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Just breathe.... or when a baby won't

Push momma push! Baby is so close. You are doing so well. You are so strong! No, I cannot pull it out.... they are meant to be pushed out. Breathe... that's it, slow down a little and "blow out candles". Breathe. There's the head and body and "It's a ...

Those minutes are filled with relief, elation, exhaustion, admiration, shock and exhilaration and all swirl around together into a moment called birth. While you are counting fingers and toes and gazing into the eyes, the midwife is checking respirations, tone, color, activity and the general appearance of the baby. We oftentimes miss what sex the baby is ... well, because it isn't our immediate concern.

Let's discuss the normal transitional phase of the newborn. In utero, the baby's lungs have high pressure. They are filled with fluid. At the first breath, there are circulation changes within the cardiovascular system (another post for another day) and the baby is breathing air. The baby is working to absorb and expel liquid in the respiratory system. The majority of fluid is absorbed. What is normal?

Normal respiratory transitional changes in a newborn.

  • Taking a little while to cry. Sometimes 10-15 seconds may seem like a really long time when you are listening for your baby to announce their arrival. By a minute, we would like to see an APGAR score above 7. APGAR is graded in 5 areas of baby response and can receive up to 2 points in each areas making a 10 APGAR the best grade.

  • Blue on the hands and feet and lips. (acrocyanosis) It takes a little while for that circulation to transition from in utero to air to occur. Most resolve within a few hours, for some it takes a couple weeks. Primary acrocyanosis can be a genetic occurrence in a small percentage of the population and can occur with cold temperatures or emotional distress into a person's 20s.

  • Bubbles may be working their way out of the mouth. I was at a client's hospital birth because baby was a few weeks premature. Baby did amazing and as they were snuggling their newest addition, he began to bubble at the mouth. The parents were a little concerned and the nurse just handed them a bulb and showed them how to use it, stating that it was completely normal. Some babies never have this, some do. Your baby will probably start blowing bubbles about 2-3 months of age. No worries there either. :)

  • It's normal for babies to have watery or mucous vomits for the first few days after birth. As long as your baby is breathing and acting normally, this is not a concern. I had a client send me a picture once showing me a large amount of mucous, a couple days after birth. It was enough that it surprised me. I sent the picture to a local family primary care provider to be assured it was normal. So, even midwives can be surprised at what a baby will work out.

  • A respiration rate of 40-60 breaths per minute. This is the ideal. We want to see normal, non-labored, non-grunting breaths. Occasionally, a baby will have Transient (it goes away within a few days) Tachypnea (breathing over 60 bpm) of the Newborn. TTN. The lungs do not completely absorb fluid as quickly as they should. This is benign and goes away on its own. Depending on the severity, it may require hospital monitoring.

One of my most reassuring signs after birth is a baby rooting and nursing. Nursing is a wonderful sign. Nursing rarely occurs when a baby is struggling to breath. If respiratory distress is occurring, a baby will focus their entire energy on breathing. They have no interest for the breast. There is no energy to nurse. Nursing is also a great way to encourage the babies to breathe through the nose. Breathing through the nose requires babies to clear their nasal passages and often improves breathing significantly.

There are many changes taking place during the first few hours of life. Some of those happen slowly such as the ductus arteriosus valve closing with the rerouting of the blood in the baby's heart. Some transitions should happen quickly, such as the fluid leaving the baby's lungs, but it still continues for days. Also, as the placenta completely stops pulsing, it will stop providing oxygen to the baby. Some long cords can still be pulsing 30 minutes later, I have noticed most have weak pulsing until 10-15 minutes after birth. This is oxygen given to the baby. Some babies begin to show respiratory concerns when the cord stops pulsing. Leave the cord intact for as long as possible! Wharton's Jelly will begin to collapse upon the cooler out of body temperatures. It is God's design for cutting the cord. When it has done it's job, then the baby will have all their own blood supply.

Source: -- showing time lapse from birth to 15 minutes later.

What happens when the baby isn't breathing or is struggling to breathe? Some babies struggle from the moment of being born. Some progressively get worse. Some start out great with amazing APGARS and then begin to struggle later on. Some babies start out a little rough but continually get better and have no concerns before going home. We have training and tools for that. We will discuss the complications of respiratory distress in newborns and our tools in the next post.

Mavis Gunter, a UK physician, did an extensive study in 1957 on delayed cord clamping. It is a sad thing that the information has been around for as long as it has and the practice it only recently to "delay" clamp of 1-2 minutes in the hospital

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