- Preparing for Resuscitation
- Equipment, Apgar Scoring, and Family Communication
Preparing for Resuscitation
The team that goes into a delivery prepared outperforms the team that doesn't. This lesson covers what preparation actually looks like.
Anticipating the need for resuscitation
Perinatal risk factors are the primary tool for anticipating which deliveries are likely to require resuscitation. They fall into two categories: antepartum factors, which are identified during pregnancy, and intrapartum factors, which emerge during labor and delivery (Table 2):
| Antepartum risk factors | Intrapartum risk factors |
|---|---|
| Multiple gestation | Emergency cesarean section |
| Preterm gestation (<37 weeks) | Forceps or vacuum-assisted delivery |
| Post-term gestation (>41 weeks) | Breech or abnormal presentation |
| Pre-eclampsia or eclampsia | Category III fetal heart rate tracing |
| Placenta previa or abruption | Prolapsed umbilical cord |
| Maternal diabetes | Chorioamnionitis |
| Fetal anomaly identified on ultrasound | Significant intrapartum bleeding |
| Oligohydramnios or polyhydramnios | Meconium-stained amniotic fluid |
| No prenatal care | General anesthesia |
Any identified risk factor (antepartum or intrapartum) means having a skilled resuscitation team in the room at the time of delivery. The absence of risk factors does not eliminate the need for readiness, as at least one person trained in neonatal resuscitation and capable of initiating PPV should be present at every delivery.
Team assembly and role assignment
When a high-risk delivery is anticipated, team composition and role assignment should be confirmed before the baby is born. A full resuscitation team includes the following roles:
- Team leader: directs the resuscitation, calls interventions, monitors time, communicates with the family
- Airway provider: manages initial steps, PPV, and advanced airway if needed
- Chest compression provider: stands by for escalation; performs compressions if required
- Medication and vascular access provider: prepares and administers epinephrine, manages umbilical venous catheter (UVC)
- Recorder: documents interventions and timing throughout the resuscitation
For low-risk deliveries, a smaller team is acceptable, but every member must be capable of escalating to the next level of intervention if the situation changes unexpectedly.
Pre-delivery team briefing
A structured pre-delivery briefing takes less than two minutes and significantly reduces the risk of errors during resuscitation. It should cover: anticipated gestational age and known risk factors, likely need for resuscitation, role assignments, equipment location and status, and any relevant maternal history (medications, infections, known anomalies). Closed-loop communication (where every instruction is acknowledged verbally) should be established as the communication norm before the delivery begins.
Medically reviewed by: Kim Murray, RN, MS., Medical Educator
