I believe it is possible to do anything necessary to assess and
"resuscitate" a normal baby without taking it away from its mother.
I don't rush to cut the cord, but also don't generally wait as long as I
am aware some people do.  I dry and stimulate the baby on its mother's
abdomen.  I'd be uncomfortable with a baby who didn't start breathing
fairly promptly, and especially whose heart rate was less than 100.
Those two parameters plus some tone and some responsiveness give an APGAR
of at least 6 or 7.  (7 or above is usually considered acceptable at 5
minutes).  APGARs can be assigned by observation with just a touch with a
stethoscope or palpation of the cord to assess heart rate, and some sort
of assessment of responsiveness to stimulation.  I almost never see a
totally pink baby who hasn't received supplemental oxygen; even dim light
is enough to distinguish totally blue from partially pink and the room
light is certainly plenty.  (I personally think an APGAR of 10 at one or
even 5 minutes is probably abnormal!)

It is very hard to convince some nurses, especially those that commonly
deal with sick or high-risk babies, that this can all be done on mom's
tummy.  Sometimes I even clamp but "forget" to cut the cord so they can't
snatch the baby away.  Once we get past the first few minutes and baby is
obviously fine, they are usually OK with waiting to finish their
routines.  I try to keep in mind that the nurses really have the baby's
best interest in mind, just that their perspective and training differs
from mine. It takes some practice and enough experience with this kind of
care to become comfortable that babies who are not crying are in fact
just fine.

Please email me privately if you'd like to share some strategies for
dealing with the politics involved.

--
Anne Montgomery, M.D.
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St.Peter Hospital Family Practice Residency
Olympia, WA