Evidence-based practices for the fetal to newborn transition

Mercer JS, Erickson-Owens DA, Graves B, Haley MM. J Midwifery Womens Health. 2007 May-Jun;52(3):262-72.
Many common care practices during labor, birth, and the immediate postpartum period impact the fetal to neonatal transition, including medication used during labor, suctioning protocols, strategies to prevent heat loss, umbilical cord clamping, and use of 100% oxygen for resuscitation. Many of the care practices used to assess and manage a newborn immediately after birth have not proven efficacious. No definitive outcomes have been obtained from studies on maternal analgesia effects on the newborn. Although immediate cord clamping is common practice, recent evidence from large randomized, controlled trials suggests that delayed cord clamping may protect the infant against anemia. Skin-to-skin care of the newborn after birth is recommended as the mainstay of newborn thermoregulation and care. Routine suctioning of infants at birth was not been found to be beneficial. Neither amnioinfusion, suctioning of meconium-stained babies after the birth of the head, nor intubation and suctioning of vigorous infants prevents meconium aspiration syndrome. The use of 100% oxygen at birth to resuscitate a newborn causes increased oxidative stress and does not appear to offer benefits over room air. This review of evidence on newborn care practices reveals that more often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn.
The transition from fetus to newborn is a normal physiologic and developmental process -- one that has occurred since the beginning of the human race. Many hospital routines that are used to assess and manage newborns immediately after birth developed because of convenience, expediency, or habit, and have never been validated. Some practices are so ingrained that older traditional practices, such as providing skin-to-skin care or delaying cord clamping, must be considered "experimental" in current studies.[1] However, recent research is beginning to identify some older practices that should not have been abandoned and some current practices that should be stopped. In order to achieve a gentle, physiologic birth and family-centered care of the newborn, practices that might interfere with maternal and newborn bonding need to be closely scrutinized. This article examines the evidence about practices related to the newborn transition, including the effects of various drugs used labor, umbilical cord clamping, thermoregulation, suctioning, and resuscitation of the newborn. Article Outline Introduction
Effect of Maternal Analgesia on Newborn Transition: Apgar Scores and Umbilical Cord pH Respiratory Depression Neonatal Sepsis Evaluation Breastfeeding Early Neurobehavioral Effects Admission to a Neonatal Intensive Care Unit
The Timing of Umbilical Cord Clamping: Immediate Cord Clamping and Anemia Clamping the Nuchal Cord Before Delivery of the Shoulders Cord Blood Harvesting Thermoregulation and Infant Placement Suctioning of the Newborn at Birth Management of Infants With Meconium-Stained Amniotic Fluid Gastric Suctioning
Room Air Versus Oxygen for Neonatal Resuscitation: History of Oxygen Use and Studies Cerebral Blood Flow Markers of Oxidative Stress Neonatal Resuscitation Guidelines
Full article: http://www.ncbi.nlm.nih.gov/pubmed/17467593 Address correspondence to Judith S. Mercer, CNM, DNSc, FACNM, Nurse-Midwifery Program, University of Rhode Island College of Nursing, 2 Heathman Road, Kingston, RI 02881-2021. jmercer@uri.edu