Establishment of Newborn Breathing
The
physiological event of how newborn babies start to breathe on their
own has nothing to do with the need for air, and if oxygen flow was
restricted, the baby would start gasping for air from body reflex due
to high carbon dioxide levels. (You can see this if you pinch, clamp
or cut the cord right after birth - DON'T DO THIS!!)
The actual reason babies start breathing is thought to be a combination
of biochemical changes and physical stimuli - cold, gravity, pain, light,
noise, etc which cause excitation of the respiratory centre.
This
may be a reason water birthed and some home birthed babies do not
always start breathing immediately but take a couple of minutes before
their first breath. See the Ennings modified APGAR for waterbirthed babies here.
It is normal to breathe on and off until the switch
over from uterus environment to breathing with lungs is complete -
this can take anywhere from 1 minute to 7 minutes for normal breathing
patterns. Before breathing can even occur, the baby needs natural
drainage of his/her airways - if laid on the mother with the head
below the body, all the gunk will either be swallowed, coughed or sneezed or otherwise drained out.
A comment from a midwife on newborn resuscitation;
"Oxygen from a tank is really cold - and blow-by oxygen doesn't provide pure oxygen. By the time it gets to baby, it's diffused by quite a bit. IMHO (in my humble opinion), I don't think blow by does much.
If a baby needs more oxygenation to the tissues, it should be seen in a hospital. If you're waving O2 under its nose in hopes that the baby will breathe, you're just stimulating the breath holding reflex that babies have (ever blown in a baby's face??).
I'd much prefer doing a quick mouth to mouth blow - I believe the life force has so much power, along with the mother's touch and communication with baby.
It's not even evidence-based to use O2 in short-term resuscitation efforts with a bag valve mask. It's very rare, the baby that needs resuscitation of any sort after a normal birth. Mouth to mouth, in my opinion, is far superior to any instrument or anxiety to getting a baby to really come into his/her own."
Newborn Resuscitation
It is recommended that a course on infant resuscitation is taken - see your local TAFE or St. John's Ambulance for more information.
St John's Ambulance Child Resuscitation
Expired Air Resuscitation (EAR)
To be performed when a pulse is detected but the baby is not breathing.
- Support the infant's head. Cover infants mouth and nose with your mouth and give 2 gentle puffs of air from your cheeks, only sufficient to make the infants chest rise.
- After the initial 2 puffs, check the pulse. If there is a pulse but no breathing, continue to inflate the lungs at a rate of 20 times per minute.
- Check the pulse about every minute.
Note: Infants pulse can be found on the inner upper arm(brachial pulse).
Cardiopulmonary Resuscitation (CPR)
To be performed when no pulse is detected.
Note: For a newborn baby, chest compressions should NOT be attempted by anyone untrained in neonatal resuscitation.
- Use 2 fingers (index and middle) over lower half of sternum (one fingers breadth below the inter-nipple line) to give chest compressions.
- Compress chest approx 1/3 depth of chest.
- Give 5 chest compressions in 3 seconds followed by 1 breath.
Also see another method of infant resuscitation here.
Other Resources
St John's Ambulance Child Resuscitation
St John's Ambulance on Giving Breaths
St John's Ambulance on Compressions
Why Do Babies Cry? The Anatomical and Physiological Changes During the Moments After Birth.
Here are some links to info on air vs oxygen:
Air, Not Oxygen, Should Be Used First for Neonatal Resuscitation
http://www.medscape.com/viewarticle/490988
Air versus oxygen for resuscitation of infants at birth
http://www.cochrane.org/reviews/en/ab002273.html
Room-Air Resuscitation Causes Less Damage to Heart and Kidney than 100% Oxygen
http://ajrccm.atsjournals.org/cgi/co...ct/172/11/1393
"If the child has not taken the first breath, or is depressed and cannot breathe, the massive increase in pulmonary blood flow generated by the placental transfusion may, of itself, initiate ventilation.
Jaykka [1,2] showed that the fetal lungs are erectile tissues; by injecting serum through the pulmonary artery of excised animal fetal lungs, the engorged capillaries around the alveoli erected them and caused air to enter through the trachea.
With establishment of pulmonary blood flow, the high colloid osmotic pressure of blood causes absorption of amniotic fluid from the alveoli and “dries out” the lungs, filling the “erected” alveoli with air."
An excerpt from "Emergency Childbirth: A Manual" by Dr. Gregory White;
"The normal baby is pink or purplish, has a good deal of tension in his muscles, tends to hold his arms and legs rather stiffly, and resists external efforts to move them. He will make a face when his face is touched. If held with the face down and to the side as previously described, to allow him to cough out any mucus that may be in his throat, and stimulated gently by rubbing of the attendant's hand up and down his spine, the normal baby will breathe and cry within 3 or 4 minutes and can be put aside in a safe place while the attendant returns to the care of the mother.
The baby who is born pale, pale blue, or white, and limp, with no expression in the face, no movements in the limbs, no tendency to resist outside efforts to move his arms and legs - this baby is already seriously embarrassed and may need help in breathing.
This baby's mouth should be wiped out with a clean cloth to start with. Some high ranking experts in the field believe that this is all that can or should be done. They have reasons for thinking that any baby who can take his first breath will do so; that any baby who can not draw the first breath himself cannot have it done for him.
Artificial respiration, if used must always be extremely gentle in the case of a newborn baby, which is subject to injury if there is any rough handling. If gentle efforts do not succeed in helping him to breathe, he cannot be helped. This means that he should not be slapped or dunked in water or forcefully squeezed, swung about or otherwise manhandled.
The following method of artificial respiration should be used with a newborn baby. The baby's body is held in the two hands of the attendant, with the palms up underneath the body - one hand under the hips, the other under the shoulders and head, holding the head in a middle position so that it is neither crammed down on the chest nor dangling far back.
The two hands holding the baby are gently raised, turned and brought partly together so as to bend the hips towards the shoulders, bending the whole body like a hinge to the point where the tummy is decidedly compressed.
The hands are then straightened and let go outward a bit so that the baby's body straightens.
This will produce the movement of air into and out of the lungs. The approximate rate should be 12 per minute, or once every 5 seconds.
Mouth to mouth artificial respiration, recommended by the American Red Cross is also suitable if the attendant is trained in this method as applied to infants.
The artificial respiration should be continued until the baby begins breathing on his own. Efforts should be continued during this whole difficult situation to procure the services of a doctor or to get the baby to a doctor.
The methods described will, in the majority of cases, not be found wanting. In the occasional case where the baby fails to rally, other methods would not be more likely to produce success.
If the police or fire department can bring in an oxygen unit, this is a good supplement to artificial respiration. It does not by any means, supplant it. Mechanical emptying and filling of the lungs must proceed no matter how rich the atmosphere is in oxygen; but with good artificial respiration, oxygen properly applied can be a help.
The proper application of oxygen for the newborn consists of delivery of a steady stream of oxygen at a fairly slow rate to the region of the face. On no account should a mask be clamped tightly against the baby's face, nor should a high-pressure stream of oxygen be blown into his face."
