breastfeeding gone wrong

[adpiRN]

It was my first day on L&D today and my preceptor and I had a scary moment. The new mom was trying to breastfeed, though the baby was a little sleepy and not latching on well. So we left her in the room to try while her OB was in the room chatting with her.

We came back in a few minutes later and my preceptor took one look at the baby and grabbed her and ran to the warmer, giving her a slap on the back to stimulate her. She unwrapped the baby and she was blue! The nose must have been occluded by the breast while trying to nurse and the mom and OB just didn't notice. After a few seconds of blow-by O2 she pinked right up again. But it was really scary! How common is this and how do I prevent it? My preceptor said that a baby actually once died at our hospital that way. How horrible!

[MystyqueOne, BSN, RN]

Oh My Goodness!!! That sure is scary!!! Makes complete sense that they wouldn't notice. I think maybe while attempting to BF for the first few times, NOT to have any interruptions by the OB or other staff? That way the mother can focus on trying to get baby to latch on. That's my thoughts. I'm glad to hear the baby is okay!

[CEG]

The breast does not occlude the baby's nose. Breastfeeding requires suction which requires air. A baby who is suffocating is not going to continue sucking at all costs and commit nipple suicide. It drives me crazy when people tell moms they have to hold their breasts back from baby's nose. All the baby has to do if it is not getting air is unlatch.

More than likely this baby had an episode of apnea, some transitional issues or some gunk it needed to work up. It did NOT almost suffocate on the breast.

There are cases of babies who suffocate while breastfeeding- these are cases where the mother was exhausted or under the influence of something and suffocated the baby NOT a case of normal breastfeeding causing a death.

By the way I wanted to add the according to new NRP guidelines, higher concentrations of O2 do not confer benefit over room air so baby who pinked up with a few seconds of blow by would in all likelihood have pinked up with a few seconds of room air.

[PICNICRN, BSN, RN]

The breast does not occlude the baby's nose. Breastfeeding requires suction which requires air. A baby who is suffocating is not going to continue sucking at all costs and commit nipple suicide. It drives me crazy when people tell moms they have to hold their breasts back from baby's nose. All the baby has to do if it is not getting air is unlatch.

More than likely this baby had an episode of apnea, some transitional issues or some gunk it needed to work up. It did NOT almost suffocate on the breast.

There are cases of babies who suffocate while breastfeeding- these are cases where the mother was exhausted or under the influence of something and suffocated the baby NOT a case of normal breastfeeding causing a death.

By the way I wanted to add the according to new NRP guidelines, higher concentrations of O2 do not confer benefit over room air so baby who pinked up with a few seconds of blow by would in all likelihood have pinked up with a few seconds of room air.

The NRP guidelines speak to the initial recus of the newborn...we used to give evry baby 100% FIO2 until they pinked up. Now we have found that this is not nesessarily helpful and, in fact, may be harmful in some cases. However.... this is a baby that was past that initial stage and as you said- may have had an apneic episode. It is perfectly appropriate to provide that baby with 02.

Anyway, sounds scary... I hope that baby got a work up- as the above post stated-this was most likely not at all related to the breast.

[babyktchr, BSN, RN]

I had the same thing happen. Mom had baby on breast, left the room. Call light on, went in, dad holding baby and said, "is this color ok?". Ok, so you know the color of a fetal demise....this is what I was looking at. I ran to the bedside (like OJ Simpson in those old Hertz commercials....seemingly in sllllllooooow motion) and grabbed the baby. No breathing, no HR. Took the baby to the warmer, started resuscitation and got help. The baby came back after a minute and started crying, pinked up, etc. Questioning the parents afterwards, they relayed that the baby stopped nursing and just laid there a bit, then dad took the baby. What I just could not understand is why why why would anyone think that the color blue is ever a good color for a baby? I really don't think that it matters if you have had a baby before or not, blue on anyone is just not normal. Baby was worked up and subsequently shipped to another facility. It was scary as hell. I don't think I ever left a room after that without saying, BLUE IS NOT GOOD.

[CoffeeRTC, BSN, RN]

Never heard of suffocation while nursing. TMI, but I am rather large in the chest and have nursed all my babies (currently on #5 baby at 1 month old)..never had that problem.

I'd like to hear more on this.

[CEG]

The NRP guidelines speak to the initial recus of the newborn...we used to give evry baby 100% FIO2 until they pinked up. Now we have found that this is not nesessarily helpful and, in fact, may be harmful in some cases. However.... this is a baby that was past that initial stage and as you said- may have had an apneic episode. It is perfectly appropriate to provide that baby with 02.

.

Thanks for the clarification... what would you consider the cutoff for following the "initial" guidelines. Just curious because I had never differentiated with my newborns who left my care at

[RAYLO!]

sounds like apnea to me..

[adpiRN]

I'm a newbie to L&D and it all happened so fast, so I really don't know what it was. I think the problem was the baby was not actually feeding, just pressed up against the breast. If she had actually been sucking and swallowing there would have been nothing to worry about.

Does apnea happen a lot like that to the point of turning the baby blue? How do we prevent that?

Could the fact that the mom was using an epidural during the pushing phase have anything to do with it? (or is that just a risk with narcotics used too late?)

[bagladyrn, RN]

To those who think this is not possible - I can attest that it is. I had a similar experience with a 15 year old mom with large pendulous breasts. She had been left in room nursing baby. At shift change when I went in after receiving report, found the infant in her arms with the breast tissue kind of pressed over the face occluding mouth and nose.

Mother said to me "I think he's sleeping". Infant waxen blue, no resps, heart rate in the 60's. Required bag and mask and chest compressions to resuscitate.

Young mothers with no experience need more supervision at first to make sure the infant is ON the breast, not UNDER it.

[runmommy1]

Wow! I have never heard of such a thing.....I would not have thought of it. I have learned so many new things reading these posts!!

[BabyLady, BSN, RN]

I'll be honest...I blame this on your PERCEPTOR.

Your perceptor didn't give the mother enough instruction...and that is ok when someone has just given birth...but you cannot give someone virtually no instruction and then walk out of the room when someone is breastfeeding a newborn.

The baby should be positioned where the mother CAN SEE the baby. She should have been taught what to look for...the lips are the first thing to turn blue...around the mouth...this is the first sign...she should have been told had she seen this to set up the baby and pat it's back like she was going to burp it, and make sure it's head was not down...a healthy baby should have been fine.

Be aware that sometimes these mothers are exhausted and really, really drugged up....there is no way I would hand any of them a baby without anyone else there to actively watch the feeding and leave.

Let it be a lesson of what NOT to do.