Cayman is a wonderful place to have a baby. However, like anywhere, complications do occur and it’s important to consider them from a Cayman perspective. Grand Cayman is over an hour’s flying time from any major children’s hospitals. Fortunately, however, there are good facilities on-Island and George Town Hospital has an excellent neonatal unit for preterm and newborn complications. –Dr Sara Watkin, Neonatal and Paediatric Specialist
Maximising safety is about making sensible choices with our Island in mind. Birth complications can occur with no warning in an otherwise healthy pregnancy. I attended a normal delivery with an experienced obstetrician when the baby developed serious birth complications requiring resuscitation and advanced techniques to avoid brain injury. Luckily, I was already there for this severe, unexpected event with no warning. It reminds us that birth location is important and that positive outcomes can sometimes depend on swift specialist support.
Timing and mode of delivery can matter. Although a caesarean section may be safer in certain specific circumstances, e.g. when the baby has not turned, generally a normal vaginal delivery is best for the baby, leading to fewer complications. Babies born by elective caesarean section are more likely to have breathing problems, sometimes leading to urgent neonatal unit admission. Chances of complications rise the earlier delivery is. Even at 38 weeks, there are significantly more complications than at 40 weeks, rising further if labour has not already started (in caesareans for no medical reason, for example). Good obstetricians recognise nature’s good design, unless there are strong medical reasons otherwise.
Sense of Perspective: when reading an article on complications, it’s natural to find yourself worrying. Cayman births are generally wonderful experiences, leading to happy, healthy lives and many things discussed here are not unique to Cayman.
If you have any concerns about your newborn, ask a newborn paediatrician at any point.
1. Asphyxia Around Birth
The most serious birth complication is that of asphyxia (lack of oxygen), which can occur if there are problems with the placenta or the umbilical cord getting kinked or wrapped around the baby’s neck. Asphyxia is life-threatening and those surviving often have severe brain damage. While fortunately it is rare, it tends to happen unexpectedly. Time is critical. The right support, immediately, and specialist techniques like brain cooling (therapeutic hypothermia), ideally started in minutes, are crucial. Birth location can make a difference when minutes count.
The last few weeks of gestation are very busy inside the baby. Lungs and vascular systems mature greatly, ready for life independent of mum. Premature birth interrupts this, often leading to breathing and oxygenation difficulties. These infants are more susceptible to infection and experience feeding difficulties just when they need good nutrition for growth.
Babies can survive from about 23 weeks gestation. We are fortunate to have excellent neonatal nursing in George Town Hospital, and I have spent my career looking after the sickest, tiniest infants, including here. However, the rarity and complexity of these babies pushes the limits of our small Island, so we tend to care for babies of 27 weeks or greater gestation. These infants still require lots of specialist support, fairly long stays in our neonatal intensive care unit (NICU), sometimes periods of ventilation and close monitoring. Our outcomes, I am proud to say, really are world-class.
3. Other Problems
Babies sometimes have problems occur during pregnancy or as a result of genetic issues. Nowadays, increasingly, obstetricians can identify these problems ahead of delivery, allowing them and your paediatrician to forewarn you and plan ahead of delivery. Sometimes these babies need to be delivered by caesarean section and transferred to NICU.
Each individual condition tends to be rare and sometimes difficult to spot before or at birth. This reinforces the importance of baby checks and a schedule of well-child checks to help pick things up.
Dr. Sara Watkin MB ChB, MRCP (paeds), FRCPCH, MD is a tertiary neonatal and paediatric specialist at Integra Healthcare. With 25 years’ service as a consultant, including as Chief of Service at University College London Hospital, a world-class tertiary centre for babies from 23 week’s gestation onwards and with complex paediatric and neonatal challenges. She is highly qualified and experienced in supporting children from their earliest preterm and term days right through to early adulthood.
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