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>> A LOT OF FAMILIES ASK US, "AM I GOING TO HAVE TO HAVE
A C-SECTION BECAUSE MY BABY'S GOING TO BE SO ILL?"
AND I THINK THAT, OVERALL, VAGINAL DELIVERY IS PREFERABLE.
>> MOST INFANTS WITH CDH WILL UNDERGO A FAIRLY ROUTINE LABOR.
THEY'LL BE MONITORED TYPICALLY, AND MOST OF THEM UNDERGO
A VAGINAL DELIVERY.
>> WE WERE SURPRISED BECAUSE WE THOUGHT THAT IT WOULD BE BETTER
FOR THEM JUST TO GET HER OUT REAL FAST AND BE ABLE TO DO WHAT
THEY NEEDED TO DO WITH HER.
BUT THEY ACTUALLY TOLD US THAT IT WOULD BE BETTER FOR HER TO BE
DELIVERED NATURALLY.
SO WE DID THAT, AND SHE WAS BORN NATURALLY.
>> MANY TIMES WHAT WE WILL DO IS SCHEDULE AN INDUCTION OF LABOR,
AS LONG AS THE *** IS FAVORABLE.
SUCH THAT EVERYBODY HAS A HEADS-UP AND IS READY
AND WAITING FOR THE BABY WHEN IT'S BORN.
>> IT'S A BIG DEAL TO COORDINATE EVERYTHING.
SO IT'S IMPORTANT THAT OBSTETRICIANS AND THE SURGEONS
AND THE NEONATOLOGISTS AND THE ECMO TEAM AND THE NURSING STAFF
KNOW WHEN THAT BABY'S COMING, BECAUSE WE ALL WANT TO BE THERE,
AND WE WANT TO BE READY.
>> THE FETUS AND THE NEWBORN WITH THE SEVERE DIAPHRAGMATIC
HERNIA PROBLEM IS AS FRAGILE AS ANY BABY WE TAKE CARE OF
AT THE CHILDREN'S HOSPITAL OF PHILADELPHIA.
>> AND ONE OF THE THINGS THAT'S IMPORTANT IS TO MONITOR LABOR
PROGRESS AND THE STATUS OF THE FETUS IN UTERO JUST PRIOR
TO LABOR AND BE ABLE TO HAND THE NEONATOLOGIST A BABY WHO
IS AN OPTIMAL CONDITION FOR RESUSCITATION.
>> THE ISSUE IS TO MINIMIZE INCREMENTAL RISK FACTORS THAT
COULD LEAD TO THE BABY DYING.
AND ONE SUCH RESOURCE, WHICH IS AMAZING,
IS THE SPECIAL DELIVERY UNIT, WHERE ALL OF THE BABY'S CARE,
ALL OF THE MOTHER'S CARE CAN OCCUR IN ONE PLACE.
>> THE SPECIAL DELIVERY UNIT, OR SDU, IS A UNIT THAT WAS DESIGNED
ESPECIALLY FOR A BABY BORN WITH AN ANOMALY,
WHO'S GOING TO NEED AN INTERVENTION SHORTLY AFTER BIRTH.
>> ALL OF THE BABY'S CARE, ALL OF THE MOTHER'S CARE CAN OCCUR
IN ONE PLACE WITH STATE-OF-THE-ART RESOURCES, BEFORE BIRTH,
DURING BIRTH, AND AFTER BIRTH.
>> SO THE BABY WITH CONGENITAL DIAPHRAGMATIC HERNIA,
WHO NEEDS EXPERT MULTIDISCIPLINARY CARE FROM
THE FIRST MOMENT, IS THE PERFECT EXAMPLE OF THE TYPE
OF PREGNANCY THAT WE FEEL SHOULD BE DELIVERED IN THE SDU.
>> WE WEREN'T EXPECTING HER TO CRY.
SO SHE CRIED OUT AND SHE LOOKED-- SHE OPENED HER EYES
AND LOOKED AT US.
>> THEY LET US SAY "HELLO" AND WHISKED HER INTO THE NEXT ROOM
TO START TAKING CARE OF HER.
>> THE BABY REQUIRES PROMPT INTUBATION WITH AN ENDOTRACHEAL
TUBE, REQUIRES PLACEMENT OF A NASOGASTRIC TUBE,
WHICH DECOMPRESSES WHAT IS OFTEN A DILATED STOMACH.
>> REMEMBER, THE STOMACH IS IN THE CHEST.
SO, IF THE BABY GULPS AIR, THE STOMACH EXPANDS,
TAKES UP EVEN MORE SPACE IN THE CHEST.
>> --REQUIRES PLACEMENT OF INTRAVENOUS LINES,
MONITORING LINES, USUALLY AN UMBILICAL ARTERIAL LINE,
FOR ARTERIAL BLOOD PRESSURE MONITORING AND FOR BLOOD GASES,
ALL THAT NEEDS TO BE DONE QUICKLY AND EXPERTLY.
>> AND THEN, ONCE THE BABY IS STABILIZED, THEY TRANSPORT
THE BABY OVER TO THE NEONATAL INTENSIVE CARE UNIT,
WHERE ADDITIONAL PERSONNEL FROM THE TEAM ARE READY AND
WAITING FOR THE BABY TO FURTHER EVALUATE THE BABY AND DECIDE
WHAT THE BEST MEDICAL MANAGEMENT IS.