Care Given To The Baby At Birth

Your baby will be given his first exams in life at 1 minute and 5 minutes after birth. This two-part evaluation is called the Apgar score and is designed to show how well the baby handled labor and delivery, and how he is adjusting to life outside the uterus. (See Figure 10.2.)

Apgar Scoring Chart

Figure 10.2. Babies are evaluated at 1 minute and 5 minutes after birth using the Apgar Scoring Chart to determine how well they handled delivery and are adjusting to extrauterine life.

The scoring system was developed by an anesthesiologist, Dr. Virginia Apgar. A score of 8 to 10 at 1 minute of life means that the baby’s condition at birth is good. A low Apgar rating alerts the staff that the baby is in distress and needs assistance, and that he will require continued observation. The rating at 5 minutes indicates the baby’s adjustment to extrauterine life. You can ask your caregiver what Apgar score he gave your baby. (For the criteria that must be met for a baby to be sent home, see “Criteria for Newborn Discharge From the Hospital” on the bottom of this page.)

Measuring the head is part of the admission procedure following birth.

After you have had an opportunity to hold and soothe your newborn, the nurse may “borrow” him to perform admission and identification procedures. Since the birthing room will probably be about 20°F cooler than body temperature, your baby must be kept warm. During the procedures, therefore, he will be placed under a warming light. When he is with you and covered with a blanket, he will not need a light because mothers are the best baby warmers!

The nurse will record your fingerprint and your baby’s footprints on the proper documents. Ask her to record the baby’s footprints in your baby book, too, if you brought it with you. The nurse will also give both you and the baby identification bracelets, which will be checked throughout your hospital stay. These bracelets are intended to prevent nursery mix-ups. Interestingly, mothers who are awake and bond with their babies right after birth rarely look at the identification bracelets because they know their babies by sight. In some facilities, the father also receives an identification bracelet to allow him to retrieve the baby from the nursery. (For a discussion of how to choose a name for your baby, see “Naming Your Baby.”)

A baby's footprints are recorded as part of the identification procedure following birth. If you bring your baby book to the hospital or birth center, you can also have the footprints recorded there.

All states have a law requiring that an antibiotic ointment or silver nitrate drops be placed in a baby’s eyes soon after birth. The purpose of the medicine is to prevent blindness in the baby if the mother has gonorrhea. It also prevents other bacterial eye infections. You can ask the nurse to delay administering the ointment or eye drops until after the bonding period, since eye-to- eye contact is an important component of the bonding process. The antibiotic ointment is less irritating to the eyes than the silver nitrate drops and is used more commonly.

Your baby will also receive an injection of vitamin K while he is still in the birthing room or upon his admission to the newborn nursery. Vitamin K is an important factor in blood clotting and is manufactured by the body in the intestines once certain normal bacteria are present. Babies are all deficient in vitamin K, however, as their normal flora, or bacteria, is inadequate. In some areas, vitamin K may be available in oral form.

Between the first and second hour after birth, your baby may have his heel stuck for a drop of blood to check his glucose level. If this level is low, he may be given sugar water and also be stuck several more times to recheck the blood sugar. To prevent low blood sugar, nurse your baby as soon after the delivery as possible, especially before sending him to the nursery if required.

This baby boy weighs in during the admission procedure after birth.

Within the first week of your baby’s life, he will have his heel stuck to send several drops of his blood to a laboratory. This is called the infant screening test, and it checks for several rare inherited metabolic diseases. Some of them can be managed with diet or medications. Others require close management to prevent complications. Through early screening, your baby can be saved from serious problems, including mental retardation or death. Among the dis¬eases for which your baby may be tested are phenylketonuria (PKU), hypothyroidism, galactosemia, sickle cell anemia, congenital adrenal hyperplasia, and thalassemia. The diseases that are screened vary from state to state. The test is not valid until the baby has received at least 24 hours of breast or formula feeding. It is usually considered valid after 48 hours of age. If you are discharged from the hospital prior to that time, the test will be performed any¬way and you will be instructed to return for a repeat test.

Criteria for Newborn Discharge From the Hospital

In October 1995, the American Academy of Pediatrics issued the minimum criteria that should be met before a baby is discharged from the hospital. These criteria included:
□ An uncomplicated pregnancy and vaginal delivery.
□ The baby is an appropriate weight for term, with good vital signs.
□ The baby has completed at least two successful feedings, has urinated, and has passed at least one stool.
□ No evidence of jaundice in the first 24 hours.
□ The mother has received adequate training to care for the newborn.
□ A plan is in place for follow-up and support, including a physical examination by a nurse.

If risk factors—such as substance abuse by the mother, a family history of domestic violence, or child abuse or neglect—are present, the discharge should be delayed until a solution to the problem is available. The commit¬tee did not believe that the criteria could be accomplished in less than 48 hours.

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