Wellness & Education

Wellness & Education

Portland Midwife's Advanced Resuscitation Skills Save Nepali Newborn

On a recent medical aid trip to a remote village in Nepal, Women’s Healthcare Associates Certified Nurse Midwife Helen Welch saved the life of a minutes-old baby boy in distress.

Map of Southeast AsiaIt was a fluke that Welch was present when the baby was born. The humanitarian aid trip, sponsored by Project HOPE, was designed to provide ambulatory primary care, optometry, pediatrics, physical therapy and women’s health care services in the remote village of Machhapuchhre, 45 minutes outside Pokhara, Nepal.

Welch didn’t go to deliver babies. She went to meet the basic health needs of women, and to teach important emergency birth skills to Nepali healthcare workers and traditional birth attendants. That all changed at 8:30 one morning as Welch and her colleagues were setting up to see patients. A 32-year-old woman in active labor with her fourth child had hiked 20 minutes up a steep gulley toward the village before catching a ride to their clinic.

“I felt her belly and realized immediately that the baby was breech,” said Welch, “she was seven centimeters dilated at that point and her contractions were five minutes apart. We had no equipment for a breech delivery or to care for the infant when it arrived. The nearest hospital was 45 minutes away; it was a risk we had to take.”

Welch and two physicians, a pediatrician on the aid mission and a Nepali family practice physician, loaded the woman on to a military-issue gurney and raced by jeep down the mountain. “There was barely room for all of us. I was kneeling beside the woman the whole trip, monitoring the baby’s heart rate, rubbing the woman’s back and reassuring her. In my head, I was running through the maneuvers I had taught many times to safely deliver a breech baby in an emergency.” When the group arrived, they ran through the crowded hospital to labor and delivery.

Helen Welch, CNM - Project HOPE in NepalWith the woman now safely in the hospital’s care, the team thought that was the end of their journey. Having come this far to assure a safe delivery, however, they decided to stay and take pictures of the baby. They were ushered aside to wait and respectfully stayed out of the way.

Finally, the trio received news of the birth. “The baby is here; it’s a boy. He’s not breathing and we’re waiting for the pediatrician,” one of the hospital staff relayed. The team begged to assist and was finally given permission. The infant lay still and grey on the hospital resuscitation table. Welch checked and found his tiny heart rate was 50 beats per minute (normal is 120 beats per minute or above). Realizing her neonatal resuscitation skills were the most valuable in this situation, the pediatrician asked Welch to take over.

“I knew the baby was fine on the trip to the hospital and had plenty of strength in reserve. We would never give up on a baby with the heart rate of 50.” Thankfully, there was a bag and mask nearby. “There were people everywhere and it took several tries to get the mask in position. After his little chest began moving, my pediatrician partner checked his heart rate again. It rose steadily in response to the supply of oxygen. In three minutes the child was pink and screaming.”

Nepali Mother and Child“In a situation like this here, there would have been a team standing by to take the child. I’ve resuscitated babies before, but always with the comfort of knowing there was someone else coming. I realized in an instant in Nepal there was no one coming. Thirty years of experience came down to that one moment and my training took over.”

Normally, volunteers on this type of medical trip do not make home visits. After saving the child, however, the team was welcomed into the family’s home to visit the baby boy, his parents and three older sisters.

Helen Welch, CNM practices at the Peterkort South office of Women’s Healthcare Associates. She teaches the American Academy of Family Practice Advanced Life Support in Obstetrics skills courses (ALSO) to midwives and family practice physicians at OHSU.

Certified nurse midwives like Welch and the 18 others who practice at Women’s Healthcare Associates have Master’s degrees in nurse midwifery from institutions accredited by the Accreditation Commission for Midwifery Education (ACME). They are licensed as both Registered Nurses and Nurse Practitioners and are certified through the American Midwifery Certification Board. Learn more about midwifery services at Women’s Healthcare Associates >

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