The aftermath (part I)

Clearly the birth is the main event of any labour, but once you have a delivery then what next?

Given we were only in the delivery suite for two hours of my labour, actually the majority of time spent there was post-labour – we didn’t leave the delivery suite till 12.30am, i.e. six hours after the delivery. I have no idea how standard or otherwise that was, but I was glad of it as we got to spend a good set of hours together as a family before having to head down to the communal living (four beds per room) of the post-natal ward where visiting hours were over so Fred would be chucked out. But what exactly were we doing for all that time?

There are three main sets of stuff going on after the birth: stuff for the baby, stuff for me and stuff together for our first attempt at breastfeeding. To allow you to spend some of your day not reading this blog, I will split this into three – the following covering what happened in Elphaba’s first minutes on this Earth, the second about me, me, me and the third tied into the overall topic of breastfeeding. So without further ado, Elphie’s story:

Immediately following the birth, there is a flurry of activity associated with checking that the baby is ok. She was given to me immediately, this was supposed to be skin to skin but in reality there was an attractive hospital gown in the way so that didn’t quite work out as planned. During this time, Fred got involved in cutting the umbilical cord (if we’d had a birth plan we might have opted for delayed cord clamping as Cath had described, so that would be another benefit of having a birth plan!).

None of this took very long, before Elphaba was whisked off for her checks. This part of proceedings was certainly influenced by her being so preterm – she had her own personal paediatrician on standby watching the birth (and I really felt for her – she looked so bored, obviously wondering when I was actually get her out so she could do her job!), had she been one day later and officially 36 weeks then the paediatrician wouldn’t have been there. The initial job of the paediatrician, which I guess would normally be done by a midwife, is to check her AGPAR (Activity, Pulse, Grimace, Appearance, and Respiration) score at 1 minute and 5 minutes after birth. BabyCenter has a really good article on how the score is derived, but basically normal babies will have a score of 7 or above, those with scores of 4-6 could need some initial support such as oxygen, and those of 3 or less will need resuscitation. Elphaba scored 9 on both occasions being marked down for Appearance because presumably her hands and feet remained a bit blue after birth.

The main paediatrician stuff was conducted on an infant warmer (pictured below) and I am not sure of all the checks that were done, but she was certainly weighed and had three other main interventions: her first set of antibiotics, her first blood sugar check and her vitamin K shot.
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Weighty matters

The birth weight… It all seemed so simple at the time – 2.92kg or in old money 6lbs 7oz. For some reason we still announce babies’ weights in imperial measurements, quite quaint really, so we needed to know the pounds and ounces for the birth announcement texts. A funny story about the imperial weight… The midwives didn’t know the conversion so one went off to find out and then apparently got the wrong room on the way back, proudly announcing “6lbs 7oz” to a woman who was still in labour and rather surprised by the prediction! The birth weight is an important number for another reason – the baby needs to be at or above its birth weight before you can be discharged from the care of the community midwives, and given when breastfeeding the baby’s weight can drop 10% or more – hitting that magical number again becomes a bit of an obsession.

Antibiotics

Antibiotics were offered as a preventative measure by our hospital to preterm babies because there is an increased risk of neonatal bacterial infection within 72 hours of birth for babies who are born out of preterm spontaneous labour and as this is a significant cause of newborn mortality and morbidity then rather than wait for the baby to get sick or for its blood results to come back the NICE guidelines are to pre-empt this by starting a course of antibiotics. The main impact of this for the baby is a huge cannula on the back of her hand for the first couple of days which is probably not very comfortable. We were given the choice on the antibiotics and I suspect she was always at lower risk of infection than other preterm babies in that we were pretty sure the spontaneous arrival into this world was caused in reaction to my liver packing up rather than a bacterial infection, but it seemed stupid to refuse it just in case.

Blood Sugar

Another check they did was of her blood sugar level, and this test would continue to be done over the next 48 hours until her levels stabilised. This is done by pricking her heel and drawing some blood from it (as are all baby blood tests seemingly) and seemed to cause the greater consternation than the cannula. I am not sure if the obsession with blood sugar levels was because she was preterm or something done as standard – I imagine the former, but I’ll be interested to hear if mini-Cath is tested when they make an appearance.

Vitamin K

The Vitamin K is standard for all babies though. As the NCT explains:

“Your body needs a certain amount of vitamin K to help your blood clot so that you stop bleeding if you have an injury. Compared with adults, babies are born with lower levels of vitamin K but the amount is usually enough to stop bleeding if they have an accident.

A very small number of babies, however, do not have enough vitamin K to prevent internal bleeding problems, if they occur. The risk of bleeding is highest in the first 13 weeks of life. This is either called Haemorrhagic Disease of the Newborn (HDN), or Vitamin K Deficiency Bleeding (VKDB).

VKDB is a rare but very serious disease. It affects about 1 in 10,000 babies if they are not given vitamin K at birth. More than half of all babies who bleed have a haemorrhage into their brain (intracranial bleeding). This is likely to cause brain damage, and often the baby will die.”

And some babies are at higher risk of VKDB than others:

  • “Babies born before 37 weeks of pregnancy.
  • Babies whose birth involved the use of forceps, ventouse or caesarean, where bruising might occur.
  • Babies who had trouble breathing and did not get enough oxygen when they were born.
  • Babies whose mothers are taking anticonvulsants, anti-coagulants, or drugs to treat tuberculosis.”

 

Given two of the above factors affected me (born before 37 weeks, being on anti-coagulants myself), a dose of vitamin K seems like the right call, but given its lack of apparent side effects and the difficulty in predicting which babies will have difficulties clotting then it seems sensible for all babies to have it.

You have a choice of how it’s administered though – either by a single injection or 2-3 injections by mouth. We chose the injection, mainly because as part of my treatment for obstetric cholestasis, I had the pleasure of needing to take vitamin K orally and by pleasure I mean it was one of the most disgusting things I had ever tasted – like a combination of a decomposed compost heap and engine oil. So I think parents faced with the choice, who don’t like the idea of their baby being stuck with a needle, should be forced to have it orally themselves before inflicting it on their baby!

Once she had been checked and balanced (which seemed to take forever) she was given back to me for us to attempt breastfeeding…

More on that later – tune in next time for the next exciting episode of labours!

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