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BIRTH SUITE · FOUNDATIONS
How to prepare, assess the newborn and support the transition at birth, and escalate confidently when the baby needs help - a core skill from your first shift.
BEFORE THE BIRTH
Most of a good resuscitation is done before the baby arrives. Use the time you have.
Get the essentials: gestation, why you are called, singleton or multiple, meconium-stained liquor, any known concern, and how urgent it is.
This tells you what to expect and who else you need in the room.
At Gosford, the resuscitation equipment is on the red trolley - Ruby. In many units it lives in resuscitation drawers; here you bring Ruby into the room and check her before the birth.
Turn on the warmer and start the clock. Check suction, the air / oxygen blender and your T-piece or bag-mask.
Lay out the right mask and airway sizes, and warm towels. Add a hat only if the baby is preterm.
The preterm pack and the resuscitation record are in the bottom drawer of Ruby.
Check who is coming and your escalation path. If acuity might rise, call for senior help before the birth, not after.
You are never expected to run a resuscitation alone.
AT BIRTH
As the baby is born, ask three quick questions and act on the answers.
Term? Good tone? Breathing or crying? A vigorous term baby who is crying needs only warmth, drying and skin-to-skin with mum.
If the answer to any is no, move to the resuscitaire and start the initial steps.
Aim to have effective breathing established, spontaneous or supported, within about the first minute of life.
Warm, dry, stimulate and position the airway. This alone gets most babies going.
This works alongside delayed cord clamping: for a well baby you can dry and stimulate with the cord intact; if the baby needs active resuscitation, clamp and move to Ruby without delay.
For most vigorous babies, delay cord clamping for around 60 seconds. It improves transition and is supported by evidence (APTS).
If the baby needs resuscitation, prioritise warmth and the airway.
IF THE BABY NEEDS HELP
Neonatal resuscitation is a sequence: each step is added only if the baby is not responding. Reassess tone, breathing and heart rate after every step. This is the shape of the ANZCOR Newborn Life Support algorithm, not a substitute for it - keep the flowchart on the resuscitaire.
Keep the baby warm, dry and stimulate, and position the airway in neutral or slight extension. This fixes the majority of babies.
Open the airway and give positive pressure ventilation by mask. Start term babies in air (21%); preterm as per local guidance. Effective ventilation - visible chest rise - is the single most important step.
Heart rate is the key indicator. If it is rising and above 100, continue support and titrate oxygen to the SpO2 targets below. If not improving, recheck ventilation (mask seal, airway, pressure) before escalating.
Add chest compressions, coordinated 3:1 with ventilation, and increase oxygen toward 100%. First be sure ventilation is truly effective - most bradycardia is a ventilation problem.
Give adrenaline, ideally intravenously via a UVC, at ANZCOR / local doses. Gain vascular access and consider reversible causes, especially inadequate ventilation and volume loss.
Escalate to your senior and NETS, keep the baby warm, consider therapeutic hypothermia if HIE criteria are met, and think about the cause. Debrief and support the family.
OXYGEN
Oxygen saturation rises gradually after birth. Measure pre-ductal (right hand or wrist) and titrate oxygen to these ANZCOR targets rather than aiming for 100%.
| Time after birth | Acceptable pre-ductal SpO2 |
|---|---|
| 1 min | 60-70% |
| 2 min | 65-85% |
| 3 min | 70-90% |
| 4 min | 75-90% |
| 5 min | 80-90% |
| 10 min | 85-90% |
THE PRETERM BABY
Preterm babies lose heat fast, have surfactant-deficient lungs and are easily injured. A few things change.
Place infants under 32 weeks straight into a polyethylene wrap or bag under radiant heat, without drying, and add a hat.
Wrap reduces hypothermia (HeLP), even though on its own it does not change mortality.
Support with CPAP where you can, use the lowest effective pressures and oxygen, and give surfactant per guideline.
Avoid large tidal volumes - the preterm lung is easily injured.
Delay cord clamping where the baby is stable. It reduces death and major morbidity in the very preterm (APTS).
AFTER THE BIRTH
The job is not finished when the baby is pink and breathing.
If you provided any resuscitation - defined as applying a mask to the face - complete the NSW resuscitation record form.
Record what you did and the timeline: Apgars, cord gases if taken, and the response to each step.
Give a clear handover, admit to SCN if needed, and update the family.
A good handover names what happened, what you did, and what to watch for next.
Where to go next when the baby needs the nursery: