What happens to your baby during the first hour of life
BY KATHY P. BEHAN
The moment you’ve waited for after nine long months has finally arrived, and you hold your baby in your arms. You can’t help but ask, “Is she all right?” The obstetrician says that she looks just fine. But the doctor’s quick assessment is only the beginning of the detailed evaluation your child undergoes after delivery.
Here’s a look at the typical medical procedures that take place.
As soon as your baby’s head emerges, the obstetrician uses a bulb syringe to clean out any fluid in her mouth and nostrils, explains Ulana Sanocka, MD, assistant professor of pediatrics at Columbia Presbyterian Medical Center, in New York City. Clearing the airways enables the baby to breathe more easily.
Once the rest of the body has been delivered, the umbilical cord is clamped in two places, and a doctor, nurse or sometimes a parent cuts between the clamps. A sample of the baby’s blood is taken from the cord, to be analyzed later.
If this is your first child, you may be surprised at how she looks. She won’t resemble the pink, perfectly shaped cherubs you’ve seen in commercials. First of all, her head is molded from passing through the tight confines of the birth canal. (It will take on a more normal shape within three days.) And her hands and feet may be slightly blue because her circulation isn’t very efficient yet.
THE FIRST BREATH
After your newborn cries spontaneously, or with a little physical encouragement (by rubbing her back or tapping her feet), the infant will “pink up.”
“When the child actively cries,” says Ian Laing, MD, Fellow in Newborn Medicine at Children’s Hospital in Boston, “there’s usually a simultaneous increase in chest and limb movements.
Gradually, over the early minutes of life, a baby goes from a rather gray-blue color to an attractive pink. Even then, the toes and fingers may retain a slight blueness, which may last for a few hours.
Don’t be alarmed at your child’s strange breathing. The baby coughs, sputters and wheezes trying to get rid of all the fluid she’s inhaled and beginning the new experience of breathing air.
“When a baby is born vaginally, the infant has been squeezed in the birth canal,” says Dr. Sanocka. “About fifty cubic centimeters of fluid is actually squeezed out of the baby’s lungs this way.” “The big squeeze,” as she calls it, facilitates easier breathing. Infants born by cesarean section will take shallower and quicker breaths until the fluid is cleared from their airways.
Even after a child gets the hang of breathing, her respiration is different from an adult’s. “A baby’s normal breathing is irregular or periodic,” says Kim Harvey, MD, a pediatrician in private practice in Palo Alto, California. “A newborn will take some big sighs and a few pants, hold her breath and then breathe very quickly.” Her respiratory rate is much faster than an adult’s, too—about 45 times a minute contrasted to an adult’s rate of 20 times per minute. The heartbeat is quicker as well: 120 beats a minute, compared with 70 for an adult.
You’ll notice that your child is covered with a whitish coating that protected her skin while she was in utero. Delivery-room personnel wipe away this substance as well as clean off the amniotic fluid. This keeps the infant from getting chilled as the wetness evaporates. For the past nine months your child has been in a balmy, tropical 98.6-degree climate. Now she has to cope with varying, and much lower, temperatures. Explains Dr. Laing, “Babies have more skin in proportion to their weight than adults do. This means babies have a greater area to lose heat from. Since they also have bigger heads proportionally, and relatively little hair, the head can be another source of heat loss.”
To help ward off a chill, your child is placed on a warming table and given a fast once-over by the delegated nurse or pediatrician. Antibiotic eyedrops, such as erythromycin or silver nitrate, are often put into the baby’s eyes, primarily to protect them against gonorrhea! infection.
The infant is footprinted, and an identifying band is placed on her wrist. Then the child gets an intramuscular vitamin K shot in the thigh. In the past, newborns had a tendency to bleed internally during the first 24 to 48 hours of life.
“It was due to a deficiency in the liver’s ability to produce vitamin K-dependent clotting factors,” says Dr. Laing. “This simple intervention—giving the child a shot of the vitamin—has virtually eliminated the problem.”
KEEPING SCORE The baby is assigned an Apgar score when she’s one minute old and again at five minutes. This assessment system was developed by and named after physician Virginia Apgar. At minutes one and five, five different qualities—the child’s color, breathing ability, muscle tone, heart rate and response to stimuli, are awarded 0, 1 or 2 points (2 being the best). The maximum number of total points is 10.
“The most common score is 8 at one minute and 9 at five minutes,” says Dr. Harvey. She believes that a low Apgar has more significance than a high one. “If the one-minute Apgar is 4 then you know the baby had a tough time during the delivery and may have been temporarily deprived of oxygen. However, if the five-minute score is adequate, then the problem’s been corrected and the child will most likely be fine.”
Physicians don’t routinely tell you your child’s score unless you ask for it. “Doctors don’t volunteer this information because most parents don’t even know what an Apgar test is,” says Dr. Sanocka.
TIME ALONE After these initial procedures, a nurse diapers the baby, wraps her in a blanket and hands her to you or your spouse. Depending on the hospital, this initial getting-to-know-each-other ritual may last minutes or even hours. “It’s important for the family to be left alone and given a feeling of togetherness,” says Dr. Laing. “We like to give them time to be as proud of each other as possible.”
If a mother has opted to breastfeed her child, she may choose to nurse at this time. However, some women just want to cuddle their babies, waiting for a more tranquil time or until they’re better rested to begin feeding.
Though her milk supply hasn’t yet come in (this normally takes three days), and her child may be too sleepy to eat, the mother’s breasts are filled with colostrum. This yellowish fluid contains important immunizing substances, and has a mild laxative effect that helps clear fetal waste. It also has the proteins and fats for the baby’s early feedings.
WEIGHING IN There’s no rush to take babies to the nursery, but since this is where they get weighed and measured (you are probably very curious about your child’s weight and length) they will most likely be taken there within a half hour of delivery. Then, she’s put under a warmer and a nurse will take her temperature. Since infants are prone to getting cold, keeping them warm is often the staffs main concern.
Next, a nurse will give your baby her first bath, followed by a thorough physical exam. The infant’s pulse, blood pressure, reflexes, eyes, head, genitals, skin and limbs will be examined. When checking the eyes, for example, the nurse will note any discharge, blinking or tearing problems, pupil abnormality, hemorrhaging, redness and eyelid puffiness. Even if the baby will be “rooming-in,” she will be observed closely for the first four to six hours.
You may be surprised to know that during the first hour of life, babies can be amazingly alert and eager to socialize. Immediately after birth, for example, a newborn may gaze into your eyes for up to an hour. Researchers have proven that infants can see, hear, taste and smell better than they’ve been given credit for. Though some of their senses still need a lot of fine-tuning (their vision is blurry, for example), and they need more time and experience in order to make sense of the world around them, babies respond to the sight and touch of their parents. Your baby will especially enjoy being held on your chest. That way, she can hear and feel your heartbeat. This close position will be comforting for both of you, right from the start.
Kathy P. Behan, a mother of three, is a freelance writer specializing in parenting and health issues.
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