Hello everyone,

I am asking a question regarding my friend's recent delivery both for my and her knowledge. She had her baby at home--not her first child or first homebirth. The cord was very short and the midwife said that she thought the placenta might have been tearing loose during labor, so it was good my friend's contractions never got strong (she had to really work to push this one out) or it could have completely torn loose and baby would have been in trouble. The baby was born really grey looking--my friend describes photos of her husband dressing the baby as looking like he was dressing a dead baby. Baby went into several stopped-breathing fits during the first 24 hours. When the midwife consulted with a Dr. (baby was never seen by Dr.), they decided it was a mucous plug. Baby finally cleared it and pinked up about 24 hours after birth. Midwife seems unconcerned that anything was wrong and said as long as baby didn't lose oxygen for more than 10 minutes, everything will be fine. So far, at one month, baby seems fine. My friend is bothered by this since none of the other babies had breathing problems.

My questions are: What is this mucous plug they are talking about?

Is there possibly anything more that should have been done for the baby? Suctioning? Transport to hospital?

What would have been done differently in a hospital, and would it have been beneficial, debatably beneficial, or harmful?

Was this a potentially serious problem, or was the midwife's unconcerned attitude ok? It just doesn't seem right to me for a baby to be grey (not getting enough oxygen) for its first 24 hours.

Thank you,

Melanie

Hi Melanie, A mucous plug is a glob of mucous that is stuck in the airway somewhere. It blocks or restricts the amount of air that goes to the lungs and alveoli where the gas exchange takes place. This results in breathing difficulties for baby and lower oxygen saturation. It is not an uncommon occurrence. At birth babies are assessed for their Airway, Breathing and Circulation (ABC's). If a baby is not pinking up you start with airway management which means positioning and suctioning to clear the airway. If the baby is breathing normally and has a normal heart rate but still not pink with a clear airway you give oxygen by free flow mask and monitor the SaO2 (oxygen level in the blood). If the respirations are weak or irregular you would give baby oxygen by bag and mask resuscitation and possibly intubate. If the heart rate is below 100 you would start cardiac compressions. You would listen to the breath sound with a stethoscope to ensure air entry to the lungs. A chest X-ray and blood gasses would be obtained. These would be helpful to see that the airway was indeed clear and if there were other factors like a collapsed lung that were contributing to the problem. I agree that a baby should not be grey after birth. There are numerous things that may have caused it. If I was attending this birth I would have actively managed the ABC's and had baby transported to hospital. I am so glad baby seems OK. It must have been a worrying time for the family and IMHO should have been for the midwife who should be current on her NRP skills/certification. Mary, RN, BSN, PNC(C)

Thanks for responding, Mary. Not being a nurse, I wouldn't know what steps are taken to care for babies having respiratory difficulties. Clinical background aside, it seems obvious to me that this baby was having problems deserving of evaluation. I suggest in my book, Thinking Woman's Guide to a Better Birth, that one interview question when considering a home birth attendant is:  "Under what circumstances would you recommend transfer to hospital care?" This story illustrates why that question should be asked. While you don't want a midwife who jumps at shadows, you don't want one who is too cavalier either.

-- Henci