Before you apply any form of resuscitation, make sure that:

• The baby is alive: If the newborn doesn't appear to be alive, FIRST listen to its chest with a stethoscope. If there is no heartbeat, the baby is already dead.
• You graded the extent of asphyxia: If you can hear a heartbeat, but you estimate it to be less than 60 beats/minute, apply heart massage first, then ventilate alternately on and off, till the heartbeat is above 60 beats/minute.
• The baby is not deeply meconium stained: If the baby's skin is stained with meconium, or the oral and nasal cavities are filled with meconium-stained fluid (Figure below), you should not resuscitate before suctioning the oral, nasal and pharyngeal areas. Ventilation will aggravate the baby's breathing problem because it will force the meconium-stained fluid deep into the baby's lungs, where it will block the gas exchange.