Several people have asked questions about how and where they can obtain training in neonatal resuscitation. If you're in the States, visit the AAP's NRP page. In Canada, visit the CPS' NRP page. You can find links to current NRP guidelines and search for instructors or courses.
I took my NRP course from Karen Strange, who travels all over the country teaching NRP workshops. She teaches everything required for the NRP certification and addresses how to adapt these to the realities of an out-of-hospital setting (cord usually left intact, resuscitating baby in place with a portable heated surface rather than removing baby to a warmer, etc). She's hilarious, quirky, and has a last name that totally fits her personality.
Nothing replaces actual hands-on experience gained at NRP workshops. But if there are no NRP courses near you, you can of course study on your own. Do what you can with the resources available to you. Buy or interlibrary loan the latest NRP manual. Watch videos. Read textbooks. Learn more about the fetus-to-newborn transition.
Who would benefit from taking a NRP class? Besides the obvious (midwives, physicians, nurses), I feel that doulas should also be certified in NRP. Sooner or later, most doulas will attend a precipitous birth where the mother has the baby before she can make it to the hospital, or where the midwife doesn't arrive in time at a planned home birth. In addition, I'd strongly recommend NRP for women planning a home birth or with a history of fast labors.
What about Inga's birth?
There is disagreement, even among NRP instructors and NICU/L&D nurses, about whether or not I should have done more aggressive stimulation (drying with towels, rubbing the back, etc) before proceeding to mouth-to-mouth. I am aware of the NRP flow chart (pictured below). During Inga's birth, it was clear to me that she needed mouth-to-mouth at that point, rather taking more time to get out of the tub and dry her off first. Inga was born with color and tone and then started losing it, which indicates secondary rather than primary apnea. In that case, stimulation is less likely to be effective than positive pressure ventilation (either by mouth-to-mouth or bag-and-mask).
If you read the comments on Inga's birth story, part 2, you'll see a conversation going on among L&D/NICU nurses and NRP providers about whether I should have done more stimulation before proceeding to PPV. Some suggested doing a bit more stimulation/clearing the airway, while others felt that moving to mouth-to-mouth at that point was most appropriate. For example, Sarah, a NICU nurse, explained:
With primary apnea (a baby born without tone and color) rubbing the baby and clearing the airway will often work to stimulate breathing. With secondary apnea, where the baby loses tone and color, stimulation will not work. The baby needs PPV/ rescue breaths. Stimulation is really irrelevant in these cases.From cileag:
I think it's intimidating for people to see a baby "crash" like that. Like Housefairy said, mostly it's the "perfect" homebirths that get shared. As an OB nurse and practitioner of NRP, I know that the good thing about NRP is that it almost always works.My nurse-midwife, who herself is a NRP instructor, wrote to me:
Stimulation [in the form of giving breaths] and a moment for the cord blood to return to baby again...and baby was clearly just fine. She had no additional need for support, not even blow-by oxygen, which is evidence that this was an acute scenario [i.e., temporary and quickly reversible] and she had a good reserve.Okay, now I'm really tired of talking about neonatal resuscitation, since Inga's was such a minor part of her overall birth. There are all sorts of ridiculous things being said on the internet about me and about her birth. Just to give you a few examples:
- I am a bad, unfeeling mother because I remained unnaturally calm. A good mother would have panicked more and shown signs of distress and remorse. This reminds me of when I was engaged to Eric. People worried that I had made a bad decision "because I wasn't glowing enough." Apparently there's an engagement smile-o-meter that I failed to pass. Just as I failed the precipitous birth panic-o-meter.
- Because I didn't follow the NRP flowchart to the letter, I was ignorant and uninformed. Never mind that Inga responded almost immediately to the mouth-to-mouth and had an Apgar of 9 or 10 by time she was 2 minutes old.
- Everything turned out fine, but YOU OR THE BABY COULD HAVE DIED! Yes, I could have had a hemorrhage, even though I lost only 10 cc of blood. Yes, the baby could have needed more extensive care, but it didn't and skilled help was on the way. Yes, I could have had a heart attack or an amniotic fluid embolism. But I didn't.
- Inga's birth proves that home birth kills babies. Holy non-sequitur Batman!