Helping Babies Breathe at Birth

A newborn who doesn’t breathe at birth needs help immediately. By one minute after birth—the golden minute—a baby should be breathing well or you should be giving the baby ventilation. This video shows the steps to help a baby breathe at birth.

Always be prepared: Be sure the place is clean, well-lighted, and warm. Have these supplies to help a baby breathe at every birth:

Wash your hands, then check your resuscitation equipment. First squeeze the bag and watch for the valve to open and close. Next, make a seal with your palm and squeeze the bag. You should feel pressure against your hand, see the bag re-inflate, and hear air escaping from the pop-off valve. Then test your suction device: squeeze it, block the tip, and release. It should not expand until the tip is free.

The golden minute starts at birth. Place the baby on the mother’s abdomen. As you quickly dry him, you notice he hasn’t cried. Now change to a dry cloth. You see he’s not breathing. Raise the baby’s jaw and check for secretions. Then stimulate him. He’s still not breathing. Now move the baby to a firm surface. Position his head, place the mask, and make a tight seal. Then start your ventilations.

Let’s show these important first actions again in more detail. Immediately after the birth, place the baby on his mother’s abdomen and note the time of birth. Dry the baby’s head, body, arms, and legs quickly and thoroughly. Drying the back can help to start the baby breathing. Notice he has not cried yet. A crying baby is a breathing baby. Change to a dry cloth to keep the baby warm.

Now start the steps to help him breathe. Raise the baby’s jaw to make it easier to breathe, then check for secretions. His nose and mouth are clear so there is no need to suction. Now rub the baby’s back a few times to stimulate breathing. Observe his chest closely: the baby is not breathing. Cut the cord now to move the baby to a separate area for ventilation. Stand at the baby’s head and raise his jaw. Place the rim of the mask just below the baby’s mouth, then roll it over his mouth and nose. Make a tight seal by pressing down on the mask and holding his chin up. Squeeze the bag smoothly. The chest should gently rise with each breath, but here, the chest does not rise.

Now follow these steps to improve ventilation. First, reposition the baby’s head. Then reapply the mask. Again, give breaths. If the chest still does not rise, open the mouth a little and clear secretions from the mouth and nose. Try again to give breaths. If you still don’t see chest movement, squeeze the bag a little harder to give a larger breath.

Now the baby’s chest is rising. Give the baby breaths for one minute. Count out loud, “breathe — two — three, breathe — two — three.” Squeeze the bag on “breathe” and release the bag on “two, three.” Now and then the baby gasps. These breaths are not effective. You need to continue to ventilate. After one minute of giving breaths with good chest movement, your helper quickly checks the heart rate. Her finger moves in time with the beats of the baby’s heart. It’s faster than an adult heart rate, so it’s normal. Continue to ventilate and watch for the baby’s own effort. Stop giving breaths when the heart rate stays normal and the baby starts crying or breathing well on his own. Reassure the mother that her baby is breathing now.

Put the baby on the mother’s chest, skin-to-skin, and cover with warm blankets. Keeping the baby warm after resuscitation is life-saving! A baby who needed resuscitation is especially vulnerable in the first hours after birth. Check the baby’s breathing and temperature every 15 minutes until the first complete exam between 1 and 2 hours after birth. When the baby shows feeding signals, help the mother start breastfeeding.

Remember, be prepared to resuscitate at every birth. Dry the baby, keep him warm, check that his airway is clear, stimulate his breathing, then give breaths if he’s not breathing on his own. Helping a baby breathe is the key to bringing a baby to life.