Wednesday, 29 June 2011

Tiny, little babies

This week I was working on the antenatal/postanatal ward along with a student midwife so I thought I would share a little about some of our tiny babies.

One of the reasons Mums have to stay on the ward for some time is when they have a very early or small baby who needs some TLC. I am not claiming that all early or small babies do well but I think many people would be very suprised at some of the things that are achieved here. While there are no neonatal units, paediatricians or neonatal equipment such as incubators there are some little miracle babies on the ward every week, making it through another day with us. Yesterday we had a couple which I thought I would share about.

The first was a baby weighing 1.28kg at birth, now almost returned to it's birthweight after losing a little weight, and the second 1.08kg at birth, now just 900g. They were 8 days and 6 days old. .These little ones always make me smile as they wear a nappy almost as big as them (as you can't get pre-term ones here) and are either tucked down their Mum's clothes or wrapped in so many blankets that you can hardly seee them. Both had needed some resuscitation at birth, but actually not very much and had adjusted to life outside the womb within a couple of minutes despite their small size. This is testimony in itself to the staff where I am working - when I attended a midwifery conference here in SL a few months ago with midwives from other hospitals and taught some of the neonatal resuscitation as groupwork I was shocked by their complete inability to even initiate basic newborn resucitation (opening an airway, giving initial breaths, maintaining breaths and cardiac compressions). I am sure our midwives are saving many babies through just being competent with basic newborn resuscitation skills - no they can't do everything, drugs wise we are limited and there is not any further support for babies in terms of ventilation or anything, but what they can do they do well.

Once they are born and in the days ahead our priorities are simple - keep them warm and keep them fed, prevent infection and observe them closely. We encourage kangaroo care, where babies are put next to their mother's skin and then both of them covered. This helps keep the babies nice and warm. When the Mum's need a break then we just wrap them well. The feeding is a little more complicated with these small babies, especially the early ones who are not able to breastfeed. We get the Mum's expressing milk and feed this to the babies either by nasal tube or by syringe and gradually increase the amount they take at each feed. The little ones usually need some IV fluids too initially (it is always a big challenge trying to get cannulas into babies that weigh less then 1kg and I was very happy that one of the other midwives bravely took this challenge and got it in first time with the little one yesterday!). There are no pumps here to help with giving fluids so it's back to what we learnt in nursing school many years ago - calculating how much fluid they need for their bodyweight per day, minus the milk they are having, making up the bag with a mixture of dextrose and saline, eventually working out how many drops per minute the drip needs to drip at. This bit becomes quite time consuming - partly because the drip rate often changes when the baby moves and partly probably because of my paranoia that we will overload one of these tiny babies with fluid if it drips too fast and we fail to notice.

Tiny babies don't always make it, but many, many do, and it really is just these simple things and some midwives who know what they are doing who are making it happen. It might not sound like much, but each time I go to work and see these tiny babies tucked down their Mum's gowns it is like seeing a miracle before my eyes and I love it.

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