Delivery and the transition to breathing air
The minutes around birth are a physiologic “handover”: lung aeration, cardiovascular transition, thermoregulation, glucose adaptation, and infection exposure.
Vaginal birth vs cesarean
- Vaginal birth: generally lower maternal surgical risk; may reduce neonatal respiratory transition problems versus elective cesarean.
- Cesarean: can be life-saving (placenta previa, fetal distress, malpresentation). May increase some longer-term allergic disease risk in offspring in meta-analyses.[12]
- Interpretation: associations may be partly confounded, but appear consistent across large systematic reviews.[12]
VBAC/TOLAC (vaginal birth after previous cesarean)
- Main serious risk is uterine rupture; absolute risk varies by scar type and induction/augmentation methods.
- Benefits: avoids repeat surgery and lowers cumulative placenta accreta spectrum risk across multiple pregnancies.
- Safety depends on selection and on access to rapid emergency cesarean capability.
First minutes: newborn priorities
Breathing and ventilationMost babies breathe spontaneously; some need stimulation, airway support, or ventilation per NRP guidance.[8]
Thermal careDrying/warming and skin-to-skin reduce hypothermia-related complications.[8]
Circulatory transitionDeferred cord clamping (often ≥60 seconds when feasible) is recommended for many newborns.[8]
Glucose adaptationAt-risk newborns may require screening for hypoglycemia and prompt feeding/IV glucose depending on symptoms and level.