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Evidence-Based Practices for the Fetal to Newborn Transition


  • Judith S. Mercer CNM, DNSc,

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    • Judith S. Mercer, CNM, DNSc, FACNM, is a Professor at the University of Rhode Island College of Nursing and Adjunct at Brown University.

  • Debra A. Erickson-Owens CNM, MS,

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    • Debra A. Erickson-Owens, CNM, MS, is a doctoral student at the University of Rhode Island and former Director of the University of Rhode Island Nurse-Midwifery Program.

  • Barbara Graves MN, MPH, CNM,

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    • Barbara Graves, CNM, MN, MPH, FACNM, is the Program Director at the Baystate Midwifery Education Program.

  • Mary Mumford Haley CNM, MS

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    • Mary Mumford Haley, CNM, MS, is in clinical practice at East Bay Family Health Center and Memorial Hospital of Rhode Island and is on faculty at the University of Rhode Island.

Nurse-Midwifery Program, University of Rhode Island College of Nursing, 2 Heathman Road, Kingston, RI 02881-2021. E-mail:


Many common care practices during labor, birth, and the immediate postpartum period impact the fetal to neonatal transition, including medication used during labor, suctioning protocols, strategies to prevent heat loss, umbilical cord clamping, and use of 100% oxygen for resuscitation. Many of the care practices used to assess and manage a newborn immediately after birth have not proven efficacious. No definitive outcomes have been obtained from studies on maternal analgesia effects on the newborn. Although immediate cord clamping is common practice, recent evidence from large randomized, controlled trials suggests that delayed cord clamping may protect the infant against anemia. Skin-to-skin care of the newborn after birth is recommended as the mainstay of newborn thermoregulation and care. Routine suctioning of infants at birth was not been found to be beneficial. Neither amnioinfusion, suctioning of meconium-stained babies after the birth of the head, nor intubation and suctioning of vigorous infants prevents meconium aspiration syndrome. The use of 100% oxygen at birth to resuscitate a newborn causes increased oxidative stress and does not appear to offer benefits over room air. This review of evidence on newborn care practices reveals that more often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn.