Skilled Birth Attendant

Skilled Birth Attendant
Neonatal Resuscitation Training

Latter-day Saint Charities


















Based on the Textbook of Neonatal Resuscitation
 5th Edition

American Heart Association
American Academy of Pediatrics
Rev. 09/18/2008



TABLE OF CONTENTS
Lesson 1:  Which Babies Require Resuscitation? 3
How does a baby receive oxygen before birth? 4
What happens with normal transition? 6
What are the signs of an abnormal transition? 7
Why premature babies are at higher risk 8
How do you prepare for resuscitation? 8
Key Points 9
Lesson 2: Initial Steps of Newborn Care: The First 30 Seconds 10
Is there meconium? 10
Provide warmth 10
Position by slightly extending the neck 11
Clear mouth and nose 11
Dry, stimulate to breathe, and reposition 12
Evaluate the baby to determine if resuscitation is needed 13
Key Points 15
Lesson 3:  Positive-Pressure Ventilation: The Second 30 Seconds 16
When to ventilate 16
Equipment for positive-pressure ventilation: Self-inflating bag and mask 17
Important characteristics of face masks 20
Testing a self-inflating bag 21
Preparing for positive-pressure ventilation 21
What if the heart rate, color, breathing, and muscle tone do not improve? 24
Key Points 27








Introduction:
The goal of every birth is a healthy baby capable of making the transition from life with the mother to life in the world.  The key to the transition is being able to breathe and get oxygen to the body through the lungs instead of from the mother through the placenta. The birth attendant must do all possible to assist the baby in making that transition as soon as possible.

Lesson 1:  Which Babies Require Resuscitation?

What is resuscitation?

Neonatal resuscitation means to revive or restore life to a baby. This course is designed to teach the steps necessary to ventilate a newborn baby that is not breathing.

Basic steps in resuscitation

90% of newly born babies make the transition from intrauterine to extrauterine life without difficulty.  They require little to no assistance to begin spontaneous and regular respirations.   Approximately 10% of newborns require some assistance to begin breathing at birth and only about 1% need extensive resuscitative measures to survive.

The diagram below illustrates the relationship between resuscitation procedures and the number of newly born babies who need them.  At the top are the procedures needed by all newborns.  At the bottom are procedures needed by very few.




























ABCs of resuscitation

The ABCs of resuscitation are the same for babies as for adults.


   




Ensure the airway is open and clear.
Be sure there is breathing, whether spontaneous or assisted.
Make certain there is adequate circulation of oxygenated blood.


Risk factors associated with need for resuscitation

Maternal Risk Factors Before Labor

Pre-eclampsia and eclampsia Previous fetal or neonatal death
Maternal infection (HIV, STD, Malaria) Multiple gestation
Premature rupture of membranes Diminished fetal activity
Post-term gestation Bleeding in second or third trimester
Maternal diabetes Age <16 or >35 years
Anemia No prenatal care


Risk Factors During Labor

Foul smelling amniotic fluid Unusual vaginal bleeding before delivery
Prolonged rupture of membranes Precipitous labor
 (>18 hours before delivery) Shoulder dystocia
Prolonged labor (>24 hours) Prolapsed cord
Fetal bradycardia (slowing of heart rate) Forceps or vacuum-assisted delivery
Meconium Narcotics administered to mother
Premature labor   within 4 hours of delivery
Breech or other abnormal presentation Cesarean section
Prolonged second stage of labor (>2 hours) Uterine tetany

Maternal complications are often unpredictable, but newborn complications are usually predictable based on these factors. Therefore, it is usually possible to anticipate and prepare for resuscitation.



How does a baby receive oxygen before birth?

Oxygen is essential for survival both before and after birth.
Before birth, the placenta provides all of