What is the routine care for a newborn baby born in a breech position?

Routine Care of a Newborn Breech Baby

Routine care for a newborn delivered in breech position follows the same immediate stabilization protocols as vertex deliveries, with particular attention to delayed cord clamping, temperature maintenance, and gentle stimulation rather than aggressive suctioning. 1

Immediate Delivery Room Management

Cord Clamping

• Delay umbilical cord clamping for at least 1 minute in term breech deliveries to reduce anemia in infancy and improve neurodevelopmental outcomes 1
• For preterm breech infants, delay cord clamping for at least 30 seconds to reduce transfusion needs, intraventricular hemorrhage, and necrotizing enterocolitis risk 1
• Only perform immediate cord clamping if the infant requires immediate resuscitation or placental circulation is compromised 1

Temperature Management

• Maintain body temperature between 36.5°C and 37.5°C from birth through admission and stabilization 1
• Immediately dry the infant and cover the head to reduce heat losses while awaiting cord clamping 1
• Use prewarmed blankets to cover the newborn's body after drying 2, 3
• Maintain operating room or delivery room temperature at 21-25°C 1

Respiratory Support

• Gently stimulate the infant for breath or cry; approximately 85% of term infants will initiate spontaneous respirations within 10-30 seconds 1
• Avoid routine suctioning of the airway or gastric aspiration—only clear secretions if they appear to obstruct the airway 1
• Do not routinely supplement with oxygen outside of resuscitation, as this may be associated with harm 1

Assessment

• Document Apgar scores at 1,5, and 10 minutes after delivery 1

Positioning and Sleep Safety

Sleep Position

• Place the breech-delivered infant supine for all sleep periods, just as with vertex-delivered infants 1
• The risk of SIDS outweighs any theoretical concerns about aspiration, even in infants with gastroesophageal reflux 1
• For preterm breech infants, maintain supine positioning from 32 weeks postmenstrual age onward to establish this habit before discharge 1

Sleep Surface

• Use a firm sleep surface (safety-approved crib mattress) covered by a fitted sheet with no other bedding or soft objects 1

Initial Newborn Visit (Within 3-5 Days Post-Discharge)

Timing

• Schedule at 72 hours for discharge before 24 hours of age, 96 hours for discharge between 24-47.9 hours, and 120 hours for discharge between 48-72 hours 4

Critical Assessments

• Measure actual weight and calculate percentage of weight loss or gain from birth weight—this is mandatory 4
• Assess hydration through physical examination and feeding pattern evaluation 4
• Measure total serum bilirubin or transcutaneous bilirubin if any doubt exists about jaundice severity—visual inspection alone is insufficient 4
• Document stool and urine output patterns to confirm adequate intake 4

Feeding Evaluation

• For breastfed infants, directly observe feeding and document successful latch, swallowing, and infant satiety 4
• Review appropriate urination and stooling frequency 4

Laboratory Review

• Review newborn metabolic screening results (repeat if performed before 24 hours of milk feeding) 4
• Review hearing screening results and any state-mandated screenings 4
• Review maternal laboratory tests: syphilis, hepatitis B surface antigen, and HIV status 4

Parental Education

Safety Counseling

• Reinforce supine sleep positioning for all sleep periods 4
• Verify proper car seat installation and use 4
• Educate on recognition of warning signs: fever, poor feeding, lethargy, increased jaundice, and respiratory distress 4

Routine Care

• Provide training on umbilical cord care, skin care, newborn genital care, and temperature assessment 4

Special Considerations for Breech Delivery

The mode of delivery (breech vs. vertex) does not change routine newborn care protocols. While breech delivery may create additional stress for the newborn during the birth process 5, 6, the immediate postnatal care remains identical to vertex deliveries. The key is vigilant assessment for any signs of birth trauma or respiratory compromise, but routine interventions remain the same 1.