Did I make the right decision not to aggressively resuscitate this baby?

The edge of viability is hard enough in the hospital setting; bless you for confronting it in the field. Please be kind to yourself.

The combination of the birth history, delay of treatment, iffy gestational age (sounds like *maybe* 23-24 weeks based on weight and fused eyelids) no heart tones or response after 10 minutes of CPR... This would not have been a good outcome no matter what. Even if resuscitation measures were to achieve some sort of stability long enough to achieve transfer to a level III/IV facility (sounds highly unlikely), there would probably be discussions of withdrawal of support due to overwhelming neurologic devastation or sepsis. Or, down the road, NEC as a result of gut ischemia from being "down" so long.

It sounds to me like you handled a terrible situation in a way that gave dignity to both mom and baby. Thank you for the work that you do.

Trying to intubate a edge of viability baby isn't always a guarantee even while in a hospital, I can't imagine doing it out in the field. Plus you probably would've needed a 00 blade.

I think you did the best you could under very trying circumstances. If the baby was at 23 weeks (which is generally considered edge of viability), it's about a 50/50 shot if the baby makes it alive, and of those that do, another 50% or so that have moderate to severe co-morbidities. So even under the best of circumstances like a hospital, it's tough.

Hope you feel better soon, take care of yourself

I am so sorry you had that experience. As others have said, even in a hospital setting with several RNs, RTs, APRNs, and MDs in attendance, this would have been a difficult delivery. You almost certainly would have needed a 2.0 tube, a 00 blade, and potentially the ability to place umbilical lines in order to effectively resuscitate. Even if you had attempted to intubate and give epi, given the circumstances you described the baby likely wouldn't have survived. You did the best you could.

Again, I am so sorry you've had to go through this experience. We don't often lose babies, but when we do it can be very hard to make sense of the experience. If you feel up to it, I'd recommend debriefing with your coworkers and/or boss, or seeing if your employer offers an Employee Assitance Program (a free short-term counseling service). ((Hugs)).

As you said it would have had a bad outcome no matter what given the situation. The mother had a difficult time accepting that we did not aggressively work him because he was fully developed on the outside so she couldn't see the fact that his lungs and other organs were not ready for life on the outside. I think maybe he would have had a better chance if he was born in a hospital and immediately resuscitated, but that was not to be, and even then it could have been months of suffering.

So many maybes, Annie. You called it based on a doctor's OK. Who knows what happened to the baby between the time mom delivered and the time the police arrived? Hang in there. We are not miracle workers.

You did what you could. Mom is probably questioning herself and in turn, questioning everything, including your interventions.

It sounds like you did the best you could, under the circumstances. If the baby had arrived in a hospital with a top-level NICU, there might have been more to be done...but with the equipment and resources at your disposal, you gave that baby the best you could. Take care of yourself.

There is nothing more you could have done. Even if you had the skills to intubate with a 2.0 tube and a 00 blade and a fully equipped Neonatal transport ambulance (Baby Buggy) with a heated isolette, at 526g born in the toilet, it would have very little chance of survival. It was probably in the 22-23 week gestation. At that age, even born at a hospital with a NICU team (docs, nurses, RT) ready to intubate at delivery and directly admitted to a Level IV NICU, there is a very slim chance of survival. I have not seen a baby born less than 580-600g survive longer than a week that were born in the ideal setting (adult hospital attached to a Level IV NICU).

Please stop second guessing yourself. If it had been a witnessed birth maybe. But the fact that there is no way of knowing what the down time was before you arrived makes it most likely that this was not going to have a good outcome. You did everything you could and I'm sure the family is grateful for your help.

It may sound heartless, but nature knows. You saved that baby's life in a different way - from a longer life of suffering and eventual death.