The moment a newborn is delivered, the delivery room waits for a single sound: the baby’s first cry. This vocal reaction is widely seen as the first confirmation of a baby’s health. While a vigorous cry is the expected outcome, a delayed cry signals that the newborn needs immediate, focused medical attention. Medical professionals are trained to manage this scenario using standardized protocols designed to swiftly assist the baby’s transition to life outside the womb.
Why the First Cry Matters
The baby’s first cry is a powerful physical event signifying a physiological shift from fetal life to independent existence. Before birth, the fetus receives oxygen and nutrients through the placenta, meaning its lungs are fluid-filled and its circulatory system bypasses them. The cry results from the newborn taking its first significant breaths against the high resistance of these fluid-filled lungs. This forceful inspiration and exhalation helps push the remaining lung fluid out of the alveoli, the tiny air sacs where oxygen exchange takes place.
As the lungs expand with air, oxygen levels in the bloodstream rise. This increase triggers a relaxation and widening of the blood vessels within the lungs, causing a drop in pulmonary vascular resistance. This decrease signals the heart to reroute blood flow away from fetal pathways and into the newly opened lung circulation. The cry is an audible confirmation that the pulmonary system is engaged and taking over the task of oxygenating the blood.
The pressure changes created by the lungs filling with air also stimulate the closure of fetal shunts, temporary blood vessels that divert blood away from the lungs during gestation. Increased pressure on the left side of the heart encourages the foramen ovale to shut. Concurrently, the ductus arteriosus, which shunted blood from the pulmonary artery to the aorta, begins to constrict and close in response to the higher oxygen concentration. This sequence, often heralded by the first cry, completes the shift to the adult pattern of blood circulation where the heart and lungs work in series.
When Crying is Delayed: The Immediate Next Steps
When a newborn does not begin to breathe or cry vigorously within the first moments after birth, medical teams initiate neonatal resuscitation. The initial steps are non-invasive, focusing on providing warmth, positioning the airway, and performing gentle tactile stimulation. The baby is quickly dried with warm towels, which prevents heat loss and simultaneously provides the vigorous stimulation intended to prompt a spontaneous breath or cry.
If the baby remains without a strong respiratory effort after initial stimulation, care progresses to checking the airway for obstruction. Suctioning of the mouth and nose is performed only if secretions are blocking the passage. If the heart rate is below 100 beats per minute or the baby is apneic or gasping, medical staff must begin assisted breathing. This intervention should start within the first 60 seconds of life, often called the “Golden Minute.”
This next level of support involves Positive Pressure Ventilation (PPV), delivered through a bag and mask placed snugly over the baby’s nose and mouth. The goal of PPV is to inflate the lungs and establish functional air sacs, achieved by administering 40 to 60 breaths per minute. The most reliable sign that ventilation is working is a prompt and sustained increase in the baby’s heart rate.
If the heart rate remains below 60 beats per minute despite 30 seconds of effective ventilation, resuscitation escalates to chest compressions, synchronized with assisted breaths at a 3:1 ratio. Medications, such as epinephrine, are reserved for when the heart rate remains critically low even after adequate ventilation and chest compressions. This structured progression of care ensures every second is used to support the baby’s breathing and circulation until the transition is successfully completed.
The Apgar Score: Measuring Newborn Vitality
The Apgar score is an assessment tool used to evaluate a newborn’s physical condition immediately following birth. This score is administered at one minute and again at five minutes of age to assess the transition to extrauterine life. The scoring system evaluates five specific components, remembered by the acronym APGAR:
- Appearance (skin color)
- Pulse (heart rate)
- Grimace (reflexes)
- Activity (muscle tone)
- Respiration (breathing effort)
Each of the five categories is assigned a score of 0, 1, or 2, with the individual scores summed for a total ranging from zero to ten. The Respiration component directly relates to the baby’s cry, earning a score of 2 for a strong cry, 1 for slow or irregular breathing, and 0 if breathing is absent. A score of 7 or above is considered reassuring, indicating a successful transition.
A low score at the one-minute mark is not uncommon and frequently improves significantly by the five-minute assessment. When a low score persists at five minutes, the assessment is repeated every five minutes until the score reaches 7 or greater, or until 20 minutes have passed. The Apgar score is a reporting tool that informs medical staff about the baby’s status and the effectiveness of resuscitative measures, but it is not used to determine whether to start resuscitation or what specific steps to take.