Objective To evaluate the effects of two-step approach combined with unprotected perineum method on the incidence uf neonatal swallowing syndrome.Methods A total of 360 patients were randomly divided into three groups:A,B and C,with 120 cases in each group.Group A was provided traditional midwifery approach:midwifery staff manually controlled the delivery rate of fetal head with hands,assisted to deliver fetal shoulders after fetal head was delivered,and quickly used hands to clean up the completely delivered newborn and routinely sucked mucus from mouth and nose using aurilave.Group B and C were provided two-step approach combined with unprotected perineum method:midwifery staff did not interfere delivery with hands,paused after the fetal head was delivered,delivered the fetal shoulders until next contraction.Group B was cleaned up respiratory tract like group A,group C was only provided surface cleaning or squeezing nose and mouth using hands.The incidence of neonatal swallowing syndrome and the number of vomiting were recorded within 24 hours after birth among three groups,and the differences among three groups were compared.Results The incidence of neonatal swallowing syndrome in group A was higher than those in groups B(x2=6.504,P=0.011)and C(x2=7.533,P=0.006);there was no significant difference between group A and B in neonatal swallowing syndrome(x2=0.042,P=0.837).There were significant differences in vomiting within 24 hours among three groups(F=10.185,P=0.006).There were significant differences in vomiting within 24 hours between group A and group B,and between group A and group C(P＜0.05);there was no significant difference between group B and group C(P＞0.05).Conclusion Inplementing the two-step approach combined with unprotected perineum method,the newborns can accomplish cleaning up respiratory tract naturally during natural delivery of fetal shoulders.