When Baby Needs Help

Resuscitation. CPR. Heart rate. Breathing.

How do these words sit with you? Are they simply part of standard vocabulary or do they hit hard and create an unsettling image?

During pregnancy, the idea that your baby might need some help to transition can be a scary thought. It may conjure images of other emergencies you’ve experienced, or ones you’ve heard about. It’s not a pleasant thing to think about. And yet, it’s worth knowing some of the basics of neonatal resuscitation.

It is estimated that about 10% of newborns need some amount of resuscitation. Keep in mind, this number includes all babies born, whether term or preterm, with or without congenital anomalies, with out without difficult births. In other words, that 10% is not randomly distributed across all births. It goes up dramatically the earlier the birth, so that 100% of babies born very early need help, and comparatively few healthy full term babies need extra help. 

If you’re familiar with CPR, you may know that it involves so-called rescue breathing and chest compressions. In learning the skill for adults and older children, there is a relative emphasis on the chest compression part. The biggest difference between that and neonatal resuscitation is a shift in focus toward providing breaths for the baby. Remember, until the baby emerges from the womb, the lungs are filled with fluid and have never breathed air. The most important thing to do for a baby who is struggling is help them start breathing, more so than any stimulation or chest compressions. 

You may be familiar with TV or film depictions of rubbing or slapping a baby to “get them started.” The idea was to shock the baby into gasping. However, with increased understanding of physiology, we have some less dramatic methods to facilitate that first breath, and it can be a very gentle process. Try it out if you’d like. Try giving a partner or loved one a breath, and taking turns. It shouldn’t hurt, and it may be just what the baby needs after a difficult birth.

Artificial breaths can be given either directly mouth to mouth or with bag and mask equipment. While any devices can bring up concerned or triggered feelings, again, the process of breathing for someone else should be gentle. Ask to see the bag and mask prior to birth, and test out the strength of the breath it gives. It’s just a little puff to help clear the lungs of fluid and let them begin inflating on their own. Most of the time, this is all a baby might need. But if several breaths have not shown improvement, your birth attendant may move on to the next steps, including calling in extra help. 

One more thing. It is very normal for a baby fresh out of the womb to be a bit dusky in color. That healthful glow we may be used to is after breathing is well established. Your baby’s skin tone will change rapidly in the first minutes after birth, but it is a process. Don’t be alarmed. Your baby is doing miraculous things in the transition from fetal to newborn circulation.