04/03/13

Neonatal Transitional Physiology

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Neonatal Transitional Physiology

In the infinite intelligence of the body everything is set up so that it works perfectly and everything has a reason for what it does. Here is a short version of what happens physiologically at birth Neonatal transitional physiology Remember that the placenta and the cord (and the blood in these organs) are all part of the babys body. All of this blood is the babys blood. Babies need an adequate blood volume in order to fully clear the lung fluid after birth! Premature babies have more respiratory distress, difficulty with temperature control and an increased rate/risk of infection, all of which are caused or exacerbated when the cord is clamped before an adequate transfusion from the placenta has taken place, leading to a low blood volume and fewer oxygen-carrying red blood cells. This is true of women who hemorrhage and it is also true of term babies, though not as apparent. Sick babies, which include premature babies, are the most transfused population in modern medicine. A normal transfusion of blood from placenta to baby is approximately 100ml. At birth as the baby is going through the pelvis some blood (about 66ml) backs up into the placenta (Peter Dunn 1966). It is believed that this helps by causing the placenta to be fully engorged as the baby emerges which in turn helps it stay attached to the uterine wall as the uterus changes shape from the loss of its contents as the baby exits the uterus. Then as the baby leaves the pelvis and the pressure is released on the vessels of the cord, a bolus of warm, ph balanced, highly oxygenated blood is forced through the fetal circulatory pathways into the babys lungs. The constricted capillary beds surrounding the alveoli dilate and expand, pulling them open and keeping them erect. This reduces the effort the baby needs to exert in order to breathe and expand the alveoli on her own. Also this dilation in the extracellular matrix of the capillaries supports continued alveolar erection. As the capillaries dilate the osmotic pressure within the alveoli and capillaries adjusts as fluids shift from inside the alveoli to the capillary beds. Judith Mercer CNM believes that this alveolar expansion often begins before the baby is bornthus the baby we sometimes see whose head is pink and making vocal sounds before the body is born. It takes about 45ml to fully dilate the capillary beds of the lungs. A 50% transfusion occurs within approximately 90 to 120 seconds after the birth and about 100% transfusion occurs at about 3 minutesif the baby is held at the level of the introitus during this time. In addition to dilating the pulmonary capillary beds, extra blood perfuses the gut and the kidneys both of which have more demands as they begin to digest and eliminate. If the cord is left unclamped babies will have a more blood after birth. There is a shifting of fluids that occurs over the next 72 hours; over the course of these three days the hemodynamics are shifting constantly, with more stabilization of the blood volume by day 3. Babies whose cords are not clamped begin to breathe more slowly than

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Babies whose cords are not clamped begin to breathe more slowly than babies whose cords are clamped immediately. So within 45 to 60 seconds after the birth, as the oxygen levels begin to increase, the umbilical artery, which is taking deoxygenated blood back from the baby to the placenta, begins to close, starting closest to the placenta. Each time the mother has a contraction, blood is pumped into the baby. The vein stays open (which is more than twice the size of the artery) so that if too much blood ends up going into the baby, the excess can backwash through the open vein and back into the placenta (our body is always trying to maintain homeostasis). True physiologic cord closure occurs between 1 and 3 hours after birth. This seems to coincide with the surging of Oxytocin for mother and babysee below. The place where you put the baby matters only if you cut the cord quickly after birth. The baby should be placed within 4 inches above or below the placental site. If you need to resuscitate the baby, place it below the level of the placenta. In a baby whose cord is amputated shortly or immediately after birth, instead of the blood going to the kidneys and the gut, the blood is preferentially redirected to go to brain, heart, and lungs to maintain survival. Remember a full transfusion is approximately 100 ml; it takes approximately 45 ml to dilate the pulmonary capillary beds. A 50 ml blood loss in a 7 pound baby is equivalent to a 1000 ml blood loss in a 150 pound non-pregnant person losing 1000 ml of blood. A baby whose cord is amputated at birth is experiencing the same thing an adult experiences when they lose a large quantity of bloodin other words, hypovolemic shock, physically, psychologically, and emotionally. A baby whose cord is cut before the placenta is born is thus experiencing a pathological transition. Aside from the physical insult, these babies take their very first breaths in an overwhelming state of fear and panic, thus imprinting them with negative messages about having support cut off, helping to form the basis for life philosophies based upon survival and scarcity rather than abundance and wholeness. --Anne Frye, Holistic Midwifery Volume II, page 273.

Neonatal Transitional Physiology

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