
I know suctioning doesn't prevent MAS. I've read all the studies. That's why we don't suction on the perineum and we don't intubate vigorous mec stained infants.

YOu aren't going to stimulate the vagus unless you go pretty darn deep. Difficult to do with a bulb.
Even with the catheter, you don't get vagal stim really anymore than a baby would bearing down for a poop. Again, we don't do this except for mec babies or babies born through a lot of blood (as in partial abruption etc.). Blood is pretty irritating to the stomach and is often regurgitated. Which, though it may be benign, tends to freak people out. IME, babies nurse better if they don't have a stomach full of meconium/blood.

Oral aversion after a few seconds of gentle suctioning??? That certainly wouldn't be evidence of the "resilience" theory would it. I'm not denying it's existence, but I see it in babies that couldn't eat for weeks due to GI surgery or other severe illness. Not term babies who had a pass with a bulb syringe.

Just my experience....Sleepy whiny babe calls.


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## cottonwood (Nov 20, 2001)

So, what I hear you saying is that suctioning is wholely benign. Is that right?

Quote:


Originally Posted by *BugMacGee* 
SOmeone was talking about making a paper mache bulb syringe roughly the size of a baby's head.

Where?









Quote:

YOu aren't going to stimulate the vagus unless you go pretty darn deep. Difficult to do with a bulb.
I'm not an expert on this and could be wrong, but as I understand it the vagal response does not have to include direct stimulation of the vagus nerve. In any case, stimulating any part of the back of the throat (which the long stem of a bulb syringe can _easily_ reach in an infant) is irritating and certainly does trigger a reflex. All I have to do is gently touch the area beyond the roof of my mouth with my finger, and it's very unpleasant. I've just done it and can still feel the irritation half a minute later. No, such a thing might not interfere with a newborn from breastfeeding easily; on the other hand, it might. Having been assaulted once, the natural reflex might be to withdraw from whatever was put next in the mouth.

We can dismiss that as unimportant in the grand scheme of things, sure. We can also dismiss the pain that infants feel when being circumcised as unimportant, because they don't remember it, right? Or being born into a world of bright lights, or slapped to start crying, or rubbed roughly with towels, or gettings shots and eye goop and being separated from the mother. _All_ of that is defended on the basis that the baby is alive, and they don't remember it, and eventually things settle down, eventually the baby breastfeeds and eventually the baby doesn't cry "for no reason" and eventually the baby doesn't have stranger anxiety, etc.

I really think that this is at base a philosophical issue. Scientifically, we can say it's not necessary except in extreme situations (that, incidently, are much more likely in managed birth.) But "not necessary" is not the same as "hurtful", so that unless I can prove it to be hurtful, whether you do the thing or not comes down to personal preference. _I_ feel it important not to subject the baby to that crap _regardless of whether it has long-term harmful effects._ Hospitals workers generally don't see it as an issue, because their goal isn't to protect the sanctity of the individual, it's simply to pass another living object along on the conveyor belt.

Quote:

Oral aversion after a few seconds of gentle suctioning??? That certainly wouldn't be evidence of the "resilience" theory would it. I'm not denying it's existence, but I see it in babies that couldn't eat for weeks due to GI surgery or other severe illness. Not term babies who had a pass with a bulb syringe.
Well, first, we weren't talking specifically about gentle suctioning, and gentle suctioning is not what is usually done in any case. Gentle, to me, is by definition using a mouth or finger (a sensing thing) to do it, not poking a long pointy nonsensing tool inside a sensitive orifice.

Second, the "resilience" is evidenced by the baby going on to successfully breastfeed _in spite of_ a response to negative stimuli, not by having no response at all.

Third, there's certainly a spectrum between no issues at all and "not eating for weeks." Breastfeeding can be successful but still not perfectly easy, and the care provider isn't privy to the whole process in any case. My midwife sat with me for an hour after the birth, came the next day, watched me, gave me tips, came a week later, watched and gave more tips, and came again at six weeks. She had no idea what it was really like for me, what happened in all the moments in between. I couldn't have even put it into words if I'd tried. There is a world of difference between the observance that "he is able to breastfeed" and the actuality of starting and maintaining the breastfeeding relationship.


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## mwherbs (Oct 24, 2004)

so for the most part we are talking the same thing right-- that say 90% atleast of babies are not going to need anything- bulb or delee--I think that is what the intent of this thread not to necessarly hash over the 10% we may or may not end up suctioning -- but the vast majority of babies that really and truly do not need the suctioning and if there is no problem then things like swelling and struggling with an amount of nipple aversion is more than you really should have to work at over coming -- there is a range of sensitivity and I think you will agree with that. I have seen mild suctioning very mild suctioning cause some swelling of the nose (and babies are obligate nose breathers)
babies that are sneezing and coughing and it is normal mucous nothing more- why would I bulb that baby or delee? parents and many providers at this point think that something should be done, I would say nope the baby is fine- the action is self-clearing-- yes observe yes pay attention
when my oldest was born they held babies up by their feet- to drain the mucous and to help circulation (I guess) with that swat on the bottom-- how often do you see that now?
at my local hospitals where there are neonatalologist on staff they don't bulb or deep suction the babies- no bulb except for resuscitation unless there is some OB that grabs a bulb out of old habit and does it but most of the time the nurses try to keep it out of reach so it doesn't happen.


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## BugMacGee (Aug 18, 2006)

*Hospitals workers generally don't see it as an issue, because their goal isn't to protect the sanctity of the individual, it's simply to pass another living object along on the conveyor belt.*

Sorry 4littlebirds, I take very serious offense to this statement. Your perception is not fact, do not state it as so.

Wow.

*Breastfeeding can be successful but still not perfectly easy, and the care provider isn't privy to the whole process in any case. My midwife sat with me for an hour after the birth, came the next day, watched me, gave me tips, came a week later, watched and gave more tips, and came again at six weeks. She had no idea what it was really like for me, what happened in all the moments in between. I couldn't have even put it into words if I'd tried. There is a world of difference between the observance that "he is able to breastfeed" and the actuality of starting and maintaining the breastfeeding relationship.*

I work in a NICU where babies stay for often long periods of time. I see them breastfeeding. Not to mention the very successful breastfeeding I did of my own children (one of whom had mec and was suctioned at birth!) Seriously, breastfeeding was about the easiest thing I've ever done.
I have seen nothing, NOTHING in my years of experience attempting to "pass living objects on the conveyor belt" that indicates that suctioning, on it's own, did any damage to the BF'ing relationship. Come by the unit someday and I'll show you! It takes a lot more to create oral aversion.

I'm not trying to say we SHOULD suction every baby. Totally not my point. I just don't think it's a particularly damaging intervention.

PS, you vagal any time you bear down. Doesn't cause any lasting damage.


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## Reha (Jul 16, 2004)

Thank you, MsBlack, for sharing about that doc. It is good to hear of docs out there like that (able to still see, not being blinded by his training, etc.) .

I can only think of a very rare situation where I would ever suction, and it would only be to clear an airway (if it wasn't clear) for needed resuscitation. From what I have seen, babies ARE resilient, but I don't interpret that to mean that they will be fine in spite of interventions, but that they come through birth so amazingly well almost all of the time if they are NOT messed with.


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## mwherbs (Oct 24, 2004)

so here are some relatively small studies but what I see even through the years- that there is consistent findings---except the one done in 04- they all agree that oxygen stats are better in the un-sucitoned baby-- but even with the findings of the 04 study being different- "findings were not considered clinically significant because values remained within normal parameters."

Aust N Z J Obstet Gynaecol. 2005 Oct;45(5):453-6.

Oronasopharyngeal suction versus no suction in normal, term and vaginally born infants: a prospective randomised controlled trial.
Gungor S, Teksoz E, Ceyhan T, Kurt E, Goktolga U, Baser I.
Department of Obstetrics and Gynecology, Gulhane Military Medical Academyand Medical School, Ankara, Turkey. [email protected]

This prospective randomised controlled trial aimed to compare the effects of
oronasopharyngeal suction with those of no suction in normal, term and vaginally born infants and was performed at a Turkish tertiary hospital from June 2003 to January 2004. A total of 140 newborns were enrolled in the trial (n = 70 per group). The no suction group showed lower mean heart rates through the 3rd and 6th minutes and higher SaO(2) values through the first 6 mins of life (P < 0.001). The maximum time to reach SaO2 of >or= 92% (6 vs. 11 min) and >or= 86% (5 vs. 8 min) were shorter in the no suction group (P < 0.001).

PMID: 16171488 [PubMed - indexed for MEDLINE]
----------------------------------------------------------------------------------------------------------
Gynecol Obstet Invest. 2006;61(1):9-14. Epub 2005 Aug 19.

Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial.
Gungor S, Kurt E, Teksoz E, Goktolga U, Ceyhan T, Baser I.
Department of Obstetrics and Gynecology, Gulhane Military Medical Academy and Medical School, Ankara, Turkey. [email protected]

BACKGROUND/AIM: There are controversies about the routine use of
oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. METHODS: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. RESULTS: The mean SaO(2) values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO(2) of > or =92% (6 vs. 11 min) and > or =86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. The mean heart rates were consistently and significantly lower
in the no suction group during the first 6 min except the second one. All
neonates without suction had an Apgar score of 10 at the 5th min, while the mean +/- SD for ONPS group was 9.34 +/- 0.48 (p < 0.001). CONCLUSION: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section. Copyright 2006 S. Karger AG, Basel.

PMID: 16113579 [PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------------------------------------------------
1: J Pediatr. 1997 May;130(5):832-4.

Oronasopharyngeal suction at birth: effects on arterial oxygen saturation.
Carrasco M, Martell M, Estol PC.
Department of Neonatology, School of Medicine, University of Uruguay, Montevideo.
The effect of oronasopharyngeal suction (ONPS) on arterial oxygen saturation
(SaO2) is described in a controlled study of 30 normal term newborn infants. In 15 of them, ONPS was performed immediately after birth. The SaO2 value was recorded through a pulse oximeter. The ONPS group had a significantly lower SaO2 between the first and the sixth minutes of life and took longer to reach 86% and 92% saturation. According to this study, ONPS should not be performed as a routine procedure in normal, term, vaginally born infants.

PMID: 9152298 [PubMed - indexed for MEDLINE]
----------------------------------------------------------------------------------------------
J Midwifery Womens Health. 2004 Jan-Feb;49(1):32-8.

Building evidence for practice: a pilot study of newborn bulb suctioning at
birth.
Waltman PA, Brewer JM, Rogers BP, May WL.
Undergraduate Program, University of Mississippi School of Nursing, University of Mississippi Medical Center, Jackson 39216-4505, USA. [email protected]

The purpose of the study was to examine the effects of bulb suctioning on
healthy, term newborns and the feasibility of conducting a large-scale study of this practice. In a randomized, controlled two-group design pilot study, 10
newborns received oronasopharyngeal bulb suctioning at birth and 10 did not.
Differences in Apgar scores, heart rates, and oxygen saturation levels were
determined. Infants were randomized to groups before delivery. The participants were 20 term, healthy newborns of uncomplicated pregnancies. Apgar scores, heart rates, and oxygen saturation levels in the first 20 minutes of life were the main outcome variables. There were no statistically significant differences in Apgar scores between groups. Apgar scores at 5 and 10 minutes were 9 or 10 for all newborns. Newborns receiving bulb suctioning showed a statistically significant, lower heart rate (P=.042) during the first 20 minutes and a significantly higher SpO2 level (P=.005) by 15 minutes of age. Although statistically significant,these findings were not considered clinically significant because values remained within normal parameters.

PMID: 14710138 [PubMed - indexed for MEDLINE]
------------------------------------------------------------------------------------------------------------------------------


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## pamamidwife (May 7, 2003)

One fault of many care providers is to cont doing something based on anecdotal theories. We need to really look at the evidence...

As a midwife, I have the gift of being able to practice evidence based medicine. Nearly all of obstetrics...and neonatal care, is not evidence based. Its fear of being sued based. So when you do more it looks better to a court.

I just wonder why we need studies to show something is harmful to get is to stop doing things. Shouldn't it be the other way around??


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## happyblessedmama (Sep 6, 2003)

just a couple of comments.

My 4th baby (hospital birth) was not suctioned, but was gagging on accumulated fluid/mucus and was spitting up feedings (not like normal spitting up). The nurses suctioned her out and it did help and she went on to quit puking the feedings and such. So I'm glad they did that.

Point #2 - my 3rd baby had heavy meconium staining and did aspirate. She had a ton of it in her mouth/esophagus as well, I remember as they were handing her off to the neonatal team that she was draining it from her mouth in a scary amount. not fun. It does happen.


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## MsBlack (Apr 10, 2007)

BugMagee--

I was wondering if you worked in a hospital. The problem here as far as the seemingly great difference in our 'conclusions' about things, maybe, is the great difference between home and hospital birth (generally speaking, since of course there are always exceptions--and in any setting, not all caregivers are just alike).

You see babies born in the hospital, where first, pregnancy is laden with a great deal of methods that both inspire fear of birth in moms/dads, and also work to suppress women's instinctual understanding and behaviors at birth. Parents are exposed to verbal teachings that do this--such as "you will need an IV/EFM during labor, for safety's sake"; they are also exposed to non-verbal teachings such as routine GTTs, u/s, etc--which act to impose the idea (oft repeated) that pregnancy and birth are disasters waiting to happen. Such methods are generally offered blankly or even kindly 'it's time for your GTT' or 'just to be sure that all is as well as we think, we offer the GTT at this stage'. Those who attempt to resist, are most often threatened overtly or covertly "I won't keep you as a client if you don't"; "your baby could die of GD if we don't test"; "this is for your baby's good, don't you care about your baby's safety?" (all things which women I know, have been told)These things concurrently impose along with a basic fear of birth, the idea that the power and understanding in these matters arises and belongs naturally with the HCP, NOT the mother/parents. In saying this I do not fault anyone; it is simply the way things are structured with med practice, with agreement of both patient and practitioner who participate in it (those who don't agree, will get out).

Then we get to birth--where most often, women's labors are 'managed' with numerous fear-and-dystocia inducing factors such as being forced to either stay on a bed altogether, or only to move around with IV kit in tow. Even without those particular things, women/fams have to deal with strangers and strange surroundings, the ever-present hospital voice, meds or the pressure to get meds, 'being on the clock', etc. Few are the women who, by that time, are able to feel relaxed and trusting of the process; few are those who are able to have a truly 'normal' birth (tho I am aware that it can happen, it is simply NOT the norm). As you are no doubt aware, most babies emerge from their mamas only after pitocin induction and/or csection and/or epidural/other pain meds and/or instrumental delivery and/or long periods of purple pushing with mom on her butt/sacrum--or the moms simply having been forced to remain on a bed for most if not all of their labor, with little to no caloric intake for many hours, and acting mostly under outside instruction rather than natural instinct.

Nearly all babies who arrive to you at NICU have been exposed to numerous factors as named above. Sure, even a relatively unhindered mom could give birth to a mec baby, for instance--but I'm sure you know that it is not the unhindered moms who are likely to have a baby that needs NICU, it is the births where medical procedures and treatments were involved. And I submit to you that what you see--babies who bottom out rapidly, and demonstrate clear need for what NICU offers--is a direct result NOT of birth, or meconium, or group b strep, etc...it is a direct result of the way pregnancy and birth are conducted, generally and particularly, in the medical realm. It is NOT the mec that causes the problems for the baby, not the mec that we should fear. It is everything else before the mec--adding a huge degree of stress to the whole process for baby-- that compromises the baby's natural vigor and innate ability to deal with mec in a naturally health-promoting way. The actions of stress ('dis-stress', not normal, health promoting birth stressors) against well-being and normal physiological functioning has been long established.

Because you only see one kind of baby--the baby who is the product of the medically managed birth--it is not surprising that your beliefs about mec and suctioning and managing RDS are what they are. This is the way it is for all of us--we tend to believe what we see, and to be taught by our experiences...and not to believe what we don't see, not to believe others' experiences if those differ by much from our own. Our 'truths', our understandings of 'reality', are generated from our underlying beliefs and the methods we use. Those truths are reiterated and more fully supported/confirmed all the time, by the environment in which we operate and the 'knowlege' which is presented to us 'by the book' *and* by the happenings around us. It's just part of the way humans tend to work.

In a homebirth tho, all is much different. At least, with a holistic practitioner who believes more in women and birth than she does in her own 'skills'/methods! In prenatal care, families are taught that the processes of pregnancy and birth are normal, healthy things, and they are taught how to support those processes with diet/lifestyle/stress management. measures. Fear is understood as part of many people's process of arriving at safe birth, but midwives tend to try to help fear get laid to rest (with info and support) rather than maximizing it so they will have more control over the mother and birth 'for their own good'. Birth is approached gently, as both a sacred and normal thing in which a woman and her baby can be trusted to figure out the dance in peace. There will be little if anything by way of restricting movement/positioning, food/fluid etc, and little if anything by way of meds or 'procedures' beyond checking FHT and dilation. Relaxation and good natural oxygenization is supported/encouraged. There will be no strangers present, and usually nothing done without permission/informed consent. (to state it very generally, tho of course exceptions occur). Variations that arise as 'potential problems' for mom or baby, are typically addressed first, with the line of least interference--such as poor FHTs, which often resolve w/maternal position change, rather than getting worse.

Arriving at birth in this calm manner then, and immediately kept in contact with moms/dads, means that even a mec baby is far better able to deal normally with mec's expulsion right away, and far better equipped to deal with the sequelae of mec aspiration should that occur. You see relatively often, then, what I will see only very rarely if ever. Even without epidural/other pain meds in a baby's system, a baby who has had to deal with the number of interferences and dis-stressors of a typical hospital birth is going to be compromised by stress alone. And at home, more typically even a baby who has mec aspiration, is NOT being compromised by excess stress otherwise, and thus is better able to cope with the challenges of MAS/RDS without suctioning, oxygen, antibiotics, etc.

As for the mec/e. coli connection you name, I can only say this: it is not germs that scare me. Germs of all types are everywhere all the time--the most virulent of which reside in hospitals anyway. It is not the germs that worry me--it is a baby (or mom) whose natural resistance to germs has been compromised by stress and/or pain meds or antibiotics, that worries me. In your world, the invasive and chemical methods are seen as necessary and a help to babies at risk. In my world of birth, it is things like immediate and near-constant skin to skin contact and bf, minimizing distractions and interferences, keeping things calm for parents and baby, that are understood as the 'best medicine' for any baby--psychologically as well as physiologically, but perhaps especially for the baby who at risk for MAS/RDS or sepsis or any other thing.

So, I believe my doc who said 'keep him home!' when I had my first case of thick mec with a fairly vigorous baby--I believe that in keeping this babe home, I minimized the chance that his 'difficulty transitioning' would progress to full blown MAS. I believe that his constant contact with his mom, in his own home, and subjected only to first line respiratory therapies such as steam, percussion and immersion--which he seemed to greatly enjoy--were things that acted to protect him most fully from crossing that line into the danger zone and instead, showing fairly rapid and constant improvement. Transport alone would have been a stressor. Deep suctioning, isolation from family, bottle/tube feeding, strangers, antibiotics, all of it would have constituted a magnitude of stressors that would be all too likely to push him over that line. Stress burn calories and uses up psychological and physical resources to maintain the body. Relaxation promotes fuller functioning of immune system and all other systems.

For whatever reasons, many families choose hospital birth and are willing and even happy to have themselves and babies treated in the medical way. Surely the day will come when I meet the baby or mom who will truly be beyond what I can offer/support at home--and then I'll be glad for the hospital too, and glad to help such a family see the bright side and the competent caring providers within a needed transport. And still--I hope that you understand that the 'reality' you see in your work is a reality formed by the underlying beliefs and practices there, NOT a 'given' or 'only' reality to be had concerning birth and babies. I hope that when you believe what you see where you work, you will look at the larger picture; not just at those babies who bottom out fast and need advanced intervention--but at how those babies came--throughout pregnancy and certainly through what happened at their births-- to be in a condition where bottoming out fast became so likely.


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *happyblessedmama* 
just a couple of comments.

My 4th baby (hospital birth) was not suctioned, but was gagging on accumulated fluid/mucus and was spitting up feedings (not like normal spitting up). The nurses suctioned her out and it did help and she went on to quit puking the feedings and such. So I'm glad they did that.

Point #2 - my 3rd baby had heavy meconium staining and did aspirate. She had a ton of it in her mouth/esophagus as well, I remember as they were handing her off to the neonatal team that she was draining it from her mouth in a scary amount. not fun. It does happen.

Christie, it is not my intention to invalidate your experience. I know babies do get mucusy and they gag quite a bit, even spit up in the first 48 hours. This is a perfect design system to clear out their throat and stomach.

With your third baby, heavy meconium staining - even in the mouth - does not require suctioning. Babies do not inhale meconium with that first breath - and they do not have issues with swallowing meconium. In fact, if your baby had mec before birth, babies swallow the amniotic fluid and likely had way more in her stomach than what what in her mouth. I do not believe that we were designed to have to be deeply suctioned when this occurs since it is natural for many babies - even with distress.

The evidence shows us that suctioning - even with heavy meconium - is not necessary or beneficial unless the baby needs resuscitation or intubation.

I know that your second scenario was quite possibly very scary because of the anxiety of the situation. However, part of what compounds the issue is the suctioning (leading to lower heart tones from a vagal response which could seriously lead to inhalation of the meconium) and the immediate cutting of the cord.

I think if you go back and read the whole thread, you will find some solid studies to back up NOT suctioning unless the baby was completely floppy and heart tones were bad. I have seen babies with good tone, though they hadn't taken a breath yet, and when the suctioning starts, the heart rate goes done and their tone is nearly absent. It's like the baby just gives up after the assault to them.

Again, if you're talking about a baby that NEEDS resuscitation (with a bag valve mask or endotrachael intubation, not blow by oxygen), then that's another story. However, suctioning just because of meconium isn't something that is evidence-based or necessary.


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## pamamidwife (May 7, 2003)

Thank you, Ms Black for pointing out the vast difference in anxiety, population exposure, and risks that are different between homebirth and hospital birth.

There is more and more evidence to show us that meconium aspiration:

1) does not occur with the first breath
2) usually happens from inhalation of meconium in utero because of hypoxia (lack of oxygen because of distress) - it's the baby's natural response and last effort to take in some oxygen
3) babies that are pre-term or have other illnesses (such as those born to moms with chorioamnionitis) are at higher risk for MAS simply because of their situation - even if there is no meconium present. We call this pneumonia, but for some reason if there is even slight mec present, it gets labeled as MAS.

I feel very fortunate to be an independent practitioner that can practice what they evidence shows us to be true. What has been the hardest thing, as I would imagine would be for any provider, is unlearning some of the more non-benificial (is that even a word??) practices and routines I have always been taught were necessary for good outcome. Fortunately, being up to date on evidence - and just being aware of how normal and uncomplicated uninterfered birth is - makes my experiences very, very different than those that practice in the hospital. In a hospital setting, I wouldn't have individual choice so it would be natural to assume that what I was doing was beneficial. I don't think many people could survive in a profession doing things that they knew was possibly harmful or not necessary.


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## jessjgh1 (Nov 4, 2004)

That was one thing that bothered me about the Gentle Birth Choices video... almost every time the attendants RUSHED over to suction the babies... and it just disturbed the whole flow.

Jessica


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## MsBlack (Apr 10, 2007)

Non beneficial...hmmm...maybe detrimental?

I like words









Otherwise, yeah, what you said!


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## BugMacGee (Aug 18, 2006)

*part of what compounds the issue is the suctioning (leading to lower heart tones from a vagal response which could seriously lead to inhalation of the meconium)*

You're contradicting yourself here Pam. YOu're correctly pointing out that MAS likely occurs before birth, but then saying that suctioning causes it.

And btw, mec aspiration had a very specific appearance on x-ray. Easily differentiated from pneumonia from other causes. But mec does cause chemical pneumonia. Clear as mud eh? It also often causes persistent pulmonary hypertension, which not all other pneumonias do. So we're not calling all pneumonias MAS just because there was mec present. Though untimately, many of the treatments are the same.

Vagal response d/t suctioning does NOT cause MAS. Babies DO NOT have persistent bradycardia from a vagal response (though they wight with a compromised airway! Hence the Airway, Breathing, Circulation axiom) Bradycardia in infants is almost always due to a respiratory issue anyway. Bradycardia does not cause the gasping.

After hundreds and hundreds of births, I think I have a pretty good feeling for those babies that could benefit from suctioning. I've had one kiddo (ONE!!!) that developed MAS and had to have an ECMO run. But his insult occurred wayyyyy prior to delivery, he was bradycardic when mom arrived in labor.


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *jessjgh1* 
That was one thing that bothered me about the Gentle Birth Choices video... almost every time the attendants RUSHED over to suction the babies... and it just disturbed the whole flow.

Jessica

yeah, I had really hoped that Barbara would have updated the video a bit...the manipulations of the babies heads was also hard to watch. however, this video is NOWHERE as bad as Special Delivery. Oy.


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## ~MoonGypsy~ (Aug 21, 2006)

Quote:


Originally Posted by *jessjgh1* 
That was one thing that bothered me about the Gentle Birth Choices video... almost every time the attendants RUSHED over to suction the babies... and it just disturbed the whole flow.

Jessica

This is actually what drew me to this thread in the first place. We just watched Gentle Birth Choices in my Childbirth class on Monday and I really was taken back by how rough the suctioning was, how it interrupted the flow of things and how utterly useless it seemed to be.


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## BugMacGee (Aug 18, 2006)

Quote:


Originally Posted by *mwherbs* 
so here are some relatively small studies but what I see even through the years- that there is consistent findings---except the one done in 04- they all agree that oxygen stats are better in the un-sucitoned baby-- but even with the findings of the 04 study being different- "findings were not considered clinically significant because values remained within normal parameters."

Aust N Z J Obstet Gynaecol. 2005 Oct;45(5):453-6.

Oronasopharyngeal suction versus no suction in normal, term and vaginally born infants: a prospective randomised controlled trial.
Gungor S, Teksoz E, Ceyhan T, Kurt E, Goktolga U, Baser I.
Department of Obstetrics and Gynecology, Gulhane Military Medical Academyand Medical School, Ankara, Turkey. [email protected]

This prospective randomised controlled trial aimed to compare the effects of
oronasopharyngeal suction with those of no suction in normal, term and vaginally born infants and was performed at a Turkish tertiary hospital from June 2003 to January 2004. A total of 140 newborns were enrolled in the trial (n = 70 per group). *The no suction group showed lower mean heart rates through the 3rd and 6th minutes* and higher SaO(2) values through the first 6 mins of life (P < 0.001). The maximum time to reach SaO2 of >or= 92% (6 vs. 11 min) and >or= 86% (5 vs. 8 min) were shorter in the no suction group (P < 0.001).

PMID: 16171488 [PubMed - indexed for MEDLINE]
----------------------------------------------------------------------------------------------------------
Gynecol Obstet Invest. 2006;61(1):9-14. Epub 2005 Aug 19.

Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial.
Gungor S, Kurt E, Teksoz E, Goktolga U, Ceyhan T, Baser I.
Department of Obstetrics and Gynecology, Gulhane Military Medical Academy and Medical School, Ankara, Turkey. [email protected]

BACKGROUND/AIM: There are controversies about the routine use of
oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. METHODS: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. RESULTS: The mean SaO(2) values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO(2) of > or =92% (6 vs. 11 min) and > or =86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. *The mean heart rates were consistently and significantly lower
in the no suction group during the first 6 min except the second one.* All
neonates without suction had an Apgar score of 10 at the 5th min, while the mean +/- SD for ONPS group was 9.34 +/- 0.48 (p < 0.001). CONCLUSION: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section. Copyright 2006 S. Karger AG, Basel.

PMID: 16113579 [PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------------------------------------------------
1: J Pediatr. 1997 May;130(5):832-4.

Oronasopharyngeal suction at birth: effects on arterial oxygen saturation.
Carrasco M, Martell M, Estol PC.
Department of Neonatology, School of Medicine, University of Uruguay, Montevideo.
The effect of oronasopharyngeal suction (ONPS) on arterial oxygen saturation
(SaO2) is described in a controlled study of 30 normal term newborn infants. In 15 of them, ONPS was performed immediately after birth. The SaO2 value was recorded through a pulse oximeter. The ONPS group had a significantly lower SaO2 between the first and the sixth minutes of life and took longer to reach 86% and 92% saturation. According to this study, ONPS should not be performed as a routine procedure in normal, term, vaginally born infants.

PMID: 9152298 [PubMed - indexed for MEDLINE]
----------------------------------------------------------------------------------------------
J Midwifery Womens Health. 2004 Jan-Feb;49(1):32-8.

Building evidence for practice: a pilot study of newborn bulb suctioning at
birth.
Waltman PA, Brewer JM, Rogers BP, May WL.
Undergraduate Program, University of Mississippi School of Nursing, University of Mississippi Medical Center, Jackson 39216-4505, USA. [email protected]

The purpose of the study was to examine the effects of bulb suctioning on
healthy, term newborns and the feasibility of conducting a large-scale study of this practice. In a randomized, controlled two-group design pilot study, 10
newborns received oronasopharyngeal bulb suctioning at birth and 10 did not.
Differences in Apgar scores, heart rates, and oxygen saturation levels were
determined. Infants were randomized to groups before delivery. The participants were 20 term, healthy newborns of uncomplicated pregnancies. Apgar scores, heart rates, and oxygen saturation levels in the first 20 minutes of life were the main outcome variables. There were no statistically significant differences in Apgar scores between groups. Apgar scores at 5 and 10 minutes were 9 or 10 for all newborns. *Newborns receiving bulb suctioning showed a statistically significant, lower heart rate (P=.042) during the first 20 minutes and a significantly higher SpO2 level (P=.005) by 15 minutes of age.* Although statistically significant,these findings were not considered clinically significant because values remained within normal parameters.

PMID: 14710138 [PubMed - indexed for MEDLINE]
------------------------------------------------------------------------------------------------------------------------------


Bolding mine.

Pretty inconsistent findings.

SInce we don't measure sats at birth, we're more concerned about hr. Two of these studies are saying the no suction group had lower hr than their suctioned counterparts. That would concern me.

Any evidence of *damage* from bulb syringing? Cause I haven't found any. SOmeone mentioned nasal inflammation. I'm curious how you would assess that. Unless it was GROSS inflammation, which occluded the nares (which might indicate the baby has bigger problems with such an acute inflammatory response) it would be really hard to tell. We use otoscopes to check for irritation with our NCPAP kiddos. No other way to tell really.

And I agree that babies are resilient. I see it every time I go to work. Wee little miracles. I see babies go through so much and turn out to be, for all intents and purposes, normal kids (we do follow many of them when they leave, some of their parents have become good friends of mine). I just have a very hard time believing that suctioning is going to cause any real harm.

I know that my practices, and those of most of my colleagues (there are the occasional bad apples, I won't deny that) is based on best practices and the clinical picture at hand.


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## pamamidwife (May 7, 2003)

wow, I guess we'll have to agree to disagree. just different approaches, I suppose.

that old theory that unless it's proven harmful, we'll just keep on doing it.









somehow I don't think any study will be recognized by you, BugMacgee. vagal response with bradycardia and resulting hypotonic babies? the fact that new NRP guidelines say that routine suctioning is not necessary? studies that show damage to newborns? hey, I guess if you can't SEE the damage there must not be any, huh? why would you use an otoscope to check for damage? don't you mean some other type of instrument? isn't an otoscope for ears? what about those babies that don't need an NCPAP? are those babies checked?

very different approaches to a newborn's experience of extrauterine life. I'm on a serious journey for gentle unhindered birth - for both mother and baby. I understand those that work within an institution rarely ever see what I see - and that's unfortunate. I also am reasonable to recognize that I see unmedicated, normal, healthy women and babies. That in and of itself is very different.

and with regards to gastric suctioning (because I sure hope that unless you're doing an ET tube, you're not sending these tubes down to the lungs!):

Re.Gastric suction at birth.
Commonly was/is used following resuc of any kind especially in the presence of meconium on the rationale that the baby might vomit and aspirate the fluid. More recent research cautions against the practice due to an association with longterm, lifelong GI disorders in the child.

For more info check out:
"Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life. " The Journal of Pediatrics, Volume 144, Issue 4, Pages 449-454. K. Anand


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## pamamidwife (May 7, 2003)

*deleted because of repeat post*


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *BugMacGee* 
*part of what compounds the issue is the suctioning (leading to lower heart tones from a vagal response which could seriously lead to inhalation of the meconium)*

You're contradicting yourself here Pam. YOu're correctly pointing out that MAS likely occurs before birth, but then saying that suctioning causes it

see, i don't think i'm contradicting myself. i just didn't end my parenthesis in the right way...it should be after vagal response. i've heard of far too many well-meaning providers that start suctioning and then insert the tube down into the lungs rather than the stomach. perhaps the lower heart tones don't lead to inhalation, but suctioning can and does.


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## Jane (May 15, 2002)

Pam, that last link is broken. It goes to a graphics file.

Someone asked upthread - why not wait for the baby to want to nurse? Well, I am willing to wait some, but I won't leave until the baby nurses well. A baby that "isn't nursing well" IMO is one that is not staying on the breast, but pulling off, getting agitated, etc, that isn't fixed by the mother's intuition, followed by some suggested position changes or other thoughts, after 2 hours or so. It's a part of having an attended birth - the midwife wants to go home if everything is okay. I certainly have stayed 12 hours after a birth for a baby that didn't want to nurse. If they don't nurse before they get really sleepy, they often want to wait until 4-6 hours later.

I suspect that sometimes the baby won't nurse because her tummy is already full of fluid. What is the capasity of a NB's stomach - 10 ml? I've seen many times the suggested capasity come out of the baby. Do they nurse because they are empty? Or for the calming effect of sucking and being close to mom? I'm not sure.


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## LemonPie (Sep 18, 2006)

Quote:

Two of these studies are saying the no suction group had lower hr than their suctioned counterparts. That would concern me.
I'd be interested to read the FULL articles and not just the abstracts (but alas, I have no subscription). However, aren't we talking context here? A lot of this depends on what is defined as a low vs high heart rate for the baby. Heart rates that fall outside certain parameters, whether high or low, in any setting are considered "bad". So it's not enough to say that the baby had a low heart rate and that proves your point.

Are we talking lower as in BETTER because an excessively high heart rate can be an indicator of a stress response in the baby? Or are we talking lower as in WORSE because the baby's heart rate isn't picking up like it should? Of course we can't answer that here, because we don't have the full text of the article. Abstracts don't tell us everything.

Jen


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## pamamidwife (May 7, 2003)

thanks, Apricot, I didn't mean for that link to get included in there.


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## mwherbs (Oct 24, 2004)

so what I saw was that babies have normal --- healthy levels with or without- the consistent findings are that these babies stay in the healthy zone with either type of care-- the post c-section babies showed something a little different didn't they from vaginal birth-- but still in normal zone even without suctioning -- which is why I included the info-- so no over all not inconsistent results-- but also yes the 2004 study showed just the opposite in trend as the 2006 study- but both agreed that all babies stayed with normal so what exactly is gained by routine stuctioning ?

so do you examine babies much who are not suctioned?


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## BugMacGee (Aug 18, 2006)

*somehow I don't think any study will be recognized by you, BugMacgee. vagal response with bradycardia and resulting hypotonic babies? the fact that new NRP guidelines say that routine suctioning is not necessary? studies that show damage to newborns? hey, I guess if you can't SEE the damage there must not be any, huh? why would you use an otoscope to check for damage? don't you mean some other type of instrument? isn't an otoscope for ears? what about those babies that don't need an NCPAP? are those babies checked?*

Are you trying to convince me that there is never place for suctioning at birth?

First, I am an NRP instructor so I'm very well aware of what the guidelines are. A couple of my attendings are on the steering committee. Secondly, I attend conferences and do extensive research on my own pertaining to neonatal care. It is my passion. So please don't tell me I'm ignoring studies. I've got a huge friggin file of them and I'm always looking for more.

These studies aren't convincing me that suctioning is *damaging* (I still don't do it routinely) And in those babies that I have suctioned, *none* of them have vagal'ed to the point of hypotonia requiring further resuscitation. Most of the start out hypotonic, then perk up with gentle stim. Resuscitations usually follow a linear pattern.

*see, i don't think i'm contradicting myself. i've heard of far too many well-meaning providers that start suctioning and then insert the tube down into the lungs rather than the stomach. perhaps the lower heart tones don't lead to inhalation, but suctioning can and does.*

I haven't ever seen a tube passed into the lungs that wasn't meant to be there. Thanks gag reflex for that one. It is far more likely to have an ET tube placed in the espohagus, though that is also very rare. You must have worked with some very incompetent providers.

Show me the research that proves that suctioning can cause inhalation. Cause I didn't find any. Vagal response can lead to bradycardia, it doesn't lead to gasping.

We use an otoscope to check for damage to the nares in our NCPAP babies because that's the only way we can see it. (which is why I question how anyone can assume nare damage just by looking at a baby) They have prongs in their noses nearing 24 hours a day (with a 15 minute break q 8) If they don't have damage to their nares, why would a baby who was suctioned once? And a baby who was suctioned once is not checked unless for some reason they require a higher level of care than bonding with mom which, in most cases, they don't. Mwherbs, we don't check the unsuctioned ones we attend except for a quick head to toe.

As for gastric suctioning, I think I've made it abundantly clear, I don't do it unless there is a large amount of blood or thick mec. Both, IME ARE irritating to the stomach, especially blood, and can inhibit BF'ing. Not to mention, the trauma you saved mom from with the suctioning will come back ten fold when babe barfs up a bunch of blood while trying to BF.

Please don't feel sorry for me. That's like me saying I feel sorry for anyone who can't help the mom of an intubated baby hold for the first time, or watch the parents of a preemie finally take their baby home. We're just about different things. I love taking care of sick babies. I love support families in crisis. I'm really good at it. As I said before, this my passion. Plus I see every kinda of differently birthed baby under the sun SO whether they were birthed gently or not is moot by the time we're in the picture in many cases.

And I have a question about delayed cord clamping since were here, what if there is evidence of placental insufficiency or abruption?


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## BugMacGee (Aug 18, 2006)

Oh and the volume of a baby's stomach is ~ 15 ml.

I know you all want to believe that we only have "medical" babies in the NICU. Well, whatever. Go to the NICU/preemie forum and have a look.


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## mwherbs (Oct 24, 2004)

you win- as far as seeing the extremes-- 1 baby with MAS in over 20 years- although I could say that luck probably had alot to do with that-- probably 2 babies with some blood swallowed- not resuscitations so not routinely suctioned but was seen in some spit up
since I look quite a bit at babies who do not have any suction at all- looking at swelling that suction produces seems clear- and I have watched babies breath hold and breath differently after being bulbed -- since the study in 04 was a pilot study-- I will write the instructor/author and see if further study has been planned.... I would like to see something on the order of several hundred or 1000---


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## pamamidwife (May 7, 2003)

i appreciate your wiilingness to discuss this. for a sick neonate, i'm glad you are there. i also know this discussion is rooted in routine suctioning.

fwiw, i never said i was sorry for you. perhaps that was your interpretation? i am glad that i see healthy newborns nearly all of the time. if i had your job, i'm not sure that i'd see birth in the same light.

still, i respect who you and what you do. i just happen to disagree when it comes to rather healthy babies and how we treat them routinely in the hospital.

and to answer your question about delayed cord clamping, I consider early clamping iatrogenic hypoxia. the immediate clamping of the cord is not something i think helps with an unresponsive baby, but alas, we have no way in the hospital to serve the needs of resusciation with the cord still intact.

if there is placental insufficiency or abruption? does UPI make the placenta more toxic? doesn't the baby still have to give back and take what is left from the placenta? i don't understand what you're asking.

for abruption - what do you mean, after the birth I'm assuming. are you talking about a depressed, non-responsive baby? again, see above about not having a place in hospitals to even resus a baby with the cord intact.

i do believe that delayed (until the placenta emerges), helps with volume in the placenta and that ensures that the placenta shears off the uterus much more evenly and efficiently. again, though, i go back to the fact that biologically we are not made to have cord clamps right away at birth. there is a specific design that is perfect - unless there are drugs in the mother's system.

if you'd like to discuss delayed cord clamping we can most certainly do that, but on a different thread. there's also the website http://www.cordclamp.com/ that makes sense to me on a physiological and scientific level.

care to debate the benefits of homebirth next? because I think I might be ready.


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## mwherbs (Oct 24, 2004)

well since we cut cords for the most part after a placenta is born- the placenta has basically come off the uterine wall -- and we resuscitate with everything still intact- right beside mom-- placenta out or not-- if a baby hasn't taken a breath we probably have not had a change in circulation yet-
stimulation and drying warmth- HR under 100 , suction then puffs, add compressions for heart rate under 80 ---

babies that have placental insuficency I hope we have them in the hosptial already-- and an abruption as well--

we should really move this to another thread--


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## LemonPie (Sep 18, 2006)

Quote:

Oh and the volume of a baby's stomach is ~ 15 ml.
Actually, on day 1, it's 5-7 mL.

http://www.llli.org/FAQ/colostrum.html

Jen


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## georgia (Jan 12, 2003)

Quote:

we should really move this to another thread--
Excellent suggestion
















Hi, everyone...just wanted to post a friendly reminder about MDC's statement of purpose:



*Quote:*

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Quote:

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*The MotheringDotCommune discussion boards serve an online community of parents considering, learning and practicing attachment parenting and natural family living. Our discussions on the boards are about the real world of mothering and are first and foremost, for support and information.*
Thanks to all for their contributions and participation


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## cottonwood (Nov 20, 2001)

Quote:


Originally Posted by *BugMacGee* 
*Posted by fourlittlebirds: Hospitals workers generally don't see it as an issue, because their goal isn't to protect the sanctity of the individual, it's simply to pass another living object along on the conveyor belt.*

Sorry 4littlebirds, I take very serious offense to this statement. Your perception is not fact, do not state it as so.

Really. I wonder what you would regard as fact, then? That the majority of managed childbirth is _respectful_ of the mother-baby unit? That it _protects_ the emotional and bodily integrity of the mother and baby? I'm sorry, but I find that laughable. In nearly all of the birth stories I have read and heard (numbering in the hundreds) and the videos I have seen, and the stories I hear from birth workers (including doctors,) and according to the clinical data that is available, that's not even close to being the case. And that includes NICU care. And yes, I'm angry about it. _I'm_ offended by the technocratic model of childbirth and by the utter lack of compassion present even when people _need_ medical care. I know that real healers exist within the system. But in my experience, that is the rare exception and not the rule. And frankly, I don't care that you're offended. I know too many people that have been deeply hurt by our medical system, and few that have actually been helped. I'm grateful that myself and my loved ones have had access to medical care when we needed it. But that doesn't nullify the fact that the system is essentially broken and _not_ about healing except in a very limited physical sense.


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## BugMacGee (Aug 18, 2006)

Oh and please give me your suggestions as to how we can better our NICU practices in your opinion.

I'm certainly open to them.


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## ericswifey27 (Feb 12, 2005)

Quote:


Originally Posted by *huggerwocky* 
My daughter wasn't suctioned at her home birth, I am sure some midwives would have done it as she wasn't crying or anything. I guess I was lucky, with the next baby I'll make sure to talk about it beforehand if I live somewhere else.

I've only seen it on TV, makes me shudder.

We share the same midwife, and ds2 _was_ suctioned. I knew it was not SOP- she said she very rarely ever suctioned, did not like to do it but felt it was necessary,(this was after an extremely long difficult labor with meconium present) but it's still nice to validate that normally that it is not done. Still not sure how I feel about it though but it is what it is ykwim?

Anyway I am filing this thread away for the next baby...


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## cfiddlinmama (May 9, 2006)

Fascinating thread. Thank you Pam for bringing this to my attention!

With my second birth, first hospital birth, the CNM decided to suction his stomach. She said that he had a lot of fluid in his stomach and he would end up spitting up colostrum. She didn't want him to waste any. Silly me, I agreed. So there's another reason for suctioning the stomach.

Also, mwherbs stated compressions for heart rate under 80. I just took the NRP class and the guidelines state compressions for heart rate under 60. Just so you know....

Anyways, thank you for the education!


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## mwherbs (Oct 24, 2004)

Quote:


Originally Posted by *cfiddlinmama* 
Fascinating thread. Thank you Pam for bringing this to my attention!

With my second birth, first hospital birth, the CNM decided to suction his stomach. She said that he had a lot of fluid in his stomach and he would end up spitting up colostrum. She didn't want him to waste any. Silly me, I agreed. So there's another reason for suctioning the stomach.

Also, mwherbs stated compressions for heart rate under 80. I just took the NRP class and the guidelines state compressions for heart rate under 60. Just so you know....

Anyways, thank you for the education!

of course you are right --- sorry -------


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## cfiddlinmama (May 9, 2006)

:


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## cottonwood (Nov 20, 2001)

Read recently at _At Your Cervix_:

"I have definitely seen babies who absolutely refuse the breast, after they have been vigorously bulb suctioned, or suctioned with wall suction and an 8 french catheter. Don't even get me started on wall suction - it truly has a time and place, but it's not for routine/normal babies! It causes stimulation of the gag reflex, which can lead to bradycardia if you keep suctioning into their stomach too much or too often." (L&D nurse)

"I was told by an experienced nurse that they over suctioning caused her nose to swell inside, which caused her not to be able to breathe well, and she put saline in the nose and it helped. I was so scared I'd go home with a baby who would die overnight after that. At one of my NST's the nurse told me they are "getting away from suctioning." "


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## QueenOfThePride (May 26, 2005)

I just had my baby a couple of weeks ago, and thanks to pamamidwife's blog and discussions in this forum, we refused suctioning. He's perfectly fine, came out screaming and didn't have any problems clearing his own airway.

Thanks!


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## georgia (Jan 12, 2003)

Please remember that the MDC User Agreement requires that we do not take personal issue with other members on threads.

Any further personally directed comments would be most appropriately taken to PM so as to not to derail the thread and to keep posts within the spirit of MDC's goal of support and community.

If there are discussion topics _other than_ routine suctioning that anyone would like to discuss, please start a new thread for future search purposes and ease of organization. As always, any questions or comments, please PM me or Arwyn









Thanks so much!


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## mwherbs (Oct 24, 2004)

to add more to this thread I thought I had read something from LLL on oral aversion -- here is a pretty good article- with some older references, but an interesting read none the less

http://www.llli.org/ba/Aug00.html

this is an excerpt from the article--
"One of the most common practices newborns encounter immediately following delivery is suctioning of the airway. NICU nurses have identified suctioning as noxious and possibly painful because it involves potential tissue damage and often elicits responses that resemble pain. 7 In one study of low birthweight babies, 75 percent of infants displayed all 4 of the specified signs of pain when suctioned, and 100 percent of the infants displayed 3 of 4 signs of pain.7 In newborns, any oral discomfort may cause an aversion to subsequent stimuli touching the mouth or lips, possibly causing more pain.6"


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## mwherbs (Oct 24, 2004)

and here is another that talks about pain- but includes suctioning as a painful procedure--

1: Arch Pediatr Adolesc Med. 2003 Nov;157(11):1058-64.

Comment in:
Arch Pediatr Adolesc Med. 2004 Jun;158(6):600; author reply 600.

Do we still hurt newborn babies? A prospective study of procedural pain and
analgesia in neonates.

Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D.
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital,
Rotterdam, the Netherlands.

BACKGROUND: Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and long-term detrimental effects. OBJECTIVE: To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population. METHODS: For 151 neonates, we prospectively recorded all painful procedures, including the number of attempts required, and analgesic therapy used during the first 14 days of neonatal intensive care unit admission. These data were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians. RESULTS: On average, each neonate was subjected to a mean +/- SD of 14 +/- 4 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6%) consisted of suctioning. Many procedures (26 of 31 listed on a questionnaire) were estimated to be painful (pain scores >4 on a 10-point scale). Preemptive analgesic therapy was provided to fewer than 35% of neonates per study
day, while 39.7% of the neonates did not receive any analgesic therapy in the neonatal intensive care unit. CONCLUSIONS: Clinicians estimated that most neonatal intensive care unit procedures are painful, but only a third of the neonates received appropriate analgesic therapy. Despite the accumulating evidence that neonatal procedural pain is harmful, analgesic treatment for painful procedures is limited. Systematic approaches are required to reduce the occurrence of pain and to improve the analgesic treatment of repetitive pain in neonates.

PMID: 14609893 [PubMed - indexed for MEDLINE]


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## photochef (Aug 14, 2005)

Since there are so many knowledgeable people on this thread, I was hoping you could give me your opinions on my situation.

Synopsis: Planned a homebirth with a midwife. Water broke for 48 hours without a single contraction. Baby's movements went way down. Midwife suggested going to the hospital for Pitocin. I accepted (shamefully) a single dose of Fentanyl as I was unprepared for the Pitocin ctx's. Labor was an hour and 43 minutes. Although I did not have a fever or elevated white count or an odor of the amniotic fluid when we went in, several hours after a lengthy 'hunt for the cervix' session I developed a fever.

By the time my daughter was born she and the fluid smelled very strongly of infection. We told them that we didn't want the cord cut before it was done pulsing. She was only out for 10 seconds before they said 'she's not breathing' and stole her away from be to put her of the baby exam table. They rubbed her and she cried immediately, but they said she had the infected water in her lungs so they deep suctioned her 4 times. I was barely aware of what was going on and couldn't get any words out to stop it. Her Apgars were 8 and 9 for color.

Several weeks later I asked the hospital midwife why she had done it that way instead of respecting our wishes and she said that because of the infection it wasn't standard of care to let her try to breathe while still getting oxygen from her cord. I asked why they had to suction her 4 times, and got the same answer (very defensive I would like to add). "Well it's better than *not* breathing, isn't it" she asked me twice - but my answer that she was, was lost on her.

So my question is this: Was this a time that suctioning was necessary to prevent something worse? I can't feel in my heart that it was, and I am so full of rage about what happened.


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## Marlet (Sep 9, 2004)

I haven't read the whole thread yet but will.

DD1 was suctioned. She was born overdosed and then suctioned and stuck on oxygen (as was I...cold enough to make my nose raw). She had trouble nursing. She just didn't want to do it...she was tired and burnt out!

DD2 was a UC waterbirth and we didn't suction (though my SIL wanted too but kept it to herself







) and there is such a difference in how she nurses! She was "wet" sounding but honestly she just came from a WET environment where she spent 9 months. We didn't expect her to sound dry! She sneezed a lot in those first couple days and then stopped sounding "wet".







If we have any more we won't be suctioning them either.


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## pamamidwife (May 7, 2003)

OMnM, you bring up a good point. Oxygen to "dry out" a baby's lungs is horrible on the baby. It's very cold and if you've ever had cold air stuck down your nose/throat, you can realize how uncomfortable it is.

Nursing a baby will help clear things out just fine. I think the idea that we need to "dry out" a baby's lungs - again - is counterintuitive to how we're designed?

Oh, how did we survive without suction devices, cord clamps and oxygen? Egads. For normal birth, none of these are necessary.


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## Lady Lilya (Jan 27, 2007)

Mine was suctioned when he was born. He gave me a hard time for nursing from the beginning. I figured it was due to the suctioning. I spent hours at a time gently persuading him to give it a try. When he would latch on, it didn't hurt and fit the descriptions I had read of how to do it correctly, so I thought everything was fine. But, on day 3 he had no dirty diapers at all. Turned out he was tongue-tied. When we counted how many sucks to a swallow, instead of being around 2 like it should be, it was more like 20 or 30. He was not interested in the breast because in his experience nothing was coming out of it. On the 5th day, we had his frenulum clipped, and within minutes he was sucking perfectly.


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## mothercat (Mar 12, 2006)

Please see comments made on the thread
Suctioning baby after birth??? (sorry, don't know how to link to that thread)
I have posted info regarding AAP and ACOG statements for suctioning at birth. It's message #16.


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## jessjgh1 (Nov 4, 2004)

it took me a while to find mothercat's post.... in homebirtht

here it is: http://www.mothering.com/discussions...5&postcount=16

Jessica


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## georgia (Jan 12, 2003)

First do no harm. Love it







Thanks so much for sharing the information, mothercat...and Jessica for finding it


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## Lady Lilya (Jan 27, 2007)

Based on that, my baby didn't need suctioning after all.


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## GatorNNP (May 17, 2004)

Hmmmmm, just chiming in... a little late. Anyhoo, I don't suction routinely at cesarean births. It isn't really supported in the literature. Anyway, hasn't anyone here ever heard of a perforated stomach? It is really fun to look at an xray with a feeding tube as soft as a usual suction catheter heading down towards the liver, hmmm!

Now, as far as the bulb, If there are copious secretions from a c/birth baby, I find that placing baby on the side, allowing fluid to collect in the cheek pocket and then gently suctioning the cheek pocket, avoiding the back of the tongue. As far as delee, I only do this if the infant is having a lot of difficulty clearing the upper airway and even then usually only pass down one side and not all the way to the stomach. That leaves one nare not all congested from suctioning and doesn't empty the stomach unnecessarily. I have seen many providers roughly bulb suction the hypopharynx of babies and this can cause delay in breastfeeding.


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## cottonwood (Nov 20, 2001)

Quote:


Originally Posted by *rowantreeinak* 
She was only out for 10 seconds before they said 'she's not breathing' and stole her away from be to put her of the baby exam table. They rubbed her and she cried immediately, but they said she had the infected water in her lungs so they deep suctioned her 4 times. I was barely aware of what was going on and couldn't get any words out to stop it. Her Apgars were 8 and 9 for color.

Several weeks later I asked the hospital midwife why she had done it that way instead of respecting our wishes and she said that *because of the infection it wasn't standard of care to let her try to breathe while still getting oxygen from her cord.* I asked why they had to suction her 4 times, and got the same answer (very defensive I would like to add). "Well it's better than *not* breathing, isn't it" she asked me twice - but my answer that she was, was lost on her.

While I understand the concern about _infected_ fluid being in the lungs, I'm wondering why she thought it would interfere with breathing. Maybe someone else can weigh in on this.

The bolded part makes absolutely no sense. If it looks like a baby should have fluid removed, they should be doing it while the baby is still attached, because obviously any difficulties breathing would be ameliorated by the fact that the baby is still receiving oxygen through the cord. It is just counter to reason to prematurely sever a baby from its most efficient life support system in order to treat it, and logically to do so would in some cases create or exacerbate problems. I assume then that they do it because it's more efficient for the birth attendants. If the situation worsens so that they have to move the baby, well, the baby is already separated from the mother so they don't have to take that extra step. As well, the baby team isn't in the mama team's space, so if the mother is hemorrhaging, for instance, they're not getting in each other's way. Understandable, but the mistake that is made is to assume that it should be routine standard of care, in other words, that the _possibility_ that it will be a real benefit (not just a convenience) to not have the baby and mother in the same space, always outweighs any other considerations.


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## cottonwood (Nov 20, 2001)

The other thread going on recently about this: http://www.mothering.com/discussions...d.php?t=742856


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## Degas (Sep 13, 2007)

My midwife at our consultation meeting said that she has to suction babies that are born in a water birth more than babies not born in water.

Will the baby have problems if not suctioned when born in water? Or would it be fine just like in a regular birth as you all have been saying in this thread?


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## pamamidwife (May 7, 2003)

Quote:


Originally Posted by *hippiekaren* 
My midwife at our consultation meeting said that she has to suction babies that are born in a water birth more than babies not born in water.

Will the baby have problems if not suctioned when born in water? Or would it be fine just like in a regular birth as you all have been saying in this thread?

This is a common misconception. Water born babies do not have to be suctioned - what are we suctioning? Goop in the mouth? Again, it's not necessary and potentially harmful. We overestimate the benefit of things like this simply because we hear babies that are 'gurgly' or 'wet'. Once babies continue to breathe and open their lungs and nurse things clear up. Midwives need to learn to just trust the process and sit on their hands. It all is a perfect design!

If you need to discuss this more with her and she still carries this belief, please have her contact Barbara Harper at Waterbirth Intl.

All hands should be off that baby unless it needs resusciation for at least the first 15 minutes to a half hour - including the routine of putting on hats and towels. Nobody touches that baby but the mom/dad!


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## phreedom (Apr 19, 2007)

Quote:


Originally Posted by *courtenay_e* 
Because it keeps them busy. Because it's something they can control. Probably because some babies who have snot/fluid in their head/gut gag on it. So they treat them all. KInd of like they treat all babies for chlamydia and gonnorhea (I know I prob. spelled that wrong) even though a tiny population are actually affected by it. Because they can.

That´s exactly why. Ugh. Seriously I have plenty of things to do to ¨keep me busy¨ than jam things down babies throats that don´t need it, just to piss parents off and exert my ¨control¨ over them.

When I attend deliveries as the nurse for the baby, I personally do not suction unless the baby needs it. And I define ¨need¨ by the baby actively spitting up huge gobs of stuff...gagging on it, turning blue...obviously blocking the air way. When this happens I turn the baby on its side and gently use the bulb syringe or the Delee to gently suction the oral cavity. I don´t cause the baby to gag and I have never had to go all the way down.

I have had to suction endotracheally on a baby that aspirtated meconium, but the baby NEEDED it. The baby was blue, limp and NOT breathing.

This is me personally...I do still see a few nurses and old school doctors that still deep suction. I know the new NRP guidelines do not recommend routine deep suctioning. For wet sounding babies I find that some gentle CPT helps break up secretions. And really sounding wet shortly after birth really isn´t a big deal...itś normal, the baby was swimming around in fluid for 9 months.


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## Lizzo (Jul 26, 2005)

I come from the training that believes bulb syringes are useless-that if you have to suction, it makes the must sense to use the delee. Not to mention most bulb syringes are sterilized with that awful carcinogenic stuff.
Funny story: I was at a birth where the granny to be was an ob nurse. This was a primip, had a beautiful, fast labor with a hard, long 2nd stage requiring lots of position changing for a nuchal hand. We break the water to see if that will help the baby come faster- and there is mec. Not much at all. So, the Granny is holding the mama on the birth stool, the baby finally comes out. he's a little stunned, but fine and the Granny FREAKS out, BEGS for this bulb syringe (which is always on the tray to be PC)and goes to town on this baby! Oh it was horrible and shocking and funny all at once!


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## janellesmommy (Jun 6, 2004)

For the midwives who do not suction: I would hope that you discuss this with your clients before the birth, and warn them that there may be some or a lot of gagging, choking, crying at first. My midwife did not use the bulb suction, and my baby cried a lot after birth. We were worried there was something wrong, and after a few hours of crying right after birth, I began to feel distant and resentful of my baby.







The crying was a result of mucous.


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## Peppamint (Oct 19, 2002)

Quote:


Originally Posted by *janellesmommy* 
For the midwives who do not suction: I would hope that you discuss this with your clients before the birth, and warn them that there may be some or a lot of gagging, choking, crying at first. My midwife did not use the bulb suction, and my baby cried a lot after birth. We were worried there was something wrong, and after a few hours of crying right after birth, I began to feel distant and resentful of my baby.







The crying was a result of mucous.

Yes, we let them know what is normal and what isn't normal regrading breathing. And that sneezing the goopies out is good, etc.

Lying the baby across your lap with the head slightly down for a couple of minutes will help stuff drain.


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