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, the full physical assessment of the newborn, give vitamin K intramuscular injection of 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