I had a terrible call the other night and it has been on my mind since then, I keep second guessing myself and getting upset about it, and wondering what if I had...
Anyway we were dispatched for a woman in labor, updated enroute to the baby has been delivered, updated enroute to shallow respirations, updated to CPR in progress. It was in the middle of a bad snow storm so it took us about 20 minutes or so to get there. Fast forward to arrival there is a 26 year old woman sitting on a toilet at home holding a very small baby while a police officer gives blow by oxygen (They do not have the appropriate BVM so that is the best they could do) and doing compressions. The baby had no muscle tone, no pulses, and a very occasional gasping breathe. The eyes were still fused and his mouth was so small I honestly don't know that I could have even intubated him if I wanted to because the smallest we carry is a 0 blade and I don't think it would have fit. I had my people start ventilations with our neonatal BVM, the baby's face was so small the mask covered most of it. We continued CPR and I called my medical control doctor because I felt the baby was to early to be viable given his size and skin etc. Speaking with her I advised her that the mother reports some movement in the baby on initial delivery and she advised me to work him for a while and gave me the OK to stop efforts if there was no response. The mother had no idea she was pregnant and when asked she reported her last period was about 2 months ago (clearly that wasn't her period of course because this baby was a lot further along than 8 weeks). I asked when her last period was before that and she said she didn't know, so figuring out gestational age was even more difficult.
Per the mother, she felt cramping discomfort like she had to go to the bathroom for a couple hours starting around 2330 and when she got into the bathroom she felt a gush of water, pushed once and out came the baby. The baby was born around 0300 hours and we didn't get there until around 0340 ( for some reason there seemed to be a lapse in time from birth to the 911 call, but her times may have been off). The baby was probably about 6-7 inches long from head to toe ( I am totally estimating could have been more or less), as I said his eyes were fused, and his mouth was about 1 inch long maybe even more like a half inch. We did CPR with ventilations for at least 10 minutes and had no response other than a very occasional gasp, but no brachial pulse or heart sounds so I made the difficult decision to stop efforts and not go to Epi or IV fluid. I am now totally second guessing myself.
The weight at the hospital was 526 grams which I have read is a baby that some hospitals would do a full resuscitation on. Was I wrong to call it and stop efforts and not try and intubate or try epi? The labor and delivery nurse called me later to ask some more questions for the records and she said that they more than likely would not have tried to resuscitate that baby. She also said they were unsure of the gestational age and were still trying to figure it out (this was two hours later). It is a community hospital with no NICU or SCN.
Any advise or comments would be helpful, even if you disagree with stopping efforts, I need to learn in case this happens again. This is the first time I have ever had a field deliver of a preterm neonate so I had nothing to compare the baby too as far as using that to figure out an actually gestational age and viability.
