Starting Baby Classes

BABY CPR
On Monday night this week, we went to a baby Cardio Pulmonary Resuscitation (CPR) class. The instructor was a senior RN named Fern Drillings who works in the Obstetrics ward at Columbia Presbyterian.

At the start of the class, the instructor asked everyone in the room to introduce themselves and share their due date or the age(s) of the child(ren) they have. There were roughly 26 people in the class -- many couples who are pregnant at various stages, some parents who've had children within the last 9 months, and at least 4 - 5 nannies, some who were there with their employers.

There was one woman in the class who is at the 38-week mark who looks the same size as me though I'm 31 weeks... and a couple of other women who are due in June who looked less 'large' than me, leading me to realize I am indeed on the 'biggish' side for this stage. So although it's a bummer when people in the office go "You're huge!", I realized they are right.

She gave us a brief overview of procedures to follow for a range of injuries or ailments that could affect infants and toddlers, ranging from burns and fevers to choking relief procedures and CPR.

CPR has evolved since I took a class 15 years ago. In the last five years, the health industry has updated the CPR protocol, and the good news is that the number of breaths and compressions is now the same for all ages.

Baby CPR differs from adult CPR now only in terms of the amount of pressure put on the sternum (chest) when doing compressions [for babies: two fingers only, pressing down 1/2 - 1 inch vs. for adults: using palms -- one over the other -- and pressing down 1-2 inches)].

The current CPR procedure for any age is:
1) Call 911
2) (Person lying on back) Tip head back to create clear airway passage
3) Check for indications of breathing (by listening/feeling for breath and watching chest)
4) Give 2 breaths - check that airway is clear (by looking for rising of the chest)
5) If airway is not clear, follow procedure to clear airway, and then proceed to CPR
6) If airway is clear, proceed with CPR:
2 breaths + 30 compressions
2 breaths + 30 compressions
(repeat until medical help arrives or person recovers consciousness and breathes on his/her own)

OBSTETRICS ANESTHESIA
Tonight Michael and I attended a free lecture on anesthesia and analgesic options available at Columbia Presbyterian, given by the Chief Anesthesiologist, Dr. Richard Smiley. He has a staff of seven Anesthesiologists and the eight of them rotate duty 24/7 and typically have 1-2 senior resident doctors in tow per anesthesiologist during each shift to perform or observe the procedures.

Fun fact: Dr. Smiley is the fourth Chief Anesthesiologist to lead the OB anesthesiology department at Columbia Presbyterian since Virginia Apgar - the most famous female physician of modern times - who pioneered the Apgar test for newborns. See here:
http://www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_12.html
Dr. Smiley clearly enjoys his work -- his presentation was interspersed with pictures from a past sabbatical in Switzerland, a picture of his dog, and photos from a visit to a museum in France featuring the work of Volti, an Italian artist who made sculptures and works of art about women - especially pregnant women. Added bonus: free food and beverages were provided.

The trend now and the goal of the OB anesthesiologists is to provide analgesia (moderate pain relief while still enabling movement and sensation) vs anasthesia (complete numbness and loss of feeling - e.g. for surgery).

Dr. Smiley covered the pain relief options in great detail, including epidural, spinal block, IV, and the benefits, risks, side-effects and specific dosages and types of medication used.

More than 80% of women who give birth at Columbia Presbyterian opt for pain relief, and the majority get a combination spinal epidural (CSE) for which the patient can give themselves additional dosages to a controlled degree. The procedure involves the insertion of a soft catheter into the epidural area of the lower spine. The epidural catheter is taped to the back and stays in for several hours until delivery, and allows some degree of mobility though walking is not generally encouraged.

Michael enjoyed the presentation very much. I found it useful and learned a lot, but given my aversion to needles and the low (but possible) risks and side effects, I'd like to try and soldier through as long as I can without using an epidural. Have read many blogs online and many friends and colleagues have said "whatever you do, get the epidural!", and Columbia hospital statistics show that 85%+ of women who give birth at the hospital opt for pain relief, so it is very popular, and if I did pass it up, I'd be in a very small minority.

By the end of the lecture, the room was very hot and the topic made me feel queasy so I was glad to leave. We are both glad we attended; we'll be well-informed and reasonably prepared for whatever happens in June.

I spoke to my mom and learned she received anasthesia when I was born (either a spinal or epidural), and she said she got a painful headache afterward -- one of the side-effects of a spinal block, though they've recently been able to reduce the probability of a headache significantly.

3-Month Check-up: Finding a Doctor Who Delivers! (Wednesday, 6 December 2006)

3-Month Checkup: weight 137.5 pounds, blood pressure 110/70.

My cousins and friends gave us recommendations for obstetricians, but those that I could track down were unavailable – no longer do deliveries, were booked for the next six months, not accepting new patients, or don’t accept any form of insurance. Who knew it would be such a challenge to find a doctor that delivers in Manhattan?

Today I met Dr. Holden for the first time, and the visit coincides with a 12-week checkup. He is part of an obstetrical practice associated with Columbia Presbyterian Hospital – reputed to be one of the best in the city for delivering babies and providing neonatal care. He reviewed the test results from the first doctor visit and took a history of my health, Michael’s health, and the events leading up to this visit. He looks young…younger than us, but seems competent, cheerful, and mentioned he is married with a young son. That’s a good sign… at least he’s married and has been through one birth of his own! He gave me all his office numbers and his cell phone number and encouraged me to call anytime for any reason.

I was directed to an exam room, where a nurse took my vitals and put a fetal heart monitor on my abdomen to listen for the fetal heartbeat. Initially, we couldn’t hear anything and I started to worry, but the nurse assured me that when the fetus is small, as it is at week 12 (about 3-4" long!), it takes time to find the heartbeat. Within a few moments, she found the heartbeat, and it was very rapid. Pelvic exam normal.

After the exam, Dr. Holden and I regrouped in his office. He advised me that because of my age, we should decide whether to get genetic testing – either Chorionic Villis Sampling (CVS) http://www.babycenter.com/refcap/pregnancy/prenatalhealth/328.html or Amniocentesis http://www.babycenter.com/refcap/pregnancy/prenatalhealth/327.html?ccRelLink=&url=%2Frefcap%2Fpregnancy%2Fprenatalhealth%2F328.html&xTopic=prenattest&bus=content– -- to confirm the health of the baby.

Women who are 35 or older at the time of delivery are encouraged to take either the CVS or Amniocentesis test (and insurance companies cover the cost). While there are risks associated with both procedures, the probability of finding a genetic problem with the baby is greater than the probability of complications resulting from either procedure because of the statistics associated with maternal age. Before I left the appointment, Dr. Holden and I agreed to meet once a month going forward for progress visits.

I am not going to look further for a doctor – glad to find someone who is positive, seemingly trustworthy, and makes himself available to answer questions anytime. My initial thinking about wanting a female OB has gone out the window; other worries eclipsed any hesitation I had about a male doctor performing pelvic exams, and Emma and others assure me that when the Bean is born, any shyness I had about strangers seeing 'my business' will disappear.

Before I left the office, I gave several vials of blood for tests, including HIV. The nurse asked me to sit in a chair in a very small office (claustrophobic). When she was done, I fainted, and woke up on the floor with my feet propped up on the wall. After a few minutes of laying down, my equilibrium was back and I was up and ready to go home. The nurses told me its pretty common, but it's a bummer that it's a challenge for me to stay upright for blood tests.

Tonight ranks as one of the most stressful I can remember in recent times. Lots of crying on the phone to Michael, my parents, Emma, and my brother. The CVS procedure is scary and I dread the risk to the baby, as well as the decisions we face if the results aren’t good. At what point (if any) would aborting feel like the humane thing to do? In cases of Trisomy 13 or 18 where the baby would suffer severe birth defects and would not be projected to live longer than 12 months (in pain and on life support systems)? The risk of CVS complications is slightly higher than amniocentesis, and the safety of the test depends heavily on the experience of the doctor performing it. On the positive side, the geneticist, also a Melissa, told me Dr. Wapner pioneered the procedure, has performed more than 22,000 of them, and does about 80 a month. She said if she had to get the test, he’s the only one she’d trust, and he comes to Columbia every Thursday to perform the test for those that need it.

I’m 12 weeks and 5 days, so this is the last week of opportunity for me to take the test. Need to do it tomorrow, or wait until week 18-20 for Amniocentesis. After discussing the options with Michael by phone tonight (he is on a business trip this week), we agreed that CVS would be the best plan because of the ability to get results more quickly than amniocentesis, and Dr. Wapner sounds like the best man to do it.

Michael won’t be back until the day after this test, so I’ll be on my own tomorrow.