What to do for the baby

This content is from
pages 240 to 245 of A Book for Midwives

When the baby is born, even before you cut the cord, put him on his mother's belly. The mother's body will keep the baby warm, and the smell of the mother's milk will encourage him to suck. Be gentle with a new baby.

Note: In many medical centers, doctors or nurses take the baby away from the mother to check his health. This is easier for the doctors and nurses, but it is not best for the baby. The baby should not be taken from the mother unless there is an emergency.

If the baby is having trouble breathing, leave her on her mother's belly and rub your hand firmly up and down her back. Never hit or hurt a baby or hold her upside down to make her cry. If you have it, give oxygen to a baby who continues to have breathing problems. Watch the baby closely — if these problems do not improve, she may need medical help.

To give oxygen to a baby who is not breathing well
give 5 liters (L) of oxygen		each minute, for 5 to 10 minutes
	If you have a small oxygen mask for a baby, put it on the baby's face. If you do not have a mask, cup your hand loosely over the baby's face and hold the oxygen tube near her nose (1 or 2 centimeters away from her face). When the baby is breathing better, turn the oxygen off slowly, over a few minutes.

Suctioning a baby who is not breathing well will probably not help and may actually make breathing more difficult.

Baby does not breathe at all

A baby who is not breathing at all one half minute after birth, even with firm back massage, or who is only gasping for breath after one minute, needs help immediately. Begin to give the baby a few breaths of air.

If she does not breathe soon after birth, this may cause brain injury or death. Most babies who are not breathing can be saved. If you use the following steps, the baby will probably recover well.

Rescue breathing

Lay the baby on her back. She should be on a firm surface — like a firm bed, a table, a board, or the floor. Keep the baby warm. Put a warmed cloth under her, and a cloth on top of her, leaving her chest exposed.
Position the baby's head so that it faces straight up. This opens her throat to help her breathe. You can easily get the baby into this position by putting a small rolled-up cloth under her shoulders. Do not tilt the head back far — it will close her throat again. The baby may start breathing after you put her in this position.
If the baby had thick meconium at birth, quickly suction her throat.
Put your mouth over the baby's mouth and nose. Or close the baby's mouth, and put your mouth over her nose.
Breathe into the baby using only as much air as you can easily hold in your cheeks. Do not blow. Too much air can injure the baby's lungs. Give 3 to 5 slow breaths to start. This clears fluid from the baby's lungs. Then give small, quick puffs about 3 seconds apart.

Breathe...

...2...3...

Breathe...

...2...3...

Look at the baby's chest. It should rise as you breathe into the baby.
If the baby's chest does not rise, reposition the baby's head
— the air is not getting into her lungs.
Breathe about 30 breaths every minute. But it is not so important to get exactly the right number of breaths.
Check for breathing. If the baby starts to cry or breathe at least 30 breaths a minute, stop rescue breathing. Stay close and watch to be sure the baby is OK.

If the baby does not breathe, or breathes less than 30 breathes a minute, keep rescue breathing until she breathes well. See links for videos that show how to help a baby breathe.

WARNING! The baby's lungs are very small and delicate. Do not blow hard into the baby's lungs, or you can break them. Breathe little puffs of air from your cheeks, not from your chest.

If the baby does not breathe on her own after 20 minutes of rescue breathing, she will probably not be able to. She will die. Stop rescue breathing and explain to the family what has happened.

Note: Rescue breathing has a small risk of passing infections between a midwife and a baby. To reduce risk, cover a baby’s mouth with gauze or a very thin piece of cloth. Or you may be able to buy a mask that covers the baby’s nose and mouth, that the midwife breathes into. You may also be able to buy a bag and mask that give just the right amount of air to the baby, and getting trained to use them is easy.

Heartbeat

A new baby’s heart should beat between 120 and 160 times a minute — about twice as fast as an adult heartbeat. Listen to the baby’s heart with a stethoscope, or place 2 fingers over her heart. Count the heartbeat for 6 seconds, then multiply by 10 (or add a “0” — if you count 12 heartbeats in 6 seconds, the baby's heart is beating 120 times a minute). After the baby has good color and is breathing well you can take the time to count the heartbeat for 1 full minute.

If the baby’s heartbeat is slower than 100 beats a minute, or if she has no heartbeat at all, give rescue breathing.

If her heartbeat is faster than 180 beats a minute, get medical help. She may have a medical problem with her heart.

When a family loses a baby
When a baby dies, either before or just after birth, the mother and other family members will have many feelings. Some feel angry, some are afraid of what it might mean and do not want to talk about it, even to get support, some are overwhelmed with grief. For many families, the death of a baby is a spiritual time, when religious practices are very important. As a midwife, you can support the family in the ways that are used in your community — and also in the ways that feel best to that family. Family members may want someone to talk with, or they may want someone to help with the work of the household. Women may have difficulty asking for help. While not the same as a miscarriage, the emotional and physical support needed may be similar.

A woman who loses a baby will have all the physical recovery needs of any other woman who just gave birth. She will also have breast milk, and her breasts may become painfully engorged. See how to relieve breast pain. There may be plants in your area that help dry up breast milk, but do not give Western medicines to do this — they are not safe.

	This baby has good muscle tone.
	This baby is limp.

Muscle tone

A baby who holds his arms and legs tight and close to his body, and his elbows and knees bent, has strong and healthy muscles, or good muscle tone. A limp baby has weak muscle tone. His arms and legs are loose and open. Some babies are born limp if they did not get enough oxygen before they were born. But a healthy baby should gain strength in his arms and legs within a few minutes.

The longer the arms and legs stay limp, the more likely it is that the baby is in trouble. A limp baby will not breathe well. If the baby is just a little limp, try rubbing his back and talking to him. This may help the baby wake up and try harder to breathe. If the baby is very limp, especially after the first minute, suction or wipe out his mouth and nose. He may need oxygen as well.

Reflexes

Reflexes are the body's natural reactions. For example, when you fall down, you put your hands out to catch yourself — without even thinking about it. Or, when an insect flies at your eye, you blink. Strong reflexes are a sign that the brain and nerves are working well.

Moro reflex:
arms open wide

At birth, a healthy baby should have these reflexes:

grimace

Grimace. The baby should make a face if you suction his mouth and nose.
Moro reflex. If the baby is moved suddenly or hears a loud noise, he stiffly flings his arms wide and opens his hands.
Sneeze. A healthy baby will sneeze when there is water or mucus in his nose.

If the baby does not have any of these reflexes but he is breathing and his heartbeat is more than 100 beats in a minute, get medical advice.

Color

Most babies are blue or even purple when they are born, but they quickly become a healthy color in 1 or 2 minutes.

Babies who have darker skin do not look as blue as babies with lighter skin. Look at a dark-skinned baby's hands and feet to see if they are bluish. All babies can look dusky or pale if they are not getting enough air in their lungs.

Baby is very pale or stays blue after the first few minutes

It can be OK for just a baby’s hands or feet to stay a little blue for many hours. But if a baby’s whole body stays pale or blue for more than 5 minutes, there may be a problem.

Most of the time, babies stay pale or blue because they are not breathing well.

Babies can also be blue:

when they are cold.
when they have an infection.
when they have heart problems.

Check the baby's temperature or touch him to see if he is warm. Wrap the baby in blankets or cloths, and cover the baby's head. Put a hat on the baby if you have one.

If the baby is still blue or pale when he is warm, he needs help breathing. If you have oxygen, give it now. Check the baby's heartbeat and breathing. See information about the baby having a hard time breathing.

If the baby is still blue or pale after you give him oxygen, get medical help.

Help the baby breastfeed

If everything is OK after the birth, the mother should breastfeed her baby right away. She may need some help getting started. Chapter 16 is about breastfeeding, and explains what breastfeeding positions work well.

The first milk to come from the breast is yellowish and is called colostrum. Some women think that colostrum is bad for the baby and do not breastfeed in the first day after the birth. But colostrum is very important! It protects the baby from infections. Colostrum also has all the protein that a new baby needs.

Early breastfeeding is good for the mother and baby.

Breastfeeding makes the womb contract. This helps the placenta come out, and it helps prevent
heavy bleeding.
Breastfeeding helps the baby to clear fluid from his nose and mouth
and breathe more easily.
Breastfeeding is a good way for the mother and baby to begin to know each other.
Breastfeeding comforts the baby.
Breastfeeding can help the mother relax and feel good about her new baby.
Breast milk is the best food available for a baby.

If the baby does not seem able to breastfeed, see if he has a lot of mucus in his nose. To help the mucus drain, lay the baby across the mother's chest with his head lower than his body. Stroke his back from his waist up to his shoulders. After draining the mucus, help put the baby to the breast again.

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This page was updated:28 Aug 2024

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Keep the baby warm and dry