Every 15 days, I visit each of the five hospitals I work with as part of the Safe Care, Saving Lives project. The mornings are early and the trips long. It was one such day.

As I stood at my doorstep waiting for the taxi, I turned around to see my 18-month-old daughter. She was fast asleep in my husband's arms. Her face had no inkling of worries. She had just a hint of smile, assuring me, "I can wait until you come back from work."

As I caught some shut eye in the taxi, I dreamed about my baby playing in the garden in front of our house: happy, carefree, and healthy.

Our trip today was to a small government hospital with a special newborn care unit. The special newborn care unit is not really a full fledged intensive care unit. This unit provides care for critically ill babies that do not require invasive ventilation.

I was met by what has become a very familiar sight: babies asleep in the infant warmers, recovering from their afflictions, some still trying to prove Darwin's theory of Survival of Fittest, none smiling.

A nurse took me to a two day old baby that she was caring for. The baby was underweight. She struggled to drink the milk that was given to her through apalada, a small vessel used to feed a baby, tiring out after every few suckles and then trying again. She reminded me of my own daughter, who only takes small sips of her milk. The nurse told me that the baby had suffered from severe perinatal asphyxia and seizures.

Perinatal asphyxia is also known as asphyxia neonatorum. The World Health Organisaton (WHO) defines perinatal asphyxia as a "failure to initiate and sustain breathing at birth." Perinatal asphyxia describes a condition that occurs when a baby does not get enough oxygen during the birth process.

The WHO estimates that approximately four million babies die every year before reaching the age of one month. 1 Perinatal asphyxia and birth injuries together contribute to almost 29% of these deaths.

In India, according to data from the National Neonatal and Perinatal Database 2000, 2 perinatal asphyxia was responsible for 20% percent of all neonatal deaths. Perinatal asphyxia was also the most common cause of stillbirths, accounting for one third of all such cases.

Perinatal asphyxia is a leading cause of infant death and infant brain damage worldwide.
The outcomes of the condition depend on how long a baby was without oxygen. Outcomes for surviving babies range from no consequences to major longterm disabilities.

Early diagnosis and prompt treatment – early resuscitation in first minute following birth – are vital to saving babies and minimising complications.

The physician on shift in the special newborn care unit saw me looking at the baby as she struggled to drink. He told me that the child had a very high likelihood of developing cerebral palsy or diplegia (toe walking) in the future.

He added that her situation could have been prevented if proper steps had been taken to restore her breathing within the golden minute, that vital first minute following birth.

He pointed out one of the protocols posted on the wall of the special newborn care unit. It was the protocol for neonatal resuscitation. There are several of these protocols published worldwide. All of them stress the importance of drying, stimulating, and warming babies, and of clearing the airway immediately after birth.

The protocols advocate for the effectiveness bag and mask ventilation. Bag and mask ventilation ensures that oxygen reaches the vital organs of babies who do not breathe adequately immediately after birth.

These protocols posted on the wall were simple steps that, if followed, could prevent newborn deaths. The physician also told me that babies who do not breathe well immediately after birth improve remarkably with the timely interventions outlined in the protocol.

As I left the hospital, my thoughts kept going back to that baby struggling to feed.
Who was to blame for giving the child a potential lifetime of suffering and disability? Whose fault was it that the baby did not get a breath of air after she was born?

Is it our system, which continues to function with resource constraints? Is it our attitude that loves to complain about lack of resources? Or is it our insistence that the status quo cannot be changed?

Ultimately, it is only the child and her parents who suffer. The child and her family will bear the consequences of someone else's actions, or inactions.

Several of our hospitals in the Safe Care, Saving Lives project deal with a high rate of neonatal deaths related to birth asphyxia. As we work toward finding locally relevant solutions to ensure that neonatal resuscitation becomes a priority, I find myself looking for potential solutions in every step of the process of care delivery.

That child is what keeps me going. I do not want what happened to her and to her family to ever happen to another mother, another baby, in any hospital. I will continue this work until I make a difference, even if we only save one baby at a time.


  1. World Health Organisation. Perinatal mortality: a listing of available information. FRH/MSM.96.7. Geneva:WHO, 1996. Downloaded from www.newbornwhocc.org
  2. AIIMS- NICU protocols 2007, Report of the National Neonatal Perinatal Database (National Neonatology Forum, India) 2000

[Sujata Rao works with the Quality and Process Improvement Team of Access Health International in India. She facilitates the implementation of the Safe Care, Saving Lives project in Andhra Pradesh and Telangana. This was first published as a blog in http://accessh.org]