Wednesday, April 18, 2007

Starting Baby Classes

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)

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:
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.

No comments: