When do babies start breathing

meirman said:

When do babies start breathing?

Assuming no problems, they start breathing when they *can*
(e.g., when their mouth and nose are free of the birth canal
and cleared of mucus, blood, and amnion, and the pressure of
the birth canal is removed from their chest wall, allowing
unrestricted chest excursion and permitting the lungs to
fill with air). Normally, this all transpires immediately
following delivery.

Quoted message said:

IIUC, none are breathing when they are still in the birth
canal, even if they are part or mostly out. Is that so?

Generally, yes. See above.

Quoted message said:

And that normally the umbelical cord is still nourishing
them so there is no need to breathe.

Correct. The placenta exchanges oxygen and CO2 in utero.
Respiration is not required (and, in fact, is impossible, as
the lungs are filled with fluid).

Quoted message said:

I had the feeling the most typical scenario was that the
baby started to breathe, I'm guessing, 5 to 20 seconds
after he is out. Yes?

That's probably pretty close.

Quoted message said:

And that if he doesn't breathe by then, he gets slapped on
the tush, yes? They still do that, don't they?

Not usually. Infants who are slow to begin respiration are
stimulated typically by being rubbed, or by having the soles
of their feet flicked with the fingertip. Tush-slapping is
for old Hollywood movies.

Quoted message said:

I presume with a small number, they don't want to start
breathing at all, and some sort of mechanical ventilation
is needed, for hours or days, but that some of those still
become healthy children. Is that so?

Generally, yes. Most brain anoxia resulting in long-term
developmental problems (a.k.a., cerebral palsy) occur while
the infant is in utero, usually from umbilical cord or
placenta problems, or from maternal problems which affect
the placenta. Many times, the etiology is unclear. Hordes of
malpractice attorneys, however, would love for you to
believe otherwise.

Quoted message said:

(I searched on 'blue baby' and got lots of hits but most
seemed to be poems or about stuffed bears. Now that I
think about it, I guess they are blue not because they
didn't breathe but because their umbilical cord was
pinched for a while during birth. Is that right? That
would be what happened to my oldest brother.)

Most babies start out looking rather gray, or "blue." They
usually pink up rapidly once they start breathing. When
medical personnel speak of "blue babies", they're usually
referring to one of several congenital heart defects that
interferes with the proper oxygenation of blood, resulting
in a periodic or chronic "blue" appearance. I don't know
what happened with your brother.

Anon answered everything else, so I'll address just this one
question....

meirman said:

I see videos of doctors cleaning out the baby's mouth. Are
they just being tidy or is that ever necessary to let the
baby breathe?

Not just being tidy. They're suctioning mucus, fluids, or
meconium that might obstruct the airway or cause problems if
aspirated.

anon <[email hidden]> wrote:
: On 2004-03-21 01:10:57 -0500, meirman
: <[email hidden]> said:

: > When do babies start breathing?

: Assuming no problems, they start breathing when they *can*
: (e.g., when their mouth and nose are free of the birth
: canal and cleared of mucus, blood, and amnion, and the
: pressure of the birth canal is removed from their chest
: wall, allowing unrestricted chest excursion and permitting
: the lungs to fill with air). Normally, this all transpires
: immediately

FWIW, coming thru the birth canal helps squeeze the amniotic
fluid out of their lungs. (Which is why C/S delivered babies
can have fluid in their lungs when delivered.)

Emma

anon said:

meirman said:

When do babies start breathing?

Assuming no problems, they start breathing when they *can*
(e.g., when their mouth and nose are free of the birth
canal and cleared of mucus, blood, and amnion, and the
pressure of the birth canal is removed from their chest
wall, allowing unrestricted chest excursion and permitting
the lungs to fill with air). Normally, this all transpires
immediately following delivery.

That's the best way to think about it that I've heard in a
long time. They don't breathe until they can.

Remember, of course, that babies have respiratory movements
in utero. They "inhale" amniotic fluid at regular intervals.
It's one of the signs of a healthy fetus that
ultrasonographers look for when assessing normal activity.

Quoted message said:

Quoted message said:

And that if he doesn't breathe by then, he gets slapped
on the tush, yes? They still do that, don't they?

Not usually. Infants who are slow to begin respiration are
stimulated typically by being rubbed, or by having the
soles of their feet flicked with the fingertip. Tush-
slapping is for old Hollywood movies.

Because that's what they used to do. The act of dangling the
infant upside-down was supposed to use gravity to help drain
fluid from the airways, and then a swift swat on the butt
could act as a stimulant. But, yes, current neonatal
resuscitation guidelines suggest flicking the sole of the
foot or rubbing the trunk.

Quoted message said:

Quoted message said:

I presume with a small number, they don't want to start
breathing at all, and some sort of mechanical ventilation
is needed, for hours or days, but that some of those
still become healthy children. Is that so?

Generally, yes. Most brain anoxia resulting in long-term
developmental problems (a.k.a., cerebral palsy) occur while
the infant is in utero, usually from umbilical cord or
placenta problems, or from maternal problems which affect
the placenta. Many times, the etiology is unclear. Hordes
of malpractice attorneys, however, would love for you to
believe otherwise.

The original poster should note, of course, that the vast,
vast, vast majority of infants who "don't want to start
breathing at all" require little more than some tactile
stimulation and possibly less than one minute of manual positive-
pressure ventilation before they begin to breathe on their
own. Requiring mechanical ventilation, even for a few hours,
is highly unusual.

And, also, as anon has noted, many of the babies who are
difficult to resuscitate and require mechanical ventilation
did so because they had problems to begin with. The baby was
brain damaged or otherwise ill before delivery and thus
required extra support. But a common, unfortunate scenario
is for the obstetrician and resuscitating practitioner to
get blamed for the baby's condition simply because the baby
looked terrible during the resuscitation even though nothing
that occurred during or after the delivery had anything to
do with causing the condition, and in fact the delivery room
personnel should be praised for saving the infant's life.
But no, whenever anything goes medically wrong in the U.S.,
someone has to be "blamed," and obstetricians are a favorite
target. It's no wonder why they have the highest malpractice
insurance premiums.

Quoted message said:

Quoted message said:

(I searched on 'blue baby' and got lots of hits but most
seemed to be poems or about stuffed bears. Now that I
think about it, I guess they are blue not because they
didn't breathe but because their umbilical cord was
pinched for a while during birth. Is that right? That
would be what happened to my oldest brother.)

Most babies start out looking rather gray, or "blue." They
usually pink up rapidly once they start breathing. When
medical personnel speak of "blue babies", they're usually
referring to one of several congenital heart defects that
interferes with the proper oxygenation of blood, resulting
in a periodic or chronic "blue" appearance. I don't know
what happened with your brother.

The original poster should be aware that normal newborns
have a remarkable tolerance for hypoxia. It is unusual for a
baby NOT to be at least somewhat blue at delivery. The
umbilical cord does indeed get compressed during
contractions and by the time of delivery the infant has had
many periods of hypoxia. Newborns are built to withstand
this without suffering brain damage. They have remarkably
high blood counts (the opposite of anemia) and fetal
hemoglobin which together not only allow the blood to hold
more oxygen, but also makes one appear blue at higher oxygen
levels than an adult would.

PF

Emma Chase VanCott said:

anon <[email hidden]> wrote:
: On 2004-03-21 01:10:57 -0500, meirman
: <[email hidden]> said:

: > When do babies start breathing?

: Assuming no problems, they start breathing when they
: *can* (e.g., when their mouth and nose are free of the
: birth canal and cleared of mucus, blood, and amnion, and
: the pressure of the birth canal is removed from their
: chest wall, allowing unrestricted chest excursion and
: permitting the lungs to fill with air). Normally, this
: all transpires immediately

FWIW, coming thru the birth canal helps squeeze the
amniotic fluid out of their lungs. (Which is why C/S
delivered babies can have fluid in their lungs when
delivered.)

Although, to be fair, this is probably a very, very
oversimplified explanation of what is actually happening
physiologically. The reasons babies born by caesarean
section are more prone to TTN (transient tachypnea of the
newborn, simplistically described as "extra fluid in the
lungs"😉 are a bit more complex.

The mechanisms and physiology of normal onset of labor and
parturition are not well understood, but it likely involves
many hormonal and other physiologic signals between the
mother and fetus, which may indeed prepare the lungs for
breathing air. While the pressure on the chest in the birth
canal may be one such physiologic signal, and increased
intrathoracic pressure may enhance absorption of the
amniotic fluid into the pneumocytes, I don't think it's as
simple as when Bugs Bunny pumps someone's arms after a near
drowning and the fluid comes out the mouth like a geyser.

PF

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