What happens to a baby at birth

Before birth, oxygenated blood from the placenta flows into the child’s inferior vena cava and mixes with blood returning from the lower part of the body. The atria are, in effect, one chamber due to the open foramen ovale; however, laminar blood flow tends to supply the left atrium and ventricle (and hence the upper body) with more placental (oxygenated) blood than the right atrium receives. The ventricles also act as one and pump blood around the body. Blood from the right ventricle bypasses the lungs, flowing through the ductus arteriosus and joining blood from the left ventricle in the descending aorta. A large portion of this blood flow goes to the placenta through the umbilical arteries.

Although the pulmonary vessels are fully developed in the fetus, only a tiny amount of blood (about 5% of cardiac output) flows through them due to intense vasoconstriction of the pulmonary arterioles. The nutritive blood supply to the lungs is from the bronchial arteries that arise from the aorta. The collapsed alveoli (air sacs) are filled with amniotic fluid.

Oxygenated blood is red, de-oxygenated blood is blue, and at the moment of birth, a normal newborn is circulating a mixture of blue and red blood. The color (lips and tongue) of a healthy newborn at birth is a pinkish purple; the child has been this color for nine months and normal placental function (cord pulsating) will maintain this color until the lungs function.

When the lungs are functioning, the umbilical vessels close, the ductus venosis closes, the hepatic portal vein is open, the foramen ovale closes, the heart is two sided, the cardiac output from the right ventricle (blue blood) goes through the lungs and is oxygenated, the left ventricular output (red blood) goes through the body, the ductus arteriosus closes, the pulmonary arterioles are open, the alveoli are full of air and the child turns from purple to pink. All of this complicated process is coordinated and controlled by the child’s reflexes; it usually happens within three or four minutes of birth. What makes it happen?

All babies are born soaking wet, and on meeting the atmosphere, the skin cools; this triggers two reflexes:

The cold crying reflex - cold, wet diapers produce the same result, crying.
The cold pressor reflex - cold skin raises blood pressure.
In order to cry, the child must first take a deep breath, and an inspiratory "gasp" is often the first sign, triggered by cold, that a child is going to cry or breathe. Contraction of the diaphragm and intercostal muscles increase thoracic volume and create negative intra-thoracic pressure. Once air is in the lungs, another reflex is triggered that relaxes the pulmonary arterioles; this causes an enormous increase in pulmonary blood flow.

The cold pressor reflex increases the blood pressure in the aorta, and this may be sufficient to reverse blood flow through the ductus arteriosus causing more blood to flow through the lungs.

The cord is also cooling, and the cord is a well-designed self-refrigerator. It has no skin and blubber to keep it warm like the child. It contains only the cord vessels surrounded by a watery gel, Wharton’s jelly, covered by a single layer of cells, the amnion. Water evaporation cools it rapidly, causing the vessels, especially the muscular arteries, to constrict; this further helps to raise systemic blood pressure and to reverse ductus arteriosus flow.

At the same time, a large transfusion of placental blood is being forced into the child by gravity and/or by uterine contraction, greatly increasing cardiac output and pulmonary blood flow. The net result of these changes is a large amount of blood flowing into the left atrium from the lungs, which raises left atrial pressure and closes the foramen ovale - the heart changes from one-sided to two-sided. The lungs are now oxygenating blood that is pumped round the body by the left ventricle - the child turns pink.

If the child has not taken the first breath, or is depressed and cannot breathe, the massive increase in pulmonary blood flow generated by the placental transfusion may, of itself, initiate ventilation. Jaykka [1,2] showed that the fetal lungs are erectile tissues; by injecting serum through the pulmonary artery of excised animal fetal lungs, the engorged capillaries around the alveoli erected them and caused air to enter through the trachea. With establishment of pulmonary blood flow, the high colloid osmotic pressure of blood causes absorption of amniotic fluid from the alveoli and "dries out" the lungs, filling the "erected" alveoli with air.

Cold will eventually cause the cord vessels to close; however, a high arterial blood oxygen concentration is probably a key factor in umbilical artery closure - they close before the umbilical vein closes; it may also cause ductus arteriosus closure. After umbilical artery closure, the placental transfusion may continue through the cord vein in a very measured and controlled manner.

Information found at: http://whale.to/a/morley4.html