Start resuscitation within one minute of birth if baby is not breathing or is gasping for breath

  • Observe universal hygiene precautions to prevent infection
  • Prepare for resuscitation at each delivery even where there are no signs of foetal distress, just in case the baby
    requires it

Minimum preparation for every birth

Ensure that the following equipment is available and in good working order:

  • Two warm cotton cloths and a small one to position the head
  • Heat source to keep the baby warm
  • Mucus extractor such as a penguin sucker (or bulb syringe)
  • Ambu bag and new-born masks of varying sizes (0 and 1), pulse oximeter
  • Clock or watch
  • A birth attendant skilled in new-born resuscitation


  • Keep the baby warm by drying the baby using the first cotton cloth and change to the second dry
    cotton cloth. Rub the back 2-3 times

    • Clamp and cut the cord if necessary
    • Transfer the baby to a dry clean warm surface
    • Tell the mother that the baby is having difficulty starting to breathe and that you will help the baby
  • Open the airway
    • Position the head so that it is slightly extended
    • Place a folded towel <2 cm thick under baby’s shoulders
    • Suction if secretions in mouth or nose and if baby born through meconium stained amniotic fluid:
      suction 5 cm in the mouth, 3 cm in the nose while withdrawing, for max 10 seconds in total.
    • Do not suction too deep into the throat as this may cause the heart to slow down or breathing
      to stop
  • Form a seal with mask covering chin, mouth and nose
  • Squeeze bag 5 times
  • Observe chest

If not rising

  • Reposition head, check mask seal, squeeze bag harder
  • Once good seal and chest rising, ventilate for one minute at 40 squeezes per minute then stop and
    look for breathing

If breathing >30/minute and no severe chest indrawing

  • Stop ventilating
  • Put baby skin-to-skin on mother’s chest
  • Observe every 15 minutes for breathing and warmth: take temperature, count breaths, observe
    for chest-in-drawing or grunting respiration. Monitor SpO2
  • Encourage mother to breastfeed within one hour

If breathing <30/minute or severe chest in-drawing

  • Continue ventilating
  • Arrange for immediate referral
  • Give oxygen if available
  • Reassess every 1-2 minutes
  • Continue to ventilate during referral

If not gasping or breathing at all after 20 minutes of ventilation

  • Stop ventilation, the baby is dead
  • Room air is sufficient in the absence of oxygen
  • Cardiac massage is RARELY required; it is dangerous when done incorrectly. A slow heart rate almost always
    responds to good breathing assistance only
  • Usually, there is no need for drugs if prompt and sufficient ventilation is provided
Harmful and ineffective resuscitation practices
  • Routine suction of new-born’s mouth and nose as soon as the head is born
  • Stimulation of the new-born by slapping or flicking the soles of the feet
  • Postural drainage (putting the baby upside down) and slapping the back
  • Squeezing the back to remove secretions from airway
  • Routine giving of sodium bicarbonate to new-borns who are not breathing.
  • Intubation by an unskilled person