Ok. So, you finally go into labour…Check. You got to the hospital in time…Check. You deliver your baby like a rock star…Double check! Your baby isn’t breathing on his own…Wait, what?! What if the nurses and doctors have to whisk your precious baby away to warmer? What if you have to watch as they crowd around her instead of putting her on your chest skin to skin like planned?

Unfortunately, you are not alone. Roughly 10% of newborns require some form of help breathing after birth, and 1% will need serious efforts. Those are pretty good odds, but that does not take away how overwhelming it is when it’s happening to your baby.

Although hospital staff will try to keep you in the loop as much as possible during this scary time, they will be focused on making sure that your baby has the best outcome. They may not be able to spend much time explaining things until after it happens, leaving you scared, confused and worried in the meantime.

You probably don’t want to even think of this happening, but if you are the type that likes to know what is going on around you, this article is for you. Here is a guide to newborn resuscitation that may be helpful for you if you unfortunately run into this situation.

What Are They Saying?

Here are some common terms that you may overhear and not necessarily understand if your baby needs to be resuscitated:

• Intubate: Placing a plastic tube into baby’s airway. This is done carefully by a doctor and will be double checked to ensure proper placement.
• Endotracheal (ET) tube: The plastic tube used during intubation.
• Laryngeal mask airway (LMA): A device that is inserted into baby’s mouth that helps keep the airway open to help baby breathe.
• Meconium: Baby’s first poop. It will be black and tarry (and impossible to clean during diaper changes!). If there was meconium when your water broke, they will be preparing to intubate baby and suction the airway if she does not cry right away.
• Orogastric (OG) tube: The plastic tube inserted through baby’s mouth and into her stomach to act as a vent for the extra air building up.
• Umbilical vein catheter (UVC): A plastic tube inserted into the umbilical vein so that they can give  your baby medications or fluids if needed. This is a more readily available alternative to starting a intravenous (IV) line in baby’s hand.
• Ventilation: Helping your baby breathe through various measures, either by use of a mask, ET tube or LMA.
• Oxygen saturation: The oxygen levels in your baby’s blood. They will attach a pulse oximeter to baby’s right hand, and there will be specific targets they are looking to reach depending on how old baby is, minute by minute. This will be how the team will determine how much oxygen they need to give.

What Are They Doing Over There?

There are various things that the doctor’s and nurse’s will be checking for and doing to your baby to help her begin breathing on her own. These will include:

• Stimulating baby – Providing there was no meconium present, the team try to get baby to breathe on her own. They will do this by drying baby off, keeping her warm, positioning her on her back and stimulating her by flicking the soles of her feet or rubbing her back.
• Checking baby’s pulse, oxygen levels, breathing efforts and blood pressure – These will tell them what steps they need to take to ensure your baby gets better. If you see them holding the umbilical cord at the base they are checking how fast baby’s pulse is.
• Clearing the airway – If baby is not breathing at birth and meconium (baby’s first poop) was present when your water broke, they will quickly take baby to the warmer, intubate and suction that meconium out of baby’s lungs. They may need to do this a couple of times to get it all. If there was meconium but baby is crying already, then they will suction the nose and mouth and keep a close eye on baby’s temperature to check for an infection that may need antibiotics later on. Even if there is no meconium, they may need to suction excess mucous and blood out of baby’s mouth and nose.
• Helping baby breathe – Ventilating your baby properly is the most important thing that the resus team will do. A newborn’s heart rate should be between 120-160 beats per minute (BPM). If baby’s pulse is less than 100 beats per minute (BPM) and not breathing on their own, the team will begin ventilating baby by applying a mask to her that is hooked up to the warmer. You may hear that they need to intubate if the mask is not helping. This means that the doctor will carefully insert a tube into your baby’s airway to make sure air will be reaching her lungs. This will increase her chances of a better outcome.
• Putting in an orogastric tube – If baby requires more than a couple of minutes of resuscitation, they should be inserting a tube in baby’s mouth, to vent off the extra air in baby’s stomach.
• Providing chest compressions – If baby’s pulse is less than 60BPM and not breathing on their own, they will need to start chest compressions in addition to helping baby breathe. They will be coordinating compressions and breaths and you may hear them counting it out together.
• Starting an umbilical vein catheter (UVC) or intravenous (IV) line – If baby is not responding to good ventilation and chest compressions, they will want to get access to a vein so they can give medications or fluids. They will normally try to get a line into the umbilical vein first, but if they are unable to they will need to try for an IV line.
• Giving medications – the most common medication given during resuscitation is Epinephrine (same medication used for an Epi-Pen). This medication will shunt much of baby’s blood supply towards her vital organs by constricting veins, and is given if baby has no pulse or it is very low.
• Giving fluids – if there is a previous history of mom bleeding before birth or if baby comes out looking very pale, it is a good possibility that baby may need some extra fluids. Fluids are given in small amounts depending on your baby’s size and over 5-10 minutes to prevent fluid overload.

Why Are There So Many People?

It can be very scary and intimidating when you see five medical professionals hovering around your tiny newborn baby. How can someone so small need so many people to help? Newborn resuscitation is not taken lightly in hospitals, and if a “Code Pink” is called, many will come running.

If your baby needs help immediately after birth, there will be at least two people working just with baby: one person helping baby breathe, and one person checking heart rate, applying an oxygen monitoring probe and listening to breath sounds in the lungs.

If baby continues to not make any effort to breathe or they need someone with extra skills, additional staff will be called upon. There may be one to give chest compressions, and yet more to intubate, insert an umbilical vein catheter, give medications or fluids, and to document. These people picked this profession for a reason and will do everything in their power to help your baby thrive.

Why Is This Happening?

Sometimes there is no explanation why a baby needs extra help breathing on their own, and sometimes there were complications during pregnancy, labour and delivery that made resuscitation likely. Here are some potential risk factors:

• Preterm birth
• Intrauterine growth restriction
• High blood pressure during pregnancy
• Diabetes during pregnancy
• Certain drugs taken by mom during pregnancy and labour
• Baby was deprived of oxygen during labour, such as if baby’s cord was being compressed or if there was an issue with the placenta
• Airway obstruction from blood, meconium or mucous
• Malformations of the lungs or brain
• Unknown!

Dealing with the labour and delivery of your beautiful baby is hard enough. Throwing in a newborn resuscitation where stress is high and communication is sparse is downright awful. If it happens to your baby (which I pray it doesn’t!), I wish her all the best and hope that this information will give you and your partner a sense of power in such a terrible moment of helplessness. It really does take a village, but the most important person to the tiny being that you just miraculously produced, is YOU. Be strong, Mama! <3