When A baby Needs Help At Birth….
When Baby Needs Help at Birth — What's Actually Happening and What to Do
The physiological truth that changes everything about how we respond in the room
By Kristen Nagle | Former NICU Nurse · Founder, Reclaiming Birth Gathering
Most people who prepare for birth — even those who prepare deeply — arrive at the moment of birth knowing what they want to happen, and very little about what to do if it doesn't.
As a former NICU - I had to deprogram my mind of all the possible things that could go wrong, and instead focus on the physiology of birth and all the mechanisms, hormones and design that’s in place to allow birth to happen safely, and beautifully.
However, there are times when babies need some help. In the past, what I had seen was immediate cord cutting, baby whisked away, placed on a table and vigorous intervention to stimulate baby into crying. Sometimes CPAP and other mechanical breathing apparatus’ were applied.
But what I learned, when looking at physiology, changed everything, something I wish that more knew in the hospital setting - it would drastically change outcomes.
The truth is one in twenty-five babies requires breathing support at birth. The other twenty-four just need time, warmth, and a cord left intact.
First: most crises at birth are not inevitable
Before we talk about what to do when a baby needs help, I need to name something that my years as a NICU nurse made impossible to ignore.
Many of the emergencies we see in birth settings are not things that arrived from outside. They are created — by interventions not performing as intended, by medications with cascading side effects, by a timeline imposed on a process that has its own timeline, by fear entering a room and triggering a sequence of events that would not have unfolded in its absence.
Understanding this is not about blame. It is about recognizing that calm, knowledgeable, physiologically-grounded birth attendance changes outcomes. Not because it prevents every difficulty — but because it responds to difficulty with the right tools instead of with panic and invasive techniques.
What a baby in distress actually looks like
If a baby has been in a challenging position — head born but body not yet through — and that head is turning dark purple, the baby is communicating something clearly.
Carbon dioxide is rising. The baby may begin to gasp.
This is a baby asking for help. Not a baby beyond help.
That dark, congested, purple head is a temporary physiological state — the result of blood pooling in the head due to gravity, combined with a pause in the circulation that was flowing through the cord. The body, in contrast, may appear white and floppy — almost bloodless — because the blood hasn't yet returned through the placenta to circulate back through the baby's body.
This picture — dark congested head, white body, low tone — is telling you exactly what is happening. And knowing what is happening tells you exactly what to do.
What this baby needs is time, a pulsing cord, and calm hands.
What this baby does not need is rubbing or slapping. This still remains common practice in many settings, but is not the solution. A compromised baby who is rubbed vigorously or stimulated through slapping does not benefit from it. The stimulation irritates already fragile skin. It can trigger panic responses in a system that is already under strain. In cases where the skin is particularly fragile, it can cause tears, which I have unfortunately seen often. A compromised baby does not need to be startled into the world. A compromised baby needs blood flow restored.
Those are different things. Entirely different responses.
The cord is already doing the work
This is so important to recognize, as often the cord is immediately cut for interventions to begin.
If the cord is pulsing — there is a heartbeat, there is circulation, and there is time. This is the lifeline.
The pulsing cord is not a redundant structure waiting to be cut. In the moments after a difficult birth, when a baby is dark and floppy and silent, the cord is the most active, most essential thing in that room. It is the bridge between the blood and oxygen pooled in the placenta and the baby who needs it.
The dark, congested head needs time to dissipate. The pooled blood needs to begin moving. The body needs time for circulation to restore — for colour to return from white to pink, for tone to come back into those limbs, for the eyes to open and find the room.
You will see it happen. If you watch and wait instead of cut and rush, you will watch a baby come back to itself in front of you — not because of anything done to it, but because the system that was designed for this was given the time it needed to do what it does.
As blood begins to circulate through the baby, you will see colour change first. Tone follows. The eyes open. The baby may not be breathing independently yet — and this is important to understand — because there may not yet be enough circulating blood for the pulmonary resistance in the lungs to function. The lungs need adequate blood flow to begin working. That blood is coming. Through the cord. From the placenta. Still doing its job.
Never cut the cord.
Placing the baby below the level of the placenta can actively assist blood return in these moments. Gravity contributed to the pooling — and gravity can assist the return.
Never cut the cord.
When a baby needs breathing support
If a baby has gasped — during birth or immediately after — that baby is asking for help with lung inflation. This is a clear signal. And it is a signal that can be answered.
A birth attendant can give breaths. A mother can give breaths. This is not a complicated, equipment-dependent intervention. It is presence and knowledge and the willingness to respond to what the baby is asking for.
Mom can also clear mucus from the airway at this point — gently, including with her own mouth if necessary — to assist with air entry.
What is happening in the lungs
Your baby's lungs, until the moment of birth, have been filled with amniotic fluid. The lungs do not simply open the moment a baby is born. They open gradually, breath by breath, as that fluid is pushed back into circulation and the tiny air sacs — the alveoli — receive oxygen for the first time.
The first breaths given to a baby who needs assistance are called inflation breaths. Three to five, given gently. Their sole purpose is to begin opening the lungs — pushing amniotic fluid into the circulatory system, creating space for oxygen to enter, beginning the process of lung expansion that the first cry would otherwise accomplish.
If the heartbeat is not improving after initial inflation breaths, continue with gentle ventilation breaths. The moment rhythmic, independent breathing begins — stop. Follow the baby's lead.
Why these babies often don't cry
This is something that surprises many people and worries many more — and it is worth understanding clearly.
The first cry is not just an emotional moment. It is a physiological mechanism. That initial wail is partly what forces fluid out of the lungs and drives the first full inflation. When breaths have been given to accomplish that same inflation another way, the cry isn't needed in the same way. Its job has been done.
A baby who has been ventilated and is now breathing peacefully without crying is not in distress. The absence of crying is not a warning sign. It is a sign that the lungs have been helped to open through a different path.
How ventilation supports the heart
Ventilation improves a weak heartbeat not directly — but by increasing the efficiency of circulation. As the lungs begin to function, blood moves more effectively between the baby and the placenta. Oxygen reaches the heart. The whole system — which has been designed from the beginning to work as one interconnected unit — begins to come online together.
The catecholamine surge — and why it matters
When birth unfolds physiologically — undisturbed, unmedicated, allowed to follow the pace the body sets — a surge of catecholamines floods the baby's system in the final moments of birth. This is one of the most important and least discussed aspects of newborn transition.
Among the things this surge does: it drives surfactant into the lungs.
Surfactant is the substance that allows the alveoli to separate, expand, and stay open. Without adequate surfactant, the lungs cannot function independently. This is well understood in premature babies — but it applies to all babies.
When the physiological process of birth is interrupted — by interventions that alter its pace, its hormonal environment, or its sequence — this catecholamine surge can be missed or diminished. And a baby who misses it may have greater difficulty establishing breathing, not because of any intrinsic problem with the baby, but because the process that was supposed to prepare the lungs for first breath was disrupted before it could complete.
This is one of the reasons undisturbed physiological birth matters beyond philosophy. The hormonal sequence of birth is preparing your baby's body for the world. Every element of it serves a purpose. Interrupting it has consequences — sometimes immediately, sometimes in ways that are harder to trace.
A note on breech babies
A baby born breech has not been compressed through the vaginal canal in the same way as a vertex (head-first) baby. This means they may carry more mucus on arrival and may benefit from gentle airway clearance.
Two important things here.
First: gentle. The keyword is gentle. This is not aggressive suctioning.
Second: do not use a bulb syringe. This is something that needs to be said plainly because bulb syringes remain in widespread use despite their documented negative effects. The bulb syringe stimulates the vagus nerve — the nerve that directly regulates heart rate. In a baby who is already in the middle of one of the most demanding physiological transitions of its life, vagal stimulation is precisely what you do not want to introduce. It can slow an already fragile heart rate at the worst possible moment.
If airway clearance is needed — do it gently, and do it without the bulb syringe.
The balance that skilled attendance requires
This post is not an argument for doing nothing.
There is a real and important balance that skilled birth attendants hold — between giving the mother and baby the time and space for their own efforts to unfold, and not waiting so long that the window for effective response has closed.
A head turning dark purple and a baby gasping are signs that something needs to happen. The skill — the thing that separates knowledgeable attendance from fearful attendance — is in knowing what that something is.
It is almost never cutting the cord.
It is staying present. Reading the signs accurately. Supporting the circulation that is already trying to restore itself. Offering breaths if the baby asks for them. Keeping the cord intact. Placing the baby where gravity assists. Watching for the colour change and the tone returning and the eyes opening.
And knowing — with the steadiness that knowledge provides — that the body, given the right conditions, is doing what it was designed to do.
This is the education that belongs in every birth space
This is not radical information. It is physiology — the same physiology that has governed birth since the beginning of human life on this planet.
What is radical is how thoroughly it has been removed from the hands of families and birth workers and replaced with protocols that too often create the very emergencies they claim to prevent.
A birth worker who understands what is happening in a compromised baby's body makes different decisions than one who has only been trained to cut and transfer. A mother who understands this can advocate in the hardest moment. A partner who understands this can stay grounded when everything in the room is pushing toward panic.
This is what we talk about at Reclaiming Birth Gathering.
Not to frighten. Not to pretend that birth is without risk or that help is never needed. But to put the right knowledge in the right hands — so that when help is needed, the right help is given.
This is why the work of Traditional Birth Companions are so needed right now, and they represent a big part of the change we are creating together in person. So families can connect with companions and real relationships and trust can be established.
Reclaiming Birth Gathering — September 10–12, 2026 · Caledon, Ontario.
For birth workers doing this work outside the regulatory system. For families preparing for birth with their whole selves. For anyone who has ever watched an unnecessary intervention unfold in a birth room and known — deeply, immediately known — that something was wrong with the picture.
Year 4. Unlike any other before.
[Get your tickets → reclaimingbirthgathering.com]
Share this with a birth worker, a doula, a midwife, a mother preparing for birth. This is the education that changes what happens in the room.
About Kristen Nagle
Kristen is a former NICU nurse, mother, speaker, and founder of Reclaiming Birth Gathering — an annual family gathering in Ontario restoring trust in physiological birth and the families it transforms. She writes at kristennagle.ca.
Follow: @kristen_nagle · @reclaimingbirthgathering