Understanding the First Day of Life

When a new baby is born there is a rush of excitement and relief for the parents and a cry from the baby who somehow seems reluctant to relinquish his unborn status.  As the newborn goes through the transition from life in the womb to life in this world there are many adjustments that have to be made.  The doctors and nurses must watch the baby carefully to see if he needs medical intervention to help him through this special time.

Here is an overview of what happens in the delivery room and nursery to help new parents understand what is happening with the baby in the first few minutes, hours and days of life.

The APGAR score

A - Appearance - skin color  

       0 = blue or pale all over, 1 = mostly pink,  2 = pink all over

P - Pulse rate/beats per minute  

       0 = 0,  1 = less than 100, 2 = more than 100 

G - Grimace - also call reflex irritability

       0 = no reaction, 1 = grimace or weak cry when stimulated, 2 = crying loudly when stimulated

A - Activity - the muscle tone of the baby

       0 = totally floppy, 1 = some flexion, 2 = flexed arms and legs that resist when pulled

R - Respiration

       0 = absent, 1 = weak or gasping, 2 = strong, lusty cry

The APGAR score is a quick assessment of the baby at one minute and five minutes of life.  The purpose of the score is to alert the staff if a baby is in need of medical attention.  Each of the criteria is given a score of 0, 1 or 2.  Then the five scores are added up.  If the baby’s total score is between 7 and 10 at five minutes he is probably ready to be sent to the regular nursery.  A very low score means that the baby needs help - such as stimulation, oxygen, or respiratory assistance. 

The APGAR score does not usually predict the future health of the baby. The only exception is if the score is persistently below 5 as late as 10 minutes after the birth. This indicates serious problems that need intensive care.

Bonding

The baby is often given to the parents to hold within the first few minutes after birth. This early initial contact fosters “bonding”- encouraging the feeling of love and caring towards the baby. Most centers try to give the parents at least 30 minutes with the baby before taking the infant away to the nursery.

Nursing in the delivery room

For a breastfeeding mother, nursing a baby right after the birth generally helps to avoid the problem of nipple confusion. The baby remembers how to nurse even if he is given bottles after that. 

Eye drops, Vitamin K and Keeping Baby Warm

The nurse usually puts eye drops or ointment into the baby’s eyes immediately after birth to prevent infection. The baby is also given an injection of vitamin K to prevent bleeding problems in the first few days of life. The baby is placed in a warming bed that has a radiant heater above it. Although the baby is naked he is not cold. The nurses and doctors watch the baby’s breathing and general activity before he is wrapped up in warm blankets and taken out of the radiant heater bed.

Meconium

Before the baby is born the colon produces a green/black tarry substance called meconium. The first bowel movements that pass from the baby are meconium. Occasionally, the baby passes meconium while still in the womb. This usually does not cause a problem but it is sometimes a sign that the baby is under stress. When this happens, the amniotic fluid is green/black tinged. Rarely, the baby breathes in the meconium-stained fluid at birth-a condition called meconium aspiration. This can cause serious lung problems immediately after birth. When this happens the baby needs intensive care in the Nursery ICU. In the regular nursery, the nurses and doctors take note when a baby passes his first bowel movement with meconium. This should happen on the first day of life.

Urine Output and “Brick Dust”

The baby usually urinates soon after birth and periodically after that.  The nurses keep track of wet diapers.  If the baby does not produce urine in the first hours of life it may be a sign of a problem in the urinary tract. On the first day of life, the baby has very little intake of fluid so the urine is scanty and dark in color.  It is not uncommon for the urine to have an orange tinge on the diaper.  This brick dust is caused by urate crystals in the urine.  It usually clears up when the baby takes in more fluids and when the mother’s milk supply comes in.

Assessing the Baby’s Sucking

It is very important for the baby to have a strong suck in order to be cleared to go home.  The nursing mother can easily notice that the baby is sucking adequately.  Sometimes there are problems with “latching on”.  If the baby cannot get a good grasp of the nipple when nursing, the mother should request assistance from the hospital lactation consultant.  This problem must be dealt with right away to ensure that the baby gets enough milk. If the baby is bottle-feeding the mother can note how well the baby is sucking and how much he is taking in.

The Umbilical Cord

The umbilical cord, which is cut and clamped at the time of birth, gradually dries up and falls off.  The clamp is removed when the baby goes home.  The care of the cord is usually just allowing it to dry up.  Some doctors recommend alcohol to be applied, others suggest powder.  The cord sometimes bleeds as it separates. This is normal.   If the skin around the naval gets very red or if the naval has a foul-smelling discharge a doctor should be contacted.

Once the first week is over, all of the transitional issues fade away, and the newborn becomes part of the family. Despite the sleep deprivation and the unending demands of caring for the new baby, the fun and joy really begin.

The development from a newborn to a real person is one of life’s most amazing miracles.  As the baby changes from day to day we must look back to those first few hours of life and realize how fast and far the progress has been. It will make us all more appreciative of the miracle we’ve been blessed with.

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