Care of the Baby in the Delivery Room

Newborn Care in the Delivery Room

The birth of a baby is one of life’s
most wondrous moments. Few experiences compare to this event. Newborn babies have
amazing
abilities. Yet they depend on others for feeding, warmth, and comfort.

Amazing physical changes occur with
birth. When the baby is delivered, the umbilical cord is clamped and cut near the
navel.
This ends the baby’s dependence on the placenta for oxygen and nutrition. As the baby
takes its first breath, air moves into the lungs. Before birth, the lungs aren’t used
to
exchange oxygen and carbon dioxide, and need less blood supply. The fetal circulation
sends
most of the blood supply away from the lungs through special connections in the heart
and
the large blood vessels. When a baby starts to breathe air at birth, the change in
pressure
in the lungs helps close the fetal connections and redirect the blood flow. Now blood
is
pumped to the lungs to help with the exchange of oxygen and carbon dioxide. Some babies
have too much fluid in their lungs. Stimulating the baby to cry by massage and stroking
the
skin can help. This brings the fluid up where it can be suctioned from the nose and
mouth.

Providing warmth for the newborn

A newborn baby is wet from the
amniotic fluid and can easily become cold. Drying the baby and using warm blankets
and
heat lamps can help prevent heat loss. Often a knitted hat is placed on the baby’s
head.
Placing a baby skin-to-skin on your chest or belly (abdomen) also helps to keep the
baby
warm. This early skin-to-skin contact also reduces crying, improves your interaction
with your baby, and helps you to breastfeed successfully. 

Immediate care for the newborn

Health assessments of the new baby start right away. One of the first checks is the
Apgar test. The Apgar test is a scoring system to evaluate the condition of the newborn
at 1 minute and 5 minutes after birth. The healthcare provider or midwife and nurses
will evaluate these signs and give a point value:

  • Activity (muscle tone)

  • Pulse rate

  • Grimace (reflex
    irritability)

  • Appearance (skin color)

  • Respiration

A score of 7 to 10 is considered normal. A score of 4 to 6 may mean that the baby
needs some rescue breathing measures (oxygen) and careful monitoring. A score of 3
or below means that the baby needs rescue breathing and lifesaving techniques.

Newborn physical exam in the delivery
room

A brief physical exam is done to
check for obvious signs that the baby is healthy. Other procedures will be done over
the
next few minutes and hours. These may be done in the delivery room, in the nursery, or
in your room. The location will depend on the hospital policy and your baby’s condition.
Here are some things that will be checked or done for your baby:

  • Temperature, heart rate, and respiratory rate

  • Weight, length, and head circumference. These measurements help find out
    if a baby’s weight and measurements are normal for the number of weeks of
    pregnancy. Small or underweight babies and very large babies may need special
    attention and care.

  • Cord
    care.
    The baby’s umbilical cord stump will have a clamp. It needs to be
    kept clean and dry. 

  • Bath. Once a baby’s temperature has stabilized, the first bath can be
    given.

  • Eye
    care.
    Bacteria in the birth canal can infect a baby’s eyes. Your baby will
    be given antibiotic or antiseptic eye drops or ointment either right
    after delivery or later in the nursery to prevent eye infection.

  • Vitamin K shot. In the first few
    days of life newborns can’t make adequate amounts of vitamin K. This vitamin is
    needed to help your baby’s blood clot. Without this, your baby is at risk for a
    serious disease called hemorrhagic disease of the newborn.
  • Footprints. These are often taken and recorded in the medical record.

Before a baby leaves the delivery area, ID bracelets with matching numbers are placed
on the baby and on you. Babies often have 2, on the wrist and ankle. These should
be checked each time the baby comes or goes from your room.

Newborn care after a vaginal
delivery

Healthy babies born in a vaginal
delivery are often able to stay with the mother. In many hospitals, immediate newborn
assessments include weight, length, and medicines. Even the first bath is done right
in your room. As quickly as possible, a new baby is placed in your arms. Often, the
baby
is placed skin-to-skin on your chest right after birth. Some babies will breastfeed
right away.

In the first hour or 2 after birth,
most babies are in an alert, wide-awake phase. This offers a chance for you and your
partner to get to know your new baby. A baby will often turn to the familiar sound
of
the mother’s voice. A baby’s focus of vision is best at about 8 to 12 inches—just
the
distance from the baby cradled in your arms to your face.

This first hour or 2 after birth is also the best time to start breastfeeding. Babies
have an innate ability to start nursing right away after they are born. Some medicines
and anesthesia given to you during labor and delivery may affect the baby’s sucking
ability. But most healthy babies are able to breastfeed in these first few hours.
This first feeding helps stimulate breastmilk production. It also causes your uterus
to contract. This can help prevent too much bleeding.

Newborn care after a C-section

If your baby is born by a cesarean
section, chances are good that you can be awake for the surgery. Only in rare cases
will
you need general anesthesia for delivery. This means you aren’t awake for the birth.
Most C-sections today are done with a regional anesthesia such as an epidural or spinal.
With this type of anesthesia, only part of the body is numbed for surgery. You are
awake
and able to hear and see your baby as soon as they are born.

Babies born by C-section are often
checked by a nursery nurse or healthcare provider right after delivery. This is often
done right near you in the operating room. Because babies born by C-section may have
trouble clearing some of the lung fluid and mucus, they often need extra suctioning
of
the nose, mouth, and throat. In some cases, they may need deeper suctioning in the
windpipe.

Once a baby is checked over, a
nurse will wrap the baby warmly and bring the baby to you to see and touch. Many
hospitals require babies born by C-section to be watched in the nursery for a short
time. All the normal procedures such as weighing and medicines are done there. Often,
your baby can be brought to you while you are in the recovery area after surgery.

Many mothers think that they won’t
be able to breastfeed after a C-section. This isn’t true. Breastfeeding can start
in the
first hours right in the recovery room, just as with a vaginal delivery.

Plan to have someone stay with you during your hospital stay after a C-section. You
will have quite a bit of pain in the first few days and will need help with the baby.

When a baby has trouble after birth

All the baby’s body systems must work together in a new way after birth. Sometimes
a baby has trouble making the transition. Health assessments such as the Apgar test
done right after birth can help find out if a baby is doing well or having problems.

If there are signs the baby isn’t
doing well, treatment can be given right in the delivery room. The healthcare provider
or midwife and other members of the healthcare team work together to help the baby
clear
excess fluid and start breathing.

Babies who may have trouble at birth include those born prematurely, those born with
a difficult delivery, or those born with a birth defect. Fortunately, special care
is available for these babies. Newborn babies who need intensive medical care are
often admitted into a special area of the hospital called the neonatal intensive care
unit (NICU). The NICU combines advanced technology and trained health staff to give
special care to the tiniest patients. NICUs may also have intermediate or continuing
care areas for babies who are not as sick, but need special nursing care. Some hospitals
don’t have a NICU. Babies may need to be transferred to another hospital.

Having a sick baby can be
stressful. Few parents expect pregnancy complications or their baby to be sick or
premature. Parents will have many different emotions as they try to cope with the
difficulties of a sick baby. But it’s reassuring that today’s advanced technology
is
helping sick babies get better and go home sooner than ever before. It also helps
to
know that while being apart from your baby is painful, it doesn’t harm the relationship
between you and your baby.