Articles

Key takeaways

• Skin-to-skin contact immediately after birth helps you bond and calms your baby.
• You have two options for delivering the placenta: active or physiological management.
• Your baby will have important first checks and their first feed of colostrum.

The golden hour: your first moments together

Right after birth, your midwife will dry your baby. If you and your baby are well, your midwife will then place your baby on your tummy. This is for skin-to-skin contact. Skin-to-skin contact means holding your baby naked against your skin. This is usually under your top or under a blanket. You will be encouraged to have skin-to-skin contact as soon as possible. You can include this in your birth plan.

Skin-to-skin contact helps your baby in many ways. Having your baby on your chest helps them hear your heartbeat and voice, this can calm and relax them. A blanket can be placed over both of you for warmth. Skin-to-skin contact helps regulate their temperature, breathing, and heart rate. It also helps build their immunity to infections. It can calm and de-stress both of you. This contact helps boost your milk supply. It also stimulates your baby's feeding instincts. When babies feel secure, it releases a hormone called oxytocin. This helps their brains grow and develop. Being close like this also causes your body to release oxytocin. This is your body's natural feel-good chemical. It makes you and your baby calm and relaxed.

Holding, smiling, and talking to your baby also releases oxytocin in you. This helps with your growing bond.

Delivering the placenta: the third stage of labor

After your baby is born, your body will deliver the placenta. The placenta is the organ that supplied nutrients to your baby. The membranes that held your baby are attached to the placenta and will also be delivered then. This is called the third stage of labour.

If you have a vaginal birth, you will push out the placenta through your vagina. If you have a caesarean section, your medical team will deliver the placenta.

You have two options for how to deliver the placenta after a vaginal birth. These are active management or physiological management. Your midwife or doctor will discuss these options with you. They will explain the pros and cons of each. How you deliver the placenta is your decision.

Active management

Active management means you will receive an injection. This injection contains a hormone called oxytocin. It is given into your thigh, often as your baby is born. Oxytocin helps your womb to contract. This injection speeds up the delivery of the placenta. This usually happens within 30 minutes. It also lowers your risk of heavy bleeding after birth (postpartum haemorrhage).

Some people may feel sick or vomit after the injection. Your healthcare professional can offer anti-sickness medication. It can also make afterpains – contraction-like pains after birth – worse.

During active management, your midwife will clamp and cut the umbilical cord. This is usually done between 1 and 5 minutes after birth. This delay ensures your baby receives all the blood from your placenta. This is good for your baby's iron levels. However, the cord may be cut sooner if there are concerns about you or your baby.

As the injection works, your womb reduces in size. This helps the placenta to come away. You may be able to push the placenta out. Your midwife may also help deliver it. They might put a hand on your tummy and keep the cord pulled tight. This is called cord traction. The blood vessels that were holding the placenta will close off as your womb gets smaller. This helps prevent too much bleeding.

Physiological management

Physiological management means no oxytocin injection is given. The third stage of labour happens naturally. Your body releases oxytocin when you breastfeed your baby. It also releases it when your baby lies on your chest with skin-to-skin contact. This helps your womb to tighten and push out the placenta and membranes. The cord is not cut until it has stopped pulsing. This usually takes around 2 to 4 minutes. This means blood is still passing from the placenta to your baby. Once the placenta has come away from your womb, you will feel pressure. You will then need to push the placenta out. It can take up to an hour for the placenta to come away naturally. However, it usually only takes a few minutes to push it out.

If the placenta does not come away, or you bleed heavily, you may switch to active management. Your midwife will weigh up and explain the possible risks of physiological management. This is especially true if you had issues in labour or a previous birth.

Immediate postpartum care for you

After birth, your midwife will check you for any tears or grazes. If you need any stitches they will discuss this with you. They will also monitor your bleeding. It's normal to bleed after birth. This is called lochia. It will be like a heavy period at first, then gradually get lighter.

When you are able to, your midwife will help you to the toilet and ensure you can pass urine. They will also offer pain relief if you need to.

Your baby's first checks and first feed

After the cord is clamped or cut, your baby will be dried. They will then be covered with a towel to stop them getting cold. You can continue to hold and cuddle your baby during this time.

Your midwife will check your baby over, looking at:

• Breathing
• Heart rate
• Skin colour
• Muscle tone
• Reactions

These checks form the Apgar score. This score is usually taken at 1 minute and 5 minutes after birth.

A midwife, neonatal nurse, or paediatrician will examine your baby. They will weigh and possibly measure them. Your baby will also be given a wrist or ankle band with your name on it. Your baby will be offered a newborn physical examination within their first 72 hours. This usually happens before you leave the hospital. It may also be done at a local clinic or at home. This examination checks their eyes, heart, and hips. For baby boys, their testicles are checked to ensure they are in the right place.

In the early days, the midwife will check your baby for:

• Signs of jaundice
• Infection of the umbilical cord or eyes
• Thrush in the mouth
• Temperature, weight, and reflexes

Your baby's first feed

When your baby wants to feed, they are likely to root. This means they will turn their head and open their mouth. They will be looking for food.

The fluid your breasts produce in the first few days is called colostrum. It is thick and usually a golden yellow colour. Colostrum is a very concentrated food. Your baby will only need a small amount at each feed. This is about a teaspoonful. Colostrum is easy for your baby to digest. It will help them have their first poo. It is also full of antibodies. This will help them to fight infections. Your baby will benefit if you are able to breastfeed, even for a short time.

The midwives will help you, whatever you choose. This includes breastfeeding, formula feeding, or combining both.

If you choose to formula feed, you can give the first feed during skin-to-skin contact. Holding your baby close and looking into their eyes will also help you bond.