ABSTRACT
OBJECTIVE: To assess whether defined reference ranges of oxygen saturation (SpO2) and heart rate (HR) of term infants after birth also apply for infants born after midwifery supervised uncomplicated vaginal birth, where delayed cord clamping (DCC) and immediate skin to skin contact (ISSC) is routine management. DESIGN: Prospective observational study. SETTING AND PATIENTS: Infants born vaginally after uncomplicated birth, that is, no augmentation, maternal pain relief or instrumental delivery. INTERVENTIONS: Midwives supervising uncomplicated birth at home or in hospital in the Leiden region (The Netherlands) used an oximeter and recorded SpO2 and HR in the first 10 min after birth. MAIN OUTCOME MEASURES: SpO2 and HR values were compared to the international defined reference ranges. RESULTS: In Leiden, values of 109 infants were obtained and are comparable with previously defined reference ranges, except for a higher SpO2 (p<0.05) combined with a slower increase in the first 3 min. The Leiden cohort also had a lower HR (p<0.05) during the first 10 min with a slower increase in the first 3 min. In the first minutes after birth, tachycardia (HR>180 bpm) occurred less often, and a bradycardia (<80 bpm) more often (p<0.05). CONCLUSIONS: Defined reference ranges can be used in infants born after uncomplicated vaginal birth with DCC and ISSC, but higher SpO2 and lower HR were observed in the first minutes.
Subject(s)
Delivery, Obstetric/methods , Postnatal Care/methods , Umbilical Cord/blood supply , Constriction , Heart Rate/physiology , Humans , Infant, Newborn , Mother-Child Relations , Natural Childbirth , Oximetry/methods , Oxygen/blood , Physical Stimulation/methods , Prospective Studies , Reference Values , Time Factors , TouchABSTRACT
OBJECTIVE: to evaluate the feasibility of using pulse oximetry (PO) for evaluating infants born in community-based midwifery care. DESIGN: a prospective, observational study of infants born after midwifery supervised (home) births. SETTING: 27 midwives from seven practices providing primary care in (home) births used PO at birth or the early puerperal period over a ten-month period. Data were obtained on the effect of PO on outcome, interventions and decision-making. Midwives were surveyed about applicability and usefulness of PO. PARTICIPANTS: 153 infants born in primary midwifery care. FINDINGS: all births were uncomplicated except for one infant receiving supplemental oxygen and another was mask ventilated. In 138/153 (90%) infants PO was successfully used and 88% of midwives found PO easy to use. In 148/153 (97%) infants PO did not influence midwives' clinical judgment and referral policy. In 5/153 (3%) infants, midwives were uncertain of the infant's condition, but PO measurements were reassuring. In case of suboptimal neonatal condition or resuscitation, 100% of midwives declared they would use PO again. KEY CONCLUSIONS: it is feasible to use PO in community based midwifery care, but not considered an important contribution to routine evaluation of infants. Midwives would like to have PO available during suboptimal neonatal condition or when resuscitation is required. IMPLICATIONS FOR PRACTICE: PO can be applied in community based midwifery care; it does not lead to insecurity or extra referral. Further research on a larger group of infants must show the effect of PO on neonatal outcomes.
