What should be the first action taken if a newborn is not breathing at birth?

When a newborn is not breathing at birth, the first action to take is to provide positive pressure ventilation. This practice is crucial because at birth, effective breathing is essential for adequate oxygenation of the infant. When a newborn does not initiate breathing spontaneously, providing positive pressure ventilation helps to inflate the lungs and establish effective gas exchange.

This action is critical in the first moments after delivery, as newborns depend on the establishment of breathing to transition from fetal to neonatal life. The application of positive pressure ventilation can help stimulate the respiratory centers in the brain and may lead to the newborn taking spontaneous breaths.

In contrast, initiating chest compressions is inappropriate in this scenario unless there is evidence of poor circulation or cardiac arrest, which usually is not the immediate concern if there is no breathing. Checking the newborn's reflexes may provide some insight into neurological function but is not the immediate priority when the infant is apneic. Lastly, waiting and monitoring may lead to delayed intervention, which could result in significant harm to the newborn due to lack of oxygen. Therefore, providing positive pressure ventilation is the most critical and immediate response needed to assist the newborn in establishing effective breathing.