Right after your baby is born, a series of routine procedures help ensure both you and your newborn are healthy and stable. Here's what to expect in the delivery room following a normal vaginal birth with no problems for you or your baby.
Delayed umbilical cord clamping
It is now common to wait at least 30 seconds to 1 minute after delivery to cut the umbilical cord (also called delayed cord clamping or timed cord clamping). During this time the obstetrician or midwife may place the baby on your lower abdomen.
Once the pulsing in the cord stops, the cord will be clamped and cut (there are no nerves in the cord; the baby will feel no pain). The clamp remains in place for 24 to 48 hours, or until the cord is dry and no longer bleeds. The stump that remains will usually fall off between 1 and 3 weeks after birth.
Skin-to-skin care
Most of the time, after delivery and delayed cord clamping, your baby will be placed directly on your chest, belly down, for skin-to-skin care. Your care team will dry your baby and cover them with a warm blanket while your newborn settles on your chest.
This first hour of skin-to-skin contact allows you and your baby to get to know each other. It also has other important health benefits. Sometimes babies need to be evaluated and brought to a warmer immediately after birth. If that happens, when your infant is stabilized they can be brought to you for skin-to-skin care.
Your baby should be placed skin-to-skin after birth if possible; Apgar scores can be assigned while you hold your baby. It is important when parent and baby are healthy and stable to maximize skin-to-skin procedures as much as possible during the first hours after delivery.
Benefits of newborn skin-to-skin time
Skin-to-skin contact can help stabilize a newborn's blood sugar concentrations and body temperature. It can also help prevent hypothermia (decreased body temperature), decrease crying, and provide stable blood flow and breathing, especially for late preterm newborns. For the mother, skin-to-skin contact decreases maternal stress and may help reduce postpartum hemorrhage (bleeding after delivery).Vitamin K & other preventive measures
After about an hour, your baby will be weighed, measured and examined. Your baby will be given a dose of vitamin K to help with normal blood clotting. Because bacteria during the birthing process can infect a baby's eyes, your baby will be given an antibiotic eye ointment (erythromycin eye ointment is commonly used) to prevent a potentially serious eye infection from occurring.
Depending on the hospital routine, the umbilical cord stump may be dried and cleaned, and your baby may be given their first bath. All medically stable newborns weighing at least 4 pounds 6 1/2 ounces (2 kg) should receive their first dose of hepatitis B vaccine within 24 hours after birth. You will need to sign a consent form for the vaccine to be given.
Vitamin K plays a critical role in preventing serious, life- threatening bleeding in your newborn. Newborns often do not have enough vitamin K in their bodies because they lack the bacteria that help make this nutrient. All newborns should receive an injection of 0.5 to 1 mg of vitamin K shortly after birth. Babies who don't receive this shot are at greater risk of bleeding in various parts of the body and brain. Rarely, such bleeding can result in brain damage or death and can occur as late as 2 to 6 months after delivery.
Vitamin K has been used for a long time and is proven to be safe and effective.
Apgar scores
As soon as your baby is born, a member of the birth team will set a timer for one minute and another for five minutes to give your baby's first tests, called Apgars. The Apgar scoring helps the physician to estimate your baby's general condition at birth. It measures your baby's heart rate, breathing, muscle tone, reflex response and color at 1 minute after birth and at 5-minute intervals if the scores are low.
Apgar scores cannot predict how your baby will develop. Likewise, they do not indicate intelligence or personality. However, it alerts your baby's care providers to evaluate the need for assistance as your baby adapts to the new environment.
If your baby is having trouble
If your baby is having difficulty breathing, moving or crying at birth, hospital providers specially trained in evaluation and resuscitation of newborns will evaluate and treat the baby accordingly. This may include drying the baby vigorously and/or using a special mask over the nose and mouth attached to a bag to give breaths of air or oxygen, called positive pressure ventilation. This intervention usually leads to improvements in breathing, movement and color.
If these strategies do not help, a tube can be placed into their airway (the windpipe, or trachea, which goes into their lungs) to help breathing by pushing air and oxygen directly into the lungs. Also, fluids and medications may have to be administered through the umbilical cord vein to strengthen their heartbeat, if needed. Your baby may be taken to the special-care nursery or neonatal intensive care unit (NICU) for observation or more intensive medical attention.
ID bracelets
Both you and a support person of your choice will receive matching labels bearing the newborn's name. After you verify the accuracy, these labels will be attached to your wrist, the wrist of your partner or other person of your choosing, and your baby's wrist (and often the baby's ankle as well).
Each time your baby is taken from or returned to you while in the hospital, the nurse will check these bracelets. Many hospitals also footprint newborns as an added precaution and attach a small security device to the baby's ankle.
Leaving the delivery area
If you delivered in a birthing room or alternative birth center, you probably won't be moved right away. But if you delivered in a conventional delivery room, you'll be taken to a recovery area, where you can be watched for any issues such as excessive bleeding.
Unless your infant requires urgent medical attention, ask not to be separated from your infant. Your infant should receive their first medical examination by your side. This exam will measure the baby's vital signs: temperature, respiration and pulse rate. The examiner will check your baby from head to toe, paying specific attention to their color, activity level, and breathing pattern. If vitamin K and antibiotic eye ointment were not given earlier, they will be administered now.
The first bath should be delayed 12 to 24 hours to help with breastfeeding and bonding. Depending on your baby's gestational age, the season and whether you received immunization for RSV (respiratory syncytial virus) during pregnancy, your baby may receive an immunization before leaving the hospital or at your pediatrician's office. This shot will help prevent RSV, a serious respiratory virus that can lead to hospitalization and life-threatening illness in infants who contract it.
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