HELP HELP!! BABY born not breathing

LightningRN · Jul 26, 2007

So last week, I had my first newborn code white (like code blue for adults but for neonates) at my delivery. I was literally NOT expecting it AT ALL!! My pt was sectioned for failure to progress and fetal intolerance to labor. After 3 hrs of pushing (with epidural) she only made it to plus 1 station with molding, zero station for actual fetal skull. Mom had the urge to push so we started pushing. Anyways baby looked fine on the monitor for me the majority of the time. She of course had variables here and there wth maternal pushing but great overall variability and accels. No pit was used, but baby did have thin mec when artificially ruptured.
SO my question here is..does general anesthesia usually wipe out the baby more so than a spinal??
My strip was fine before she was sectioned, but baby had a hard time being taken out in the OR. Baby was wedged tight under pts pubic bone. MD was pulling up and I was pushing the head upwards to MD. This took appox 5 mins. Baby came out not breathing, code was called, intubated, but finally had spontaneous breathing.
The nurses I conversed with stated it was probabably related to the GENERAL ANESTHESIA. Is that true?? please help, with days like this, it makes me wonder if I would really like to continue is such a highly litigious area of nursing. ?????????? mom was fine , dad was shaken a bit when he saw 500 mds/nurses runing to the OR, but was better when he went to the NICU to visit baby,
p.s. any advice woud help right now. should i quit l/d/?? i'm soo scared now

General anesthesia does affect babies. Babies react to general anesthesia very similarly to how moms react to it. Babies born under general are very often lethargic, floppy, blue, ... all the things we don't like to see. They usually come out of it just fine, but it is a risk. Thats why when a mom is put under general the surgeon usually tries to work quickly because the more time that passes the more profound the symptoms may be. I don't think you should quit L&D because of this. You must realize that sometimes bad and scary things are going to happen. Its going to be that way with any aspect of nursing.

fergus51 · Jul 26, 2007

Plus, the good days outnumber the bad in L&D.

I work NICU now and sometimes forget that there are babies who are born breathing;) As long as you followed NRP, you are ok. You did what was right. Take a deep breath and follow it with another and another:) There is no need to give up an area of nursing that you love because of one scary experience. You will move on from this and next time you'll be better prepared.

Jokerhill · Jul 26, 2007

I agree with Fergus51, I forget there is any other way to bring a baby into life. Here the NICU goes to all C/S and do no need to call a code as we are already there. That goes for all high risk deliveries the NICU team is called before the baby is out. No need to quit just to learn and plan better be prepared for the worst and be happy when you wasted your time preparing.

suzanne4, RN · Jul 26, 2007

I agree with the above posters. You usually do not see a code called with a newborn. Not breathing is not that uncommon, that is why there is the NRP program. Knowing what to do when they are not breathing is the goal and what saves them. And even in the NICU, you do not usually see Codes called, they are handled by the staff that is there.

Any field of nursing is going to have bad outcomes as well as the good outcomes. How you deal with it is what makes a good nurse. Luckily enough, more come out breathing if they are term, but for what ever reason, things do happen. That is why you always want to be prepared and leave nothing to chance.

And remember that the C/S was done because there were issues happening, not scheduled in advance because of infant size. This is the time that you always expect there to be an increase in the chance of having problems.

You did just fine...................:balloons:

nurse79 · Jul 26, 2007

well thanks so much for youre words of encouragement. I knew coming in to L/D from postpartum that the stress level is very high, and ANYTHING can happen. Even though NICU comes to all of our C/S we call codes whenever chest compressions are initiated. Along with the anesthesia, there was difficulty getting baby out, which scared the living #*$&(*%&$Q*(&% outta me. everything happened so fast, but i know for sure it was a learning experience. thanks again:crying2:

moongirl · Jul 27, 2007

had same situation a few weeks ago.Pushed 4 hours, notta. went to OR. Spinal went to high. pt looked at me said " I cant breathe" then they put her under. we prepared for depressed baby. No resp, heart rate 70. PPV for 3 minutes. Apgar at 5 minutes was 8. NRP in action. dry, ppv, reposition, more ppv.We dont call it a code, but had the crash cart in the OR

crysobrn · Jul 27, 2007

My nightmare experience was when I had a patient that had cervidil placed by someone else. I pulled it because she was contracting regularly and getting uncomfortable, checked her, she was very posterior and about 2cm. She got up to the shower and came out breathing hard, requested an epidural, I call the doc he says he'll be in shortly, he comes and by the time he gets there I say "the last time I checked her she was 2" but she is really working do you want me to check her, he says no, he checks her and she's complete and breech!!! This doc does not do breech deliveries so to the OR we go. The anesthesia person on call takes what seemed like forever to get there, puts mom out and baby comes out with apgars of 2 and 7!!! BAD news for us. Be happy that you have a NICU at all. We don't and we rarely call a code on a baby, we use our OB staff unless something is going VERY wrong we call in people from other parts of the hospital.

I was very dissapointed in myself that I didn't know she was breech, but she was checked by the nurse that placed the cervidil as well as the doc and later when he talked to me he said he was sure that she was vertex as well. So, either the kid flipped in the shower or everyone that checked her was wrong. There will always be scary moments in OB thank goodness the good does outweigh the bad or we'd all quit;)

nurse79 · Jul 27, 2007

how did the baby turn out moongirl?? and as for cervidil pts. i think i fear that the most..inducing a breech presentation. How do you know its cephalic if baby is sky high???? shouldnt we just scan EVERYONE to make sure baby is head down FIRST. Leopolds is hard for me at times to determint baby position.

one more question, do you guys usually amnioinfuse THIN MECs???

33-weeker · Jul 28, 2007

Sounds like it was a combo of stress, general anesthesia and then a prolonged time to get baby out. Once you give general, you have to get baby out fairly quickly.

The three times I get really nervous at a delivery (besides little or no HR on strip) is head out-shoulders not delivering, head out - cord cut on perineum (especially if shoulders are not delivering!), and general anesthesia - doc having trouble getting baby out.

Anyhow - as to the 'code white' - we don't call a code in nursery or NICU at our hospital (overhead PA). None of the hospitals I've ever worked for do that. We have the pull handles on the walls, but we don't use them. We call for help other ways; by phone or call system.

If my hands are busy, or if while waiting to catch baby I see possible trouble coming, I delegate to anesthesia or circulating staff to call help for me - even if I end up not needing it. I can dry, suction, BB &/or bag by myself If I have to - the only time I really need help is if the baby needs compressions or intubation (which is pretty rare around here) but I try to have a second set of hands just in case.

Don't let this shake you too much. You will see that true, full-out codes don't happen that often in OB/Nsy. Usually it's a couple of breaths with the bag to 'jump-start' them breathing, a little blow-by, then all is well. As bad as it sounds, you will discover that you get desensitized to such as this after you've been through enough 'codes' to see that you encountered them and you handled them. Just calm down and go through the steps.

For me, it was having a couple of babies die that actually helped me to calm down. The fact that they died was awfull, of course, but it made me realize that they died and the sky didn't fall. Life went on. No one sued me. It's all part of it. We can't save them all. Once the 'worst' happens to you, you don't have the fear of that unknown anymore. Maybe that sounds weird, but that's the best way I can expain it.

NPinWCH · Jul 28, 2007

It sounds like you did fine. OB is occasionally like that, but like everyone it's usually not. We don't have NICU and we don't call baby codes...though everyone knows if OB pages, "RT to room X" that it's for a baby.

I just wanted to comment that you stated you didn't expect a bad baby...but you also stated that the baby wasn't really tolerating labor. So that is already one red flag.

The next was the general anesthesia (as you found out these babes sometimes don't breath...remember the drugs they use knock out the mom so it can effect the baby also).

The third was the difficult extraction. Even on a C/S under a spinal or epidural a difficult extraction increases the chance of getting a poor baby, BUT a difficult extraction under general anesthesia almost always results in a blue, floppy kiddo. The longer the baby is exposed to the anesthetic=the greater the chance for problems.

Every crappy delivery I have teaches me something...and I've been doing it for 12 years. You learned some things and the outcome was actually good (I know it doesn't feel like it but the baby left you with spontaneous resps). Don't quit, just take what you've learned and use it next time. For example: I have RT present anytime we have a C/S under a general (even if it's just because they couldn't get the spinal/epidural) because there is an increased risk for a floppy kid. So what if the kid comes out screaming...just thank them for coming and standing by.

Ohh and we almost never use amnio infusions anymore. The evidence isn't out there to support them, they simply haven't shown to be any good even with thick mec. I think it just makes the docs and/RNs feel better. Also, where I am amnio infusions are only started by the docs.