Monday, December 04, 2006

Blue Baby

I ended up not driving to meet my new preceptor. I was 20 minutes on the road when my mama due with her sixth baby called and said she was having ctx about 4-5 minutes apart and they were really hard. I took the next exit and cut over to her house, calling Faerylady on the way. After I had been there about an hour, I checked her. I couldn't even reach the os, her cervix was so far posterior. The baby's head was low, and she was having every other contraction double peak.

We stayed ALL DAY. Finally at supper time, I checked her again. The cervix was slightly further forward, but not much. We decided to go home. She was still having contractions, but was running around showing us stuff, chatting away, etc.

I got called the next morning at 4:45 AM with her sounding panicky and saying she was having contractions 3 minutes apart, really hard, with lots of bloody show. I got in the car right away. She lives 40 minutes away. I called Faerylady and she said her client had just called an hour before saying her water had broken. She wanted me to go ahead and let her know if she had a chance of making it.

I was 10 minutes from the house when the daughter called me on my cell saying "Mama's water just broke". I hit the gas harder and pulled into the drive, grabbed my prenatal bag (I had left all my other equipment set up from earlier) and ran in the house. I could hear her in the back. She was on her hands & knees on the bed and the baby's head was at a full crown. I slapped on a pair of gloves and smeared olive oil on her bottom. I supported while she pushed the rest of the head out. I then called the dad over (he wanted to catch). I told him, "I don't have the baby, I have her". He said he had the baby. She pushed and there came their baby, into daddy's hands. We passed him through her legs and she started crying and loving on her baby.

He was very calm. At five minutes, he was breathing quietly and had a good heartrate.

She started feeling contractions, but the placenta was not yet detached. About 20 minutes after birth, she had a separation gush. She pushed the placenta out. The baby started turning a dusky color. I listened and could hear some mucus/fluid in his lungs. We rubbed his back and percussed a little with a newborn face mask. About 5 minutes or 10 minutes later, he started grunting. His heartrate was still good, his respirations were a normal range for rate, but I could still hear stuff in his lungs. He was not retracting, his nostrils were not flaring. I started some blow-by and called Faerylady. She suggested to keep working with him.

The mom did not have any tearing, just some minor skin splits.

The baby would get more pink and then he'd get more blue again. If we tried putting his head lower than his body to drain, he would turn purple. He was slightly dusky to pink between his mother's breasts and upright. After continuing to work with him an hour, one lung sounded clear, but the other still sounded gunky. The mucus was so thick, that suctioning wasn't bringing it up. We decided to transport. The parents chose to go to a local community hospital. This hospital does not have a maternity section (I didn't know this) and do not every work on newborns. They tried blowby for a while and decided to intubate. The first time, they used too big of a tube.

Eventually, they stabilized him and he seemed to be getting better. They said they could hear that his ductus arteriosus had not yet closed and so his oxygenated blood was mixing with his deoxygenated blood. Plus, the mucus in his lungs was very thick. When they tried to intubate him, they caused a pneumothorax.

He was taken by ambulance to the level III hospital where they admitted him to the NICU. They said the heart sounded fine, but he had a pulmonary hemorrhage. They said that this could have happened if the ductus had not closed properly, but they didn't have any good answers. Because of the pneumothorax, there was a blood clot blocking the tube in his lungs and he was crashing as they pulled up to the hospital.

As of today they were weaning him off the oxygen. He's down to 45% at lunchtime when I talked to the parents. They said the only thing they can think of they would or could have done differently is that about 15 minutes before I said "Let's go in" that they were thinking "let's go in". But they didn't say anything, they were thinking, like I was, let's try the next thing. And he really didn't look bad when we left in the car. I really, really thought, if they suctioned him really good, or put him in an O2 tent, he would be okay. Now, because of the pneumothorax and the blocked tube, who knows how long he was really hypoxic, or anything. No idea what the long term consequences may be.

They told the parents on Saturday that he was sicker than they thought initially. His lungs continued to seep blood, and while all his cultures are negative, he still has some minor potential signs of infection, like the thick mucus in his lungs and petechiae.

All his reflexes are intact, which is a good thing, and they are keeping him sedated because he is fighting the tubes. The biggest problem has been that because his body is not using the oxygen, he keeps going into metabolic acidosis.

If you are the praying type, please pray for this baby and his family.


Cheriem said...
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Sarahthedoula said...

I am the praying type.... so I will pray for this little one who is fighting so hard for every breath. And for you, as you process your involvement with this family.