During a delivery, the bag of waters breaks and you notice thick greenish fluid. The infant is apneic at birth. What is the first action you should take?

In the scenario where the bag of waters has broken and you observe thick greenish fluid, this raises a concern for meconium-stained amniotic fluid. Thick meconium can pose a risk to the newborn, as it may lead to respiratory complications if aspirated into the lungs during birth. Given that the infant is apneic at birth, immediate intervention is crucial.

The first action of assisting ventilations with a bag-valve-mask (BVM) is appropriate in this case because the infant is not breathing on their own. Providing positive pressure ventilations can help establish adequate oxygenation and ventilation. This is essential, especially considering the potential risk associated with thick meconium, which can cause airway obstruction or aspiration. Prompt assistance with ventilation can improve the infant's chances of survival and reduce the risk of complications.

The other options, while part of neonatal resuscitation procedures, are not the immediate priority. For instance, performing chest compressions would only be necessary if there is a heart rate below a certain threshold after adequate ventilation has been attempted. Mouth-to-mouth resuscitation is not suitable for infants, as BVM should be the preferred method for delivering breaths. Administering oxygen alone would not address the immediate need for ventilation