A 28-year-old woman G3P2 is brought in by ambulance in active labor.  She is sitting up and frantically squirming on the gurney shouting “it’s not supposed to be like this!”  You see an agitated obese woman in active labor, with green, thick particulate matter on a wet gurney.  The only information you can gather from her is that she is expecting a singleton child, due last week.  The baby is crowning.

The child is delivered precipitously and appears limp and apneic.  His heart rate by umbilical cord approximation is 90 beats per minute.

Which of the following is the CORRECT approach?

A.   Dry, warm, and stimulate the child

B.   Start positive pressure ventilation via bag-valve mask

C.   Start an IO line and give 0.01 mg/kg epinephrine

D.   Intubate and connect the ETT to suction


In the meantime, a quote --   "Love and pregnancy and riding on a camel cannot be hid"   -- Arabic proverb