One of the great blessings we experienced this summer was the arrival of grandchild #3, son of KOTPE and his wife, Buttercup. And he challenged us with drama all along the way. The first was the usual just trying to get through the first trimester alive; his mom already had a record of miscarriages. Then came the more frequent doctor visits because she was now classified as being high-risk. And sure enough, right in line with his older sister, Sweet Pea, and his older brother (who went straight to heaven), he was not gaining enough weight. Growth-restricted is what they call it.
That qualified him and his mom for weekly doctor visits, half of which were a four-hour drive to the big city. Fortunately, KOTPE took those days off work so he could drive Buttercup to those appointments. He seemed to be doing pretty well and hovered around the 7-10th percentile for growth.
But at 34 weeks, when Tiger dropped below the 3rd percentile for growth, that got his mom scheduled for an induction 3 weeks early. At least he had dropped into birth position and indicated that he was ready to move on to his next stage of life.
However, not wanting to miss the opportunity to squeeze a little more drama in, the night before he was to arrive, he decided to flip. Breech position. No good. And no amount of manipulation by the doctor was going to persuade him to flip back into birth position. Then he started exhibiting signs of distress. That warranted an emergency Caesarean section. Bummer.
Tiger arrived on the scene at a not-so-whopping 4 lbs 8 oz.
Even now with functioning hospitals, there’s not much anyone can do about a growth-restricted baby (and anecdotal reports from a few people I know in OBGYN/ultrasound positions indicate a significant increase in growth-restricted babies since COVID). Most of us aren’t going to be prepared for a c-section. But we can prepare for low-birth-weight babies.
In all the off-grid texts that I have here, there is next to nothing about caring for newborns, especially sick and underweight newborns. So I felt extremely fortunate today to stumble upon another gem. The Alaska Community Health Aide Practitioner Manual 1987 was written for the approximately 210 community health aide/practitioners (CHA/Ps) who deliver primary health care in rural Alaska. These CHA/Ps receive only 10 weeks of formal training before beginning their work in rural villages. Naturally, they rely on being able to connect with physicians by phone and they have all the desired supplies at their disposal, things we have a harder time procuring because we aren’t licensed.
Nonetheless, this manual is a true treasure trove of information for individuals preparing for the challenging times ahead. And the best chapters in this manual, in my opinion, are those relating to maternal and child health and mental health issues.
So what does this manual have to say about caring for low-birth-weight babies? Lots.
Low birth weight is defined as weighing 5.5 lbs or less. This infant may also have:
- Limp appearance/poor muscle tone
- Soft and floppy ears
- Little or no breast tissue
- Few creases on the bottoms of the feet
- Lots of fine body hair
- Thin skin
- Little fat under the skin
Begin care as for all newborns. Check the Apgar scores and record them at 1 and 5 minutes after birth. After drying the baby, loosely wrap his arms, legs, and torso in plastic wrap. Make sure to keep a stocking cap on his head at all times. Babies lose much of their body heat through the head. Wrap the baby in a warmed blanket. Make sure you can observe him without disturbing him. Keep the baby in a warm area. Assuming no incubator is available, improvise with a cardboard box with viewing holes and some water bottles.
If the baby’s temperature drops below 97.6°F, do the following:
- Prepare hot water bottles.
- Wrap the hot water bottles with towels or blankets so that there is 2” of cloth between the bottles and the baby. Place the hot water bottles in the enclosure with the baby.
- Check the baby’s skin often to prevent burns.
Low-birth-weight babies are also at risk for low blood sugars. (Low blood sugar in a newborn is defined as less than 30 mg/dL in the first 24 hours of life, and less than 45 mg/dL after that. By the second to third day of life, the baby’s blood glucose levels should increase to the adult level of 80-120 mg/dL.) Symptoms may include:
- Bluish or pale skin color
- Apnea (breathing pauses) or rapid respiration
- Hypothermia
- Jitteriness, grunting, or irritability
- Poor feeding or vomiting
- Tremors or seizures
The risk factors for low blood sugars in newborns include the following:
- Maternal hypertension
- Premature birth
- Maternal or neonatal infection
- Baby needing oxygen after birth
- Maternal diabetes
- Restricted growth of baby in the womb
- High or low birth weight[1]
Armed with this information, I have added hot water bottles
to my Amazon cart and will have them shipping soon. I spied liquid glucose packages at the
pharmacy last time I was in, so I’ll stop by on my next trip into town to pick
some up. And, of course, I am going to
be printing up this manual in the next day or two.
References:
[1] https://www.stanfordchildrens.org/en/topic/default?id=hypoglycemia-in-a-newborn-baby-90-P01961
Thanks for the link. I've printed it.
ReplyDeleteExile1981
Quite late in my life, I am going to be a grandmother. My husband & I spend most of our energy prepping for this little family. We hope your grandchildren & our little baby & all the little ones make it. Thank you for helping us all!
ReplyDeleteMany congratulations!! Grandchildren are the best. May we all prepare the best we can for them and their future.
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