Rethinking Your Baby’s First Few Minutes of Life

 

Think back to when your babies were born—what happened in those first 5-10 minutes of life?  Did you hold your baby?  Were you encouraged to breastfeed your baby?  Or did someone take your baby away from you?

These days most babies go directly to a health care provider for evaluation.  Sometimes, if the baby Kangaroois breathing and appears well, the mother will get to look at or hold the baby for a few seconds before someone whisks the baby away for “necessary” medical care.

Things are changing.  We are rethinking how a baby should spend his or her first few minutes of life.

As a hospital-based pediatrician, I have been attending deliveries regularly for almost ten years, and I love it.  I never tire of witnessing the joy of new parents.  I feel privileged to take care of babies in their first few seconds of life.  But those first few minutes of life are not meant to be spent with me.  Those precious few minutes are meant for bonding between baby and parents.

With the support of the Best Fed Beginnings program and Baby Friendly USA, Barnes Jewish Hospital has started giving babies directly to mothers as soon as they are delivered, provided they are breathing and appear healthy.  Newborns go “skin-to-skin,” meaning that we place the baby, unwrapped, on mom’s bare chest, between her breasts.  We usually place a warmed blanket over the baby.  Because many of the pediatricians at Barnes Jewish Hospital also work at Missouri Baptist Medical Center and Progress West Health Center, these hospitals have also started skin-to-skin at some deliveries.

Babies can be evaluated by a pediatrician and/or nurse on mom’s chest, if needed.  If a baby is in distress and needs medical care, obviously we do whatever is necessary.  But most of the time babies are fine.  They do not need a pediatrician in the first few minutes of life.  We can even do skin-to-skin at cesarean sections.

And then something amazing often happens: babies start breastfeeding.  All by themselves.  They just find the breast and latch right on.  And usually when they are less than ten minutes old.

If you’ve ever struggled to breastfeed a newborn, you know how hard it can be to get them to latch on to your nipple.  Breastfeeding can become a stressful burden on a very tired mother.  But babies who breastfeed in the first hour of life—and preferably in the first 30 minutes—have a much easier time learning how to latch.  Why? Because when the baby is inside mom’s uterus, she is constantly and rhythmically sucking in amniotic fluid and swallowing it.  At birth she cries, breaths air, and starts to forget how to suck and swallow.  If you wait more than an hour to breastfeed, babies can have a hard time latching, sucking, and swallowing.  If you breastfeed right away, the baby still remembers how to suck and swallow.  If you put a baby skin-to-skin between mom’s bare breasts at delivery, she will be warm, soothed by mom’s voice, find the breast herself, latch right on and start nursing.

The moms giggle and cry.  They are so happy.  This is how the first few minutes of life are meant to be.

What did the nurses and doctors used to do when they took babies away from moms at delivery?  Here’s what we used to do, and how we do it now:

  • Check baby to be sure she is healthy: Pediatricians and/or nurses used to take babies away from moms to be sure baby is breathing well and healthy.  We still do this, just on mom’s chest.  Later, when mom is ready to rest, we do a complete physical exam on baby.  We also weigh the baby, measure length and head circumference, and get footprints.  But all this can be done when the baby is one or two hours old—it doesn’t need to be done in the first ten minutes of life.
  • Draw blood tests: If necessary, we would draw blood for tests, usually to check babies for infection.  Now we do any needed tests a bit later, when we do the baby’s physical exam.  Occasionally it is still necessary to get tests right away, but usually only on very sick newborns.
  • Give baby a shot of vitamin K: Vitamin K deficiency can cause serious bleeding and death in newborns under two weeks old.  This uncommon condition can be prevented by a shot of vitamin K in the first few hours of life.  The Vitamin K shot is recommended by the American Academy of Pediatrics and is standard newborn procedure in most hospitals.  We still give vitamin K shots to newborns, but after mom and baby have bonded and breastfed. 
  • Put antibiotic ointment in baby’s eyes:  All babies get antibiotic ointment in their eyes shortly after delivery to prevent serious newborn eye infections.  The ointment does blur baby’s vision.  Now we wait an hour or so before giving the ointment, so that baby can breastfeed and bond with mom. 
  • Give baby a bath: Babies are born covered in vernix, a white substance that coats them in the uterus.  Usually babies get a bath to remove vernix, at least within the first few hours of life.   There is no reason for a bath in the first few minutes of life.

So go skin-to-skin with your baby, talk to her, nurse her.  Everything else can wait.

Kathleen Berchelmann, M.D. About Kathleen Berchelmann, M.D.

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine, director of the St. Louis Children's Hospital Social Media Team, and co-founder of the ChildrensMD hospital physician blog. Her work has been featured in print and online publications including the St. Louis Post-Dispatch, the Chicago Tribune, and TIME magazine. She is a frequent contributor to Fox2 News STL Moms. Kathleen and her husband are raising five children.

Follow Dr. Kathleen Berchelmann on Facebook: ChildrensMomDocs Twitter: @MomDocKathleen and connect with her on .

Comments

  1. I love that you are promoting more skin to skin contact at birth!

    However, I do have to admit to cringing when you mentioned that the newborn bath “within the first few hours of life,” with an allusion that this bath is necessary to remove vernix. This is absolutely not true! The World Health Organization recommends delaying the first bath at least 6 hours to help with temperature maintenance and breastfeeding (http://www.professionaldoula.com/uploads/World_Health_Organization_Recommendations.pdf and https://apps.who.int/rht/documents/MSM96-13/essential_newborn_care.htm#Thermal protection). Perhaps you are delaying the firt bath at least 6 hours, but that isn’t the image I get when I hear that bathing is happening in “a few hours” after birth.

    As for removing the vernix, this is also unnecessary, and perhaps harmful as the vernix has beneficial properties–so it may just be that the bath is not even needed at 6 hours. WHO specifically says “{bathing} is usually done for cosmetic purposes (to remove the vernix). Vernix has lubricating and anti-infection properties and does not need to be removed.” A study regarding the significance of vernix was published in the American Journal of Obstetrics and Gynecology, 191 (6), 2090-2096, titled: Antimocrobial Properties of Amniotic Fluid and Vernix Caseosa are Similar to Those Found in Breast Milk.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595247/ This study revealed that a number of immune substances were present in both amniotic fluid and vernix samples. Tests using antimicrobial growth inhibition essays show these substances are effective at deterring the growth of common perinatal pathogens— group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans and E. coli. This is just one of many studies demonstrating the benefits of vernix…this blog summarizes several more: http://birthbliss.wordpress.com/2010/09/01/benefits-of-vernix-its-amazing-stuff/

  2. Jennifer says:

    I agree with the above poster about the benefits of vernix and delaying bathing a baby for days or weeks. Natural baby smell is amazing and babies do not get dirty or smelly like adults!

    Also I feel the need to mention that the Vitamin K shot, the eye ointment, the newborn bath all can be declined. New moms please research the procedures listed above and know that any of these can be declined :-)

Trackbacks

  1. [...] you want to hold your baby skin-to-skin right after delivery, even if you have a c-section?  You need to be clear about this.  Also specify your plans [...]

Speak Your Mind

*