Sensitive Midwifery - Issue 44 - October 2019

Mom & Baby after C-section in an e ff ort to establish a ‘normal’ microbiome. Safety of this practice as well as its e ff ectiveness are not supported by robust evidence. 3. Stabilisation of the infant The oxygen saturation should be monitored in all infants by preductal pulse oximetry (SpO 2 ) on the right hand after birth. No infant should leave the delivery room/theatre without a documented SpO 2 . Normal oxygenation implies an SpO 2 of 90–93% in room air and a respiratory rate of 50–60 breaths per minute in a non-crying infant. Record the SpO 2 and supplemental oxygen requirement 4–6 hourly for 24 hours. Refrain from a clinical assessment of oxygenation by noting the colour of the infant’s tongue. An infant with a pink tongue can have a low SpO 2 , necessitating supplemental oxygen. Inadequate oxygenation and can only be diagnosed by an SpO 2 . Guard against an SpO 2 >95%. Skin-to-skin care on the mother’s chest (if she is normothermic) should be initiated after the infant’s stabilisation in an e ff ort to initiate surges of oxytocin and prolactin in the mother-infant dyad to facilitate bonding, lactation and a positive maternal feeling. These surges are blunted after the first hour in the event of C-section and fail to recur thereafter. 4. Proactive breastfeeding support Initiate nipple contact and colostrum intake immediately after delivery to optimise the prognosis for successful short- and long-term lactation. Most mothers secrete colostrum at birth which should be aspirated with a 1cc syringe and administered to the infant should suckling be ine ff ective at this time. Proactive professional lactation support should be available at all times and in particular before di ffi culties with breastfeeding arise. Reactive support in response to problems are less e ff ective at this time. Refrain from supplementary formula feeds at all times. 5. Surveillance of the newborn infant Monitor oxygenation (by SpO 2 ), thermoregulation, glucose metabolism and breast milk intake at 4–6 hourly intervals for at least 72 hours after a scheduled delivery. Record the infant’s weight daily, as well as urine output (at least six wet nappies over 24 hours) to ensure that the intake of breast milk is adequate. If more than 10% of the infant’s birth weight has been lost by 72 hours, inadequate intake of breast milk should be diagnosed and treated to prevent jaundice and hypernatraemic dehydration. Bilirubin levels should be recorded in all infants before discharge irrespective of whether jaundice is present. The value should be plotted on a percentile chart to determine the risk after discharge of hyperbilirubinaemia necessitating intervention. The availability of nursing personnel and relevant equipment for e ff ective monitoring of caesarean- delivered infants is mandatory. 6. Neurodevelopmental surveillance Infants born before spontaneous onset of labour by means of a scheduled delivery should be o ff ered neurodevelopmental surveillance until school-going age, as delays can only be diagnosed by this means. This is important due to physiological and organ immaturity (including the brain). Early remedial intervention improves the long-term prognosis. Decreasing the burden To decrease a wide range of potential health and developmental adverse e ff ects, the overuse of caesarean deliveries in the private sector should be acknowledged, reported and addressed. Meticulous surveillance by midwives and nurses to minimise risks to these newborn infants is essential to further decrease the burden. Comprehensive references: Professor Delport has provided exhaustive references to substantiate her concerns about the e ff ects of unwarranted C-section delivery prior to spontaneous labour commencement. Sensitive Midwifery urges all readers to use these to educate unenlightened colleagues. See them on page 55. 48 eSensitive Midwifery Magazine Issue 44