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Receiving an adequate blood volume from placental transfusion at birth may be protective for the distressed neonate as it prevents hypovolemia and can support optimal perfusion to all organs. New research shows that ventilating before\nclamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the newborn. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of these neonates. Current protocols for resuscitation imply immediate cord clamping and the care of the newborn away from the mother's bedside. We suggest that an intrapartum care provider can achieve placental transfusion for the distressed neonate by milking the cord several times or resuscitating the neonate at the perineum with an intact cord. Milking the cord can be done quickly within the current Neonatal Resuscitation Program guidelines. Cord blood gases can be collected with delayed cord clamping. Bringing the resuscitation to the mother's bedside is a novel concept and supports an intact cord. Adopting a policy for resuscitation with an intact cord in a hospital setting will take concentrated effort and team work by obstetrics, pediatrics, midwifery, and nursing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jmwh.12206","type":"journal-article","created":{"date-parts":[[2014,10,8]],"date-time":"2014-10-08T14:38:02Z","timestamp":1412779082000},"page":"635-644","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Is It Time to Rethink Cord Management When Resuscitation Is Needed?"],"prefix":"10.1111","volume":"59","author":[{"given":"Judith S.","family":"Mercer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debra A.","family":"Erickson\u2010Owens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,10,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(69)92328-9"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.11.1241"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004074.pub3"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181fe46ff"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000423817.47165.48"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","unstructured":"AAP.Timing of Umbilical Cord Clamping After Birth.2013;131(4):1323.","DOI":"10.1542\/peds.2013-0191"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/JPN.0b013e31825d2d9a"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005237-200203000-00007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2013.143"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2012.250084"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12097"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)31013-3"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.2832"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.12.1662"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-994455"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1966.tb15226.x"},{"issue":"1","key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1542\/peds.40.1.6","article-title":"The effects of placental transfusion on respiratory mechanics of normal term newborn infants","volume":"40","author":"Oh W","year":"1967","journal-title":"Pediatrics"},{"issue":"4","key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1542\/peds.42.4.678","article-title":"Electron microscopy of cutaneous capillaries of newborn infants: Effects of placental transfusion","volume":"42","author":"Pietra GG","year":"1968","journal-title":"Pediatrics"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1582-4934.2010.01029.x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d7157"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2011.00432.x"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2007.12.009"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.160.11.1108"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-3535"},{"key":"e_1_2_10_26_1","volume-title":"Infant Brain Study","author":"Mercer J.","year":"2014"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/glia.20784"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-1136(199606)17:2<83::AID-GLIA1>3.0.CO;2-7"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.2257-10.2010"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1203\/01.pdr.0000197309.08852.f5"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0408258102"},{"key":"e_1_2_10_32_1","unstructured":"CottenM.Cord Blood\u2010 Neonatal Hypoxic Ischemic Encephalopathy.2014.http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00593242Accessed February 20 2014."},{"key":"e_1_2_10_33_1","unstructured":"Erickson\u2010OwensDA.Placental Transfusion at birth in full\u2010term infants. 6th Annual Normal Labour and Birth Conference. 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