The efficacy of facemask resuscitation was assessed by measuring the expiratory tidal volume during the first three inflations in nine babies with birth asphyxia and comparing the results with those obtained in a further nine babies resuscitated after endotracheal intubation. The facemask system was relatively inefficient, with tidal exchange less than one third of that seen after intubation and rarely sufficient to produce adequate alveolar ventilation. Successful resuscitation depended on stimulating the baby to make his own respiratory efforts.