My license is up for renewal this year (it's been two years already!!) and one of the items on my long checklist of things to do before renewing is to make sure my CPR and NRP are current.
I'll be taking a renewal CPR for health care professionals class next week, and yesterday I took my renewal NRP class. NRP stands for Neonatal Resuscitation Program, which is a program put out by the American Academy of Pediatrics. It's about handling the resuscitation (think CPR) of newborns, since they require special consideration as compared to older kids or adults. NRP is required for all licensed midwives and anyone who works with newborn babies.
The stats: About 10% of all newborns will require some help with breathing immediately after birth. Less than 1% will require extensive help with breathing immediately after birth (beyond what we can provide at home). When people ask the "what if something happens" question about home birth, this is half of what they're referring to (the other half being bleeding problems for the mom), even if they don't realize it.
Part of the midwife's job is to prevent breathing problems as much as possible in the first place. Many of the things that cause breathing problems in the baby are avoided by birthing at home (epidurals or any kind of pain meds, cesarean section, forceps, vacuum, early cord clamping), plus we don't deliver premature babies or those with any known birth defects at home. Some situations in which a breathing problem is more likely (breech births, really long labors, really fast labors, maternal bleeding, etc) make the midwife extra alert and extra prepared for a resuscitation immediately after the birth. Sometimes, though, breathing problems can't be predicted ahead of time so we are prepared to handle an emergency at every birth, just in case. This involves carrying medical grade oxygen, suction catheters, ambu bags, heating pads, and special newborn size face masks, along with having an assistant or student who is NRP certified at each birth.
One big difference between the medical management and midwifery management of neonatal resuscitation is that midwives do not separate mom and baby unless it is absolutely necessary. Some local hospitals are slowly catching on to the benefit of this, but it's a hit or miss situation. Midwives (in general) do not immediately cut the umbilical cord after birth, waiting instead until it has finished pulsing. Especially if a baby is having problems breathing, the baby needs every bit of oxygen it can still receive from the cord blood. Plus, the mother's body is already the perfect temperature on which to lay the baby so it doesn't get cold. There are a few other differences between how doctors/nurses and midwives would handle an emergency with the baby, which is why we try to take our NRP classes from someone who understands our work.
Yesterday's NRP class was taught by a former labor and delivery nurse who was super friendly and knowledgeable about home birth midwifery. She walked us through drill after drill of possible realistic scenarios involving breathing problems with newborns, using models on which we could practice everything from gentle stimulation (rubbing with a blanket or a hand) to bag and mask techniques to chest compressions for a full on resuscitation. Those "less than 1%" births where I had to actually perform or help with a resuscitation will never leave me. It's one of the worst case scenarios of our work, but it's also amazing how resilient babies can be.
Just before our class started, one of the other midwives passed around a book she had just bought that contained tons of photos of odd placentas. Midwives like to look at all kinds of funky stuff like this. I was checking out the book when I started feeling just the slightest bit queasy, which I thought was strange. Our class started and I totally started to feel like I was going to pass out any moment. What in the world? At one point I had to grab a chair and later I asked if I could crack the door for some outside air. I was so scared that I would actually pass out and completely embarrass myself in front of everyone. I suppose if a pregnant midwife was gonna pass out, that would have been the best place to do it, but I had to really fight the feeling.
When class was over, T asked me if I was okay, because she had noticed I turned a different color at one point. I told her how I was feeling and she thinks it's because the class material was super heavy (talking about dead babies and all) and that I'm probably a little more sensitive now than I used to be. I'd like to think it was really due to the fact that one muffin was probably not enough breakfast that particular day, but maybe she's a little bit right.
Good grief, when did I become such a wimp? I've never been queasy about birth stuff before, even the really hard stuff. I've never passed out, I've never thrown up, never really been bothered by the blood or pain or heart-racing moments of birth, ever. I wasn't even thinking about my own pregnancy during the class. Is this another one of those biological moments I can't fight, like my nesting urge?
I had always planned to work right up until my due date, but now I'm so relieved that I'm not providing primary care to anyone at the moment. I'm certain I could still handle an emergency if it came up, but I feel like a bit of my sharpness and quickness is missing. I definitely feel a little inept when it comes to my work at the moment, and it's not a good feeling.
In the end, I stayed on my feet during the whole class and only T knew what was going on, because we can read each other so well. We stopped for lunch and groceries at Whole Foods after class. As I was trying to decide which parking spot to take, she starts laughing at me and how different I am now that I have pregnancy brain. It's true! I am such a flaky ditz right now. I'm forgetful and clumsy and I've lost about half my normal vocabulary. I'm indecisive and I really just feel like my brain is stuffed with a bunch of cotton balls. I'm glad she thinks it's funny.
Anyway, I walked into the store and immediately spotted the hard boiled eggs at the salad bar. There are few things in this world more overpriced than a hard boiled egg at Whole Foods, but I knew right then that I needed that egg. I gave in to the urge and enjoyed my overpriced salad. I came home, sat down on the couch, and woke up an hour later with a sore neck, not even realizing I had fallen asleep.
Ay dios.
At almost 8 months, I am finally feeling really pregnant now. I totally miss my brain.
No comments:
Post a Comment