PREGNANCY

What Happens if Something Goes Wrong with Baby at Birth with Neonatal Nurse Practitioner Jen Mills

Having something go wrong with baby at birth is something that a lot of people are afraid of. Today I wanted to give you a peek behind what might happen if something is wrong with baby and what the hospital can do.

Today’s guest is Jen Mills, DNP, APRN, NNP-BC. Jen was a bedside RN for 10 years at a Level 4 NICU that specializes ECMO, surgeries, cardiac and genetics patients. She then obtained my Doctor of Nursing Practice and continue to practice in that same Level 4 NICU, as well as a Level 3 NICU and a Level 2 NICU at a local community hospital. She specializes in cardiac patients but also love attending deliveries and taking care of feeder grower babies at the community hospital.

Big thanks to our sponsor The Online Prenatal Class for Couples — if you’re looking to learn more about what is going to happen at birth, it is the class for you!

In this episode

What happens at a normal birth, and what might happen if something goes wrong with baby (or the staff worries something is wrong).

What happens if baby continues to have issues.

Producer: Drew Erickson

when they cry that's when they're clearing out their lungs
Transcript
[00:00:00.170] – Hilary Erickson

Hey, guys. Welcome back to the Pulling Curls Podcast. Today in Episode 196, we are talking about what we do if something goes wrong with baby at birth. Let’s untangle it.

[00:00:19.580] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls Podcast: pregnancy and parenting untangled. There’s no right answer for every family, but on this show, we hope to give you some ideas to make life simpler at your house. Life’s tangled just like my hair.

[00:00:39.960] – Hilary Erickson

Okay. This was one of the biggest fears. I think actually the biggest fear that you guys had about labor and delivery. Totally normal. So I just want to give you guys some statistics. It is one in 10 babies that has some difficulty transitioning to living in an air world right out of the womb.

[00:00:56.160] – Hilary Erickson

And these are very normal things, things we’re very used to taking care of. You’ll see the nurse stimulate the baby. We’re going to talk more about that in this episode. But all of that is very normal. That’s 10 % of all babies. Now, 1 %, meaning 1 out of 100, will need something a little bit more than just those initial steps.

[00:01:12.730] – Hilary Erickson

We’re going to talk about that more with Jen. But these things do happen and we are trained to handle them, especially people like today’s guest. She was a NICU nurse for 10 years and she is now a neonatal nurse practitioner. That means she’s like a nurse practitioner just in the NICU, which stands for Neonatal intensive care unit, which is where babies go. We call them a clean unit, meaning the babies only go to the NICU right after they are born.

[00:01:36.770] – Hilary Erickson

So you wouldn’t go home, baby then gets a cold or whatever and then go to the NICU. Those babies would go to what we call as PICU. But the NICU just takes care of babies right after birth. And a neonatal nurse practitioner would be someone who is trained just to take care of babies in those newborn stages.

[00:01:52.180] – Hilary Erickson

So she also works at a level 2, 3, and 4 NICU. She like floats between the different ones. And I just wanted to explain a little bit about that to you guys. NICUs are graded 1, 2, 3, or 4, and that just means that they can handle a certain amount of baby issues up to a certain point. Usually, there are only level 4 NICUs in major metropolitan areas. There’s maybe one or two in very large cities. Usually, the level threes can handle pretty much everything. And then if it gets beyond their skill set, then they’ll transfer to a level 4. The most important part of today’s guest is that she and I have been friends since junior high. We used to play in the band together in junior high. We were flute players. I want to introduce today’s guest, Jen Mills.

[00:02:32.920] – Hilary Erickson

Do you feel prepared for your delivery? In just three short hours, you can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class.

[00:02:45.870] – Hilary Erickson

I’ll use humor, stories from my 20 years in the delivery room to engage both of you. I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page from bump to bassinet.

[00:02:58.500] – Hilary Erickson

Join the online prenatal class for couples today. You can save 15 % with coupon code UNTANGLED. You can find the link in the show notes. Hey, Jen, welcome to the Pulling Curls podcast.

[00:03:10.870] – Jen Mills

Hey, thanks for having me.

[00:03:12.670] – Hilary Erickson

Jen is a neonatal nurse practitioner, but more importantly, she played flute with me in the seventh grade.

[00:03:18.060] – Jen Mills

Yeah, that was a good time.

[00:03:21.040] – Hilary Erickson

So many good times in junior high band. God bless our band teacher, Mr. Furnace.

[00:03:26.630] – Jen Mills

Well, I’ve been taking it into Mr. Fulmer in high school.

[00:03:30.090] – Hilary Erickson

I’m just going to leave that there. All right. B efore we get started, a couple of thoughts. Fun fact, your OB literally can’t do anything on the baby. They’re not even trained. I don’t know. Is that the way it is where you work, Jen?

[00:03:44.230] – Jen Mills

That is correct. The baby, they’ll come over and say, Oh, hey, how is it going with the baby? But other than that, they’re hands off.

[00:03:51.970] – Hilary Erickson

Yeah. In general, they turn into the communicator with mom because they have a pre existing relationship with mom. And all the nurses in the room are trained in what we call neonatal resuscitation, like the beginning stages, depending on where you’re going to deliver at. The nurses are trained a certain amount on… So I am trained to basically do the things we can do before the NICU team gets there, right? Exactly. And that’s all I need to be trained for because that’s what anyone would do the first few minutes of life. And I have seen some people on TikTok, babies will come out and they’ll be stimulating them. And people on TikTok are like, man, they are so rough on that baby. And I’m like, well, because we want to keep it alive.

[00:04:31.490] – Jen Mills

Those first 30 seconds, you’ve got to stim, stim, stim, rub, rub, rub, get them to cry. That’s the best thing they can do is cry and get rid of all that fluid in their lungs.

[00:04:40.780] – Hilary Erickson

So baby, hopefully, is going to go to your chest, and we can do a lot of this while the baby is on your chest. We don’t have to take the baby to the warmer to stimulate them. And when we mean stimulate, we mean we’re rubbing their back, we’re rubbing their feet. Again, on TikTok, I saw somebody like, They’re wiping the verbiage off that baby. And I was like, Yeah, oxygen, probably more.

[00:04:58.970] – Jen Mills

Important than verbiage. Absolutely.

[00:05:02.770] – Hilary Erickson

And then we’re at about 30 seconds, we’re like, What’s going on here? Baby’s not crying, baby’s not perking up because all babies come out like, I don’t breathe there. I just get my oxygen through this umbilical cord. So if we’re at 30 seconds to a minute and I’m not seeing much, I’m like, call NICU. So I would hit your call light or I’d hit whatever system the hospital alarms at. And then someone like Jen comes in. And this depends on your hospital also, because some people have a NICU nurse at every delivery. I don’t know those hospitals. If we know that there could be a problem, like the baby has meconium or it’s early, then we call the Gens of the world to come to the delivery because we have an idea that something could be wrong. But I have to tell you guys, there are times that that baby looks perfect. She’s had great prenatal care, absolutely no issues. Young baby comes out and it’s just like, Nope, not going to live here.

[00:05:56.760] – Jen Mills

It’s scary. It definitely happens. It is. I always when they say the miracle of birth, they really mean the miracle of birth. It’s amazing when nothing goes wrong.

[00:06:07.330] – Hilary Erickson

Yes. And actually, I’m just going to give a plug for hospital birth here right now because most of the issues that happen with home birth happen with baby because baby comes out and they don’t have a gen there. Your midwife is going to be trained just about as well as Hillary. I mean, I can help with more procedures. I have more equipment there. But essentially, those first 30 seconds to a minute, we could all manage those. But then you need a Gen if we’re getting past that. Jen, you come in the room, what do you do?

[00:06:34.010] – Jen Mills

As a nurse practitioner, I usually have a respiratory therapist and then one of the NICU nurses that comes with me. As soon as we get the baby over to the open warmer, we continue to stimulate, and usually if we need to, we’ll start oxygen. We’ll use a mask called a CPAP mask. I always describe it as it’s the same thing that we give old men when they snore at night. We’ll give them oxygen that way if they’re having a hard time breathing. We also put monitors on them to make sure, see what their oxygen saturation or how much oxygen is in their blood.

[00:07:08.960] – Jen Mills

Then we also listen to their heart rate. There’s different protocols we have through the neonatal resuscitation program that let us know when we need to escalate or maybe give them some breaths with that mask, or if we need to actually put in a breathing tube, which actually is pretty rare. We don’t have to do that very often. Usually by doing the stimulation and giving them some oxygen through that CPAP mask, we can actually get the baby pretty comfortable and transitioning to life outside of the womb. Yeah.

[00:07:43.010] – Hilary Erickson

And then neonatal resuscitation. So we take this program called neonatal resuscitation. If you have taken CPR as a person, you know that there’s these steps you go through, like the ABCs of breathing or whatever BLS tells you. It’s the same thing for NLP. We’re watching to see how baby is breathing. We’re checking their heart rate. If it’s a certain level, they tell us to do this. It’s just like an algorithm, right?

[00:08:02.710] – Jen Mills

Yeah. And it’s really nice because it actually works. It’s been proven and over and over and over and over again. It’s been well studied. And every few years, they’ll change things up and improve the practice of it that’s going to be safer for your baby and make them more successful.

[00:08:20.890] – Hilary Erickson

Yeah. And actually, one of the parts of NLP is delayed cord clamping. So for a long time, we had our babies that were very hesitant because they thought the baby was going to bleed out. I don’t know. God bless their little hearts. But I was like, Really? The cord is white. How are they going to… Okay. So delayed cord clamping is something they added to NLP. So that’s something your OB is involved with. We told them you need to wait 30 seconds to a minute to delay cord clamping because they show or they’re hoping that that has better outcomes for babies.

[00:08:45.010] – Jen Mills

Yeah. It actually it’s been really nice because our babies have a nice, juicy hematocrit when they get the delayed cord cramping. So for my hospitals, my hospital system, as soon as the baby is born, we start the Timer. And you guys have probably heard of Apgar’s one minute Apgar, and it describes how the baby is looking. But we’ll have someone call out 15 seconds, 30 seconds, 45 seconds, and then clamp.

[00:09:14.340] – Jen Mills

And then that’s when the doctor lamps. And the whole time we’re waiting for that minute, the nurse is stemming that baby and helping stem that baby. And the doctor is helping to stem the baby. And if the baby looks great, then the baby goes to mom’s chest. And then like Hillary mentioned, if the baby is struggling to breathe, sometimes we can’t delay the cord clamping and we take the baby directly to the warmer. Yeah.

[00:09:35.990] – Hilary Erickson

So all of this is very normal. I think a lot of people… Well, first off, I’ve heard moms be like, His Ap cars weren’t very good. His SAT scores weren’t very good. And I’m like, The Apgar is literally just a way for us to convey to other people how baby looked at birth without having to go through a giant report. Because when I know that baby was a three and then a nine, I’m like, oh, baby just took another minute to perk up. So I just know that by you telling me that. That’s all it is. It’s just an easy way for us to tell other people how baby did.

[00:10:08.780] – Jen Mills

A birth. Exactly. And we do it. We do the Apgar at one minute and then we do it again at five minutes. And if the baby is still struggling at five minutes, we’ll do another one at 10 minutes. And it’s really nice actually to see a baby go from a three to a nine. That’s always very reassuring.

[00:10:26.230] – Hilary Erickson

Yeah. Because well, first off, it’s such a transition for a baby. If you think about the baby’s heart and how it’s handling blood inside the mom versus having to breathe, it’s.

[00:10:35.750] – Jen Mills

The worst. Yeah. That’s why they come out and they’re like, some of them are so startled. And they’ll just have this look on this day’s look on their face, like, what just happened? And their arms are stretched out and they’re just like, Oh my gosh, I can’t believe I went through that. And sometimes with the stimulation, we have to remind them it’s okay, go ahead and breathe. Go ahead. This is life now.

[00:10:59.740] – Hilary Erickson

So it’s and soon you’re going to have to poop, buddy. Everything’s going downhill here.

[00:11:05.100] – Jen Mills

Exactly.

[00:11:06.060] – Hilary Erickson

So what percentage of deliveries would you guess that they end up calling the NICU? Do you have any idea?

[00:11:12.060] – Jen Mills

So I would say just I’m sure there’s an actual percentage, but I would say about 50 % of deliveries we get called to go on. So if a mom is on SSRIs or antidepressants, which I would never tell a mom to not take an antidepressant. I know with Zoloft, they’ll sometimes recommend that you stop two weeks beforehand to get out of the baby system. But I would never recommend a mom not take it just because your mental health is very important.

[00:11:39.140] – Jen Mills

But just know that your baby might come out and we call it stunned, where it takes them a minute to actually realize they’re supposed to breathe and it’s completely normal. I really appreciate it when OB’s will tell moms that so they’re prepared for it. Any SSRI deliveries, if the baby has meconium or is pooped during labor, will come down for that because the bad thing is if they inhale their own poop, then it might take them a little bit to breathe and they could sometimes end up with.

[00:12:07.620] – Hilary Erickson

An infection. Honestly, it’s surprising how often they inhale their own poop and absolutely nothing happens.

[00:12:12.100] – Jen Mills

I’m always Exactly. I was just going to say, I’m like, that is it’s super rare.

[00:12:17.500] – Hilary Erickson

To happen. Because I think if you or I inhaled our own poop, it would not be good for our future.

[00:12:22.420] – Jen Mills

We would have a problem. And then we also, if there’s a forceps delivery or a vacuum delivery, they’ll call us down. And then if there’s a C section, they always have the NICU team down there because the labor delivery nurses aren’t usually… There’s only one or two in a C section, so they have us come down.

[00:12:40.710] – Hilary Erickson

Yes. Also, just because baby doesn’t get squeezed the same way it comes out of the vagina. A lot of times they don’t get all that fluid, like, rung out of their lungs or whatever. Plus it’s colder in that room. And we really love having a nurse there that knows a lot, that can convey a lot to the parents rather than the labor nurse who’s just like, Yep, baby looks good.

[00:13:03.250] – Jen Mills

Yeah, exactly. I like to watch the C section. And depending on how the baby comes out, sometimes they will swallow a huge amount of amniotic fluid on their way out. And so when I see that happen, I know we’ve got to stimulate even more, try to get them to cry because when they cry, that’s when they’re clearing their lungs and we could suction out their mouths and get all that goop out. And then some babies need a little bit of oxygen support when that happens. And so we’re there to provide that oxygen support. And then if we need more help, we’ll call in more friends. But usually within 5 to 10 minutes, the babies are good to go.

[00:13:38.720] – Hilary Erickson

Yes. So I am trained in ACLS, which is where we would shock the moms and all those different kinds of things. And I’m trained in NLP. When I take ACLS, I literally have no idea. Every single time I’m like, I don’t remember how much up you to give. I don’t remember any of this. Nlp, it’s just second nature for a lot of us because a lot of times babies just come out and they look a little wonky. And so we just go through it real… Probably by year five, I was just like, Yes, I’m doing compressions on a baby. This is so normal because it’s not unusual for us and it’s something we do really frequently. So I think a lot of parents are freaking out that, Oh, my gosh, the NICU team is in here. So normal.

[00:14:16.950] – Jen Mills

Yeah, it absolutely is. And we try to calm parents and just let them know, like, we’re just here just in case. And if you really need us, you want to have us right there. And it is like our resuscitations are, it is, it’s second nature. And we practice that. We do simulations on computerized babies that actually can make the noises that let us know the baby is grunting.

[00:14:44.260] – Jen Mills

You might think they’re cute noises, but it’s the baby trying to keep their own legs open. And these simulated babies can do all these fun things that newborns do when they’re born. And we practice every few months, we’ll go through and practice to make sure that our skills are all up to stuff and that we’re as prepared as possible for any emergency that happens.

[00:15:06.300] – Hilary Erickson

Right. And learning to work as a team, all of that’s just super important. And it is stuff that we go through emergencies really often at the hospital. So I hope that that is clear to you guys that we are prepared for things to go wrong. So hopefully you’re a little bit less nervous that if something goes wrong, the hospital, that’s what you’re paying us for.

[00:15:23.650] – Jen Mills

Exactly. We are the best paid babysitters you’ll ever have is what we like to say in the NICU.

[00:15:31.730] – Hilary Erickson

Probably the best babysitters they’ll ever have. Absolutely. Although you’re not like playing Lincoln Logs and Legos, so that’s a shame.

[00:15:39.120] – Jen Mills

I wish we could. We usually have no time. Yeah.

[00:15:43.800] – Hilary Erickson

Okay, so if baby still has an issue, then what happens to baby?

[00:15:47.650] – Jen Mills

So if baby has issues beyond the first 5 to 10 minutes, then we do what we call early lung recruitment, where we put that CPAP mask over their face and we keep it on for about 30 minutes. In our hospital system, we do the first 30 minutes in labor and delivery so that baby can stay with mom. And then we just give them an opportunity to help clear their lungs out, help get used to breathing.

[00:16:13.040] – Jen Mills

And then hopefully we can take that mask off and if baby looks great, then we pass over to mom and do skin to skin and initial breastfeeding and all that fun stuff. If the baby beyond the first 30 minutes still needs help, then we’ll go up to the NICU and you have six hours to transition out of the NICU.

[00:16:32.540] – Jen Mills

So during that six hours, we will do two more rounds of the early lung recruitment. And then if the baby still requires CPAP, then we will do an X ray, keep them on CPAP, and then maybe start exploring other options for why it’s possible they still require that CPAP. Sometimes we’ll test for infection. We look at their blood sugar because some babies can have low blood sugar, and we just try to explore options.

[00:16:58.880] – Jen Mills

If it looks ike, usually after 4 hours for me, if it looks like the baby is still going to require CPAP, then we will admit to the NICU and do a couple of days of antibiotics. Then what’s really nice is usually after 24 hours on CPAP, the baby is able to come off CPAP, go straight to room air, and then usually we can get him back down with mom and dad.

[00:17:20.070] – Hilary Erickson

I think a lot of people worry that as soon as that baby goes to the NICU, they’re thinking it’s going to be months of a NICU stay, and that’s not true at all. A lot of it is just having someone there with a lot of training on babies who can watch them because your labor nurse is not that person.

[00:17:36.320] – Jen Mills

Yeah. And in postpartum, too, they already have usually four couplets that they’re taking care of, maybe three couplets. And when babies go up to the NICU, it’s like, we want to have them on monitors. And that monitoring is not possible down in postpartum with the constant monitoring and making sure everything is going okay.

[00:17:57.270] – Jen Mills

And so the NICU sounds like a scary place. And it’s very disconcerting to have your baby go upstairs and to know that they’re not going to be able to be right next to me. But to try to offset that, we do encourage our parents to spend as much time as possible in the NICU, especially when mom is still impatient.

[00:18:15.930] – Jen Mills

I mean, definitely, we want you to rest and we want you to take care of yourself because you need to be well enough to take care of your baby when it’s time to go home. But there’s a huge movement for the NICU for it to be a very family centered, parent driven experience. So we want your input. And then we also want you to be able to sit back and let us do what we need to do to make sure that your baby is safe to go home.

[00:18:41.140] – Hilary Erickson

Yeah. I think it’s hard for moms to find that balance because they feel like they need to be in the NICU constantly. And I’ll be like, have you taken a shower? Let’s just get you feeling good. Baby’s taken care of, right? We fed the baby. If you’re pumping or whatever, take care of you also. Both of you really need to be taken care of. And baby is 100 % taken care of.

[00:19:00.180] – Jen Mills

Yeah. And that’s what we tell moms all the time. Especially sometimes we have babies that are born a little early, 34, 35 weeks, and they’re not quite ready to breastfeed yet. And usually at that early stage, mom has been either dealing with preeclampsia and it’s just really not feeling well or had to have an emergency C section.

[00:19:19.580] – Jen Mills

The worst thing that you can do is not take care of yourself and have a problem like you wear your C section scar dehisses or opens up, or you end up sick and you move back in the hospital. I mean, that happens sometimes for women and it’s just that’s harder than maybe taking four hours away from the bedside to go home, go down and sleep, or make sure you’re drinking your water and eating. It’s just very important. Yeah.

[00:19:42.950] – Hilary Erickson

That’s just like for the rest of parenting. It’s hard. It’s a balance forever. All right. And what age would you say are babies more likely to not be out of the NICU for you? We say under 37, 36 would be a late preterm baby, but usually those babies don’t go to the NICU. What age do you think usually ends up in the NICU? Not every baby can surprise us.

[00:20:05.050] – Jen Mills

Yeah. I would say for us, obviously, we have a couple of community hospitals that are level two NICUs, so we’re able to have babies that are as low as 32 weeks. If you have a baby between 32 and 36 weeks and you end up in the NICU, especially with those 36 weekers, we always say plan on being gone by your due date. With 35 or 36 weekers, I have especially boys, our wimpy white boys, that 35th and 36th week of pregnancy is when your baby is doing a lot of growing and they don’t get that suck, swallow, breathe mechanism really down and they’re not really ready to do that until 37 weeks.

[00:20:45.920] – Jen Mills

And so if you have a 35 or 36 week baby, some babies are great and they take off and you only end up being in the NICU for a week. And some babies, I have seen so many babies lately that literally they’re 39 and five seventh weeks or 39 weeks and five days old. And that’s when they decide that, oh, I think I like the bottle. And it is so frustrating for parents because their baby was a 34 weeker and they thought, oh, we’ll be out of here soon because the baby looks great.

[00:21:14.910] – Jen Mills

But they’re not mature enough to handle that bottle and handle that breast. So definitely our 34, 35 weekers are the ones that tend to end up in the NICU for a little bit.

[00:21:26.430] – Hilary Erickson

And that is another change because probably for three quarters of my career, it was all 36 weeks. 36 weeks we get baby and all of a sudden then they were like, Just kidding, 37 weeks is what we’re aiming for. Because I think they just found that is when babies do better. That isn’t to mean that if you have a 36 week baby that they’re going to end up in the NICU. It just really depends on each kid. And again, boys are lazy.

[00:21:48.570] – Jen Mills

And it also depends on weight. If your baby weighs less than two kilos, they have to come up to the NICU. And again, it’s just because when they’re smaller, they are less mature and they need a little bit of extra time. And they’re also really prone to have hypoglycemia or low blood sugar. And sometimes that requires an IV with some glucose water or sugar water to keep their glucose s up. So just something to think about. It’s not a bad thing at all. It’s just that we’re trying to prepare your baby to be the most successful they can be when they go home.

[00:22:19.060] – Hilary Erickson

And that’s really all the NICU is, period, right?

[00:22:21.450] – Jen Mills

Yeah. It’s a good training center for them.

An 11-page guide on how to get your body, brain and baby on board with your plan.
[00:22:24.290] – Hilary Erickson

Where is the NICU for teenagers? That’s what we need is the new training center when they’re failure to thrive in high school.

[00:22:33.070] – Jen Mills

That is awesome.

[00:22:35.530] – Hilary Erickson

All right, thanks for coming on, Jen. I hope this helped everybody understand that the hospital is there to support you and your baby. We’re trained. There’s good people like Jen there to help those little tiny babies.

[00:22:46.400] – Jen Mills

Absolutely. Thank you so much.

[00:22:48.260] – Hilary Erickson

I hope you guys. Found that episode helpful. I think a lot of people just don’t even think about what would happen if baby had an issue at the hospital, mostly because they don’t want to think about it. And I totally understand that.

[00:22:57.870] – Hilary Erickson

There’s a lot of things about my kids that I don’t want to think about either. But I want you to know that we are trained to do it and that most of the nurses in labor and delivery and postpartum are trained to handle the widest variety of things.

[00:23:08.090] – Hilary Erickson

And then if we need more help, we would transition to needing someone from the NICU. So I hope you guys enjoyed it and I hope you guys found it helpful. Come find us over on Instagram and tell me if you found it helpful. I would love to know.

[00:23:19.440] – Hilary Erickson

Stay tuned because next week’s episode, we are doing another 180 and we’re talking about organizing for the summer. So come join us then.

[00:23:26.740] – Hilary Erickson

Thanks so much for joining us on today’s episode. The Pulling Curls podcast grows when you share us on social media or leave a review. If you do, please tag us so that we can share and send you a virtual hug, which, frankly, is my favorite hugging. Until next time, we hope you have a tangle free day.

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