The first sixty seconds of a newborn's life outside the womb are critical. During this time, the baby must rapidly transition from obtaining oxygen through the placenta to breathing air independently. When a baby is born, fluid-filled alveoli in the lungs must clear out and fill with air, allowing oxygen to enter the pulmonary bloodstream. At the same time, the umbilical cord is clamped, the placenta is bypassed, and the baby's circulatory system undergoes dramatic shifts, including the closure of fetal shunts like the foramen ovale and ductus arteriosus. Midwives must act swiftly during this window. If a baby fails to breathe effectively within this first minute, secondary apnea can occur, leading to a rapid drop in heart rate and blood pressure. Preparedness and rapid assessment are therefore non-negotiable skills in any Nigerian labor ward.
Immediately after delivery, the midwife places the baby on a warm, flat surface under a radiant warmer if available, or in a clean, draft-free area. Standard initial steps include:
Once the initial steps are completed, the midwife rapidly evaluates three vital signs to determine if resuscitation is needed:
When assessment reveals a compromised infant, systematic protocols must be followed without delay. If the heart rate is below 100 beats per minute, or the baby is gasping or apneic, start positive pressure ventilation (PPV) using a self-inflating bag and mask with room air or blended oxygen. Ensure a tight seal on the face. Check for chest movement after fifteen breaths. If the heart rate remains below 60 beats per minute despite effective ventilation for thirty seconds, introduce chest compressions coordinated with PPV at a ratio of three compressions to one breath. Medications like epinephrine are rarely needed in delivery rooms but may be considered if the heart rate stays below 60 beats per minute despite adequate ventilation and chest compressions.
Once spontaneous breathing and a normal heart rate are restored, the work is not finished. The baby requires careful post-resuscitation monitoring to prevent secondary deterioration. Keep the infant warm to avoid hypothermia and hypoglycemia. Monitor oxygen saturation levels using a pulse oximeter on the right hand or wrist, which reflects pre-ductal oxygenation. Document the exact timeline of events, including the Apgar scores at one, five, and ten minutes, as well as the interventions performed. Communicate clearly with the mother and her family about the baby's condition and transfer the infant to a special care nursery if ongoing respiratory support or close observation is necessary.
After ensuring the baby is stable, the midwife performs routine care and measurements. Administer eye prophylaxis—such as tetracycline eye ointment—to prevent ophthalmia neonatorum. Give an intramuscular injection of Vitamin K to prevent hemorrhagic disease of the newborn. Take accurate anthropometric measurements, including weight, length, and head circumference, using clean equipment. Record all findings carefully in the child health card and explain each procedure to the mother so she understands the preventive health measures being given to her baby.
For a stable newborn, early initiation of skin-to-skin contact is vital. Place the naked baby prone on the mother's bare chest, covering both with a warm blanket. This promotes thermal regulation, stabilizes the baby's heart rate and breathing, and colonizes the infant's skin with the mother's friendly bacteria. Within the first hour of life, babies display natural feeding cues such as rooting, licking, and hand-to-mouth movements. The midwife should encourage and assist the mother to put the baby to the breast during this golden hour. Early breastfeeding ensures the baby receives nutrient-rich colostrum, which provides essential antibodies and stimulates uterine contractions in the mother through oxytocin release.