Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
CHAPTER 8: Resuscitation for Birth Asphyxia
Birth asphyxia is a major cause of death in the newborn period, accounting for about 23 percent
of deaths in the first four weeks of life. From 3-5 percent of newborns do not start spontaneous
breathing at birth. A great number of newborns do not receive appropriate care because many
birth attendants do not have the knowledge, ability, or the appropriate equipment and supplies
to perform the necessary steps of resuscitation in an optimal manner. It is extremely important
to train healthcare personnel in this area to prevent neonatal deaths and disability.
The term birth asphyxia indicates the baby’s inability to commence and maintain
breathing. A normal baby at birth has a good cry; continues to breathe well; has a pink tongue,
lips, palms and soles; and has adequate reactions and good muscle tone, with the limbs well
flexed and moving well. The slight bluish tinge of the palms and soles commonly seen in babies
at birth is due to vasoconstriction of the local blood vessels as a result of the chilling that takes
place at birth. This chilling is due to the baby coming from a warm intrauterine environment to
the colder exterior and to the evaporation of the amniotic fluid. The blue color changes rapidly
to pink as the baby is dried, wrapped, and warmed.
Basic resuscitation of the newborn is not the exclusive field of a specialist. Midwives, nurses,
and doctors who attend deliveries at all levels should have the skills and resources to
resuscitate babies with birth asphyxia in order to decrease neonatal mortality and morbidity.
This training program of staff at the peripheral health centers will focus on:
• drying and stimulation and maintenance of temperature
• clearing of the airways
• ventilation with bag and mask
It will not deal with cardiac massage, intubation, or the use of drugs because:
• more than 80 percent of asphyxiated babies require only stimulation, clearing of airways,
and ventilation for revival.
• health workers at peripheral centers (such as health centers and health posts) targeted
in this training program are likely to deal with far fewer cases of birth asphyxia and are
thus more likely to lose some of their skills unless there is constant supervision and
opportunities to practice, at least on mannequins which, in practice, does not often
happen. It is thus better to limit this discussion to the minimum actions required to deal
with most cases.
Each of the following is a prerequisite to successful neonatal resuscitation:
• anticipation
• appropriate preparation
• timely recognition of the signs of asphyxia
• rapid implementation of treatment
It is best to have two persons to provide appropriate care at resuscitation, even if the two are
not equally skilled. Hence, centers should plan in advance and train additional persons at the
site who can assist the more skilled person carrying out the specialized tasks for resuscitation.
Integrated maternal and newborn care
Basic skills course
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