Stop Suctioning the Airway of a Baby at Birth

Evidence based clinical guidelines recommend NOT suctioning a baby’s airways unless they are unresponsive, floppy and require resuscitation. And even then only to do so using a laryngoscope so that you can see what you are doing.

NICE guideline, Resuscitation Council UK, more guidelines (Geneva Foundation for Medical Education and Research). Wiswell et al. 2000Vain et al. 2004.

Hopefully, your birth team does not still practice the outdated method of using the blue bulb and suctioning baby’s airways at birth.  Make sure to ask at your next appointment, and include it in your birth plan if you have not already. Birth is natural. Our bodies are meant to do it, and our babies’ bodies are meant to experience it.  There is a natural ‘Fetal Heimlich Maneuver’ that occurs as the baby is born.  He gets a nice tight squeeze right around his sternum (breastbone), by the intact perineum, which pushes amniotic fluid out of the esophagus and mouth in a way that is like a natural Heimlich maneuver.   Birth It is normal for a baby to work fluid out through birth and as he transitions over to using his lungs to breathe.  It is not natural or normal for a baby to have a pointy bulb syringe gag him in the throat in the first minute of his new life in this world. In theory, your doctor or midwife is trying to clear your baby's airway so that the baby does not breathe amniotic fluid and mucous in.  It used to be thought that suctioning should clear everything out so your baby can breathe better.  But studies have shown that this suctioning can actually cause your baby to receive less oxygen than is optimal.   File May 21, 1 50 14 PM   Suctioning at birth: Source
  • Does not reduce the risk of MAS
  • Can cause the baby to gasp (inhale deeply which is exactly what you are wanting to avoid with meconium stained liquor) (Roggensack et al. 2009)
  • Can lower the baby’s heart rate for up to 20 minutes (vagal bradycardia) (Waltman 2004).
  • Can interfere with the initiation of breastfeeding (Killion 2000)
  • Can cause tissue trauma (Davies & MacDonald 2008).
  • Can produce bradycardia
  • Can cause laryngospasm
  • Can cause cardiac dysrhythmias
  • Can cause edema
  • Can cause trauma to mucous membranes
  • Can cause tachycardia
  • Can cause emotional distress
  • Can cause bronchospasm
  • Can cause cardiac arrest
Suctioning can truly hurt the baby, physically and emotionally. It can also damage the breastfeeding relationship.  When a new baby is transitioning from one way of living and breathing to a very new way, where he has to keep warm, and eat to feel full, and breathe, and manage the new brightness of the world - being poked in the nose and mouth and throat is a very unnecessary act to add to the mix, especially when it is not actually doing anything but hindering.   Black and white shot of newborn baby right after delivery   Fetal to newborn transition does not happen the moment baby joins the world.  Instead, it is a complex process of chemical, hormonal, and physical responses that initiates the infant’s first breath. Some newborns take longer to transition than others.  Hearing the gurgling and gagging sound of a brand new baby can be scary. Even for midwives and doctors who have heard it numerous times before. It is very easy to reach for the bulb syringe (or the Delee) to try to suction out the fluid in an attempt to help the newborn transition faster.  But this is not evidence-based birthing.  The research and studies show that not only does the suctioning (with the bulb and/or Delee) not improve outcomes, it can actually be very harmful to the newborn.

Latest Research

The latest research now shows that babies who have their faces wiped (mimicking the licking that mammals do after birthing) have a clinical outcome that is exactly the same as those who are suctioned. This is very exciting, as wiping the face has zero side effects or risks!

What about suctioning when there is meconium?

Meconium is the sticky black bowel movement that your baby will pass in his first days after he is born.  Sometimes babies pass it in utero during labor, or sometimes as they are being born. We have already shared how this is a completely normal process. Many doctors routinely suction the baby's mouth and nose only when there is meconium stained amniotic fluid present.  A baby aspirating (breathing in) meconium can cause Meconium Aspiration Syndrome (MAS).  Suctioning the baby's mouth and nose to reduce the amount of meconium has been believed to help prevent this; however, ALL current research shows there is absolutely no difference in outcomes between (vigorous) babies suctioned and those left alone.  If suctioning did work for these situations, then there would be almost no cases of MAS once routine suctioning became the norm in care.  That isn't the case though.

Why are babies still being suctioned?

It’s as if we thought that despite many millions of years of evolution, human beings were not capable of surviving unless someone sucked out their upper airways after birth.

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