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What A Neonatal Resuscitation Educator Can Tell You About That Miraculous First Breath

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That first breath when a baby comes into the world is a miracle. But for 10 percent of babies, the transition from womb-side to earthside requires medical assistance, and for 1 percent of babies neonatal resuscitation at birth is necessary, according to the National CPR Association. This sounds scary, but Karen Strange, a certified nurse midwife and American Academy of Pediatrics neonatal resuscitation program (NRP) instructor, believes education about this transition can actually alleviate fears around birth and help parents understand their babies better.

Strange prepares birth professionals for the 10 percent of births requiring intervention as a neonatal resuscitation educator. "Our job at the birth overseeing the birth is to help that baby become an air-breather," she explains to Romper by phone.

In 1988, when she began her work as a certified nurse midwife, Strange was working in a birthing center in El Paso, at the Texas border, which handled a large volume of births daily. The hospitals in the area were offering the Neonatal Resuscitation Program released by the American Academy of Pediatrics in 1987, and midwives in the area attended as well.

“We were thinking, this is so different from how midwives do births in a home or a birth center,” she explains. “So the owner, Deborah Kaley, and I decided to become instructors.”

Her course has evolved to consider perinatal psychology, specifically training birth professionals to understand what babies experience during birth.

Strange became an instructor in 1991, teaching right from the book provided by the American Academy of Pediatrics for a period of time because it was all she knew. It was a chance to review a chapter on Neonatal Resuscitation being written by midwife Anne Frye — one that opened her eyes to what else could be learned and taught to midwives and birthing professionals about neonatal resuscitation, including the peer-reviewed research supporting resuscitation practices, how resuscitation was being handled around the world, and a clearer understanding of the transition being experienced by babies at birth.

“It gave me tools to really explain what is happening to the baby,” she says.

Over time, her course has evolved to consider perinatal psychology, specifically training birth professionals to understand what babies experience during birth and how trauma and memories are stored in the body.

“As I started incorporating what I was learning into the class, I noticed that it becomes so much easier to respond to a baby if you actually understand what they’re feeling,” she explains. “If you actually understand what is happening to them and not just a set of numbers.”

Although Strange is a neonatal resuscitation instruction through the American Academy of Pediatrics, her course is differentiated from other Neonatal Resuscitation Program classes because of the additional insight and training she provides. Today, she offers a day-long program called Integrative Resuscitation of the Newborn.

These are the things she hopes parents will understand, using this information to inform their decisions about birth providers, whether they intend to birth at home, in a birthing center, or in a hospital. Since there is a lot of fear surrounding the topic of neonatal resuscitation, Strange also hopes that more information will provide parents with an ease of mind going into birth, because they know their provider is prepared to handle complicated births.

Before we talk about resuscitation, Strange believes we must answer the question of what is happening to the baby at birth. What a newborn experiences at birth, if breathing assistance is needed, is not the same as CPR. In infants, children, and adults, CPR is often related to the heart, while neonatal resuscitation is all about the lungs.

“Babies in utero, they have a placenta, and they’re not using their lungs,” she explains. “They are getting oxygen through the placenta. Their lungs, the little air sacs, the alveoli, are actually fluid-filled and the capillaries that surround the air sucks are constricted.”

When babies are born, the experiencing a major transition, they’re making the switch from fluid-filled lungs to air-filled lungs. Blood is flowing from the cord into the constricted capillaries, helping to dilate them. The fluid is clearing from the alveoli in their lungs. After this transition, they can breathe through their lungs and they no longer need the placenta to get their oxygen but it is a process that takes a couple of breaths.

“It’s a transition and all transitions take time,” she adds. “When babies do not fully transition on their own... and the baby doesn’t naturally breathe on its own, then our job as birth providers is to help the baby breathe, to do for the baby what the baby cannot do for itself.

This is accomplished by giving the baby some breaths, typically by using a resuscitation bag, which helps the baby to clear the fluid in their lungs. Most of the time, this little extra help is all the baby needs and it doesn’t even indicate a serious problem, explains Strange.

This brings us to the task of finding a provider, and the kind of things parents can consider as it relates to neonatal resuscitation. All birth providers, midwives, and hospital staff alike, should have neonatal resuscitation training. This doesn’t mean parents should take their training for granted.

When [babies] are placed back with their mother, their stress hormones drop, and the baby will synchronize with the mother’s body.

Strange recommends finding a doula who has NRP training. She clarifies that doula should not be managing a birth, but this training provides them with the grounding they need to remain calm and connect with parents in the event that neonatal resuscitation is used during their birth. Additionally, some babies come on their own time-frame, and it isn’t a bad idea for the doula to have this training in case they are the only professional present when the baby arrives.

Next, she says that parents will want to know what kind of experience their provider has with neonatal resuscitation, including how many times they have resuscitated a baby.

“I would ask how many they have done, how they feel, are they prepared, and do they practice their skills on a regular basis?”

Additionally, ask your provider how resuscitation is prepared for and carried out. In home births, you want to know your provider has everything they need to set out and ready at the time of birth.

In the hospital, parents want to know who will be helping their baby. They also want to know if their baby will be kept with them in the case of a resuscitation, will their cord remain intact, and then will the baby be returned to the mother’s chest immediately to be monitored from there.

“The thing that stabilizes baby is the mother’s body,” she says. “Babies are undifferentiated from their mothers... even though they are now out, they are their mothers. When [babies] are placed back with their mother, their stress hormones drop, and the baby will synchronize with the mother’s body.”

As parents look ahead to their births, they can take comfort in knowing they have done the work of educating themselves and interview their provider to ensure they are prepared for unlikely scenarios like Neonatal Resuscitation. It isn’t always easy to dive into these topics, but it is ultimately what many parents need to feel emotionally prepared for their births.

“The thing about birth is, it’s an intense subject,” says Strange. “One of the things I learned is that we have this body memory, this cellular memory, this implicit memory, that when you talk about birth, some of that memory comes up not in a conscious way but in a cellular way."

Strange is not afraid of this subject, and speaks with confidence. "Talking about possible complications can and does help lessen the fear around it," she says.