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baby. Place an IV and draw maternal blood for blood type and antibody screen.
Position the mother on a table with stirrups, or if unavailable elevate her hips and
back with pillows/stacks of towels or upside down bedpan. The goal is to raise
the perineum above the surface of the bed so that there is room to move the infant
posteriorly during delivery manipulations. Remind the mother not to bear down
unless the fetal head is crowning. The pressure felt from descent of fetal head and
pain of contractions lead to a reflexive desire to push, but a controlled delivery is
preferable. If the head is crowning, the mother should be instructed to make only
modest expulsive efforts in an effort to avoid maternal or fetal trauma with an
uncontrolled delivery. Once the head is delivered, feel for umbilical cord around
the neck and, if present, gently slip it over the head.
Guide the head downward so the anterior shoulder slips out, then guide the
head upward so posterior shoulder passes over the perineum. At this point the
remainder of the infant should follow. Note the time of delivery. Place the baby
on the mother’s abdomen, double clamp and cut the cord, and turn your attention
to newborn care and assessment. Neonatal care should follow the neonatal
resuscitation algorithm. Most infants will only require drying and warming.
Remove wet linen, bulb suction the mouth and then the nose, do the full physical
assessment of the newborn, give vitamin K intramuscular injection of 1 mL in the
thigh, and give erythromycin ointment in both eyes. Be sure to inform the
neonatal providers if you have not given vitamin K or erythromycin. Always
make sure that the mother and baby are not separated until correct identification
tags have been placed on both. Placental separation and delivery occurs naturally
within 30 to 60 minutes after delivery. Seek obstetric help for any baby who has
an abnormal presentation, for example, footling breech, breech, or is in a
transverse presentation.
Abnormal Newborn Screening Results
Goals of Treatment. Newborns screenings are performed in every state. Current
newborn screening tests prior to discharge from the hospital include blood spot
screening for metabolic and genetic conditions, pulse oximetry for cyanotic
congenital heart defects, and hearing screening tests. There is variability from

state to state. While primary care physicians caring for the newborn should be
notified of results and usually arrange follow-up, ED physicians should be
prepared to manage neonates who present to the ED with abnormal screening
results.