“Routine” Suctioning

By Krista Gray, IBCLC. Last updated August 2, 2017.

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When I was at the pushing stage in labor with my first child, I was totally unprepared for the nurse to look over at me and say, “I know your birth plan says you would like your child handed to you immediately following birth for uninterrupted skin-to-skin time but there is a little meconium and hospital policy states that we must first do an endotracheal intubation and oral suctioning.  It won’t take long, and then she will be brought to you.”  To say I was heartbroken would be an understatement but when you are 10 cm dilated and having a baby is not the time to negotiate.

I was elated to have just had a totally natural birth and decided not to dwell on this “minor” situation.  It seemed very brief, although looking back at the time on pictures, I realize it had to have taken several minutes (in which they weighed her as well) before she was given to me.  Once she was in my arms we did cuddle and nurse and have nearly 1 1/2 hours of skin-to-skin time. It was absolutely incredible. And I fell in love.  But, I always had in the back of my mind that this intubation was unnecessary and I wanted to make sure I was better prepared if there was a next time.

Research supports what my heart felt.  In otherwise healthy, full-term babies no benefits are shown for pharyngeal, esophageal, or gastric suctioning, although there are many negatives.  First, studies have shown a statistically significant lower heart rate for 20 minutes in babies who are suctioned.1 A Cochrane review concluded that routine endotracheal intubation and suctioning of term babies due to the presence of meconium is not a best practice and should be abandoned.  More importantly, there can be long-term consequences when this procedure is performed in terms of intestinal disorders and delay in baby’s prefeeding behaviors.2  We also know that immediate and uninterrupted skin-to-skin contact between mom and baby immediately following birth has a significant impact on successful breastfeeding as well as many other benefits including regulating baby’s temperature, stabilizing baby’s heart rate, lowering stress levels for mom and baby, reducing crying, stabilizing blood glucose levels, promotes bonding, increases mom’s levels of oxytocin and milk volume.  Whew.  With all of these important benefits, anything that takes a baby away from immediate skin-to-skin contact for the first 2 hours of life should be significant and medically necessary.

When my fourth baby came along this exact same situation presented itself while I was in labor pushing.  This time, however, I was better equipped.  I had talked with the midwives about this scenario and they agreed that the best practice would be to give my baby to me for immediate skin-to-skin following the birth and not suction him first.  Two hours later, while Jack and I were still enjoying our precious skin-to-skin time together the midwives checked his temperature (one early indicator if there were a problem) and he was just fine.  This was a much less invasive method and achieved the same goal – a healthy, happy, breastfeeding baby!

Show 2 footnotes

  1. Waltman, Patricia, Joyce Brewer, Barbara Rogers, and Warren May.  Building Evidence for Practice: A Pilot Study of Newborn Bulb Suctioning at Birth (Journal of Midwifery & Women’s Health, Vol. 49, Iss. 1, p. 32-38, January-February 2004)
  2. Widstrom, M., B. Ransjoarvidson, K. Christensson, S. Matthiesen, J. Winberg, and K. Uvnasmoberg.  Gastric Suction in Healthy Newborn Infants:  Effects on Circulation and Developing Feeding Behaviour (Acta Paediatrica, Vol. 76, Iss. 4, p. 566-572, July 1987)