Baby's First Hours

In the Delivery Room

The big day is finally here: After all those hours of labor, you'll see your newborn for the first time. And while you've probably read up on what will happen to you after giving birth, you may not have realized how busy your baby will be during his first 48 hours. Procedures vary from one hospital to the next, but here's what you can expect -- from the cutting of the cord to the last screenings your baby will need before you put him in his car seat and head for home.

When your baby is born, her first cry will kick-start her lungs. The obstetrician will suction her mouth and nose to clear away any mucus or amniotic fluid and make sure both nostrils are fully open. Your newborn will be put onto your body, cord intact, and covered with a blanket. If you have a C-section, the doctor will lift your baby up so you can see her; then she'll be cleaned up and given to your spouse to hold. If your baby is born prematurely or is in respiratory distress, she will be taken immediately to the neonatal intensive care unit for examination. Large babies (those weighing more than 8 pounds, 13 ounces) may need to be taken for a heel-stick blood test, since they are at risk of having low blood sugar levels during the first few hours of life.

• Cutting the cord. The cord is usually cut within the first few minutes. After the doctor clamps it in two places, the baby's father is often given the honor of snipping it. Your doctor may also take a blood sample from the cord for later screening. If you've elected to donate cord blood to a blood bank, it will be collected now.
• Testing, testing. One minute after birth, and again five minutes later, your newborn will receive an Apgar score, an evaluation of his vital signs, and physical responsiveness. During this test, the nurse will listen to his heart and lungs to make sure his respiratory and circulatory systems are making the transition from life in utero to the world outside, says Ann Stark, M.D., former chair of the perinatal pediatrics section of the American Academy of Pediatrics. Then he's weighed, measured, and checked for signs of illness.
• Protective measures. All newborns receive an injection of vitamin K, which clots blood, to prevent excessive bleeding. At birth, a baby's liver, which makes vitamin K, is immature. "We give newborns a boost to tide them over until their system turns on," says Susan Wright Aucott, M.D., medical director of the neonatal intensive care unit at Johns Hopkins University Hospital, in Baltimore. In addition, an antibiotic ointment or drop is applied to the eyes to protect against infection.

Next, your infant will be diapered, wrapped, and capped. If you're up to it, you can breastfeed. If not, you can still hold your little bundle. Babies are usually quite alert after birth -- the perfect time to begin bonding.

In the Nursery

After about 30 minutes, a nurse will likely put your baby in a warmed Isolette (an enclosed crib on wheels) and bring her to the nursery. However, if your hospital allows "rooming in" -- in which the mother and baby are kept together -- you and your newborn will travel to your postpartum recovery room, where she'll be checked out.

• Vital stats. A nurse will listen to your baby's heart and lungs, check her temperature and examine her for any abnormalities, such as spina bifida. The nurse will also remeasure your child's height, weight, and head circumference and give her a warm bath.
• First physical. Within the first 24 hours, a pediatrician will examine your baby. (Of course, if a problem arises, she'll be alerted right away.) She'll compare your infant's measurements with the norm for his gestational age -- the number of weeks since the first day of your last period -- to make sure they match up. (If your baby was premature or if he was full-term but has a low birth weight, the doctor will use the Ballard exam, a checklist that assesses physical characteristics and muscle tone to gauge "relative" gestational age).

Next, your doctor will listen to your baby's chest for heart murmurs and his abdomen to make sure his bowels are functioning normally. She'll feel your baby's soft spots, look for swellings on his head (most are harmless), and examine his eyes and genitals. She'll also check for things like cleft palate, collarbone fracture (which is not uncommon during delivery and generally heals on its own), birthmarks, and hip dislocation. "In addition, most states check for congenital hearing loss," says Deborah Campbell, M.D., director of neonatology at the Montefiore Medical Center, in New York City. Then, with your consent, your baby will be given the first of his immunizations, the hepatitis B vaccination. (It can also be given later, at the first well-baby visit).

After such a busy beginning to his life, your newborn can at last look forward to some peace and quiet: It's finally time to go home with you.

Lifesaving Screenings

Sometime during your newborn's first two days of life, blood will be drawn from her heel and screened for certain disorders. Exactly which disorders she'll be tested for depends on where you live.

All states require testing for congenital hypothyroidism and phenylketonuria (PKU), a rare but serious metabolic disease. Most states also test for sickle-cell disease. Before delivery, ask your doctor what other screenings are done routinely. If any metabolic disorders appear in your family history and your state doesn't screen for them, your doctor can order specific tests.

Copyright © 2002 Denise Porretto. Reprinted with permission from the December 2002 issue of Parents magazine.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.