Helping Babies Breathe - Facilitator Flip Chart Second Edition - UNHCR
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Helping Babies Breathe
Facilitator Flip Chart
Second Edition
© American Academy of Pediatrics, 2016
What the facilitator needs to know and do
BEFORE - DURING - AFTER
the workshop
Use this section to prepare yourself as a facilitator and guide the development of a Helping Babies Breathe program before, during, and after the workshop.
As a facilitator, you are essential to achieving the goal of having at least one person skilled and equipped to help a baby breathe at every birth.
This workshop can be the first step towards improving care for mothers and babies.
BEFORE
Begin planning for a Helping Babies Breathe course
DURING
with local leaders well in advance
Evaluate knowledge and skills
• Visit hbs.aap.org to get the Facilitator Toolkit with a workshop planning
checklist, order equipment, print materials and find other useful resources. • Evaluate the participants in a way that encourages further learning.
• Use the Knowledge Check as a pre-test and post-test.
New learning
• Ask participants to “Show how you would help a baby breathe with a
bag and mask” as a simple skills pre-test.
• Use the Bag and mask skill check, OSCE A and OSCE B to evaluate
learning at the end of the course and continue practice after the course.
Improvement Skills mastery
of care
Engage every participant in discussion
and practice in pairs
• As you Present and demonstrate, involve participants by asking questions
(What? Why? How?)
Prepare yourself as a facilitator Clinical Practice in pairs • Spend more time on practice than on talking and use the exercises to assure
experience and teams mastery of skills. Helping Babies Breathe is a hands-on and active course.
• Review the Provider Guide. • During practice in pairs, encourage self-reflection, feedback, and review of
• Read the Background and Educational advice sections actions to improve performance (debriefing).
so that you can answer questions and get teaching tips. • Always emphasize communication between mother and provider, and also
• Plan how you will actively involve participants between providers.
on each page of the Flip Chart. • Use group discussion questions to identify ways to overcome barriers and
• Arrange the space to facilitate learning with put skills into practice in the facility.
1 facilitator for every 6 participants. • Review how to disinfect, test, and store equipment.
Resources:
- Workshop planning checklist
- Sample workshop agendas
- Facilitator videos at hbs.aap.org
AFTER
Identify and support leaders and clinical champions
in health facilities who promote ongoing practice
and improvement of care New learning
The Golden Minute
• Provide support and encouragement to a champion in the facility
who leads ongoing practice.
Improvement Skills mastery
of care
• Encourage providers to continue the use of self-reflection,
feedback, and review of their actions during practice and after
helping a baby breathe.
• Help establish a system for case reviews.
• Promote collaboration with the local health system to collect data, Clinical Practice in pairs
carry out improvement activities, and share experiences among facilities. experience and teams
• Register the workshop at hbs.aap.org and share experiences.
DURING
Help participants commit to making a difference
• Resources at hbs.aap.org
- Combined maternal and neonatal practice scenarios
- Reprocessing guidelines for basic neonatal resuscitation equipment • Saving newborns lives after Helping Babies Breathe training requires
- Improvement Guide: improving the care of mothers and babies ongoing low-dose high frequency refresher practice with pairs and
- Links to additional Helping Babies Survive and Helping Mothers Survive teams of providers in the facility in order to change clinical care.
programs and other resources
• Reflect with the participants on
- What are you going to do differently?
Improving Care - What will you no longer do?
of Mothers and Babies®
A guide for improvement teams
- How are you going to make these changes happen?
• Develop a plan for routine practice, self-reflection, review of actions
(debriefing), and case reviews/audits after helping .a baby breathe.
• Help participants plan a change that will improve care in the facility.
• Resources:
Questions to improve care and What to monitor in the Provider Guide
To improve care in your facility What to monitor
- Who is responsible for having equipment disinfected and - Is equipment to help a baby breathe available at all births?
available for every birth?
- How can a second skilled person be available to help in
an emergency?
1
Start with a story Explain and demonstrate Facilitate practice
Have each participant place one hand How to make a difference Ask participants to practice in pairs
on the simulator or mannequin. • Be present and prepared to help Use a neonatal simulator or mannequin
Say to the participants, “Close your eyes and a baby who does not breathe to show crying, breathing, heart rate
imagine that a baby is born. The baby is not By one minute after birth - The Golden
breathing. There is no one to help the baby. (Pause) Minute - a baby should be breathing
The baby dies.”
well or you should be providing Check yourself (page 7)
Pause to allow the participants to reflect with ventilation Review with learners their answers to the
their eyes closed. With their eyes still closed, say,
“Imagine that another baby is born. The baby is not
• Promote cleanliness, warmth, Check yourself questions in the Provider Guide.
breathing. You are there to help the baby. You rub breastfeeding for all babies
him dry, keep him warm, and help him breathe with When should a skilled person be present at a birth?
a bag and mask. The baby begins to cry.” How to use the materials If problems occur
(Imitate a baby crying.) x At every birth
• Action Plan
“At every birth, there must be a skilled person to • Facilitator Flip Chart Which babies benefit from a skilled birth attendant?
assess the baby and help the baby who is not
breathing well.”
• Provider Guide Only babies who need help to breathe
x All babies
• Neonatal simulator or mannequin for
practice in pairs
Background Provider Guide illustrations. Point out The Golden Minute. The illustrations of
the Flip Chart match those in the Provider Guide. Each step in the Action Plan
Understanding the major causes of newborn death in the region helps is presented on the Facilitator Flip Chart. A red circle indicates the step being
participants appreciate how they can make a difference for all babies, not considered.
just those who need help to breathe. Be familiar with local statistics or invite
a local health leader to participate in the opening of the workshop. Organize learners into pairs for cooperative learning within small groups.
This helps build teamwork and skills for providing feedback. Such cooperative
learning will continue during practice after the workshop.
Educational advice Demonstrate the basic functions of the neonatal simulator or mannequin and
have the pairs of participants practice crying, breathing, and heart rate.
Begin with a story to show how Helping Babies Breathe can really save lives.
Invite participants to share their experiences. Relate these experiences to
what will be discussed in the workshop.
Introduce the Action Plan, Flip Chart, and Provider Guide. Point out the colors
of the zones, which are repeated in the background color of the Flip Chart and
2b
As a skilled birth attendant,
you make the difference
2
Ask a participant to point out • Prepare an area for ventilation and - Assemble disinfected equipment and
the action step “Prepare for birth” and check equipment supplies
the equipment and supplies needed - Assemble disinfected equipment - Test the ventilation bag, mask, and
to help a baby breathe and supplies suction device
- Test the ventilation bag, mask and - Prepare a uterotonic for the mother
suction device (Provider Guide page 47)
Explain and demonstrate - Prepare a uterotonic for the mother
Preparation for a birth
Check yourself (page 9)
• Identify a helper and review the
emergency plan with the mother
Facilitate practice What important tasks can a helper do during a birth?
Place a cold cloth on the baby’s forehead
- Communication Ask participants to practice in pairs x Call for help or assist if problems arise
- Transportation • Identify a helper and review the
emergency plan When should you wash your hands?
• Prepare the area for delivery When they look dirty
• Prepare the area for delivery
- Warm, well-lighted, clean x Before and after caring for a mother or a baby
• Wash hands
• Wash hands (Provider Guide page 52) • Prepare an area for ventilation
Background Follow the steps on page 22b of the Facilitator Flip Chart to check the bag, mask,
and suction device. Prepare the uterotonic, such as oxytocin or misoprostol,
Identify a helper and review the emergency plan. Emergency planning before birth (see Helping Mothers Survive).
should be part of every birth plan and every health system. The mother’s birth
companion can call for help as directed and remain with the mother and baby
after birth. A second skilled birth attendant can assist as needed – for example,
giving a uterotonic to the mother, cutting the cord, evaluating the heart rate,
Educational advice
or seeking advice from a higher level facility. Demonstrate each of the skills in the role of the birth attendant. Invite par-
ticipants to role play the birth companion, the helper, and the mother. Model
Prepare the area for delivery. Eliminate drafts from fans, air conditioners, or how to communicate with them. Ask questions to review the emergency plan.
open windows and doors. Warm the birthing room to 23-25oC. Clearly define the role of the helper. Show the steps to prepare the area for de-
Wash hands. Everyone who attends a delivery, including the mother, father, livery. Lead everyone in handwashing and testing of their equipment.
and birth companion, must wash their hands. Follow the pictures on page 52 Ask participants to practice how they will carry out each step of prepa-
of the Provider Guide to practice. Clean gloves also help prevent infection and ration where they work. Who will be the helper? What are the means of
protect the birth attendant from blood and body fluids. Review the regional communication and transportation? Where will ventilation be provided?
procedures for personal protection. Who is responsible to have disinfected, working equipment and supplies
Prepare an area for ventilation and check equipment. The area for ready for use at every birth?
ventilation should be warm, dry, flat, and safe, without risk for falls or other
injury. Use a warm cloth to cover and protect the baby from cool surfaces.
3b
Second Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
Before a baby is born
Prepare for birth
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
3
Dry thoroughly
Crying Crying? Not crying
The Golden Minute
Exercise: Preparation for a birth (Provider Guide pages 10-11)
Checklist Educational advice
Keep warm Identify a helper and review In a small group of learners (no more than 6 persons with 1 facilitator)
Clear airway if needed the emergency plan • Demonstrate preparation for birth and communication with the mother
and a helper.
Stimulate • Have participants practice the checklist in pairs and give one
............................................................ another feedback.
Breathing?
IdentifyKeep
helperwarm Prepare the area
- First, the participant in the role of the birth attendant reflects on his
Wash hands Prepare an area Prepare the area for delivery or her own performance of a skill.
Check
and reviewbreathing for delivery Breathing well Not breathing and
for ventilation - Next, the participant in the role of helper or mother gives any helpful
emergency plan check equipment comments to improve performance.
............................................................ - The facilitator may ask questions to help participants reflect on their
performance.
Wash hands • Answer questions and encourage correct actions during the exercise.
The facilitators will demonstrate Second Edition
Helping Babies Breathe • Share feedback with the whole group after the exercise.
how to prepare for a birth. Prepare for birth*
• Review the group discussion questions.
See HMS Action Plans for mother
............................................................
Participants will work in pairs to Breathing
Birth
Ventilate
practice the checklist. Cut cord Prepare an area for ventilation
One personCut cord
takes the role of the Group discussion
birth attendant. The other per- Dry thoroughly ............................................................
Crying Crying?
Not breathing
Not crying At the end of the exercise, ask participants to answer these questions in
son takes the role of the mother.
The Golden Minute
No chest movement the small group. Encourage them to think about how they will put the
Begin by introducing yourself. Assemble disinfected equipment skills learned into practice. Make note of other questions that participants
Call for help ask and their answers.
Then communicate with the Monitor and supplies
mother and helper while prepar- with mother
Keep warm
Clear airway if needed
1. What is the emergency plan where you work?
ing for a birth. Stimulate
Breathing?
............................................................ 2. What could a helper do during a birth? How do you prepare the helper?
Participants give one another Keep warm
Check breathing Breathing well Not breathing
3. How will you prepare the area for delivery and the area for ventilation
feedback, switch roles and Breathing Improve ventilation Test the ventilation bag,
where you work?
Essential
repeat Care for Every Baby
the exercise. mask and suction device
(See ECEB Action Plan) 4. Is there a source of clean water or alcohol-based hand cleaner
Breathing Ventilate
Not breathing
Cut cord where you work?
Cut cord ............................................................
Heart rate?
Not breathing 5. How will you have disinfected working equipment and supplies ready
* Equipment to help a baby breathe No chest movement
for use at every birth?
Monitor
Call for help
Prepare a uterotonic for the
with mother
Gloves Suction device
mother
Cloths Ventilation Essential Care for Every Baby
Breathing Improve ventilation
bag-mask (See ECEB Action Plan)
Not breathing ............................................................
Heart rate?
Head
covering Stethoscope
* Equipment to help a baby breathe
Gloves Suction device
Normal
Cloths Ventilation
Scissors bag-mask
Timer Not
Head
covering Stethoscope
Normal
Slow
Ties /Clamps (clock, watch)
Continue ventilation
Scissors
breathing Ties /Clamps
Timer
(clock, watch) Not
Continue
breathing ventilation
Slow
Disinfect equipment immediately after use
Disinfect equipment immediately after use
Decide on advanced care
Decide on advanced care
4b
Exercise: Preparation for a birth
4
Ask a participant to point out Facilitate practice Check yourself (page 13)
the action step “Dry thoroughly”
Ask participants to practice in pairs
• Dry thoroughly A baby is placed on a cloth beside the mother
Explain and demonstrate • Remove the wet cloth
without drying. What happens?
x The baby can become cold
Drying • Place the baby skin-to-skin The baby will stay warm
• Helps keep the baby warm • Cover with a dry cloth
When should you dry the baby?
• Stimulates breathing • Note the time of birth After giving a uterotonic to the mother
x Immediately after birth
At birth, dry thoroughly
• Place a cloth on mother’s abdomen
• Position the baby on the cloth
• Dry by gently rubbing with the cloth
• Remove the wet cloth
• Place the baby skin-to-skin with mother
• Cover with a dry cloth
Note time of birth
Background Educational advice
A wet baby can easily become cold. A cold baby can have difficulty breathing. Demonstrate how to dry a baby by inviting a participant to play the role of the
Drying thoroughly involves gently rubbing the body, arms and legs, and head. mother. Place a cloth on mother’s abdomen and dry the baby by rubbing vigor-
Blotting or patting a baby dry does not stimulate breathing. ously but gently. Emphasize that rubbing the large area of the back provides
strong stimulation to breathe. Contrast this method with patting dry or simply
In the past, babies with meconium in the amniotic fluid who were not crying
wrapping. Ask participants to describe the benefits of the correct method.
had their airway suctioned before drying and stimulation. It is unclear this
practice benefits babies and it may interfere with breathing. International
Emphasize removing the wet cloth and replacing it with a dry one to cover the
guidelines recommend that babies with meconium in the amniotic fluid do not
baby in skin-to-skin contact. To show how a wet cloth can make a baby cold,
receive suctioning before drying. place a cloth wet with water on a participant’s skin.
Note the time of birth to enter it later in the clinical record. The time of birth
also begins The Golden Minute. Ask participants to practice in pairs. One person takes the role of the birth at-
tendant. The other takes the role of the mother and provides the response of
the baby. Encourage participants to give feedback to one another with words
or with responses of the baby. Ask them to show that the baby who is dried
thoroughly begins to cry.
5bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
At birth
Dry thoroughly
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
5Present
Ask and demonstrate
a participant to point out Facilitate
Practice with
practice
the Action Plan Check yourself (page 15)
11)
the evaluation question “Crying?” and the
decisions “Crying” Ask participants to practice in pairs
Most babies cry atorbirth.
“Not crying” Ask the learners to practice
Use a neonatal simulator or mannequin A baby is
cries
notafter
crying
birth
after
and
thorough
then breathes
drying.quietly
He is limp.
Crying means a baby is breathing well. • Simulating movement of the chest
Explain and demonstrate to show crying/not crying
and regularly.
What should you
Whatdo?should you do?
Give routine care
care.
Demonstrate chest movements with cry. with crying and not crying
x
x Provide help to breathe.
breathe
Rapid assessment after drying at birth
is the best
A baby whoway to not
does know cryifneeds
a babyhelp
needs Follow the Action Plan: A baby cries
is notafter
crying
birth
at birth.
and then
He isbreathes
not breathing
quietlyorand
mov-
help to breathe.
to breathe. Ask a learner to point out ing and heWhat
regularly. is limpshould you do?
x Give routine care
care.
Aboutbabies
Most 1 in 10cry
babies needs help to breathe.
at birth • The evaluation question “Crying?” x Provide help to breathe
breathe.
•Demonstrate
Crying means irregular
a baby chest movements
is breathing well • The decision “Crying” or “Not crying”
•orDemonstrate
no chest movement.
a baby crying/not crying
A baby who does not cry or is breathing
Without help, a baby who does not breathe
shallowly, gasping, or not breathing at
may suffer serious injury or die.
all needs immediate help to breathe
• About 1 in 10 babies needs help to breathe
• Without help, a baby may die or
experience serious brain damage
• Quick action will help a baby start
breathing sooner
Background Educational advice
Care of babies after birth by health workers and mothers, often called Essen- Begin with a story to encourage learners to believe that ENC can really save lives.
Background
tial Newborn Care (ENC), promotes health and can increase newborn survival.
Many babies die during the first day and first week, some because they do not Educational
Invite participants to shareadvice
their experiences.
receive
A this
skilled care. The
person Essential
should Care forat
be present Every Baby
every programProblems
delivery. aims at giving
duringpro-
the Introduce
Use and explain
the illustrations to the use ofthe
contrast thefeatures
Action ofPlan and Flip
a baby whoChart. Each
is crying step
with in
one
pregnancy, labor, or delivery
viders the knowledge predict
and skill some - but
to provide not
most all - babies
elements who and
of ENC needassist
help the Action Plan is presented on the Facilitator Flip Chart. The front is viewed
who is not crying. Ask participants to describe the color, tone, position of the by
to breathe.
mothers and families in providing this care. messages
arms to mothers
and legs, hands, and fathers.
mouth. Organize learners into pairs for cooperative
learning. Each
Emphasize thefacilitator
importance should assist 3 pairs
of recognizing theofbaby
learners.
who needs help to breathe
In rare cases, a newborn baby does not cry but does breathe quietly and
in order to act quickly.
regularly. This baby may be healthy, but stimulating breathing will not harm a
quietly breathing baby. Encourage participants to work in pairs to become familiar with the mannequin
or neonatal simulator. The participant playing the role of the mother will give
information to the birth attendant by operating the simulator. The participant
playing the role of the birth attendant assesses the responses of the neonatal
simulator or mannequin to decide what steps to take next.
16 b2Second Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
After drying
Is the baby crying?
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
6Present
Ask andtodemonstrate
a participant point out Practice with
Facilitate practice
the Action Plan Check yourself (page 17)
11)
the action steps in routine care
Ask the participants to practice in pairs
Most babies cry at birth. Ask the learners to practice
• Position the baby skin-to-skin and cover What
A babycan
cries
you
after
do to
birth
encourage
and thenbreastfeeding?
breathes quietly
Explain
Crying and
means demonstrate
a baby is breathing well. • Simulating movement of the chest
with a dry cloth and a head covering
and regularly.
x Keep
Separate
Give routine
What shouldwith
baby skin-to-skin
mother
youmother
do?
care.and baby after birth
Demonstrate chest movements with cry. with crying and not crying
x
The baby who is crying can receive • Check breathing Provide help to breathe.
How can you keep a baby warm after birth?
routine care.does not cry needs help
A baby who Follow the Action Plan: A baby
Giveisanot crying
warm bathat birth. He is not breathing or mov-
ing
x and he isthe
Position limp
baby skin-to-skin with mother,
to breathe.
Keep warm Ask a learner to point out cover
Give routine
with a dry
care.cloth and a head covering
About 1 in skin-to-skin
• Position 10 babies needs
withhelp
the to breathe.
neck • The evaluation question “Crying?” x Provide help to breathe.
Demonstrate irregular chest movements
slightly extended • The decision “Crying” or “Not crying”
or no chest
• Cover headmovement.
and body
Check breathing
Without help, a baby who does not breathe
• Listen, look at or feel movement of chest
may suffer serious injury or die.
Demonstrate quiet and regular breathing
Background Educational advice
Keep
Care ofwarm. Placing
babies the baby
after birth skin-to-skin
by health workerswith mother
and gives
mothers, the baby
often calleda Essen-
source Emphasize
Begin with athat
storychecking
to encourage
breathing
learners
means
to believe
looking that
at,ENC
listening
can really
to, and
savesome-
lives.
of
tialheat. Skin-to-skin
Newborn contact
Care (ENC), can help health
promotes a babyand
breathe well. Being
can increase close tosurvival.
newborn mother times feeling the baby’s breathing.
Invite participants to share their experiences.
encourages
Many babiesearly breastfeeding.
die during the first day and first week, some because they do not In the minutes before clamping or tying and cutting the umbilical cord, the birth
Introduce can
andgive
explain the use of theasAction Planto and Flip bleeding
Chart. Each
andstep
receivebreathing.
this care. The Essential in
Check Most babiesCare
whoforcryEvery Baby
at birth program
continue to aims at giving
breathe pro-
well. Some attendant a uterotonic such oxytocin prevent moni-
viders the
babies mayknowledge
have largeand skill to of
amounts provide most
fluid in the elements
mouth and of ENC
nose.and assist
Position- the Action Plan is presented on the Facilitator Flip Chart. The front
tor the mother. Active management of the third stage of labor may occur while is viewed by
mothers
ing theseand
babies
families
on their
in providing
side may this
helpcare.
the fluid drain. A baby’s neck should messages
the to mothers
birth attendant andchecking
is also fathers. Organize
the babylearners into pairs
(see Helping for cooperative
Mothers Survive).
be slightly extended – not flexed or hyperextended. The nose should not be learning. Each facilitator should assist 3 pairs of learners.
blocked by mother’s skin or clothing.
Mother and baby should not be left alone during the first hours after birth.
A birth companion should remain with mother and baby when a health
worker is not present.
17 b4Second Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
If the baby is crying
Keep warm,
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
check breathing
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
7Present andtodemonstrate
Ask a participant point out Practice with the
Position skin-to-skin Actionchest
on mother’s Plan Check yourself (page 11)
19)
the action step “Cut cord” and the step to encourage breastfeeding.
continuing
Most babiestocry
essential newborn care
at birth. Ask the learners to practice
Continue with essential newborn care, How long
A baby should
cries afteryou
birthwait
andtothen
clamp or tie and
breathes cut
quietly
Crying means a baby is breathing well. •identify
Simulating movement
the baby, of the chest
and complete the the
andumbilical
regularly.cord
What ofshould
a crying baby?
you do?
Explain and
Demonstrate demonstrate
chest movements with cry. withrecord.
birth crying and not crying
x Clamp
x Wait
or tie care.
Give routine and cut the cord immediately
1 tohelp
Provide 3 minutes to clamp or tie and cut the cord
to breathe.
Wait 1 - 3 minutes to clamp or tie and
A baby
cut who does
the cord so thenot cryreceives
baby needs help
blood Follow the Action Plan: What
A babyactions help prevent
is not crying infection
at birth. He is notofbreathing
the or mov-
to breathe.
from the placenta. Facilitate
Ask practice
a learner to point out umbilical
ing and hecord?
x Good
is limp
hand washing,
Give routine care. wearing clean gloves,
About 1 in 10 babies needs help to breathe. • The evaluation question “Crying?” cutting
Provide with
help sterile scissors
to breathe.
Ask participants to practice in pairs
x
Cut the cord irregular chest movements
Demonstrate • The decision “Crying” or “Not crying” Covering the cord to keep it moist
• Wear cleanmovement.
gloves • Clamp or tie and cut the umbilical cord
or no chest
• Place clamps or ties around the cord at 2 using locally available supplies
and 5 fingerbreadths from the not
abdomen • Position the baby to encourage
Without help, a baby who does breathe
• Cutsuffer
between the injury
clampsorordie.
ties with breastfeeding
may serious
disinfected scissors or blade • Communicate with the mother
• Leave the cut end of the cord open to
air to dry
Background Educational advice
Timing of clamping or tying and cutting the cord may vary. Timing of clamp- The equipment and technique to clamp or tie and cut the cord differ from
ing or tying and cutting the cord depends on the condition of the baby and the one area to another. Have available the supplies that are used locally to clamp
mother during the third stage of labor. Maternal bleeding or moving the baby or tie and cut the cord. Demonstrate the local technique using devices that will
to the area for ventilation may require earlier clamping or tying and cutting of not damage the neonatal simulator or mannequin. For example, hair pins or
the umbilical cord. clips can be used to simulate cord clamps. Plastic knives can be used to simu-
late scalpels.
Cleanliness is important to help prevent infection when clamping or tying
and cutting the cord. Infection of the umbilical cord can lead to serious infec- Emphasize ways to prevent infection: clean gloves (wash or change gloves
tion. Everything used to clamp or tie and cut the cord should be sterile or highly or remove the first pair if double-gloved), clean clamp or tie, sterile or highly
disinfected. Follow the guidelines for clean delivery used in your region. In some disinfected blade or scissors, putting nothing on the cord (unless antiseptic
regions, antiseptic solutions may be applied to the cord. solutions are used).
Ask participants to discuss how they identify babies in their facility. Discuss what
information should be recorded immediately after birth.
8bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
After 1-3 minutes
Clamp or tie
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
and cut the umbilical cord
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
8Exercise: Routine care (pages 20-21)
The facilitators will
Checklist Educational advice
demonstrate routine
Second Edition
Helping Babies Breathe
Prepare for birth* Dry thoroughly In a small group of participants (no more than 6 persons with 1 facilitator)
care and the baby’s See HMS Action Plans for mother • Demonstrate routine care and communication with mother.
responses. Birth • Have participants practice the checklist in pairs and give one another
............................................................ feedback.
• Answer questions and encourage correct actions during the exercise.
Participants will work Recognize crying
• Share feedback with the whole group after the exercise.
• Review the group discussion questions.
in pairs with the
mannequin to Dry thoroughly ............................................................
practice the checklist. Crying Crying? Not crying
The Golden Minute
One person takes the Keep warm Group discussion
role of the birth
attendant. The other ............................................................
At the end of the exercise, ask participants to answer these questions in
the small group. Encourage them to think about how they will put the
person takes the role Keep warm skills learned into practice. Make note of other questions that participants
of the mother and Clear airway if needed ask and their answers.
Stimulate Check breathing
gives the response of Breathing?
1. Where will you place a baby receiving routine care immediately after birth?
the baby. The birth Keep warm
............................................................ In your experience, do mothers routinely practice skin-to-skin care?
Check breathing Breathing well Not breathing
attendant communi-
2. How can you protect mother and baby from infection during and
cates with the mother Clamp or tie and cut the after birth?
while providing umbilical cord 3.. Who cares for the baby if the mother has a problem after birth?
routine care. Breathing Ventilate
Cut cord
Cut cord
............................................................
Participants give one Not breathing
No chest movement
another feedback, Call for help Position on mother’s chest to
Monitor
switch roles and with mother encourage breastfeeding
repeat the exercise.
Breathing Improve ventilation
Essential Care for Every Baby ............................................................
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Continue with essential newborn
Gloves Suction device
care, identify the baby, and
complete the birth record
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Ties /Clamps
Timer
(clock, watch) Not Slow ............................................................
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
9bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Exercise: Routine care
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
9Present
Ask andtodemonstrate
a participant point out Practice
Keep warm with the Action Plan Check yourself
Facilitate practice
(page 11)
The Golden Minute • Keep the baby skin-to-skin
•Ask
Cover Ask the participants to practice in pairs
Most babies cry at birth. the the head (helper
learners may assist)
to practice
• Keep
A babywarm
cries after birth and then breathes quietly
Explain
Crying and
means demonstrate
a baby is breathing well. • Simulating movement of the chest
Clear
and regularly. What should you do?
• Clear the airway
care. - position the head,
Demonstrate chest movements with cry. withthe airway
crying and ifnot
needed
crying Give routine
x
Begin The Golden Minute with a breath- • Position the head slightly extended remove
Providesecretions
help to breathe.if needed
holding exercise. •Follow
Remove • Stimulate breathing
A baby who does not cry needs help thesecretions from the airway
Action Plan: A baby is not crying at birth. He is not breathing or mov-
Ask participants to stand and breathe deeply. if they are blocking
to breathe. Ask a learner to pointtheoutmouth or nose ing and he is limp
Then ask them to hold their breath for 1 minute. Check yourself (page 23)
Give routine care.
About 1 intime
Call out the 10 babies
every 15needs
seconds.help
Ask to breathe.
participants • OR
The evaluation question “Crying?” x Provide help to breathe.
to be seated if they
Demonstrate need to take
irregular a breath
chest before
movements if there
• The is meconium
decision “Crying”inor
the amniotic
“Not fluid
crying”
one minute. Which babies need clearing of the airway with
or no chest movement.
“By one minute a baby should be breathing or a suction device?
Suctioning too long, too vigorously,
receiving ventilation.” x Babies who have secretions blocking the mouth or nose
Without help, a baby who does not breathe too deeply, or too often can cause injury, All babies who are not crying
may slow heart rate and prevent breathing.
If thesuffer
babyserious injury help
is not crying, or die.
the baby Suctioning several times or suctioning deeply can
breathe in The Golden Minute. Stimulate a baby’s breathing
Stimulate breathing x Keep a baby from breathing
• Rub the back 2 or 3 times
Background Stimulation can help a baby begin to breathe, even after drying. Pro-
longed suctioning or stimulation are unlikely to be effective, may cause
Clearing the airway can cause harm if done unnecessarily or not done gently. harm, and will delay ventilation. If a baby is not breathing well or crying after
Suction only if there are secretions blocking the nose or mouth or if there is me- clearing the airway and brief stimulation, the baby needs ventilation with bag
conium in the amniotic fluid. Suctioning too deeply can bruise or tear the back and mask. More stimulation alone is unlikely to be effective. Prolonged stimu-
of the throat. Suctioning or wiping too hard can injure the lining of the mouth. In lation only wastes time while the baby is becoming sicker. Stimulation can be
both cases, the baby may not breastfeed well. Suctioning repeatedly or too long given to improve and sustain spontaneous breathing during and after ventila-
can keep a baby from breathing or cause a baby to have difficulty breathing. tion with bag and mask.
The device used to clear the airway differs from one area to another.
Each device has advantages and disadvantages. Any device can introduce in-
fection if it is not disinfected before re-use. Otherwise, the device must be dis- Educational advice
carded (page 26b). Emphasize that there are two ways to clear the airway- first by positioning the
Some forms of stimulation can harm babies and should never be used. head and second by removing secretions that are blocking the airway. Stimu-
Harmful methods include slapping the back, squeezing the ribs, forcing the lation by rubbing the back is a separate step from drying.
thighs onto the abdomen, dilating the anus, using hot/cold water, and shaking Use suction devices available locally to demonstrate the skill. Discuss their
or holding the baby upside down. Help participants evaluate other methods of advantages and disadvantages. Help participants use the bulb suction device
stimulation that may be in use. correctly by transferring water from one container to another.
10bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
If the baby is not crying
Keep warm,
Dry thoroughly
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
clear the airway if needed
Stimulate
Breathing?
Keep warm
Check breathing Breathing well Not breathing
and stimulate breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
10Present
Ask andtodemonstrate
a participant point out Practice with
Facilitate practice
the Action Plan Check yourself (page 25)
11)
the evaluation question “Breathing?”
and Ask participants to practice in pairs
Mostdecisions “Breathing
babies cry at birth.well” or Ask the learners to practice
“Not breathing” Use a neonatal simulator or mannequin A baby
babyiscries
not after
breathing
birthwell
andafter
thendrying
breathes
andquietly
rubbing the
Crying means a baby is breathing well. • Simulating movement of the chest back.
and regularly.
There areWhat
no visible
should
secretions.
you do?What should you do?
to show Suction
Give routine
the airway
care. and give more stimulation
Demonstrate chest movements with cry. with crying and not crying
x
• Crying
Explain and demonstrate
x Ventilate
Provide help
withtobag
breathe.
and mask
• Breathing quietly and regularly
A baby who does not cry needs help Follow the Action Plan: Which
A babybaby
is notiscrying
breathing
at birth.
well?He is not breathing or mov-
A baby who is breathing well • Gasping ing
x and he is
A baby wholimpis breathing quietly and regularly
to breathe. Ask a learner to point out
• Crying • Not breathing at all A
Give
baby
routine
who takes
care. one deep breath followed by a
About 1 in 10 babies needs help to breathe. • The evaluation question “Crying?” long
Provide
pause
help to breathe.
OR
x
Demonstrate irregular chest movements • The decision “Crying” or “Not crying”
• Breathing quietly and regularly
or no chest movement.
A baby who is not breathing well
•Without
Gaspinghelp, a baby who does not breathe
may
ORsuffer serious injury or die.
• Not breathing at all
Babies with shallow, irregular, slow or
noisy breathing or chest indrawing
need continued monitoring.
Background Educational advice
Some babies will require close monitoring to determine if they need Demonstrate different patterns of breathing with the simulator or your own
more help to breathe. Some babies who breathe abnormally will improve breathing: crying, breathing quietly and regularly, gasping, not breathing.
and begin to breathe normally. Others will need more help to breathe.
Ask participants to practice producing and identifying these patterns of
breathing that will be the basis for deciding on the next action step.
If a baby is not breathing well after clearing the airway and stimulation,
the baby needs ventilation with bag and mask. Prolonged evaluation only
delays needed action.
11bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
After stimulation
Is the baby breathing well?
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
11Exercise: The Golden Minute® – clear the airway if needed and stimulate breathing
(Pages 26-27)
Checklist Educational advice
The facilitators
will demonstrate
Second Edition
Helping Babies Breathe In a small group of participants (no more than 6 persons with 1 facilitator)
Prepare for birth*
clearing the airway See HMS Action Plans for mother Dry thoroughly • Demonstrate The Golden Minute – clear airway and stimulate breathing
and communication with mother and a helper.
and stimulating Birth
• Have participants practice the checklist in pairs and give one another
breathing during ............................................................ feedback.
The Golden Minute Recognize not crying • Answer questions and encourage correct actions during the exercise.
• Ask participants to review their actions (debrief) after helping a
and the baby’s baby breathe.
responses. ............................................................
Dry thoroughly
Crying Crying? Not crying Keep warm - What happened at the birth?
The Golden Minute
Participants will work - Did you follow the Action Plan?
in pairs with the ............................................................ - What went well and what could have gone better?
Clear airway if needed - What did you learn?
mannequin to - What will you do differently next time?
practice the checklist.
Keep warm ............................................................
One person takes the Clear airway if needed • Share feedback with the whole group after the exercise.
role of the birth atten- Stimulate Stimulate breathing • Review the group discussion questions.
Breathing?
dant. The other person Keep warm
Check breathing ............................................................
takes the role of the Breathing well Not breathing
Recognize breathing well
mother and gives the
response of the baby.
Group discussion
............................................................
The birth attendant Breathing Ventilate Check breathing At the end of the exercise, ask participants to answer these questions in
communicates with Cut cord
Cut cord the small group. Encourage them to think about how they will put the
skills learned into practice. Make note of other questions that participants
the mother. ............................................................
Not breathing ask and their answers.
No chest movement
Call for help Clamp or tie and cut the
Participants review Monitor umbilical cord 1. How do you clear secretions blocking a baby’s nose and mouth? What are
their actions, give one with mother the advantages and disadvantages of this method?
another feedback,
Breathing Improve ventilation ............................................................ 2. Do all babies have their mouth and nose suctioned?
switch roles and Essential Care for Every Baby
Position on mother’s
(See ECEB Action Plan) Is this useful or harmful?
repeat the exercise. Not breathing
chest to encourage breastfeeding
Heart rate?
* Equipment to help a baby breathe
3. Drying and rubbing the back are methods to stimulate breathing.
Participants should be Are other methods used in your region? Are these methods useful or
............................................................
Gloves Suction device
prepared to care for a harmful or neither?
Continue with essential new-
Cloths Ventilation
bag-mask
baby with Normal
born care, identify the baby,
Head
• meconium in the
covering Stethoscope
Scissors
Timer Not Slow complete the birth record, and
amniotic fluid
Ties /Clamps (clock, watch)
breathing Continue ventilation
Decide on advanced care review your actions
• secretions blocking Disinfect equipment immediately after use
the nose or mouth ............................................................
• no secretions
12bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Keep warm
Exercise: The Golden Minute
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Monitor
Not breathing
No chest movement
Call for help – clear the airway if needed and stimulate breathing
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
60 sec
12Present
Ask andtodemonstrate
a participant point out Practice with
Facilitate practice
the Action Plan Check yourself (page 29)
11)
the action step “Ventilate-Cut cord”
Ask participants to practice in pairs
Most babies cry at birth. Ask the learners to practice
Explain
Crying means and demonstrate
a baby is breathing well.
• Decide when to clamp or tie and cut
• Simulating movement of the chest
A baby
How
and
docries
regularly.
x Select
after birth
you select
Whatthat
the mask
and then
the correct
should youthe
covers
breathes quietly
mask?
do?
chin, mouth, and
the cord Give routine
nose, but notcare.
the eyes
Demonstrate chest
bagmovements
and mask iswith the cry. with crying and not crying
x
Ventilation with • Place the baby on the area for ventilation Providethe
Select help to breathe.
mask that covers the chin, mouth, nose,
most effective way to help the baby who • Stand at the baby’s head and the eyes
A
is baby who doesornot
not breathing cry needs help
is gasping. Follow the Action Plan: A baby is not crying at birth. He is not breathing or mov-
• Check that the mask size is correct ing andwill
Where heyou
is limp
place the baby for ventilation?
to breathe. Ask a learner to point out
Begin
About to 1 inventilate
10 babies needs help to breathe. • The evaluation question “Crying?”
Give
In
x On
routine
a crib care. from cold
to protect
x Provide
a flat,help to breathe.
warm, dry surface
•Demonstrate
Follow your irregular
facility’s routine for when
chest movements • The decision “Crying” or “Not crying”
orto
noclamp
chestor tie and cut the cord
movement.
• Place the baby on the area for ventilation
- Beside
Without the mother
help, a baby who if the does
cord isnot
notbreathe
cut
- Asuffer
may separate areainjury
serious if the cord is cut
or die.
• Stand at the baby’s head
• Check that the mask size is correct
Background Assembling equipment and supplies and checking the bag and mask
should be part of preparation for every birth. It is too late to look for equip-
During The Golden Minute the most important steps to help a baby ment when a baby is not breathing.
breathe are performed. Clearing the airway and stimulation help many ba-
Checking the mask size is important to form a tight seal on the face and
bies breathe well. Ventilation is the most effective way to help the baby who
keep the airway open during ventilation.
has not responded to clearing the airway and stimulation. Ventilation carries air
• If the mask is too large, it will not make a good seal.
into the lungs. It starts the changes in the body that are necessary so the baby
• If the mask is too small, it can block the mouth and nose.
can begin to breathe.
A mask with a round or pointed shape may be used. When using a pointed
Within The Golden Minute the baby should be breathing well or receiving mask, the pointed part fits over the nose and the round part fits over the chin.
ventilation. Delay in starting ventilation will mean that a baby needs ventila- Masks with cushioned or flexible rims follow the shape of the face and form a
tion longer before beginning to breathe. Delay in ventilation may cause serious seal more easily.
brain damage.
Each facility should decide on a routine for when to clamp or tie and cut
the cord. The best time to cut the cord of the baby who needs ventilation
is not known. It is known that babies who do not breathe or receive ven-
Educational advice
tilation by one minute are more likely to die. Cutting the cord should not Discuss how participants will decide when to clamp or tie and cut the cord
delay ventilation. In some cases, clamping or tying and cutting the cord will and where to ventilate a baby in their facility. Practice the order of steps they
occur after ventilation has begun. A second skilled person may clamp or tie and will use. Show how incorrect position can make ventilation ineffective.
cut the cord. Clamping is often faster than tying.
Demonstrate how a mask that is too large will not make a seal. Show how a mask
The area for ventilation depends on where an appropriate space is available that is too small can block the airway. Use masks that are available in the facility
and whether the cord is cut before or after ventilation begins. to show that torn or incomplete masks will not make a seal.
13bSecond Edition
Helping Babies Breathe
Prepare for birth*
See HMS Action Plans for mother
Birth
Dry thoroughly
If the baby is not breathing well
Begin to ventilate
Crying Crying? Not crying
The Golden Minute
Keep warm
Clear airway if needed
Stimulate
Breathing?
Keep warm
Check breathing Breathing well Not breathing
Breathing Ventilate
Cut cord
Cut cord
Not breathing
No chest movement
Call for help
Monitor
with mother
Breathing Improve ventilation
Essential Care for Every Baby
(See ECEB Action Plan)
Not breathing
Heart rate?
* Equipment to help a baby breathe
Gloves Suction device
Cloths Ventilation
bag-mask
Head
covering Stethoscope
Normal
Scissors
Timer Not Slow
Ties /Clamps (clock, watch)
breathing Continue ventilation
Disinfect equipment immediately after use Decide on advanced care
13Present
Ask andtodemonstrate
a participant point out Practice with
Facilitate practice
the Action Plan Check yourself (page 31)
11)
the action step “Ventilate”
Ask participants to practice in pairs
Most babies cry at birth. Ask the learners to practice
Explain and demonstrate • Position the head A babyallows
What cries after
you tobirth
move and
airthen
intobreathes
a baby’s quietly
lungs
Crying means a baby is breathing well. • Simulating movement of the chest and regularly.
during What should you do?
ventilation?
• Apply the mask to the face Give
A routine
flexed care.of the head
position
Demonstrate
Ventilate withchest movements
mask with cry. with crying and not crying
x
bag and • Make a tight seal x AProvide helpbetween
good seal to breathe.
the mask and the face
• Position the head slightly extended • Squeeze the bag to produce gentle
A baby who
• Apply does to
the mask notthe
cryface
needs help Follow the Action Plan: A baby
To help is notthe
keep crying at birth.
baby’s airway Heopen,
is notyou
breathing
should or mov-
movement of the chest ing and he
position theishead
limp
to breathe.
• Make a tight seal between the mask Ask a learner to point out
• Give 40 ventilation breaths in one minute Give routine
x Slightly care.
extended
About 1 in 10 babies needs help to breathe.
and face • The evaluation question “Crying?” x Provide help to breathe.
Hyperextended
Demonstrate
• Squeeze theirregular chest movements
bag to produce gentle • The decision “Crying” or “Not crying”
Develop with the learners a method to
ormovement
no chest movement.
of the chest set the correct tempo for ventilation.
• Give 40 ventilation breaths per minute
Without help, a baby who does not breathe
If
maythesuffer
chest is moving
serious withor
injury each
die.ventilation
breath, continue ventilation for 60 seconds
or until the baby begins to breathe.
Background position that forms a tight seal between the mask and face.
• Two-point method: The tips of the thumb and first finger push down on the mask
The amount of air delivered with each ventilation breath from a bag and • Encircling method: The thumb and the first finger form the letter “c” around
mask depends on 3 factors: the top of the mask
• The amount of air that leaks between the mask and face Show how holding the mask by the rim deforms the mask and creates a leak.
• How hard and how long you squeeze the bag
Make sure that each participant can maintain good head position with proper
• The set point of the pop-off (pressure-release) valve
chin support. Pushing down on the mask without lifting up on the chin and
Deliver enough air to move the chest as if the baby is taking a normal breath. Too jaw can flex the head and block the airway. Participants should practice until
little air means the baby may not improve. Too much air may damage the lungs. they can move the chest gently each time they give a ventilation. Help partici-
pants find leaks by feeling where the air escapes against their hand.
A ventilation device may or may not have a pop-off valve. If a ventilation
bag has a pop-off valve, know the set-point at which air escapes. This valve Ask participants to ventilate for a full minute. A sand timer or timer on a
limits the amount of air sent to the lungs – even when you squeeze the bag very cell phone is a convenient way to measure a minute. Watch for smooth
hard. Closing the valve makes it possible to give a larger breath. A very large flow of air from the bag into the baby, not jerky breaths. Help participants
breath can rupture the baby’s lungs. ventilate at the correct tempo. There must be time for air to move out of the
lungs between breaths. A rate between 30 and 50 breaths per minute is accept-
able when trying to give 40 breaths per minute.
Educational advice • Count aloud “1…2…3…1…2…3” and give a breath on “1”.
• Use a timer or watch to set the tempo.
There are 3 steps in placing the mask for ventilation. The 2 most important • Ask participants to think of a phrase or a rhythm from a well-known song or
and difficult steps in ventilation are correct head position and making a dance that helps them keep a tempo of 40 breaths per minute.
tight seal. Ask participants to experiment with correct and incorrect position of Encourage participants to help one another master the skill of ventilation.
the head. Note the change in chest movement. Help each person find the hand
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