When crying is a good sign

I was called to assist with a potential neonatal resuscitation. I didn’t know anything about the patient, her pregnancy history, or her labor issues. I barely had time to put on a white coat and gloves. Peeking into the c-section room from the hallway, I could see the mother with her arms outstretched, and two physicians scrubbed and already starting the surgery. I checked to make sure the ambu bag, oxygen tank, the infant warmer, and the suction tubing were all functional. But I didn’t need to- - the midwife was two steps ahead of me diligently checking over everything. The Labor ward was quite calm, different from my U.S. experience where any potential resuscitation would be surrounded by an atmosphere of nervous tension. Or maybe it has always been just MY nervous tension that I have brought to the labor ward.

When I peek again into the c-section room, another physician has scrubbed in, and I wish I had time to find out the mother’s pregnancy and labor history. Three physicians scrubbed in for a c-section is not a good sign (unless they are teaching new residents). The baby is pulled out, but doesn’t make a sound as it is wrapped in a cloth and rushed to the resuscitation room. We open the cloth to find a limp, wet, slightly blue baby who is not breathing. There are suddenly six hands trying to stimulate, warm, dry, cajole, suction and assess the child. We all try to take a different part of the baby- one person is drying, one person is suctioning, one person is getting the ambu bag ready. I realize that I haven’t looked at the newborn resuscitation algorithm in two months, and in that time I have been travelling, writing grant proposals and scheduling courses and so my algorithm retrieval sections of the brain are sluggish. But with six hands that all know something about resuscitating a baby, I’m hopeful that we can get the baby to cry.

When is a cry more desperately needed than in the first few seconds of life? The three of us (two doctors, one nurse) are all working feverishly to get this baby to cry. In most other settings, we try to dampen a baby’s cry (during vaccine injections, ear checks , late night awakenings, long airplane flights).
After the first seconds of stimulation and assessment , the ambu bag is used, the mask is snug on the baby’s face, and someone is giving positive pressure ventilation. Not me, though. I have taken my hands off the baby, and I notice that she is a girl. A beautiful baby girl, perhaps the mother’s first baby. The other doctor doesn’t know the mother’s history either, as he was called at the last minute also. After just twenty seconds, the baby starts to sputter, fight, and get agitated. And then she belts out a huge cry, a howl of indignation.

Yes!

We three adults finally exhale, smile, and start talking. The midwife takes over completely, as she has years more experience in what the newborn baby needs now. But I stand and coo over the crying baby, happy to hear her. I remember that the c-section room is just across the hall, and perhaps the baby’s mother is also hearing her baby cry for the first time. I think about hearing my children’s first cries, and the relief I felt. It is enough to make me cry as well, and I leave the room quickly.

I still hear the baby crying as I leave the labor ward. What a great sound.