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retractions and grunting

Last post 08-02-2009 12:10 PM by midwifea. 6 replies.
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  • 07-13-2009 9:31 PM

    retractions and grunting

     I am interested in midwives experiences with this in a newborn, what caused it, how you recognized it and how it was resolved...

    Thanks!

     

    Lesley Nelson, Warrior who prefers to move in open space in search of mysteries.
  • 07-13-2009 10:27 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: retractions and grunting

    Lesley,

    The reasons I have seen retractions and or grunting in a newborn ( I am only homebirthing) are varied.  Could be from the lung fluid/air exchange.  Respiratory stress.  Birth trauma.  Lack of maternal bonding.  For whatever reason, it is easliy reconizable by the grunting sound and visible chest retractions, also skin color and eye movement (baby has a rapid back and forth eye movement)  can cue me in...  tactile stimulation, skin to skin with mama, talking to baby about taking big deep slow breaths, papa swaddling baby and doing the sway/swing  hold back and forth to help fluid move out of the lungs are some of the actions I encourage.  It usually resolves itself with in a couple hours after birth unless there is a serious underlying ailment like infection. That's where trusting my instinct comes in and when I feel baby needs more help then I can provide at home, off we go.  That has happened to me twice.  Once was a term baby who was small and probably wasn't ready for life outside, observation for a day or so was all that was needed there. Once it was a listeria infection as the cause and that baby needed 3 weeks in the hospital.

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 07-13-2009 11:08 PM In reply to

    Re: retractions and grunting

    Was it an actual "grunt" sound you heard? Have you ever heard other wierd breathing sounds - like a mewl or chortle or high sigh/cry sound on each exhale? Could that be considered grunting as well?

    Had a baby with just the strangest high mewly sound on each exhale. Also little to no muscle tone - very limp and lethargic, no alert eye contact, just stared blankly. Transported after it wasn't resolved in a two hours after the birth. There was birth trauma involved and resuscitation. Baby was fine within an an hour of transporting (3 hours after the birth)...We tried many, many things to resolve this before transporting. Just wondering if there was more that could've been done. It seems that the NICU simply made the baby cry (injections and blood draws) and when we saw him next he was completely normal, excellent muscle tone, good vigorous cry, and alert as can be.

    We did not try to get this baby to cry. Maybe we were too gentle??? Just trying to gather more info and experiences with this from other midwives.

     

    Lesley Nelson, Warrior who prefers to move in open space in search of mysteries.
  • 07-22-2009 6:42 PM In reply to

    Re: retractions and grunting

    The first thing I do when there's grunting and retractions is check the temp. most likely, the baby just needs to be warmer. If baby is warm enough (over 97.6)  and still grunting , check breath sounds, if you haven't already. Suction if indicated, if not suspect a respiratory problem and transport. 

  • 07-29-2009 2:12 AM In reply to

    Re: retractions and grunting

     

    I was taught that is was due to Hypoglyceamia and baby needs skin-to-skin to warm up and a good feed!

    not sure whether that helps...

  • 08-02-2009 11:11 AM In reply to

    Re: retractions and grunting

     All the responses have been helpful - they confirmed the need we had for transporting this baby. Baby did Fine once at the hospital and came home a few hours later.

    BTW when we transported, baby had no sucking reflex.

    Lesley Nelson, Warrior who prefers to move in open space in search of mysteries.
  • 08-02-2009 12:10 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: retractions and grunting

    Lesley,

    When you're not sure it's always best to err on the side of safety.  Good job.

    A little off topic but I thought about this after reading one of your posts, a good cry in a newborn can really help all systems start efficiently.  I never wince if I make a baby cry trying to get them to fully breathe, I smile big.  I've  heard some birth attendants proudly say, 'their babies don't cry'. Well, to me crying communicates. Crying can jump start a little one's whole life, invigorate them, charge them up.   Sometimes we all feel better after a good cry.  A midwife friend of mine and I were just talking about this the other day.  Babies that don't cry at birth, who are they in school, as adults?  It seems they are the ones looking for a charge.  Also we talked about babies that check out after being born and have to be coaxed to get back here.  In our discussion we noticed several of our babes that did that at birth, later in their teenage years, needed to 'check out' in certain ways.  It very interesting to correlate all this info from birth and see it unfold during a life.

    I wonder what this babe in your original post will be doing 13 - 15 years from now?

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
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