TRIGGER WARNING Why did my newborn require chest compressions?

[heythereconniver]

My lovely boy is healthy but I don't understand the circumstances of his birth. I'd appreciate an informed guess if anyone is willing.

His shoulder was stuck and he was delivered using a ventouse. It was tense and slow. Once out, he was floppy and silent. A team worked on him in the corner of the delivery room. They counted 'one two THREE' for three full minutes. I got the impression they were doing chest compressions. At the start of the fourth minute, he began to breathe. Apart from a truly massive bump on his head, he was strong and gave no concerns from then on. We appreciate him all the more because of this experience and have a much deeper sympathy for parents who are not so lucky.

Even though he's fine, I now need to know what happened. From a little bit of reading, I gather that a baby needing oxygen will try to breathe. If they're in the birth canal and therefore unable to breathe, they will then lose consciousness but circulation remains good. Then (if I'm right) the heart slows and, as carbon dioxide builds up, the baby will give some gasps. If they're unable to breathe air at this point, a new phase of oxygen deprivation begins. A short time into this, circulation becomes poor and the heart fails. I've read that this whole process takes twenty minutes and most babies are being resuscitated before reaching the stage of heart failure. Therefore, most babies don't need chest compressions.

Going by that description, it would place my baby pretty far down the line in terms of how long he'd been starved of oxygen.

But it doesn't add up. The results of a test to see how oxygenated his blood was at birth showed a much better result than they had feared. There was a celebratory feeling in the delivery room, which we were too traumatised to enter into at the time. We were told the problems during those three minutes were probably due to 'shock'. I'm wondering now if they meant that our baby's heart had slowed or stopped due to 'shock' rather than heart failure due to prolonged oxygen deprivation?

Does the three minutes of chest compressions mean that my son was born without a heartbeat? Were they likely to have used a defibrillator? I do have a hazy memory of something high pitched. Would the heart have just stopped randomly because he was so squashed and stuck? It sounds mad but I'm a bit vexed about it happening without a good reason.

Thanks to anyone who can shed light. I realise that I could return to the hospital but we're now in a completely different area and it would be a mission. Even though they were utterly lovely, I don't want to go back again.

They wouldn't have been doing chest compressions they would have been giving rescue breaths, one every three seconds, chest compressions are given at the rate of 100-120 a minute

If you contact PALS at the hospital you could request a written response describing what was noted for the care after the birth. It does sound like they had to work on him but I doubt anybody will be able to really put your mind at rest unless it's through reference to the notes.
You've set out your questions very clearly and I think you could get a good result with a written response.

Thanks northern

damn Thanks - I got the impression about the chest compressions apart from the counting but can't remember how. That isn't clearly explained above, sorry. It's all a bit hazy!

Try talking to the Professional Midwifery Advocate in the unit you gave birth in. They or another senior midwife should be able to go through your notes with you. Explain you've moved and ask if they can do it over telephone. I think it's really important with anything like this to get it clear in your mind what happened and why

www.resus.org.uk/resuscitation-guidelines/resuscitation-and-support-of-transition-of-babies-at-birth/
In case you haven't seen it. Chest compressions are given if the heartbeat is slow or absent. It works be extremely unusual to defibrillate unless some congenital cardiac problem. The resuscitaire - big machine they lie baby on with monitors, heaters equipment attached etc - often makes a high pitched noise. I agree you should consider asking to sit down and debrief what happened, for your own peace of mind?

You can request the records to be sent you by post. I did this for my first as I am having my third in a different country and realised I don't really know what happened with my first and it has been really interesting to read. Everything should be recorded there

Sorry, and congratulations on your lovely boy, Sorry you had a traumatic time.

Thank you so much to everyone who has taken the trouble to respond - much appreciated. I've written a letter.

You would benefit from an appointment with a neonatologist to go through the resus notes and fully explain everything.
Chest compressions are rare in transitioning term babies unless they are really oxygen compromised or have a cardiac cobdition - if the heart rate is low, then effective inflation breaths (given slowly - 3 seconds each) should increase a slow heart rate. 5 of these are given and further sets maybe needed if chest wall movement hasn't been seen (which may explain the counting you were hearing). After that quicker ventilation breaths are given until the baby starts to breathe spontaneously. If after the ventilation breaths the heart rate is still low (and you are happy with the chest wall movement I.e. They have been effective) then, you would start with chest compressions.
A defibrillator would not be used during newborn resuscitation.
Sorry if that was a bit technical. From what you describe (and from what you have read), it sounds like your baby had a shoulder dystocia, which compressed his umbilical cord which would stop his oxygen supply and he would be unable to breathe whilst his body was in the birth canal (this would be primary apnoea). He probably didn't require cardiac compressions and you most probably heard them performing inflation and ventilation breaths (although some nurses/docs do jump in on giving compressions too early when most babies don't need them with effective airway management).
Hopefully it will be clearer when you speak to someone at the hospital!
Congratulations on the birth of your baby!

As a PP stated, neonatal chest compressions are done in sets of 30 over 15seconds. Inflation breaths are done in sets of 3 and this is what they would have been doing, not uncommon. Most likely caused by the shoulder dystocia

Neonatal chest compressions are done in a 3:1 ratio with breaths, so it definitely sounds as if that's what happened. The vast majority of compressions are done on babies who have a heart rate (the heart hasn't stopped) but the rate is too slow to adequately support blood pressure and deliver oxygen to the body. Babies with shoulder dystocia have the umbilical cord compressed, but also have the whole chest squeezed tight which can prevent blood flowing easily to and from the heart. Your little boy obviously needed a bit of support to get his circulation going after birth, but as his oxygen levels were ok he was likely not stuck for too long. Congratulations on your baby!
COI: am a neonatal doctor.

Chest compressions in a neonatal resuscitation are performed in a 3:1 ratio with breaths so it is possible that’s what they were doing but it’s more likely they were counting out the 3 seconds of each inflation breath. The only way you’ll know for sure is to ask for a debrief. They should be able to sit down with you and go through the records with you so you can get your head round exactly what happened. It’s very common for it all to be a bit of a blur afterwards.

Congratulations on your baby, sorry his arrival was so traumatic 💐

Apologies 😖 I don’t know where my brain was this morning. As above neonatal chest compressions are 3:1 (I have real pregnancy brain going on)!!! Definitely would suggest speaking to a HCP to look at that. If your baby had chest compressions I would think it very very likely you would have been informed of this... nothing is impossible though