Neonatal resuscitation methods vary in developing countries. This study describes the delivery experience at one rural Kenyan mission hospital, retrospectively analysing delivery data and newborn outcomes for a 12-month period, and prospectively characterizing neonatal resuscitation practices. Thirty-six of 878 newborns (4 per cent) suffered unfavourable outcomes, significantly associated with caesarean, breech, and vacuum deliveries (nine infants, P < 0.01) and birthweight of 2000 g or less (10 infants, P < 0.001). Observed neonatal resuscitation practices were inconsistent and notable for umbilical vein injections given in lieu of bag and mask ventilation. A basic neonatal resuscitation protocol was developed. It is concluded that at one Kenyan hospital, unfavourable newborn outcomes were significantly associated with delivery other than normal vaginal and with birthweights of 2000 g or less. Neonatal resuscitation methods could be modified for use in this setting, and might be most useful for term infants delivered by caesarean, breech, or vacuum deliveries.