The midwife should evaluate the newborn according to Silverman Respiratory Scale.

Silverman Retraction Scores (Evaluation of Respiratory Status):

Feature Observed   Score 0   Score 1   Score 2   Score   Chest Movement Synchronized Respiration   Lag on Respirations Seesaw Respirations   Intercostal Retractions   None   Just Visible   Marked     Xiphoid Retractions   None   Just Visable   Marked     Nares Dilation   None   Minimal   Marked     Expiratory Grunt   None Audible - Stethoscope Audible - Unaided Ear

Total Score of 0 indicates no respiratory distress. Total Score of 4-6 indicates moderated distress. Total Score of 7-10 indicates severe distress. Total Silverman Score

Monitor and observe closely while administering complimentary therapies.

Increase room temperature; be particularly cautious concerning thermo-regulation of the newborn.

Continue to monitor until baby has stablized or the need to transfer is apparent.

The midwife should recommend to the client that early pediatric evaluation may need to be done.