If you're expecting a baby, you're probably learning all you can about how to make your pregnancy, labor, and delivery go smoothly and leave you and your baby in good health. But it's also important to understand that certain health problems and complications can't be prevented, no matter how smoothly the pregnancy goes.
There's no way to be completely prepared for complications during delivery or for the discovery that your child has a birth defect or medical problem. But understanding common newborn health problems and how they're treated might reduce anxiety about the potential that something might go wrong.
Other birth defects can't be discovered until after the baby is born. Delivery complications such as meconium aspiration (when a newborn inhales a mixture of meconium — the baby's first feces, ordinarily passed after birth — and amniotic fluid during labor and delivery) can occur.
If a birth defect is discovered prenatally, your doctor may discuss what will happen in the time right after you deliver the baby. You and your doctor should discuss which hospital is best prepared to deal care for your baby so that you can plan to deliver there.
You might want to ask if you can tour the intensive or special care unit at the hospital to become familiar with it and meet the team of health care professionals who may care your baby. This team may include neonatologists, pediatric anesthesiologists, pediatric surgeons, neonatal nurses, nurse practitioners, and doctors in training (like fellows and residents).
It is very common for infants, particularly those born prematurely, to have jaundice or breathing problems.
Many preemies and even full-term infants can develop jaundice if their immature liver initially can't get rid of excess bilirubin (a yellow pigment produced by the normal breakdown of red blood cells) in the blood. Jaundice can make a baby's skin and whites of the eyes appear yellowish.
If your baby has jaundice, the doctor may order blood tests to measure the bilirubin levels and determine if treatment is necessary. Usually, jaundice is treated by exposing the baby to special lights that help break down the extra bilirubin so the baby's body can process it.
Immature lungs are another common problem. These occur when a baby's lungs lack sufficient surfactant, a chemical that prevents the air sacs from collapsing during breathing. Surfactant isn't usually fully in the fetal lungs until after 34 weeks' gestational age, so many preemies need help with their breathing. Ventilators, machines that are hooked up to a small plastic tube that goes into the baby's windpipe, are often used to aid in breathing.
Synthetic surfactant is now routinely given (down a breathing tube) to very premature babies soon after birth. Premature babies do not have enough of their own surfactant to keep their lungs expanded. Giving extra surfactant allows infants to breathe on their own much sooner than in the past, and they sustain less lung damage because they don't need long-term ventilator use.
In the Delivery Room
Most babies are born in a labor and delivery room. But if there are complications, the mother may be transferred to a delivery room with additional medical equipment. Besides the obstetrician, midwife, or family doctor, there might also be nurses, neonatologists, or other specialists on hand to provide special medical attention the baby might need.
For example, if a newborn has spina bifida (exposed spinal structures) or hydrocephalus (excess fluid inside of or surrounding the brain), the doctors will take special care to support the head or cover the opening in the spine. For a newborn with an exposed bowel, the intestines are covered to protect them from infection and from heat and fluid losses.
In the case of meconium aspiration, usually the doctor tries to clear the baby's airways with suction to draw out any fluid interfering with breathing. A baby who continues to have trouble breathing or is very premature may need a breathing tube.
Whenever there is a problem, the medical staff, including a pediatrician or neonatologist, will monitor the baby's breathing and heart rate and make sure that the infant is kept warm. If necessary, they will perform a special kind of CPR for newborns. When stable enough to be moved, the baby is likely to be taken directly to the neonatal intensive care unit (NICU) for further treatment.
The obstetrics (OB) team will stay with the mother while the baby is being treated, providing any medical care she needs. The OB team makes sure that the mother delivers the placenta, that she receives any needed stitches, and in the case of cesarean delivery, completes the surgery.
Ask the medical team caring for your baby in the NICU to communicate with you about your baby's condition. If your baby has a condition that was diagnosed before birth, the doctor will explain any changes from the original plan and update you on the baby's progress. When a problem is unanticipated, the doctor or nurse will explain what is going on. In an emergency, the medical staff may not be able to explain things right away, but will do so as soon as things calm down.
Beyond the Delivery Room
Once out of the delivery room, the baby might need intravenous (IV) medications or fluids. And because babies lose heat quickly, your newborn will be put in an incubator or radiant warmer to maintain proper body temperature.
If the baby's breathing is too fast or labored, the medical team may order chest X-rays to determine its cause. Sometimes, blood tests or a foot or hand oxygen monitor can tell the doctor how much help breathing the baby needs. The team may need to give the baby a little extra oxygen or put the baby on a ventilator to assist with breathing.
When the baby's breathing and heartbeat are stabilized, treatment for any birth defects may begin. This evaluation and treatment period can last days or weeks, depending on the baby's condition.
Doctors may also want to take blood tests to rule out any other problems and measure such things as the baby's blood count and blood sugar levels. Some blood tests can take blood from the baby's heel, while others must draw it directly from a vein in the baby's arm.
Time apart from a newborn is extremely difficult for the family — particularly the parents.
It's common to feel disappointment and even guilt. It can help to talk about these feelings with a member of the medical team or a hospital social worker. And getting as much information as possible about your baby's medical problem might help ease feelings of anxiety and powerlessness.
Most hospitals encourage parents to spend as much time as they can with their babies. If the baby is transferred to a hospital with a special neonatal care unit, consider asking if the mother can get necessary postpartum care there, too, so that they can recover together.
Sometimes it is necessary for babies to stay in the hospital after the mother has gone home. It's hard for new moms to leave without their babies, but it can help to talk about your feelings with friends, family, and the medical staff.
And parents should get plenty of rest and regular exercise and be sure to eat well during this time. If the mother wants to breastfeed, talk with a nurse or lactation consultant about using a breast pump so she can freeze breast milk for when the baby is ready for it.
If your baby is born with a health problem, you have many options for information and support. Start by asking your doctors for information on hospital- or community-based resources. Support groups, both in person and online, are available for many disorders and conditions.