As you prepare for childbirth, there’s such a focus on labor and delivery and getting your baby here. It’s so important that delivery happens safely. But many moms may wonder about what happens at the hospital after birth.
Jade Elliott spoke with Taylor Hanton, a neonatal nurse practitioner with Intermountain Healthcare, about the special newborn care and bonding and the important screenings for your baby that are offered at the hospital after birth .
The first hour after a baby is born is a very special time that neonatal providers like to call the golden hour as your baby transitions from living in the womb to living in the world and begin bonding with mom and her partner.
Why is the first hour of a baby’s life called the golden hour?
It’s a time for mom and baby to bond and ensure baby is adapting well to their new environment as well as making sure mom recovers from the delivery of her baby.
What happens right after birth?
The labor and delivery nurse is frequently in the room during the first couple of hours checking on mom and making sure she remains stable after delivery. The nurse will also assist mom with breast or bottle feeding and monitor vital signs on both mom and baby.
Right after an uncomplicated vaginal delivery or even caesarean birth, the baby is placed on mom’s chest, to encourage skin-to-skin contact, bonding, keep baby warm, and help regulate newborn breathing. This can happen even before the umbilical cord is cut. If you have a Caesarean section, skin-to-skin is delayed due to the location of the surgery, but often can occur prior to mom leaving the OR.
Apgar scores help measure your baby’s general condition and how well your baby is adapting to the new world outside the womb and if assistance is needed. They can be done with your baby still on your chest. Apgar assess your baby’s heart rate, breathing, muscle tone, reflex response, and color. Apgar scores are assigned at one minute after birth and again at five minutes.
Most newborns have an Apgar score greater than 7. Few babies score a perfect 10, since babies are born blue and it take some time for their entire bodies to turn pink.
Approximately 5-10 percent of newborns will require some degree of resuscitation. This may include assistance with removal of oral secretions, drying and/or tactile stimulation to increase the baby’s heart rate, and to facilitate effective breathing and consequently oxygen delivery to the body.
Only about one percent of newborns require extensive resuscitation at birth. If you are delivering in a hospital, the staff is skilled and prepared to perform all resuscitation interventions on your baby if needed. Neonatal caregivers can help baby breathe with an oxygen mask or a tube placed in the windpipe, and fluids and medications may be administered through a blood vessel in the umbilical cord. If Apgar scores are still low, your baby may be transferred to the neonatal intensive care unit (NICU) for further care.
What’s the difference between a well-baby nursery and a NICU?
Well baby nurseries are typically for babies 35 weeks and above, however some rural nurseries only care for newborns 37 weeks and above. Newborn intensive care units are for babies that require extra monitoring and care, including all babies born less than 35 weeks gestation. It’s important to know the level of care available at your delivery hospital and if you will need to go somewhere else if you go into early labor. This will help you and your newborn receive care at the same hospital and not be separated.
What advice do you have for parents during that golden hour?
It’s a time to make sure the baby is adapting to life apart from the protection of the womb. The newborn caregivers make sure the baby is breathing comfortably and does not need any assistance or additional oxygen as well as make sure the baby can maintain a normal temperature.
It’s not the best time for a lot of visitors to be in the room. Babies need a low stimulation environment as they continue to clear fluids from the lungs and use their calories to work on feeding and maintaining a normal body temperature. Newborn transition is often interrupted in babies who are overstimulated (for example being held by multiple people, loud voices, or being unwrapped). These babies often become worn out and are not able to feed as well, become cold, and/or start to work harder to breathe.
The Golden Hour is a special time for mom and partner to have some time alone with the baby and to help the baby make a successful transition to his/her new world. This is also an important time for your baby to have a positive feeding experience and receive the appropriate nutrition to continue the transitioning process. In fact, newborn baths are even delayed to not interfere with this important process.
What newborn screenings are offered at the hospital to check baby’s health?
Many newborn screenings are required by state law. Here are some screenings routinely provided in Intermountain hospitals.
A screening for critical congenital heart defects or CCHD test helps identifies babies that are born with a heart defect that could put them at risk for delivering blood and/or oxygen to the body. The screen evaluates the amount of oxygen in your baby’s blood by sticking pulse oximeter sensors to your baby’s skin. If your baby does not pass the CCHD screen, an echocardiogram (an ultrasound to look at pictures of your baby’s heart) may be performed to further access the heart anatomy and function. Early detection and treatment for CCHD can be lifesaving.
Newborn screening is the first step towards a healthy start for your baby. Neonatal screening is a state requirement to help detect specific conditions in infants who would benefit from early detection and treatment. The Utah Newborn Screening Program checks for more than 40 disorders, such conditions include hormone abnormalities, inborn errors of metabolism, immunodeficiency disorders, red blood cell abnormalities, and cystic fibrosis. Early identification of disorders, provides an opportunity for treatment that can lead to significant reductions in morbidity and mortality. This is a simple blood test that requires just a few drops of blood collected from your baby’s foot. The first screening is obtained 24-48 hours after birth and the second is performed 7-16 days after birth.
Click here for the Baby Your Baby Podcast on newborn screenings.
A hearing screening checks for hearing loss. For this test, tiny earphones are placed in your baby’s ears and special computers check how your baby responds to sound. It is not unusual for a newborn to fail one or both ears since there is often fluid still in the ear canals. If this happens, a repeat test is scheduled shortly after discharge.
Bilirubin screening is done to check for high levels of bilirubin which can cause jaundice. Mild jaundice may go away on its own, but higher levels may need treatment with special lights. This blood test is usually done at 24 hours after birth, but is may be done sooner if your baby is at a higher risk for developing jaundice.
Administering vitamin K. Babies are born deficient in Vitamin K. Giving them this important vitamin helps prevent dangerous bleeding or intercranial hemorrhage. It is best given through a shot in the thigh within three hours of birth. Administration of oral Vitamin K is less effective than the shot due to erratic absorption from the gastrointestinal tract and must be given weekly until your baby is three months of age.
Administering erythromycin eye ointment. Erythromycin eye ointment is administered within three hours of birth to treat ophthalmia neonatorum. This is an infectious and potentially blinding conjunctivitis transmitted to a neonate by exposure to maternal chlamydial or gonococcal infection during birth. These infections can cause corneal scaring, ocular perforation, and blindness as soon as 24 hours after birth. This treatment is recommended by the American Academy of Pediatrics and CDC for prophylaxis against newborn conjunctivitis.
What about vaccines and follow-up care?
Hepatitis B vaccine is given to newborns at the hospital. It’s important to follow up and take your child to their well-child visits with their provider starting a few days after discharge. During these visits, the newborn provider will check the baby’s growth, ability to orally feed, evaluate for jaundice, and listen to heart and lung sounds. Additional well-child check-ups are important to assess continued growth and development and provide additional vaccines to prevent childhood diseases.
Do caregivers teach you about taking care of your newborn?
Women and newborn caregivers will teach you about how to care for your baby. They will show you how to care for the umbilical cord, and how to hold, bathe, diaper, swaddle, nurse or bottle feed, and burp your baby. They will also provide you with information on when to call your baby’s provider for other concerns such as diarrhea, vomiting, and fevers.
For a schedule of well visits go to intermountainhealthcare.org
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.