The neonatal resuscitation team asks the obstetrician the following prebirth questions:

• What is the baby’s estimated gestational age?
• Is the amniotic fluid clear?
• Are there any additional risk factors?
• What is the umbilical cord management plan?

The four prebirth questions cover antepartum and intrapartum information and risk factors. If the answers to the questions are unremarkable, then routine care is anticipated. However, if the answers reveal a red flag, then the team prepares for possible intensive neonatal resuscitation.

The fourth question regarding umbilical cord management plans ensures both the obstetric and neonatal teams are clear on whether or not delayed cord clamping is part of the birth plan.

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Sample Scenario: Infant Born at an Expected Routine Delivery Requires Resuscitation

A nurse attends the routine delivery of a mother at 39 weeks gestation. Upon receiving the newly born, he notices the baby is apneic and bradycardic. He transfers the baby to the radiant warmer and performs the initial steps of neonatal resuscitation by providing tactile stimulation while warming and drying the baby. These initial steps do not improve the baby’s condition within a few seconds, so he opens the airway, clears the airway via bulb suctioning of the mouth and nose, and starts PPV. He calls for additional help.

As part of the institution’s protocols, additional support for a newborn delivery is always available. Additional help immediately arrives on the scene. A second team member evaluates the efficacy of PPV by visually confirming chest rise with each delivered breath. She places a pulse oximeter on the baby. The third team member prepares for endotracheal intubation and umbilical vein catheterization in case either is required.

Sample Scenario: High-Risk Delivery With Subsequent Intensive Neonatal Resuscitation

The neonatal resuscitation team has been informed that a baby is about to be delivered to a mother at 37 weeks gestation. The team determines the baby is at high risk because the obstetrician is performing an emergency cesarean delivery secondary to placental abruption.

A team is present ahead of the birth and ready to perform PPV, endotracheal intubation, chest compressions, and umbilical vein catheterization. At least four highly skilled neonatal resuscitation healthcare providers are present dedicated solely to the infant’s care. 

The team anticipates the need for expert consultation and specialist care. A neonatologist on call attends the delivery as well.