Monday, December 18, 2006

Birth Story

A long time ago, in a hospital not so far away, a woman arrived in the Emergency Room with tiny feet protruding from her vagina. They were cold and blue. No heartbeat could be detected. They rushed her to Labor and Delivery.

Since there seemed to be no hurry, the OB attending decided that this would be a good opportunity to instruct the OB resident in pre-term breech delivery techniques. Since they didn't know when the tiny heart had stopped, they thought it wise to invite the NICU team to the delivery although our presence was not expected to change the outcome.

I was precepting a new nurse, and we went through all the motions of preparing an ET tube and drawing up the resus medications. We talked about the ABC's of neonatal resuscitation while the OB attending instructed his resident. The neonatologist planned to make an attempt at resuscitation, but really didn't expect success.

You've probably deduced by now that things didn't go exactly as predicted. The OB attending talked the resident through a perfect delivery, but what happened next surprised all of us.

The baby cried.

The OB resident quickly clamped and cut the umbilical cord before handing this vigorous, if somewhat bruised, 28 week infant over to us. I don't remember the details of his clinical course - it's been over 20 years - but I'll never forget that completely unexpected, but ever so welcome wail.


frectis said...

OMG! I totally didn't expect THAT! I was expecting something more macabre. Wow.

Judy said...

The look on the OB resident's face was priceless, but I bet mine was too.

None of us expected the baby to have a heartbeat, much less cry.

Anonymous said...

Perhaps the baby experienced what's called a 'diving reflex' where when the baby is cold, he lowers his heartrate and shunts blood to the brain.

We've been taught to keep our palliative babies (non viable babies) warm, because if you let them get cold, they undergo the diving reflex, and take longer to pass away.

Judy said...

After the birth, the OB speculated that the baby, being a preemie, was so far into the pelvis that they couldn't find the heartbeat. This was 20+ years ago and the technology wasn't quite what it is now.

I don't think diving reflex applies since he was so vigorous at delivery, but that's a very interesting point about the palliative babies. We try to keep them warm, as a comfort measure, but nobody has ever suggested that the diving reflex might come into play. I wonder if there is an ethical way to find out.

Kim said...

I didn't take a breath through that entire story! Amazing!

I wonder where that baby is today, too.

What a story that mom had to tell - she must have been ecstatic at the outcome and absolutely frantic with fear before it!

What a trooper baby!

I don't think I'll be able to get my jaw off the floor for awhile!