A pulsating cord is NOT an indication that a neo nate is receiving adequate oxygen to prevent ischaemia (tissue death due to insufficient supply of oxygen) of brain tissue. Current resuscitation guidelines (which are determined by the Australian Resuscitation Council) state that an untrained person delivering first aid should assume that the non breathing patient is also pulseless. The reason for this is that most panicked bystanders can't find a pulse in a crisis or imagine that they find one which is not actually present. If bub is not breathing, you should assume he also does not have a pulse - so that inadequate supply of oxygen being delivered through the cord will not be being delivered to any vital organs if the heart is not pumping. If bub still has a pulse but is receiving an inadequate oxygen supply, not only will he sustain ischaemic damage to his vital organs, his heart will stop if an adequate supply of oxygen is not established - either with effective EAR or the onset of spontaneous respiration.

If bub is not breathing spontaneously and respiration does not commence with tactile stimulation or clamping of the cord, CPR must be performed. The first APGAR is recorded at 1 minute and resuscitation should commence at this point in a non breathing neo nate who has not responded to attempts to stimulate spontaneous respiration.

We're not talking here about a lovely planned homebirth with an experienced MW in attendance or a nice controlled hospital delivery with MW's, Ob's and NICU around the corner - this particular thread is discussing an unexpected and unplanned delivery in an uncontrolled and unprepared environment. Whilst you may prefer delayed cord clamping (I delayed the clamping of my own children), if you are sitting on the floor of your toilet with a floppy, blue, non breathing baby between your legs a minute or two after delivery... delaying clamping will be the least of your concerns.

If your baby delivers unexpectedly at home and breathes spontaneously - leave the cord alone. If your baby is flat and non breathing, do not assume that the cord will continue to provide adequate oxygenation after delivery.