CHDs and Homebirth

Baby G

On a balmy March night back in 2014 I attended what I then thought was going to be a normal birth. This was the mother's seventh child, and the sixth one that my mom would help her with. The birth its self was amazing! The baby was a surprise OP, and the mamma pushed him out in TWO pushes!! It wasn't until after he was delivered that we realized something was wrong. Even though he started breathing right away he never cried, and after his first breath he went limp. He never stopped breathing, but we had to get him stimulated to use his muscles again. After he was flexing and moving, we continued with the normal checkup, and cleanup, and the whole time he never cried. I can only describe it as a laziness, he seemed fine other than the fact that he refused to cry, and he never opened his eyes. ( he also had some signs that he might have downs syndrome, but I never heard if they got a conclusive diagnosis) Since he was breathing fine, nursing, and his heart sounded fine, mom decided that we would let the family rest that night and discuss taking him to the doctor the next day. The next day while talking to another midwife mom found out that sometimes that laziness that we had seen is the only indication that there might be something wrong with the baby's heart! Of course after that mom recommended that the parents take the baby to the doctor right away, so they did, but the doctor couldn't find anything wrong either! Fast forward a week or so, and a few more doctors, finally the fourth doctor they saw heard a murmur. It turns out that he had been born with a hole in his heart so small that a stethoscope couldn't pick it up at all. It was only after the blood had been pumping through it for a few weeks that it was big enough for the stethoscope to detect it. Fortunately they caught it before it got too big, and they did surgery on it, and now he is doing fine.


The next time I would encounter a CHD baby would be just over a month later.

Baby W

Early on a Saturday in May my mom woke me up to tell me that we needed to head to our client's house that was about two hours away because she was in labor. After we had only been on the road for about 30 minutes the Doula called and said she saw the head!! Needless to say, I floored it! I know for a fact that I got up to 110mph, and I might have been going faster. While I drove like a maniac, mom got ready to walk the dad through delivering the baby if it came to that, and we all prayed like crazy that we would make it in time for the birth. When we finally arrived we flew into the house, (we even forgot to close the car doors!) and found the mom lying down on the floor of her bathroom, thankfully without a baby. This mom had really wanted a water birth, but my mom had advised that she stay out of the water if her husband was going to end up catching the baby, so when we got there she went ahead and got in the birth pool. Not even five minuets later, we had a baby!! Let me tell you that was the calmest baby I have ever seen! She came up out of the water and gave one little cry, and then settled on her mom's chest and just looked at everyone! After we cut the cord and got mamma and baby out of the water we proceeded with her newborn check and everything looked and sounded normal. Two days later the mom called to ask us to pray as they were headed to the ER with the baby after she had had a really big cry and then her responses had slowed . When they got to the hospital the doctors found that the left side of her heart hadn't developed!! They quickly life flighted her to a heart specialist hospital and she had the first of her life saving heart surgeries. She is now doing well. 


Unfortunately Baby W's story isn't as rare as you would think. Every year 1 in 100 babies is born with a Congenital Heart Defect (CHD) and many of them have no outward symptoms, and prenatal ultrasounds don't always detect them. The CDC even addresses that fact, "Some babies born with a critical CHD appear healthy at first, and they may be sent home before their heart defect is detected. These babies are at risk of having serious complications within the first few days or weeks of life, and often require emergency care."1 


So what are we supposed to do to prevent these normal appearing, but critically ill, newborns from slipping through the cracks until it is too late? 


The answer is a simple test that can be incorporated into the normal newborn exam. The CDC's website explains, "Newborn screening for critical CHDs involves a simple bedside test called pulse oximetry. This test estimates the amount of oxygen in a baby’s blood. Low levels of oxygen in the blood can be a sign of a critical CHD. The test is done using a machine called a pulse oximeter, with sensors placed on the baby's skin. The test is painless and takes only a few minutes.
Pulse oximetry screening does not replace a complete history and physical examination, which sometimes can detect a critical CHD before oxygen levels in the blood become low. Pulse oximetry screening, therefore, should be used along with the physical examination"2


Now that we know how to check for CHDs it is critical that we get that information out there! I really didn't know much about CHDs before these births. I have a cousin who was born with a CHD, but his was caught on a prenatal ultrasound, so I didn't really pay a lot of attention to how easily they are missed until it happened to me. You can ask your midwife, or doctor, how they check for CHDs, and if they don't, refer them to pulse oximiters. It could be a matter of life and death, and it is too simple to justify skipping it. 

Baby W

Baby G

1&2 lhttp://www.cdc.gov/ncbddd/heartdefects/cchd-facts.html

The Game of Hurry up and Wait...

This is about two weeks late, I apologize for my tardiness in posting.

If you ask anyone in the military they will tell you that it's all just a game of hurry up and wait, and I have found that midwifery is exactly the same. Now I'm not comparing being a midwife to being a soldier, I just liked that they both start with the letter M, which also happens to be my first initial and my favorite letter. :) Now on to the story...

 On Thursday November 21st  I got off work, checked my phone, and found 6 missed calls, a new voice mail, and several text messages, all from Mom and Dad. Whoops! I called Mom back to find out what was going on, turns out that she was on her way to pick up some extra equipment from the cottage in Mississippi when she had a blowout!! Thankfully Dad was able to go rescue her because shortly after he got to where she was the call came in that our Mother To Be (Hence forth MTB) was having contractions three hours away. At this point I'm still in Alabama so I pulled up the GPS on my phone to find the routes that we could take that would meetup somewhere so that we didn't have to take two cars all the way to the birth. After confirming the routes with Mom I got on the road, and an hour and a half  later we met up and left her car in a parking lot.

Now comes the hurry part! On my way to the rendezvous I was only driving 80mph, but after I picked up Mom, and her bag of instruments that would legitimize our speeding if we were pulled over, I bumped it up to around 85-90mph. Well when we were 50 miles from our destination the MTB calls to tell us that her water has just broken!! After that I floored it!! At one point I was doing 105mph!! And I'm not gonna lie, it was FUN! :) Thankfully I didn't get pulled over, and we made that last 50 miles in about 30 minutes.

Then the wait... When we finally got to the house around 5:30 the MTB was doing well and was progressing, but was only about half way dilated. So after Mom checked the baby's heart tones we sat in the living room and waited, Mom had a magazine and I scrolled Pinterest.

At about 7:30 the dad informed us that he had just been asked to not leave the bed room where the MTB was laboring. Progress!! 

At about 7:40 mom checked the  baby's heart tones and the mom's dialation and and found that she was only at 8 centimeters, but she wanted to push. Mother told her not push, but two minutes later she could tell that the mom was going to push regardless and checked again and found full dialation!!!!

Two pushes later we had a head, and when mom swept the neck with her finger, to make sure that the umbilical cord wasn't wrapped around it, she bumped the tiny hand the had been born with the head and the baby grasped her finger!!!!!! (the hand was up under the chin and therefore didn't cause any problems with the delivery) That was the most AMAZING thing I have ever seen!!! After just one more push we had all 8lbs 10oz 20 1/2 inches of her at 7:51pm. 

After we weighed and measured her I got to dress and hold her. :) Mom and I stayed at the house for about three hours after the birth, cleaned up, changed the sheets (the not so exciting part of this job), checked the mom and baby again, and just generally made sure everything was hunky dory before we headed home. 

We finally got home at 2:15am, and I was back at work by 8:05 later that morning. :) 

She posed perfectly for me!! :)