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

Random Chance? Star Dust? God?

Maybe I'm just dense, but the first time I studied biology I somehow missed how excruciatingly detailed DNA and the genetic code are. Sure I learned about the double helix, and how no DNA is exactly the same (except in identical twins), and that our whole genetic makeup is derived from our DNA. What I didn't realize is that that double helix repeats, and repeats, and repeats, to form a super coil, and the super coils form chromosomes, and chromosomes are in the nucleus of EVERY SINGLE CELL IN OUR BODY!!!      When I was reviewing it the other day it hit me like brick wall, and I reread the page 3 times just to wrap my tiny brain around how awesome, and epic, and marvelously choreographed the whole process is!!

After I had that astounding revelation, my next thought was, how can people think that this all happens by random chance? I mean come on people! We are the most complex life forms on this planet and we didn't even know about DNA until about the 1960s! How on earth do we think that all of this came together by happenstance? The odds of just one protein chain forming on its own are incredible, and for us to think that every living thing, from amoebas to humans, just happened to come together from star dust, or an oozing slime pit, or a big explosion, is just mind blowing! I don't under stand how anyone with a brain in their head can look out on this amazing planet, at our complex solar system, at ourselves, and not see in it the handy work of a master Creator.

While I am studying I am reading over, and over, and over the whole process of gestation, and it never ceases to amaze me. To think that every person started as a single cell with 46 chromosomes, and over the relatively short period of nine months becomes a living, breathing human being is astounding! Looking at the process, and seeing how complex it is, and how easily it could go wrong, yet rarely does, I can't comprehend how someone could think it's just a coincidence.

When you see a baby born so perfectly human, yet oh soo tiny, and you know the journey it has made in the previous nine months, how can you say that there is no God? No master Creator?


-Megan








 

Baby's First Picture

                                                            Supplies all ready to go

                                                               Baby's very first picture

                                                     Examination to make sure he is perfect

One Down Many More to Come

A week ago today I witnessed the miracle of birth for the very first time! It was AMAZING, and happened so fast that I was only on the other side of the bedroom and almost MISSED it! We, my mother (the senior midwife) and I, had been with the mom-to-be since about 3:00am that Friday morning while she labored in the Jacuzzi. Her labor was progressing but her water had not broken, and she was getting tired. (she had been in mild labor since sometime Thursday) At about 5:10am Mom asked me to sterilize and extra little clamp that could be used to snip the amniotic sac if the baby was born without it having broken. At this point we thought that we were still a ways away from having a baby and the Father was actually watching sports in the living room. :)

All of a sudden there was a shout from the bedroom so he and I dashed in to see what was going on! The next few minutes are a little blurred but I'm going to try and piece them together for y'all. ;) Let me set the stage for you first; picture a cozy little cottage room with two twin beds, the one on the left is all prepped for a birth, the bed on the right (and closest to the bathroom with the Jacuzzi) is not set up for a birth. Naturally, as is always the case with Murphy's law, the Mom had only made it to the right bed when that monster contraction hit and brought her husband and I running in. When we got into the room the Mother-to-be was still on the edge of the right bed and my Mom was kneeling by her in the narrow (like only 2 1/2 feet) space between the bed and the wall. Mom then gave directions for the Dad to get behind the Mother and support her from behind, and for me to get her the box of gloves which she thought she had left in the bathroom. I squeezed past her (literally squeezed) into the bathroom, only to discover that she had moved them to the night stand of the left bed in preparation of the birth. Just then the Mother's water broke! All over the bed, the floor, and my Mom! I then squeezed back past my Mom, through the puddle of amniotic fluid on the floor, and quickly made my way over to the other side of the bed to get the gloves.

 Then, just as I was about to hand Mom the gloves, with one final contraction and NO PUSHING the baby practically flew out!!! I kid you not! He (it was a boy) pretty much just fell out after the membrane that had been holding him back had broken. Mom caught him in mid air, I grabbed the towel, that we had laid out to wrap him in, and wrapped him up all in the space of about thirty seconds!!  Then while I held the baby Mom clamped and cut the cord so that we could easily move the Mother over to the prepared bed. We were all astonished at how fast he was born, excited that he was here, and happy to see him!! After that we weighed and measured the baby, checked him to make sure that there were 10 fingers and 10 toes and everything else was where it was supposed to be.

After the placenta was delivered the Mother had lost a fair amount of blood and couldn't get up without being dizzy so we gave her a sponge bath, remade the right bed and made her comfortable on it so she could rest.


All in all it was quite the extraordinary event and I was thrilled to have been there!!

Until next time...

~Megan