Evidence-Based Practices for the Fetal to Newborn Transition

Judith S. Mercer, CNM, DNSc; Debra A. Erickson-Owens, CNM, MS, ; Barbara Graves, CNM, MN, MPH; Mary Mumford Haley, CNM, MS


J Midwifery Womens Health. 2007;52(3):262-272. 

In This Article


An important tenet of practice for all health care personnel is to first do no harm. This idea takes on additional importance when dealing with newborns, as there is almost no long-term data on the safety of many procedures. No clear conclusions can be drawn from studies on maternal analgesia effects on the newborn; thus, judicious use of medications in labor is recommended with further study of better biobehavioral assessment tools to differentiate outcomes. Delaying clamping of the umbilical cord appears to offer protection from anemia without harmful effects. The practice of immediate clamping, especially with a nuchal cord, should be discontinued. The evidence suggests that skin-to-skin care of the newborn after birth and during the first hour of life should be the mainstay of newborn thermoregulation and care. Routine suctioning of the infant at birth should be abandoned. Meconium-stained babies should not be suctioned on the perineum and vigorous infants should not be intubated and suctioned. There is no evidence that amnioinfusion prevents meconium aspiration syndrome. The mounting evidence suggests that use of 100% oxygen at birth to resuscitate newborns may cause harmful effects. Room air is permissible for the first 90 seconds with oxygen available if there is not an appropriate response in that time.

Routine interventions, such as suctioning the airway or stomach or using 100% oxygen for resuscitation, or immediate clamping of the umbilical cord, have never based on any clear evidence that they improve newborn care or outcomes. Yet some of these practices are so firmly entrenched that it will take a large body of research to change the standard. We must continue to build a body of knowledge that supports the evidence: more often than not, less intervention is better.


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