See One, Do One – 31st January 2009

See One, Do One

BMA News, 31st January 2009.

Aidan M. O’Donnell

Julie was fit and well and having an elective Caesarean section. As a post-fellowship anaesthetic registrar, I went to see her beforehand. Her two boys had been born by Caesarean, and she was very comfortable and familiar with the procedure. I anticipated no difficulties.

The spinal anaesthetic took effect rapidly, and the surgery was started. After a short while, the baby was delivered. Normally the midwife will take the baby away briefly, dry it off, wrap it up snugly and bring it back to show to the proud parents. Some midwives take a couple of extra minutes to administer vitamin K and to do other tasks. This can sometimes seem a long time to expectant parents who are keen to hold their new baby, so some distracting chitchat can help to pass the time.

On this occasion, Julie interrupted me. “Why isn’t the baby crying?” she asked me. She was right. The baby was already a few minutes old, and there was no sound of crying. “There’s probably nothing wrong,” I told Julie, “but I’ll go and have a look”.

As I approached the Resuscitaire, it was clear there was a real problem. The baby was blue, mottled and limp. A trainee paediatrician was attempting ventilation by bag and mask. Two midwives were also in attendance, and the paediatrician was giving instructions to them in a low urgent voice. I came up close.

“I’m the anaesthetist. Is there anything I can do to help?” I asked. There was no response. I didn’t know if the paediatrician hadn’t heard, or had decided I had nothing to offer. From listening it was clear that help had already been called. I stood closer and repeated myself more loudly. Still no response.

I stood for a moment in indecision. It was clear that the bag and mask ventilation was ineffectual, and that the baby was dying. However, having little experience of neonates, I wasn’t sure I had the skills to improve the situation. If I elbowed the paediatrician out of the way, I might make the situation worse by being less skilled than she was.

After a few more seconds, I decided to intervene. It was clear that nothing was working, and I could certainly not make things any worse by trying. Just then, however, in rushed the sister from the neonatal unit. She grabbed the bag and mask and in a less than a minute the baby was pink and squealing.

I found the paediatrician in the corridor trembling and weeping. She told me this was her first week, and she had previously only practised bagging the mannequin. She was so absorbed she had not heard me offer to help. I tried to comfort her by pointing out that everything was now fine.

Julie took home her longed-for daughter, who seemed to have suffered no ill effects. I filled in a critical incident form. Later I sought out training in neonatal resuscitation, and next time will be much quicker to intervene.

Aidan O’Donnell is a consultant anaesthetist from Livingston, West Lothian. At the time of this article he was a trainee working in a different trust.

Copyright © Aidan O’Donnell 2009.
This article first appeared in BMA News on 31st January 2009.
Unauthorised reproduction prohibited.