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Guidelines Change, Babies Don’t PDF Print E-mail
Written by Laura Maxson LM   

A baby knows what to do after birth. Instincts help him make his way to the nipple to latch on. On the way he’ll grab at and massage the nipple with his hand, make mouthing motions on his hands and the mother’s chest as he works his way slowly up toward the nipple. He will kick and push with his knees and feet, not only to propel himself to the breast, but also massaging the uterus to help keep it contracted. As he gets closer to latching, he will begin to salivate in anticipation of his first meal. Then he lunges forward, wide mouthed, to latch on and begin breastfeeding, all on autopilot.


In the past we have done much to interfere with this process, but we are learning. If parents don’t know what to expect, baby might inadvertently be interrupted on his mission to get to the breast. The drooling and bubble blowing that is part of the process might be interpreted as a bad sign and parents might question if the baby can breathe okay, leading care providers to unnecessarily suction the baby, causing a setback in baby’s quest to latch on.


Changing guidelines. Studies confirm that most babies do not need any routine suctioning – suctioning can interfere with transition to breathing and breastfeeding. Babies are usually able to cough, sneeze and swallow to clear their airway. Babies still connected to a pulsing umbilical cord in the first minutes after birth have the added benefit of receiving oxygenated blood as they try out their lungs for the first time. With immediate cord clamping, there is no cushion of back-up circulation as baby begins breathing. Studies show that babies do better when breathing is established before the cord is cut. Often requested on birth plans, delayed cord clamping should now be the norm; new neonatal resuscitation guidelines now state that all babies receive at least a full minute of umbilical cord blood flow, with up to three minutes before clamping still considered routine. Parents always have the option of requesting a longer delay – but 1-3 minutes should now be routine.


Suctioning is reserved for opening a blocked airway, especially if resuscitation breaths are necessary. For several years now, this guideline has also applied to babies born with meconium stained fluid as long as they were born vigorous and breathing. However, babies born through meconium stained fluids, not vigorously breathing at birth were intubated immediately to deeply suction the lungs before the first breath. Research is now showing that no baby in distress at the moment of birth benefits from intubation, UNLESS his airway is actually blocked. Intubation takes time, delays beginning resuscitation breaths, and can cause bleeding and abrasions, as well as trigger a braydicardia (prolonged deceleration of the heart rate).


Babies with meconium stained fluid who were not vigorous at birth have almost always had the cord immediately clamped and cut so they could be intubated. Now there is a little wiggle room for initial evaluation (even 15-30 seconds at a minimum can make a big difference) to see how baby is responding to being born before acting. Hospitals will have babies move to the warmer as soon as they can (meaning cutting the cord) as all their equipment to help the baby is there. There are mobile carts made to keep babies close enough to leave the cord intact, but none are available in our community (yet!). Midwives doing homebirth have the ability to leave the cord intact throughout any resuscitative actions that need to take place because they are at the mother’s side with mobile equipment. Cords that were flat at birth of a distressed baby have been observed to begin to pulse again as baby begins breathing. Clearly, more studies are needed in resuscitation with the cord intact.


Every birth should include someone trained, attentive and ready to intervene, but actually should intervene only if there is a real need. Remembering that every other creature on earth manages to be born and breathe with only the loving attention of its mother – without benefit of a bulb syringe – can help. Policies and habits that have been ingrained in school and over years of practice will need the ongoing vigilance from parents as they are adopted.


Dr. Nils Bergman writes in his articles on Kangaroo Mother Care,

The separation that is standard practice in our Western culture is generally well-intentioned, but, nevertheless, the worst thing to do. There will occasionally be sick newborns that need resuscitation and intensive care, but this can be provided with mother present and even with baby on mother’s chest! But in the normal course of events, it is simply bad medical practice to unnecessarily separate mothers and newborns.


Side bar

 Nils Bergman www.skintoskincontact.com/

 2016 Neonatal Resuscitation Guidelines  - www2.aap.org/nrp/7thedinfo.html

 Breastcrawl information and video www.breastcrawl.org

 Birth Network of Santa Cruz County www.Birthnet.org

Laura Maxson, LM, CPM, the mother of three grown children, has been working with pregnant and breastfeeding women for over 20 years. Currently she is the executive director of Birth Network of Santa Cruz County and has a homebirth midwifery practice. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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