The nose and mouth of the baby are suctioned to clear the baby of all secretions and to aid in its first breathing efforts. The baby should begin crying within the first 30 seconds to one minute of life. To accomplish this, gentle stimulation is usually required and accomplished by rubbing the baby's back or gently stimulating its feet.
Some of you may be familiar with old movies or books that described or depicted the delivering physician as holding up the baby by its feet in mid air and spanking the baby's bottom (translation: bare butt) in order to get the baby to cry. This procedure is no longer done because it isn't necessary. According to Dr. John, it was an accepted practice because doctors simply didn't know any better, and they went overboard a tad. Today's doctors know that aggressive stimulation isn't necessary, and it could potentially harm the baby. For example, the baby could be dropped or hit too hard in a vulnerable spot that might injure it.
The Neonatal Team Takes Over
Usually, when the delivery is approaching, the patient's nurse will call for additional personnel to manage the baby's transition. These individuals are referred to as NRPs (neonatal resuscitative providers). They may be doctors, nurses, or medical assistants, but all of them have special training in the initial evaluation of and resuscitation of newborns.
And the Ranking Is...Enter the Apgar Score
The baby's attendants will begin their initial evaluation at one and five minutes after birth, using the Apgar scoring system. The intent of the Apgar score is to provide a quick evaluation of a newborn and determine if additional measures of resuscitation are necessary.
Apgar scores range from zero to 10. In general, a low Apgar identifies those babies who may require extra attention and care. The five-minute Apgar score is generally used to evaluate how effective any resuscitative efforts were.
The Apgar table is comprised of five areas in which the baby will receive a score. These areas include the baby's heart rate, muscle tone, respiratory effort, reflexive response to stimulation, and the baby's color.
The APGAR Scoring System
|Heart Rate||Absent||< 100 per minute||> 100 per minute|
|Respiratory Effort||Apneic||Weak, Irregular, Gasping||Regular|
|Reflex||No Response||Some Response||Facial Grimace, Sneeze, Cough|
|Muscle Tone||Flaccid||Some Flexion||Good Flexion of Arms and Legs|
|Color||Blue, Pale||Body Pink, Hands and Feet Blue||Pink|
A value of 0, 1, or 2 is assigned to each category, and this gives the baby its overall score out of 10. Generally, Apgar scores in the range of 7-10 suggest that the baby doesn't require additional resuscitative efforts; however, a score between 4-7 is considered an indicator that the baby may be mildly to moderately compromised (needing attention). In those babies with a score less than 4, the rating usually indicates that the baby might need oxygen and additional attention from the medical staff. (According to Dr. John, medical people joke around and say that no babies ever get a perfect 10, unless they are a pediatrician's baby.)
My Perfect "10"
The birth of my third child (and first daughter) was something of a fiasco of my own making. I was at a teaching hospital, but didn't realize what that meant when they asked me if I'd mind having a "few" nurses observe the delivery. When they wheeled me into an amphitheater-type room, it was too late to protest. OK, 15 nurses (some male I'd forgotten there was such a thing as male nurses) gathered round to watch under spotlights. So much for intimate, personal deliveries with the lights dimmed. If I hadn't been so preoccupied having a baby, I would have been mortified.
The only good part was that they clapped when I delivered, and my daughter was a perfect "10" on the Apgar scale at 1 minute and at 5 minutes. (I think it had something to do with the movie "10" being popular several years earlier.) In retrospect, it was the only way for my drama-queen daughter to make her appearance onto the stage of life.
If the baby is doing well and is considered stable, then it can spend a short time with its mother before proceeding to the nursery. At the nursery the baby will be cleaned more thoroughly, as well as evaluated once again.
Immediately after the baby is born, it becomes the patient of another doctor (not your OB, but one who is expert in the care of newborns). The general evaluation of a normal newborn includes the observation of the baby's transition from intrauterine to extra uterine life. The neonatal teams will be establishing feeding habits of either the breast or the bottle, watching for normal patterns of urination and bowel movements, and keeping an overall surveillance of the baby for any problems. Concerning signs might include a change in the baby's activity rate, a refusal to eat, temperature changes, skin color changes, jaundice, a rapid respiratory rate, or vomiting. The neonatal team will also be giving vaccinations if necessary and doing mandatory state screening tests on the infant.
What Is Jaundice?
The most common difficulty in newborns is jaundice (yellow-looking skin), and in most cases it will disappear in two weeks or less without any special treatment. For most full-term babies, jaundice should not last longer than one week.
Jaundice occurs when excess bilirubin is released into the baby's circulation, caused by the destruction of circulating red blood cells. Jaundice may be attributed to physiological causes (immaturity of the baby's liver), prematurity, breast milk (occuring in one to two percent of breastfed babies), blood group incompatibility (Rh or ABO problems), or hepatitis (rare).
If a doctor does a blood test and decides to treat the baby, the baby will be placed under special lights (also known as phototherapy). If jaundice is prolonged or associated with other metabolic abnormalities, additional measures may be necessary.
A small percentage of babies who are breast-fed can develop breast milk jaundice. The cause of this is not entirely clear, but it's thought to be related to the composition of the mother's milk. It's normal for breast-fed babies to have higher bilirubin levels than formula-fed babies; however, the mother should continue to breast-feed.
The nursery will weigh the baby for the first time. Contrary to popular belief, the baby is not weighed right after delivery for a couple of reasons. First, there is no baby scale in the delivery room. Second, the neonatal providers have more important responsibilities when taking care of the baby than determining its weight. Although the weight is important and the most common question that parents ask, the baby will be weighed and measured later at the nursery's convenience.
The baby will be wrapped snugly in a baby blanket and placed under the warmer whenever it's not with the mother. The mother provides warmth to the baby by holding it close and transferring her own heat to it. When the mother is not holding the baby, she's asked to keep the baby wrapped in a blanket to aid in heat preservation. When the baby is cold, extra energy is expended to maintain its core temperature, and this can add stress to the baby if it occurs for a prolonged period of time.
If the baby is showing any signs of distress, which could be caused by an infection or a metabolic disorder, the baby may undergo blood tests. Amazingly, there are tiny blood pressure cuffs that can be placed around the baby's arms or legs to measure blood pressure. If necessary, intravenous lines may be placed in the baby so that it can receive extra fluids and medicines. However, most babies don't require these measures or anything much beyond the initial evaluation. The more reassuring and healthy the baby appears to the nursery staff, the sooner the baby will be returned to the mother for bonding.
If the mother desires, she can begin breast-feeding shortly after the birth, but the baby may be tired and want to sleep for several hours before its first feeding. And it goes without saying that the mother may be tired as well.
Shortly after the baby's birth, the hospital will notify your pediatrician, and he or she will visit the hospital to check on the baby's status. At that time, the pediatrician will probably perform some of his or her own tests. The nursery will also give the baby a series of immunizations, one of which is the hepatitis vaccine.
Spotting Jaundice in Your Baby
Jaundice usually begins around the second to third day of life. The baby's face will appear yellow first and then the color will spread to its chest and legs. The whites of the eyes can also be yellow.
To test for jaundice, press your fingertip on the tip of your child's nose or forehead. If the skin shows white (works for all races), then there is no jaundice. If the skin is yellow or slightly yellow, contact your pediatrician immediately. Because many babies are released from the hospital before the baby develops jaundice, it is up to the parents to spot it. Remember: jaundice can be dangerous to the baby, possibly causing deafness, cerebral palsy, brain damage, or even indicating the presence of hepatitis.
Screening Tests for Newborns
Each newborn baby gets its heel pricked for a blood test, but the specific tests that blood gets screened for depends on the state where you live.
There are several rare conditions that can be picked up in a screening and save lives (for example, some genetic diseases and immune disorders). Find out what your state screens for and make the decision yourself whether or not you want to pay for additional screening if it's not offered. Usually, you can order a test from a private laboratory that may be fairly inexpensive (it may cost as little as an extra $25), and that test can give you peace of mind if it is negative, or save a life if it is positive.
The Absolute Minimum
Finally, finally, finally, you have a baby! Rest up while you're still in the hospital and enjoy that wonderful new being in your life. But that new infant brings with it a new set of mind-boggling responsibilities. You will immediately be thrust into parenthood, and it starts right now.
Reproduced from Absolute Beginner's Guide to Pregnancy, by John Adams and Marta Justak, by permission of Pearson Education. Copyright © 2005 by Que Publishing. Please visit Amazon to order your own copy.
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