Following delivery of a neonate with greenish amniotic fluid and the baby crying, what is the initial action by EMS?

• A. Dry and stimulate him.
• B. Suction his right nostril.
• C. Suction his left nostril.
• D. Suction his mouth.

Answer: (A)

In a newborn who is vigorous enough to cry, the first action is to dry and stimulate. Drying helps prevent heat loss, which can depress breathing, and gentle stimulation encourages the baby to take deep breaths and establish effective respiration. Meconium-stained amniotic fluid raises concern for meconium aspiration, but routine suctioning isn’t needed in a baby who is crying and breathing well. Suctioning is reserved for infants who are not crying or are having poor respiratory effort or a compromised airway. So the best initial step is to dry the baby and stimulate him, then continue to monitor breathing, color, and heart rate, providing warmth as needed.