At birth most babies are born in a good condition and cry strongly within the first few minutes of life. Healthy babies can usually be put straight onto mother’s stomach, “skin-to-skin” with minimal handling. Your midwife or doctor will usually check with you that you are happy with this to be done, if not, the baby can be cleaned and dried before it is passed to you. Parents can watch with amazement as baby’s colour changes from blue to pink. During this time, direction of blood in baby’s heart is changing and lungs are filling for first time. Do not be frightened if the baby does not cry straight away as sometimes it can take a few minutes for him to show signs of life.
All new born babies lose heat very quickly and even though she is skin-to-skin she will need drying and covering at some stage soon to avoid excessive cooling.
Some babies will need some resuscitation and some extra help with breathing. In the room will be a Resuscitaire trolley, which will have been prepared and checked by midwife during labour. The baby may need extra oxygen or suction of fluids from its nose or mouth which will usually be provided by midwife or obstetrician. Most maternity units have an adjacent neo natal unit and a paediatrician will attend the delivery by invitation if there are any anticipated problems. In an emergency they usually arrive very quickly, within a few minutes. Premature babies, very small babies and babies born after complications of labour or delivery will usually be attended by paediatrician who is present at the time of delivery and can give help if required.
The baby’s condition is judged by the Apgar score which evaluates the baby on 5 different criteria on a scale from zero to two, giving an overall result out of ten.
These criteria are-
A score of 7 to 10 is considered normal. 4 to 6 is fairly low and 3 and below is regarded as critically low. If the score is low, the test will be repeated after a few minutes.
Few babies score 10 out of 10 as most are little blue especially around their fingers and toes for first few hours after birth.
You will probably be unaware of the midwife or doctor evaluating your baby, unless she spots any problems whilst assessing it.
If the baby is particularly small or premature or is having difficulty breathing, she may need to be admitted to the special care baby unit which is usually adjacent to the maternity unit and has all facilities for looking after new born babies.
There are different grades of units depending on whether they can look after babies on ventilators and or look after extremely premature babies. Less than 1 percent of babies have to be transferred out of the hospital in which they are born. Up to 10 percent of babies spend some time in a special care baby unit, usually only for very short periods.
Sometimes at time of delivery the cord is found to be wrapped around the baby’s neck, once or several times. This usually has to be unraveled before baby can be delivered but is not often as dramatic sounding as one might think. Sometimes the cord must be cut before delivery, but most of the time the cord is cut a min or 2 after the baby is born. There is not usually a hurry to cut the cord unless there is concern about the baby’s condition.
As we mentioned before, as the baby is being delivered, the mother is usually given an injection to assist with the delivery of the placenta and prevent excessive bleeding. If you do not wish to have this injection then you should let your midwife or doctor know before hand. However, we strongly advise that you do have the injection. It is perfectly safe and reduces the risk, by three times, the chance of major bleeding. It is usually painless but can make you feel a little sick afterwards sometimes.
Most units will recommend the routine administration of Vitamin K to the baby within first hour or 2 of delivery. This is usually given by injection or sometimes a course of drops. Vitamin k given within the first few hours of life has been shown to reduce the chances of unexpected bleeding into brain due to minor clotting probs. It is almost universally practiced and is a safe and sensible precaution. If you have a choice of the injection or drops, we would say that the injection is a better choice as it is quickly and efficiently absorbed. The drops may not be fully absorbed and may need repeated doses.
All mothers and babies will be recommended to start early infant feeding, which in most cases is breastfeeding, and you may have the baby put to your breast straight after delivery. Sometimes the baby will be interested in a nipple and start to suck straight away. Others may not be interested at all and be too sleepy to care. This may be a little tricky or taxing just after you have delivered and the expert care of midwife in this situation will be invaluable.
Please be patient as some babies just don’t feel like feeding to begin with. Some take their time and behave differently.