Simulation: newborn assessment video transcript

Evaluating midwife: We can see that the baby’s got good tone, because it’s moving.

Evaluating midwife: Good color, nice and pink. (beeping noise) It’s the one minute APGAR there. I’ll just assess the baby’s heart rate. Her heart rate’s around 140, which is great.

Observing midwife: Excellent! And can you count, see and feel the respirations?

Evaluating midwife: Yes.

Observing midwife: And what do you think about the color?

Evaluating midwife: The color is nice and pink, which is what I’d expect.

Evaluating midwife: There’s some blue coloration of the hands and feet, called cyanosis, which is quite normal.

Observing midwife: Where would you put the APGAR score at one minute?

Evaluating midwife: I would give the baby, um.. probably I would give the baby a 9 because of the color. Because it’s not a fully pink baby, I’d take off a 1.

Observing midwife: Excellent, excellent.

Evaluating midwife:Evaluating Midwife: Yes.

Observing midwife: So that’s 2 for heart rate, 2 for tone, 2 for response to stimulus—

Evaluating midwife: As you can see the baby’s moving.

Observing midwife: --and 1 for colour.

Evaluating midwife: Yes. This baby is not adapting very well, it’s been born for 3 minutes now. And um.. you can hear that it’s having trouble breathing, it’s really needing to use all those muscles. It’s making that respiratory noise they call a grunt. It’s also a bit floppy and hasn’t got good tone and has a bit of cyanosis. This baby isn’t transitioning well and probably needs some additional support. She should have additional tone, and her respiratory rate is higher than normal.

Observing midwife: Yes.

Midwife Joanne: So the baby’s head has just birthed, but it’s now retracted back into the perineum, so we have a “turtle” side. So I’m going to try to deliver the shoulders, without any success because the baby’s shoulders are caught around the situs pubis. So at this point I’m going to call for help, urgently.

And then I’m going to evaluate for an episiotomy which I’m not going to do at this stage because this is a bone problem, not a tissue problem.

I am then going to elevate the woman’s legs and I’m going to ask the partner of the woman to hold her legs right back so that her knees are to her nipples, to widen the pelvic cavity as much as possible. And using that manoeuvre I’m going to try to deliver the head again, without any success.

So at this point, my assistant has arrived and I’ve asked her to apply super pubic pressure above the symposis, to try to add up the shoulders. I’m going to try to deliver, without any success. After 30 seconds of trying these manoeuvres each, I’m now going to move to do an endomanoeuvres. So I’m going to try put my hand in posterially, work it up to the posterior, to the back of the anterior shoulder and I’m going to try to rotate the baby, without any success. Now I’m going to put these fingers in and attempt a reverse woodscrew manoeuvre, without any success. At this point, I’m going to try a reverse manoeuvre to try to bring the baby back the other way. There’s a little bit of movement, but not enough. So now I’m going to try to move the posterior shoulder, sorry, the posterior arm. And try to locate the humerus and sweep it over the baby’s chest and here it comes actually. Here it comes, posterior arm and shoulder. So the whole baby will now birth ...and there it is! Birth success.

Midwife Joanne: Breathe, breathe, Breathe. That’s it. Just breathe it out, a little bit more. Keep breathing, keep breathing. The head’s out now. A bit more.

Fatima (mother): Is it out? Is it out?

Midwife Joanne: The head’s out. Now, you’ve done a fine job there. Beautiful, here comes your baby! Well done Fatima!