Posted by: brambledoula | September 10, 2007

Another frequently searched subject…

I seem to get a lot of people looking for info on newborn suctioning. The good news is newborns should be suctioned a lot less than they have been. The bad news is most doctors and many midwives still suction on the perineum which can cause a host of issues on its own.

Here is some great info and links on the subject from the well researched midwife archives:


Gastric suction at birth associated with long-term risk for functional intestinal disorders in later life.
Anand KJ, Runeson B, Jacobson B.
J Pediatr. 2004 Apr;144(4):449-54.

“Noxious stimulation caused by gastric suction at birth may promote the development of long-term visceral hypersensitivity and cognitive hypervigilance, leading to an increased prevalence of functional intestinal disorders in later life.”

About the Neonatal Resuscitation Program (NRP 2000)  from the American Academy of Pediatrics

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 – Of particular note is the change in guidelines for meconium – ” Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. ”  and “There is evidence that tracheal suctioning of the vigorous infant with meconium-stained fluid does not improve outcome and may cause complications

The issue of when to suction for meconium has undergone major revision – thankfully for the babies, they should be getting suctioned a lot less than they used to be!  See About Meconium.

I’ve been carrying that same bulb syringe and DeLee for ages[Grin]! I just wipe the baby off. And if you put her/him head down you can SEE the junk run out of his/her nose and mouth — the natural mechanism is for the baby to drain and “spit” and THEN breathe, so i want to encourage it to happen that way…. (I “suspect” that suctioning -with a bulb- might make a baby try to breathe before it’s cleared)….

How do I know whether to suction? The sign I use is real simple — I gently touch the baby when just the head is out. If he purses his lips and looks like he’s “trying to spit: then I figure all the reflexes are there and I’m not going to need to suction….

Suctioning Not Always Benign

I do clinic births and home births and hospital births. I don’t really do anything different in terms of my management based on place (other than having to work somewhat harder at the hospital to keep things low key).I used to suction on the perineum. I used to suction automatically. I finally figured out that suctioning and stimulation are great first steps in a baby who is a slow starter, but that a baby who clearly getting it together on his or her own doesn’t need me to suction…. the baby seems to be quite capable of dealing with secretions on its own, and thus the suctioning is being done to make me feel better rather than because it is necessary. Now I wait, unless meconium is present. Then I suction on the perineum and afterwards, of course. But this in not the normal scenario. Still, it has been a hard habit to break……

The thing of it is, is that suctioning isn’t always such a benign intervention. There is clear evidence that over vigorous suctioning can cause babies to brady down which is not something we want. The other thing is that in my work as a lactation consultant, I have seen a few babies who seemed to develop oral aversions after really vigourous, deep suctioning, and this interfered greatly with the establishment of effective breastfeeding.

Count me as one of the reformed “blow-while-I-suction” midwives. I don’t routinely suction anymore even after the birth. I believe it also helps there to be fewer “sticky shoulder” births.

A crying baby (or even not crying, but pink and good nurser) will clear their own lungs in my experience. My former partner has a big time problem with rattly sounds in newborns and always suctions with a vengeance. When she quit, I got to do things my way and rarely found the need to suction anymore. At my own niece’s birth this past year I intended her to have as gentle a birth as possible so instructed that there be no suctioning by my assistants (including my former partner). The kid didn’t cry at all (gentle birth accomplished!) but she did breathe well and needed no help. She did sound kind of rattly and “mucousy” though for the first half hour. My partner was as nervous as could be and kept on me about it to suction her. When she was about an hour old (after everyone had held her and she got the opportunity to be at the breast a few minutes), I finally relented and listened carefully to her lungs. I heard nothing and asked my partner what she was so worried about. She said “You can’t hear it?!” I said “No, show me where she sounds mucousy” So she listened but it was gone. She couldn’t believe it because she had just listened to her lungs about 10 minutes prior and had found it “unacceptable”. 🙂

I do still suction on the perineum for mec though. I can’t break that habit yet, but am not convinced it is necessary.

Suctioning May Cause Sticky Shoulders

A midwife friend and I were talking, and we both observed that we see slow shoulders a lot less since abandoning routine suctioning. We think that the suctioning changes the pattern a bit; you get into a pattern of sort of “hold-everything-while-l-suction-the-baby-now-push.By allowing natural drainage/clearing, the mom can pay more attention to the clues to push the shoulders.

Just speculation at this stage, but she’s liking what she thinks she’s seeing!

When I spent a week with the NNR team at LA County (a very good team), I was taught that once the baby is out and needs resuscitation, the bulb is safer to use than the deLee since deep suctioning can cause a vagal response and really put an otherwise good baby into distress if used before 5 minutes. But this is after the baby is out, not on the perineum. We were taught to deLee on the perineum if there is mec (2+ or more), otherwise I don’t suction at all before the birth.

vagal response is pretty common; I think we must assume we should avoid triggering it if possible.

SO…. What magic thing happens after the baby is out? If suction can trigger vagal response once the baby is out, why should we think it doesn’t when the baby is still in?

If one wanted to, one could see vagal response on most babies by watching it appear on the fetal monitor (if it’s still reading) when you suction on the perineum.

The theory behind suctioning on the perineum is that the babies mouth. throat, nose are filled with gunk and the baby will breath this into his lungs. If suctioning on the perineum worked to avoid meconium aspiration, then I don’t think we would have ever seen a case of MAS during the decade or so of obsessive suctioning on the perineum. Wouldn’t MAS have almost disappeared with the introduction of the technique? It did not. The incidence hasn’t changed at all has it? So… why are we still doing it?

That said, I would still wipe, suction and drain a heavy mec baby — starting on the perineum — as the first step in anticipated resuscitation. I think it has an appropriate use there. [Editor’s NOTE – the NRP 2000 recommendations would recommend NOT suctioning a vigorous baby just for me.]

Just thought I’d mention that in the hospital where I am currently doing my MW training (in Scotland), we don’t suction any babies routinely…even those with mec unless the baby needs to be resuscitated. I have yet to see any negative results from this practice.

A client was told by a lactation consultant that bulbing the baby at birth could cause the baby to have “oral aversion” and might interfere with latching or sucking.  I rarely suction a baby, unless the baby is particularly gurgly, but I was wondering if anyone knows of studies that support what the client was told about oral aversion?

No… Haven’t heard about oral aversion specifically but… I feel routine suctioning is so invasive!   When a baby is trying to catch it’s first air breathing breath we suction and suppress or interfere AGAIN!  Argh!  What a bunch of nonsensical loonies we be!  We need to ask ourselves WHY we do such things!!!

I don’t like to suction babies, and usually just make rather a show of it (for the nursery nurse), but rarely do any ‘real’ suctioning with it.

I’m just guessing that this is more of a “soft knowledge” thing – probably mostly anecdotal.  I seldom suction, either, and virtually never have problems getting babies to the breast, but I’ve also observed that babies who get lots of mouth suction, in particular, seem to have a tougher time (these are usually deliveries I’m observing docs doing).  Perhaps its a multi-factoral thing – maybe it has to do with maternal analgesia which leads to less vigorous babies which leads to more suctioning, perhaps both of which lead to lousier nursing.  Don’t know.  But I, too, have heard about “oral aversion” and believe there might be something to it.

Well, if there are studies, I wonder where they are.  If this were true, we would have a couple of generations of “oral aversion” babies out there.  Bulb suctioning is common in the hospital setting and often done excessively, IMHO.

We also have lousy breastfeeding stats as a nation, and perhaps some of that results from moms whose babies just “won’t nurse.”  Many moms say that they “could not nurse” or “didn’t make enough milk,” but let us consider the root of some of those statements.  An oral-aversive baby is exceptionally frustrating, and many mothers will bottle-feed instead.


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