Lesson 9 continues the exploration of newborn transition, focusing on how to assess and support the baby’s first minutes after birth. A successful transition can be observed through clear, regular respiratory activity, a stable heart rate, and good muscle tone. Providers are reminded to rely on heart tones prior to birth to assess fetal well-being, and to continue monitoring closely after delivery—especially in waterbirth settings where dopplers and monitors are safe and useful tools.

A central concept in this lesson is recognizing what normal transition looks like. A video shown from Sanatorio Otamendi in Buenos Aires illustrates a healthy, spontaneous neonatal adaptation. In contrast, when a baby is slow to breathe, providers are encouraged to stimulate the baby while keeping the cord intact and, if necessary, ask the mother to stand—keeping the baby just above the waterline. Stimulation helps increase the heart rate, and timing is critical. If no movement is observed after 90 seconds to 2 minutes, providers should begin giving five gentle rescue breaths using a bag and mask. This will not harm the baby and may initiate the transition to regular breathing.

The lesson also introduces the BASICS cart—a tool for bedside support in gentle resuscitation with the cord intact. BASICS stands for Bedside Assessment, Stabilization, Initial Cardiorespiratory Support, and ensures providers are prepared to respond immediately and respectfully in those rare cases when intervention is necessary.

One of the most essential takeaways from Lesson 9 is the impact of uninterrupted skin-to-skin contact. When the baby is placed on the mother immediately after birth, both benefit. The newborn cries less, maintains better temperature regulation, shows higher blood glucose, and achieves slower, more regulated breathing and heart rates (Christensson, 1992). The mother, in turn, experiences elevated oxytocin, faster placental delivery, lower rates of hemorrhage and postpartum depression, and improved breastfeeding initiation and duration. As noted in studies by Ferber (2004) and Linda J. Smith, skin-to-skin fosters a quiet sanctuary that supports both physiological and emotional recovery.

Finally, the lesson emphasizes that babies are biologically wired to connect. With no assistance, the newborn will crawl to the breast using instinctive, purposeful movement (Michelson et al., 1996). Any separation—even brief—disrupts this natural agenda and creates stress for both the baby and the mother. Providers are reminded that every decision moves the mother-baby dyad either closer to connection or toward separation. Honoring that bond is one of the most profound responsibilities of birth care.