# Obstetrics



## Dominion

Ok, I was being quizzed the other day by a paramedic and the topic du jour was obstetrics.  He asked me "When delivering the baby, which do you suction first, the nose or mouth?"

I said mouth and I was told I was wrong and everyone around agreed.  So I went back today and was studying this chapter and my book did not specify.  

Mosby Text, Revised Third Edition, Page 1074, "4. Suction the infants mouth and nose with a bulb syringe to clear the airway.  Perform suction after the head appears but before the next contraction."

I looked in a Brady book (not available right now) and it said the same thing roughly, to suction just the mouth and nose without specifying which to go for.

I also looked it up online and got the following info:  "Suction the babys mouth first, then the nose"

If it's on the internet it must be true

Which is it?  I was always told that suctioning when it boils down to it, you can do either or first.  BUT if given the option to suction the mouth first, do that as suctioning the nose stimulates the baby to breath.

More importantly, if this question is asked on the NR, which is it.


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## VentMedic

Correct suctioning method is mouth and then nose.

However, the airway must be effectively cleared (bulb or catheter suction), but in a manner which does not result in pharyngeal stimulation, triggering a vagal response, and resulting in compromise of respirations and heart rate. 

Summary of NRP:
http://www.aap.org/nrp/apppendix/E/KeyPointsforLessons1Through9.pdf


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## bunkie

I know this from a case I brought against the hospital for my second child's birth. When she was delivered, the doctor suctioned her nose. Never her mouth and handed her off. My newborn was taken to a civilian NICU, intubated and on medication for a week for her aspiration pneumonia. (also had a pneumothorax but thats another story) When I began to look around for the answers, it was always mouth then nose.


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## 8jimi8

Mouth then nose.  Babies are obligate nasal breathers.  I you suction the nose first you can trigger a gasp which will likely cause them to aspirate any contents not cleared from the oral cavity.


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## Lifeguards For Life

we were taught mouth first nose second. babys are naturally nose breathers and suctioning the nose first may stimulate them to begin breathing and aspirate mucous


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