What Happens in the Delivery Room with a CDH Baby?

For most expectant mothers, the delivery room is a time for immediate skin-to-skin contact and holding their new baby. However, when a baby is born with congenital diaphragmatic hernia (CDH), the delivery room experience will look different. Your baby will need immediate medical intervention to help them breathe safely, which means you will not be able to hold them right after birth. The medical team’s first priority is to stabilize your baby’s delicate lungs and prepare them for transfer to the Neonatal Intensive Care Unit (NICU) ^[1]. You can typically expect a very quick visit—a chance to see and perhaps briefly touch your baby—before they are moved to the NICU for specialized care.

Preparing for Delivery

Because managing a baby with CDH requires specialized, coordinated care, your delivery will be carefully planned by a multidisciplinary team ^[2][3]. Your obstetrician will discuss the safest mode of delivery for you. They will also talk with you about standard birth plan requests, such as delayed cord clamping. Because babies with CDH need urgent breathing support, many hospitals require the umbilical cord to be clamped immediately so the baby can be swiftly moved to the resuscitation warmer, though practices and research regarding cord clamping continue to evolve ^[4][5].

Why Immediate Action is Necessary

In babies with CDH, a hole in the diaphragm allows abdominal organs, such as the stomach and intestines, to move up into the chest cavity ^[6]. Because these organs take up space in the chest while the baby is growing during pregnancy, the lungs are often smaller and less developed, a condition known as pulmonary hypoplasia ^[6][7].

When your baby is born, their underdeveloped lungs are incredibly fragile ^[7]. To protect them, the medical team follows strict, standardized protocols that emphasize very gentle breathing support to prevent lung injury ^[8][9].

The Danger of Crying and Air in the Stomach

In a typical delivery, a baby’s first loud cry is a welcome sound. But for a baby with CDH, crying and swallowing air can be dangerous. If swallowed air enters the stomach and intestines—which are located in the baby’s chest due to the hernia—those organs can inflate. This sudden expansion puts severe pressure on the already fragile lungs, making it much harder for the baby to get oxygen ^[6].

To prevent this dangerous compression, the delivery room team will take two immediate steps:

• Immediate Intubation: Instead of using a typical face mask to provide oxygen (which can force air into the stomach), doctors will place a breathing tube directly into your baby’s windpipe (an endotracheal tube) ^[8][9]. This ensures air goes straight to the lungs and not into the stomach. To help your baby tolerate the breathing tube safely, they may also be given sedating medications that will make them appear very still or asleep ^[9].
• Placing a Gastric Tube: A small tube will be gently passed through your baby’s nose or mouth and into their stomach ^[2]. This allows the team to suction out any air that may have already been swallowed, keeping the stomach deflated and taking pressure off the lungs ^[6].

The Multidisciplinary Delivery Team

Your delivery room will have more people in it than a standard delivery. A multidisciplinary team of experts will be present ^[2][3]. This team usually includes neonatologists (doctors who specialize in sick or premature newborns), specialized neonatal nurses, and respiratory therapists who are prepared to safely stabilize your baby the moment they are born.

Your Interaction in the Delivery Room

We know it is deeply heartbreaking to prepare for a birth without the immediate reward of holding your baby on your chest. Your care team understands this emotional toll. While immediate holding is not possible, the team will usually bring the stabilized baby’s transport isolette (a specialized, clear incubator) near you so you can see your baby and perhaps reach out to touch their hand or head before they are whisked away to the NICU.

What to Expect Next

Once your baby is safely settled in the NICU, the medical team will focus on providing ventilator support and placing necessary monitoring lines to continuously check their blood pressure and oxygen levels ^[10]. During this time, your support person or partner can typically follow the transport team to the NICU. As soon as you have recovered enough from delivery to safely move, your care team will help you visit the NICU to be with your baby.