It was widely accepted that putting the newborn baby on the mother’s chest promotes skin-to-skin contact and bonding between the two who share the common experience of birth, and enhances the chances of successful breastfeeding, after a Cesarean section. However, from the viewpoint of anesthesiologists, who oversee the critical part of keeping the mother pain-free yet healthy during the surgical procedure, this introduces unnecessary risks.
The part they object to is the baby’s contact with the monitoring electrodes. These are electrocardiographic (ECG) devices that record the electrical activity of the heart muscle. They tell the anesthesiologist that the mother’s heart rate is doing fine during the operation and recovery.
The research, published in the European Journal of Anaesthesiology, reports two cases of monitor interference by the baby.
In one, a healthy 37-year-old woman was having a C-section for her first baby after 8 hours of labor, because the baby was deemed too large to emerge through the birth canal. After the baby boy was delivered uneventfully, he was placed on the mother’s chest, but the heart rate alarm went off promptly.
The monitor indicated a sudden drastic increase in the mother’s heart rate (tachycardia), along with the appearance of an abnormal tracing and disturbance of rhythm. However, the mother showed absolutely no signs of any problem on manual checking of the pulse and blood pressure.
The source of the aberrant ECG tracing was simple: the baby was sucking the electrode placed on the right side of the chest, which was in fact recording a joint ECG from mother and baby simultaneously. The electrode was replaced to another location, when the tracing immediately reverted to normal.
In the second case, a 36-year old mother was having a full-term C-section for her second child, again because the labor was not proceeding normally. Despite being stable throughout the operation, when the child was placed on the mother’s chest and both wrapped in warm blankets, the ECG tracing showed tachycardia, and in fact, two distinct rhythms could be recognized on the monitor. The other vital signs remained normal. Here again, the baby was the innocent culprit. The right ECG lead was in the baby’s fist, and when it was replaced on the mother’s right shoulder, things returned to normal.
In both cases, the baby’s skin-to-skin contact with the mother’s electrodes led to a combination of tracings on the monitors. This led to a moment of alarm when the doctors initially thought the mother had developed a cardiac arrhythmia, or disturbance of the normal electrical rhythm of the heart.
Baby’s interference with mother’s ECG tracing
Dr. Nicolas Brogly, who was involved in the first case, and in the current article, says cautiously, “This novel source of electric interference represents a risk for both the mother and the baby. The alarm on the monitor could have led to a misdiagnosis with of supraventricular arrhythmia, which could then have led to administration of antiarrhythmic drugs, or even worse, using the defibrillator on the mother to stabilize her heart rate.” One such case has been reported in 2013, not following contact with the baby but due to a misdiagnosis of arrhythmia when the patient was actually shaking all over, producing artefacts on the ECG. The correct diagnosis could have been achieved by simply rechecking the cardiac parameters by feeling the pulse at the wrist, placing a stethoscope over the cardiac area, when the regular heartbeat would have been heard, and checking the blood pressure.
However, in a literature survey, only one case where an electrical device used in labor actually interfered with the ECG recording has been reported. Here, a transcutaneous electrical nerve stimulator (TENS) was used to relieve labor pain but produced abnormal monitor tracings during labor. In most cases, electrical interference with the ECG tracing during surgery comes from poorly functioning electrodes, cables or other external sources of current, or from the patients themselves.
The way out
Of course, there are simple, non-technical ways to identify the abnormal tracing as an artefact: if the mother is otherwise showing signs of cardiovascular stability, the pulse corresponds to the heartbeat when both are palpated simultaneously, or if the arrhythmia ends when the baby is removed from the mother’s skin or when the baby’s position is changed.
To prevent misdiagnosis of arrhythmias in such situations, the authors say that skin-to-skin contact protocols should be updated in all situations involving a laboring woman about to give birth. They recommend: “ECG electrodes should be placed where no contact will be possible with the new baby (at the back of the shoulders for example) to allow cardiac monitoring of the mother while avoiding ECG interference with the child upon skin contact after delivery.” And perhaps more importantly, a clinical examination should follow all instances of abnormal ECG tracing, to avoid obvious and avoidable errors of diagnosis.
Skin-to-skin contact during caesarean delivery – An intriguing interaction between the mother and her child Brogly, Nicolas; Slegers, Leonie; Schyns-van den Berg, Alexandra; Guasch, Emilia, European Journal of Anaesthesiology: December 2019 – Volume 36 – Issue 12 – p 973–976, doi: 10.1097/EJA.0000000000001107, https://journals.lww.com/ejanaesthesiology/Citation/2019/12000/Skin_to_skin_contact_during_caesarean_delivery__An.11.aspx