Breath Taking. Michael J. Stephen

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СКАЧАТЬ the lungs, heart, brain, and muscles of the chest to appropriately make the lightning jump from living in fluid to living in air. But of these four systems, the lungs have by far the most work to do, because in utero they are like a soaked sponge, filled with the mother’s amniotic fluid. The fetus’s source of oxygen is the placenta, that radiant red jellyfish-like structure that is expelled after birth. The placenta neatly takes oxygen-rich blood from vessels imbedded in the uterus and channels it to the fetus through the umbilical vein.

      Once in the umbilical vein, the blood travels through a series of open ducts, one through the liver and another through the right to the left side of the heart, to ensure that the dormant lungs are bypassed. The blood then goes out the left side of the heart to the aorta, where it feeds the organs. The tissues expel the oxygen-depleted blood back into veins, where it ultimately travels back into the mother’s body through the umbilical artery.

      The free oxygen ride must come to an end, and it does so dramatically at birth. In an instant, the ducts through the liver and heart close, shunting blood to the lungs to pick up oxygen. The brain must simultaneously start firing signals to the muscles of inspiration. The eyes must open and adjust to the harsh light of the world. Finally, the lungs, still filled with amniotic fluid, must inflate in an instant with the first breath of life. The alveoli pop open for the first time and, with that first deep breath, suck the fluid up and immediately begin extracting oxygen from the atmosphere. The lungs change from being water-filled to being air-filled, from being dormant to extracting oxygen, all in the first few seconds of life.

      Unfortunately, for some babies this leap from in utero to living in the atmosphere is not without significant complications. I experienced this firsthand one day. On a brutally hot day in late spring, I drove frantically to the hospital in dense Philadelphia traffic with my very pregnant wife. Adding to the discomfort, my wife was intermittently squeezing the blood out of my arm in retaliation for the contractions in her belly.

      We drove right up to the hospital and gave the attendant my key. A man instantly emerged with a wheelchair, and we were whisked up to the preadmission area for pregnant patients. A nurse in bright-green scrubs immediately and unceremoniously put a glove on her hand and inserted it into my wife. “You’re almost completed dilated,” the woman said. “We need to get you into the delivery room. Now!”

      Our hearts started racing as we instinctively clutched each other’s hand. The nurse left, but not for long, and when she came back, she was accompanied by a horde of other hospital workers. With mechanical efficiency, one of them jabbed my wife’s arm for an IV line, another thrust a blood pressure cuff around her bicep, and a third strapped a monitor onto her belly to measure the baby’s heart rate. Then she was quickly moved to the delivery room, up onto the bed, and into position.

      “What about my epidural?” my wife asked, squeezing my arm again as another harsh contraction pulsed through her. The doctor came in, young and fresh-faced, in blue scrubs and blue hat. She nodded at us and then studied the baby’s heart rate on the monitor. It had dipped down with the contraction, which was normal enough, but it was going too low, and staying too low for too long. After a long spell of slow, low-pitched, tortuous beeps, the pinging of the heart rate on the monitor resumed its brisk pace.

      “Listen, there’s no time for an epidural. You need to get this baby out. He’s ready. Your body is ready. We need to do this.”

      “You’re sure?” My wife looked anxiously around, stressed by the prospect of more pain.

      “Yes, quite sure,” the doctor responded evenly. “We need to get this little guy out. There’s something irritating him in there. His heart rate is intermittently dropping too low. Way too low. He needs to come out now.”

      Wild thoughts entered my head. He was a few days early, and now his heart rate was sporadically bottoming out. Questions about whether this would affect his brain, and whether his lungs would be ready to wake up and answer the call of terrestrial life, entered my head.

      For the next fifteen minutes, my wife’s contractions came and went. With each one, the little guy’s heart rate dipped too low and for too long. But it always came back up, granting us some feeling that everything was okay.

      Finally, in response to one long, very painful contraction and a lot of pushing, the baby’s head appeared in the canal, his hair all curly and slimy. “Okay, let’s do it on the next one,” the doctor said, now fully suited in blue paper scrubs and elbow-length white gloves, her energy raised to the next level.

      The next contraction came, and through the searing pain and exhaustion, my wife screamed and pushed, completely absorbed in that private world of childbirth. But from her pain and monumental effort came a result—my son’s head popped out. The excitement was tempered by the sounds of his heart monitor, which began bleating out the low drone of his heart rate crashing again. It dropped much lower than before, down to forty beats a minute. My wife stopped pushing, the contraction gone. Her face relaxed, and then her pelvis. The baby retreated to where he had come from, and the slow heart rate that should have started to recover by now didn’t. And it was dropping lower and lower, now thirty, now twenty, with no signs of recovery. Then the pinging heartbeat dropped to its lowest and slowest pitch yet, a sickening sign of a life slipping away.

      “Don’t stop! Don’t stop!” the doctor pleaded, grabbing my wife’s hand in hers. “You need to get this baby out. Push! Push! Push!” I joined into the entreaties and started screaming, “Push! Push!” Confused, and shielded from the reality of her newborn’s devastatingly low heart rate, my wife started pushing again. Once and nothing; then twice and nothing.

      “One more big push!” I yelled. It was my turn now to squeeze her arm, and I squeezed it hard. Finally, with a huge effort and a high-pitched scream, my wife pushed with all of her might, and the little guy came squirting out in rush of liquid and slime. He was beautiful, but he wasn’t moving at all. His head and body were completely flaccid, his eyes shut, and his skin a sickening pale blue.

      It was clear now what had caused his heart rate to dip low: around his neck the umbilical cord was wrapped tight in a single, well-defined knot. It all made perfect sense. As he got farther down the birth canal, the umbilical cord, constrained by its tether to the placenta, had wrapped itself tighter and tighter, like a perfectly constructed noose.

      The nurse quickly cut the cord, and she and the and doctor brushed past me and put the baby on the newborn bed, a bright warming light shining down.

      “Somebody page pediatrics. Stat!” the doctor yelled. “His APGAR is four.”

      She then turned the warming lamp up to high and shook our child’s chest. He did nothing, remaining flaccid and blue. The doctor grabbed the oxygen mask and strapped it onto his face, but still nothing happened. Ten seconds passed, then twenty, then thirty, without the faintest hint of a limb stirring.

      A nurse hurriedly got an intubation tray ready to insert a tube into my son’s mouth and hook him up to a ventilator. If he couldn’t breathe, the ventilator would have to do it for him. I took a look at the instruments the staff was about to employ. The intubation blade, about six inches long and shiny silver, would be used to pull open his mouth to get a good look at the airway opening. The tracheal tube was a simple piece of plastic with a balloon on the end, ready to be thrust down to deliver the breaths of life. There was no question about him needing the tube. We were just waiting for the pediatricians now.

      Another nurse came over with a breathing bag to deliver rescue breaths until they got the tube in. Before strapping on the mask, she gave my son one final shake, and through a miracle, she connected with what was likely the single neuron in his brain that was still firing. He shook his head, took a huge breath, instantly turned a bright red, and let out a huge scream, affirming his secure place in the СКАЧАТЬ