NU143CL Unit 2 Observation Analysis Example

Standing at the Warmer During a Scheduled Cesarean: An Observation Analysis of a Composite Newborn's First Thirty Minutes After Birth Without Labor, and Why Her Fast Breathing Was Watched Rather Than Treated

[Student Name]

Purdue University Global

NU143CL: Maternal Infant Nursing Clinical

Unit 2 Observation Analysis

[Instructor Name]

[Date]

The birth, newborn and staff are composite; the student observed only, and values are bracketed where illustrative.

What I Observed

The birth was a scheduled repeat cesarean at 39 weeks and 0 days. The mother had not labored. When the baby was lifted out at [0912], she cried after a few seconds and was brought to the radiant warmer. The newborn nurse dried her quickly with warm towels, removed the wet ones, and placed a hat on her head. She suctioned the mouth briefly with a bulb syringe when the baby sounded wet. At one minute the Apgar score was [8], with points off for color and tone. Her breathing rate at five minutes was [72], above the usual range of [30] to [60], with occasional soft grunting. Her heart rate was [150] and her oxygen saturation on the right hand was [93] percent at ten minutes.

The nurse watched her closely without starting oxygen. By twenty minutes the breathing rate was [64] and the grunting had stopped. At thirty minutes, with a rate of [56] and saturation of [97] percent, she went to lie against her mother's bare chest, still in the operating room.

Why She Breathed Fast

Before birth, the lungs are full of fluid. During labor, hormonal changes and the squeeze of the birth canal help the lungs absorb that fluid. Babies born by cesarean without labor miss much of this process and are more likely to retain lung fluid, which causes fast breathing in the first hours, known as transient tachypnea of the newborn. A large cohort study found that term babies delivered by elective cesarean had higher rates of breathing problems than those born vaginally or by emergency cesarean, especially before 39 weeks (Hansen et al., 2008).

What looked to me like distress was, in this baby, her lungs clearing fluid that labor would usually have cleared for her.

The Nurse's Decisions

Drying and warming came first, because a wet newborn loses heat quickly and cold stress increases oxygen use. The nurse suctioned only when the baby sounded wet, rather than routinely. She did not start oxygen immediately, because the saturation was within the expected range for a baby a few minutes old, which rises gradually over the first ten minutes. She checked the right hand, which reflects blood going to the brain. And she set her own threshold: if the breathing rate stayed above [60] or the grunting worsened, she would call the pediatric provider. Watching with a plan is different from waiting.

Watching the Room, Not Only the Baby

Standing still let me notice things I would have missed while busy. The mother, behind the drape, kept asking whether her daughter was all right, and the circulating nurse answered her each time by name and in plain words: she is crying, she is pink, the nurse is just watching her breathing. Her partner was invited to the warmer to see the baby and take a photo before she went to her mother. The room was kept warm, and the anesthesiologist delayed a conversation until the baby was on her mother's chest. None of these steps appeared in the procedure list, but each made the first minutes safer or kinder.

What I Did With Standing Still

At first I felt useless at the warmer. My instructor had told me to count the breathing rate silently every five minutes and compare my count with the nurse's. My first count was [80] and hers was [72]; I had counted for fifteen seconds and multiplied, and the baby's irregular breathing made that inaccurate. After that I counted for a full minute and matched her within two breaths. Observation turned out to be practice after all.

What I Learned

Observing without acting was itself a skill; the fundamentals text describes observation as data collection with a purpose (Potter et al., 2023). I learned to separate signs that need immediate treatment from signs that need close watching, and to ask what explains a finding before reacting. I also learned that the timing of the saturation reading matters, since newborn oxygen levels are expected to rise over the first minutes (Perry et al., 2022).

What I Want to Know

I want to learn how long fast breathing can last before it is no longer considered transient, and when a baby like this would be moved to the nursery for monitoring. I also want to understand how the team decides between skin-to-skin in the operating room and a period of observation first.

References

Hansen, A. K., Wisborg, K., Uldbjerg, N., & Henriksen, T. B. (2008). Risk of respiratory morbidity in term infants delivered by elective caesarean section: Cohort study. BMJ, 336(7635), 85-87. https://doi.org/10.1136/bmj.39405.539282.BE

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.