Paediatrician at birth

[elliejjtiny]

Has anyone done this? The midwife mentioned it at my appointment yesterday and we will be discussing it in more detail at my 36 week appointment. But I want to know now! (impatient emoticon). The midwife said he/she will sit in the corner and do nothing until baby is born. My baby (DC4) has a cleft lip (probably palate too) which as far as I know just means feeding problems. I know he/she might need to go to SCBU but I'm worried the paed will be over cautious and swoop in and take him/her straight away. I want to have a nice long cuddle, skin to skin and delayed cord clamping and then take baby to scbu if necessary when we're both ready to leave labour ward (ie after I've had a bath, toast and in my pj's). I also don't want someone sat there watching me in labour, sighing and looking at their watch, waiting to do their bit. Someone please reassure me that it will be ok. I've had 3 uncomplicated births with just a midwife and my DH there so this is all new to me.

I'm sure the paediatrician is there to ensure your baby has access to treatment immediately should it be needed. Given a paediatrician is a scarce resource in a hospital, they would not be putting him/her there unless the considered it important.

I imagine when you are in the thick of it, you will be completely unaware of their presence (and I'm sure they won't be sighing, looking at their watch) and whilst hopefully you will be able to get that long cuddle as soon as he is born, if for any reason he needs immediate attention, won't it be great that the correct person is there to attend to him, hopefully minimising any subsequent interventions that may be necessary?

Everybody hopes for the birth they want, but surely the best thing is that the baby has the birth/aftercare it needs?

I had paediatrician at my first birth - was emergency c section so bit different. She was the one who talked me and dh through the whole thing (had been in labour for 2 days and was in a real state by this point) as the others were really busy and she didn't have anything to do at that time. She was lovely and really reassuring. As soon as baby was out she got baby breathing, checked her over and then gave her to dh as I was shaking and crying to much to hold her. Dd is now 9 and i am still so grateful to the paed for reassuring us when she could have just sat waiting for baby to be born.

Thanks for replies. I know that if the baby needs urgent treatment then I'll be grateful for any intervention needed. I just think that as the anticipated problems are feeding ones then surely the most sensible thing to do is let me try and breastfeed and if he can't do it then call the paed. Or even wait and do the first feed with a paed present/in scbu if they're worried about the milk going through the hole in his palate and into his lungs. I just don't get why a paed has to be there at the moment of birth just because the baby has a cleft lip/palate. I asked the midwife and she just said that the cleft lip/palate gives the baby a "high risk" label and therefore he/she will have a paed in the room at the birth.

I think it's going to be one of those things that I will worry about and then not care when I'm in labour.

I think the Paed's job is to make sure you don't need them to do anything.
State clearly in what your birthplan what you prefer, they will try hard to go with your plan.

Just thinking that labour can go so fast as the end the odds of paed being there at that moment are 50:50, anyway.

I would agree with your concerns ellie.
If I were in your position I would be wanting to know exactly why there is a need for a paed at the actual birth. It is likely that their presence will have an effect on the midwifery management of the birth and the immediate postnatal period. You do need to know that this is really necessary. I agree that staff time is precious in hospital, but this still doesn't stop things being done for the sake of it, or hurried along unnecessarily at the detriment of normality and mothers' wishes. Having a high risk label is not a reason and you need more information than this. Request a meeting with a paed prior to birth in order to have a proper plan made and placed clearly in your notes. You do not want to be giving birth in the middle of the night with a junior present who feels as though they should be doing 'something'.
You may go past the point of caring about your birth wishes during the throes of labour, but you may well wish things had been different when you look back if actions were taken unnecessarily.
Have you been referred to a specialist cleft lip/palate nurse? How about a breastfeeding specialist /consultant? Is there a cleft lip/ palate association that you can gets lots of info from?
Best wishes.

Have you looked at the Cleft lip.and Palate association website? There is an ante-natal section on there and a parent forum, hopefully, you could get some support there.
I fannot link.from my phone, but if you google CLAPA, its the first link that comes up.
Good luck with everything

I had a whole pead team at my DS's birth. A scbu place on standby before they started induction. Most of my labour was just with midwife though. Don't know if it was meant to be a full team or just a pead initially but DS ended up being a forceps on theatre birth hence the whole team I think.
Once he was pulled out he was whisked to he side for a good check over and once they were satisfied he didn't need scbu DH was called over to cut his cord down and he had cuddles while I was stitched up. (DS not cleft btw but had craniofacial issues)

We had a paediatrician at DS1s birth, he was 5 weeks earlier and they came in just as he was being born, non intrusive, baby was handed to me for a quick cuddle and then the paediatrician examined him while I delivered the placenta, he was then handed back to me and DH. They were very nice and reassuring.

I had a paed and 2 scbu nurses at my first birth. They didn't come in until the last minutes and they just waited in the corner beside the resus unit. No intrusion to me.

My baby was having difficulty breathing so was just held up then quickly given to the paed team and she was back with me and they were all gone in minutes. I doubt they will want to whisk your baby away to scbu quickly unless there's a need for it.

They arent going to be sat there waiting for you to deliver, they will be called at the last moment. I have seen deliveries where the paed waited outside the room, and when a pink baby was delivered, they went away again. They have enough to do without wanting to lay hands on a baby for the sake of it. It might be worth discussing with the midwife exactly what risks they have in mind when they are asking for a paed to attend?

Do facial deformities come with higher risk of breathing problems? I imagine that's the main concern, having as many hands available in case.

DH is a paediatrician and I asked him when I was pregnant how many births he'd attended. A bit of a count later he estimated 1000! I had the world and his wife at my section - I think they checked baby very briefly and then handed her back. Lots of time for skin to skin.

Oh and a paed is not going to have anything to say about the delivery or obstetric bit.

I think the point is that the paed will be able to examine your baby briefly when they're born to ensure that they are safe to cuddle etc with you. That's what happened with my dd2. In her case meconium in the waters and cord orund her neck meant they needed a paed to check her and then she came straight back to me. I barely noticed tbh. Was still getting my breath back from delivery

I had a paediatric doctor at the birth of DS1, along with my obstetrics consultant and the crash team. Well they were outside the door as they were concerned about the placenta.

As soon as he was born everyone came in, checked him for a minute and managed to get him to breathe. After that we had time to do skin to skin and feed while talking to a consultant.

They're there in case of any problems, if all is well then you'll be allowed to do whatever you wish.

good luck!

I guess a lot of people seem to think it's ok for a baby to be taken away at birth for a quick check over. I would think it ok too IF THERE IS A GOOD REASON. Contrary to what many people would think, this is often done without good reason. The first hour is a really important time. I would not want my baby taken from me during this time, or the cord cut unnecessarily early. Munchkin is correct when she says a paed is not going to have anything to say about the birth bit, however their presence may be inhibiting for you, you may feel under pressure, the midwife may feel some pressure to encourage you to birth quicker, cut cord quickly, take baby away. As Mellen says, you need to know exactly what potential risks, if any, there may be that would have a need for a paed to be necessary at birth, and you also need to write a birth plan of your wishes and point this out to anyone who takes care of you.

I had a pair of paediatricians present at DS's birth - he was 6 weeks early and there were signs of foetal compromise during labour.

They didn't appear until sometime during the pushing bit, and waited quietly in a corner. Once DS was born and the cord had been cut, they took him off to check him over, and then gave him back to me for a quick cuddle before taking him off to SCBU.

It's unlikely that they'll whisk the baby off immediately unless the baby does need to go to SCBU urgently.

'Contrary to what many people would think, this is often done without good reason. '

Can you evidence that scaremongering statement?

Thanks for the next lot of replies. I tend to labour fairly fast (2.25 hours with DS3) although 25 minutes of pushing each time so they don't shoot out. Hadn't thought that the paed might not make it. I've met the cleft team and see the breastfeeding specialist in June. The cleft nurse only briefly talked about the birth. I asked about it and she said it would be fine to have whatever birth I wanted and be discharged from hospital as long as feeding is going ok. I don't see the cleft nurse again until we are discharged from hospital. I've got her phone number and email though so I can ask her if a paed is really necessary.

The surgeon and cleft nurse were very reassuring about feeding, saying that it will all be fine etc and they didn't mention breathing problems. I'm wondering if it's because the cleft team look after these babies all the time but the midwife won't see many. There was another baby diagnosed with a cleft lip at the same hospital the previous week and the midwives were saying to me it was really unusual to have 2 babies diagnosed with it so close together. Going by statistics there are probably 4 or 5 babies a year born in that hospital with a cleft lip/palate.

I don't mind if a paed needs to do anything but when something is going to happen "just in case" I want to know why. Also I'm not that knowledgeable on the subject but I think with surgery happening at 3 months DC4 will have need of the extra blood, iron etc that comes with delayed cord clamping. If a paed wants to look at his lip/palate while in my arms with the cord still attatched then fine. If they want to cut the cord and take him/her away somewhere "just in case" of something that they don't seem to know then that's not fine. If anyone wants to get the baby out quicker so the paed doesn't have to waste time hanging around, that's definately not fine. My fanjo has been stitch free despite 3 DC's and I plan on keeping it that way

I had a pead at the birth of DS when it became obvious he was distressed. He wasn't breathing at birth and having been resuscitated and checked over in the delivery room was taken to SCBU to be checked too. He was 'whisked away' but they still let me have a cuddle first and When he came back they hadn't dressed him but he was in lovely soft hand knitted blankets, rather than the hospital ones.

Hi there. I'm in a not identical but related situation in that I've been advised to have a paediatrician at the birth of my baby as I was born with a cleft palate and Pierre Robin Sequence. We are fortunate that our baby shows no sign of PRS or indeed a cleft, but I'm still higher risk due to my history (eg cleft of soft palate). My research shows that the baby is likely to have feeding, not breathing difficulties, especially with cleft lip, so we have agreed with the hospital that we will have a midwife-led birth in the birthing centre and the midwife will call the paediatrician only if/when there are breathing difficulties, so we can prioritise the skin to skin and bonding in the first hour. Later, we will call the paed for a full cleft palate check. For low-risk births, they don't check for clefts til the 72h check, so we are happy to postpone the check (all being well, of course) so the birth/bonding remains a priority. I just can't imagine a paediatrician waiting patiently while I faff around waiting for the cord to stop pulsating, etc., when I'm sure there's a whole ward of babies waiting for her/his attention. In your case you know there is a cleft, so for you the choice is weighing up whether the risk of breathing difficulties is high enough to make the paediatrician's check the priority. Like others have said, there is so much importance placed on early bonding now (unlike when I was born and whisked off to intensive care for 5 weeks without my mother even knowing why for 24 h!!) that the whole medical team will make sure it happens very early on.

All the best for your birth and little arrival!

*'Contrary to what many people would think, this is often done without good reason. '

Can you evidence that scaremongering statement?*

I really didn't intend this to be scaremongering and i don't really think it is. I meant that professionals sometimes feel as though they should do something even when doing something isn't actually necessary. It does happen, although less so than it used to IME. Interference at the time of birth in this way can have a detrimental effect on this precious time. That is why I would encourage the OP to find out exactly what potential problems the health professionals are concerned about and communicate her birth wishes to all concerned while being mindful of these potential problems.

I don't mind if a paed needs to do anything but when something is going to happen "just in case" I want to know why. Also I'm not that knowledgeable on the subject but I think with surgery happening at 3 months DC4 will have need of the extra blood, iron etc that comes with delayed cord clamping. If a paed wants to look at his lip/palate while in my arms with the cord still attatched then fine. If they want to cut the cord and take him/her away somewhere "just in case" of something that they don't seem to know then that's not fine. If anyone wants to get the baby out quicker so the paed doesn't have to waste time hanging around, that's definately not fine. My fanjo has been stitch free despite 3 DC's and I plan on keeping it that way.

I think all you say seems really sensible and would agree that delayed cord clamping would be particularly important in your baby's case in view of the surgery needed. Again, many birth/newborn professionals aren't too knowledgeable about this so you may need to read up a little bit to educate yourself. Nicholas s. Fogelson is an American ob/gyn with a special interest in cord clamping. His lectures/ research findings are available on You Tube.