What to Expect in the Delivery Room

One of the first things parents ask about and need to know is the variety of things that will happen right after your baby is born in the hospital. These are the first steps in your parenting adventure now that your baby has arrived.

Delivery Day!

The day has finally arrived! No matter how long your labor was, the baby is here! Whether you had a vaginal delivery or a C-section, the process for your baby should be basically the same.

Birth

Babies usually need their noses and mouths suctioned out; this is usually done when the head is delivered, before the rest of the body comes out of the birth canal or right after extraction during a C-section. Sometimes they require some stimulation to get them to take deep breaths. Most babies also cry, but it is not necessary for them to cry. Some just breathe quietly without crying. The baby is usually wrapped immediately in a towel; drying the baby helps keep the baby warm and also helps stimulate the baby to breathe and to cry.

When to Cut the Cord

If the umbilical cord is clamped and cut a few minutes after delivery, rather than immediately, the baby will receive some blood back from the placenta. This “delayed cord clamping” is now the recommended procedure. Giving the baby some “extra” blood has been shown to decrease the chances of anemia during the first few months of life. You may need to check with your doctor or midwife to see if he or she is aware of the recommendation and what is currently practiced at your birth location.

Cord Blood Banking

If you have chosen to have your baby’s cord blood sent to a cord blood bank, it will be collected at this time. If you are having your baby’s cord blood stored privately, you have to arrange this procedure and complete the paperwork prior to delivery. For public donations, you simply sign a consent form during registration.

Cord Blood Testing

Sometimes cord blood is used to test for problems with your baby. If your baby was in distress during delivery or appears to be responding slowly, the cord blood can be tested for oxygen levels and other chemicals to see what was happening with your baby during delivery. If your blood type might pose a problem for the baby, the cord blood can be checked to determine your baby’s blood type and if there are antibodies against your baby’s red blood cells which can increase your baby’s risk of anemia and jaundice.

Newborn resuscitation

Many babies start crying and respond right away as they are being born, or require just a little swat or pat to get started. Some babies, however, require a little more help. If the baby is not very responsive, they will take the baby over to a warmer, dry the baby off and stimulate the baby. They may suction out the nose and mouth. If this is not enough, they may administer a little oxygen and continue to stimulate the baby. If your baby has any signs of illness or is not breathing well enough without assistance, the staff will monitor your baby and transfer the baby to the Neonatal Intensive Care Unit (NICU) if necessary.

If no resuscitation is needed, the baby can be placed on your chest for skin-to-skin contact and also for breastfeeding if you choose to do so.

Apgar scores

The Apgar score, named after the doctor who invented it, is a way of assessing the baby’s alertness and responsiveness. A low Apgar score may indicate that the baby has a depressed response and may have had complications during labor, infection, or a disease or illness of some kind. A higher score means that the baby is more vigorous and alert.

Many people are familiar with these scores and want to know about them. They can be helpful to doctors in some cases; however, they are not all that often used in healthy babies. Usually, babies with low scores turn out to be fine. They are measured at one and at five minutes of life, and can be measured later if needed.

A score of 7-10 is normal; a score of 4-6 may mean the baby needs some assistance and monitoring, and a score of 3 or less means the baby needs intensive care & resuscitation.

90% of babies have a score of 7-10 at both 1 and 5 minutes. Most babies who have a low score at 1 minute have a normal score at 5 minutes.

Delayed bath & routine treatments

Until recently, after delivery the baby would be dried off then measured, given eye ointment and vitamin K injection, and other treatments. This may still be the procedure at some hospitals. However, current research and guidelines recommend delaying routine treatments to allow moms to bond with and feed the baby.

Skin-to-skin contact

If your baby is breathing well, pink and appears healthy, depending on the hospital policies, you will probably have the chance to hold your baby right away. After delivery, the baby can be dried briefly and placed on your chest, with a blanket covering the baby.
Skin-to-skin contact is now the recommended practice, even if you have a C-section. Skin-to-skin contact has been shown to help stimulate the baby, provide warmth, and help both bonding and breastfeeding. Skin-to-skin contact also improves the baby’s oxygen levels and blood sugar levels.

First feeding

During the first skin-to-skin contact, most babies show signs of rooting and being interested in feeding. It is an ideal time to breastfeed, even if you don’t plan on breastfeeding long-term. It helps the baby, it helps your body and your uterus to contract, it provides essential immune protection to the baby. Breastfeeding in the first few hours of life has been shown to improve your milk supply. If you plan to breastfeed and cannot do so in the first few hours, you should express your colostrum during this time.

Measuring your baby

At some point, the staff will measure your baby’s weight, length, and head circumference. Some hospitals also measure the baby’s chest. Measurements are now delayed to allow time for skin-to-skin contact, bonding, and breastfeeding. It is important to know whether your baby is a normal weight and size for his gestational age (weeks), or much larger or smaller than normal. Being larger or smaller than normal each presents certain health risks and more testing might be necessary, such as blood sugar testing.

Identification & security

Your baby will have identification bracelets placed around the wrist and/or ankle to ensure your baby is identified as belonging to you. Your baby may have his footprints placed on a sheet, although this is more for memories than identification. In most hospitals, a security device is also placed on your baby’s ankle. This will trigger an alarm if your baby leaves the proper area of the hospital.