What is the most critical nursing action in caring for the newborn immediately after the birth?

The successful transition of a fetus, which is immersed in amniotic fluid and totally dependent on the placenta for nutrition and oxygen, to a crying, air-breathing baby is a source of wonder. Healthy newborns (age birth to 1 month) and infants (age 1 month to 1 year) need good care to ensure their normal development and continued health.

Immediately after the normal delivery of a baby Overview of Labor and Delivery Although each labor and delivery is different, most follow a general pattern. Therefore, an expectant mother can have a general idea of what changes will occur in her body to enable her to deliver... read more , the doctor or nurse gently clears mucus and other material from the mouth, nose, and throat with a suction bulb. The newborn is then able to take a breath. Two clamps are placed on the newborn's umbilical cord, side by side, and the umbilical cord is then cut between the clamps. The newborn is dried and laid carefully on the mother's abdomen with skin-to-skin contact or on a sterile, warm blanket. Not all deliveries follow a standard pattern. For example, some women need to have a cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery of a baby by incision through a woman’s abdomen and uterus. In the United States, up to 30% of deliveries are cesarean. Doctors use a cesarean delivery... read more

Keeping the newborn warm is critical. As soon as possible, the newborn is wrapped in lightweight clothing (swaddled), and the head is covered to reduce the loss of body heat. A few drops of an antibiotic, such as erythromycin, tetracycline, or silver nitrate or, in some countries, povidone iodine, are placed into the eyes to prevent infection from any harmful organisms that the newborn may have had contact with during delivery.

Immediately after a normal birth, the parents are encouraged to hold their newborn. Some experts believe that early physical contact with the newborn helps establish bonding. However, parents can bond well with their newborn even when the first hours are not spent together. The mother and newborn usually recover together in the delivery room. If the delivery is in a birth center, the mother, father or mother's partner, and newborn remain together in the same room. Mothers who are breastfeeding put their newborn to their breast within the first 30 minutes after delivery. Breastfeeding stimulates oxytocin, a hormone that helps the mother's womb to heal and promotes development of the milk supply. Once transported to the nursery, newborns are placed on their back in a small crib and kept warm. Because all babies are born with low levels of vitamin K, a doctor or nurse gives an injection of vitamin K to prevent bleeding (hemorrhagic disease of the newborn).

About 6 hours or more after birth, newborns are bathed. The nurse tries not to wash off the whitish greasy material (vernix caseosa) that covers most of the newborn's skin because this material helps protect against infection.

Most women have a healthy, safe and uncomplicated recovery after having a baby in hospital or at home. The first few days are a time for resting, looking after yourself and learning about your baby.

First hours after birth

Soon after your baby is delivered, your healthcare team will be busy with a number of tasks. These include:

• performing an Apgar assessment (this evaluates your baby’s heart rate, breathing, muscle tone, reflex response and colour, and provides an ‘Apgar score’ which describes your baby’s condition after birth)
• putting on tags to identify your baby
• clamping the umbilical cord
• weighing your baby
• keeping your baby warm.

Vaginal birth

With an uncomplicated vaginal birth, the placenta will usually pass shortly after the baby has been delivered. You can have an injection to speed up the delivery of the placenta. Sometimes your doctor may need to repair a tear or surgical cut (episiotomy) between the vagina and the anus with stitching under local anaesthetic.

Caesarean section

A Caesarean section is a procedure to deliver a baby by a surgical operation. If you have had a caesarean section, you will probably have some time with your baby before you are taken to the recovery room. Within a few hours, you will be moved to the maternity ward. You will be hooked up to an intravenous drip to stay hydrated, and to a catheter for urination.

For more information see the Caesarean section fact sheet.

Home birth

If you give birth at home, your midwife will stay with you until they are confident that you and your baby are stable. They will help you start breastfeeding and talk to you about support over the next six weeks.

For more information see the Homebirth fact sheet.

Complications and special care

Sometimes during labour and birth there are complications that mean that you or your baby will need more attention or intervention. In some situations, your baby may need to be transferred to a higher level of care – to the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) at hospital. Premature babies often need to stay longer at hospital.

After the physical and emotional challenges of a difficult birth, this can be a stressful time. Your healthcare team will keep you and your birth partner informed and up-to-date.

For more information see the Premature babies and the Specialised care for your baby fact sheets.

Skin-on-skin time is very comforting for your newborn. Your newborn baby will be placed on your belly straight after an uncomplicated vaginal delivery.

Newborns tend to be very alert after birth and will often seek out the breast by themselves. Breastfeeding within the first hour or so has many benefits because you are giving your baby a liquid rich in antibodies, called ‘colostrum’. But if skin contact and breastfeeding cannot happen straight away, there is time later to establish these bonds.

If you had a caesarean section, you can usually hold your baby in the operating room straight after birth. You will be given the opportunity to breastfeed as soon as possible after the operation. This may happen when you are being stitched up, in the recovery room or the maternity ward. For partners, the time apart while you recover from surgery is a special time for them to hold the baby and bond.

Healthcare teams at hospital and home

If you are in hospital, a doctor will come by the maternity ward to check on your recovery. Nurses will also regularly visit and provide advice on looking after yourself over the next few weeks, including:

• urination and bowel movements
• emotional health
• perineal care (care of the area of skin and muscle between your vagina and your anus)
• breast care
• fatigue
• head or back aches
• pain relief
• contraception.

A paediatrician (a doctor who specialises in treating children) will check your baby and let you know about any follow-up appointments that you need to book.

If you had a home birth, your midwife will visit regularly at first to check on your health and help with any questions. After that, they will organise follow-up visits that suit your needs.

Physical recovery after birth

Your body will start adjusting quickly after birth. Your doctor or midwife will talk to you about what is normal and when to ask for help. Each pregnancy and birth will be different, but there are some common changes that happen to your body after the baby is born.

Bleeding

Vaginal discharge, called lochia, is normal in the first days after giving birth. This tissue and blood from the uterus will be heavy and bright red to start and then become lighter in flow and colour. It will stop after a few weeks.

To manage this heavy bleeding it is best to use maternity sanitary pads. As the bleeding slows you will be able to use regular sanitary pads. Avoid using tampons for up to six weeks after birth as this can increase the likelihood of infection.

Cramps

Cramping is also a common symptom as your uterus contracts down to its normal size. Cramps can be more noticeable when your baby is breastfeeding.

Swelling

Swelling in the legs and feet can happen in some cases. Keeping your feet elevated can help.

Bowel motion and urination

Your first bowel movement may be a few days after delivery, especially after a caesarean section. Some women have haemorrhoids, sore muscles or an episiotomy that will make going to the toilet painful. Constipation can happen. Drinking plenty of water and eating fresh fruit and vegetables will help.

After pregnancy and birth, the muscles in your urinary tract are stretched. You may find some incontinence when you cough, laugh or strain, especially if there was a lengthy labour.

Sore breasts

Your breasts and nipples will be full and sometimes sore as the milk comes in three to six days after your baby arrives. Your midwife will show you how to self-express to relieve some of the tenderness and encourage milk supply.

Caesarean section recovery and wound care

If you had a caesarean section, you have had major abdominal surgery. It will take time for your body to recover and you will be given strong pain relief for the first few days. Your stitches will need dressings changed and monitoring for infection.

If you had a vaginal birth, sitting down can be uncomfortable, especially if you have stitches. Your doctor or midwife will advise you on remedies, pain relief and care of the wound.

Hospital staff will let you know when and how stitches need to be removed.

Emotional recovery after birth

It is normal to feel a rollercoaster of emotions after giving birth. There is often a dip in mood around the third or fourth day after your baby arrives, also known as the ‘baby blues’. These feelings are very common and can be due to changes in hormone levels, breastfeeding, lack of sleep and fatigue. They usually go away in the first few weeks after giving birth.

If you keep feeling anxious or depressed, make sure you get professional advice and the help that you need. Postnatal depression is common and treatable with the right support.

For more information see the Postnatal depression fact sheet.

Feeding your baby

Breastfeeding is best for newborn health. Premature babies or babies with special health needs often require extra support, for example expressing milk or formula feeding. Your midwife and doctor will talk through your options if breastfeeding is not possible.

It can be a challenge to breastfeed in the early days as you and your baby both get used to something new. Your baby may seem unsettled on day two or three while your colostrum changes to mature milk. It is normal for a newborn to feed every two hours, which will mean disrupted nights, even with help from nurses at hospital.

Advice on position and attachment can really make a difference when you are starting to breastfeed. As well as tips from midwives and breastfeeding support groups, private lactation consultants can help with breastfeeding problems.

If you need to bottle feed, you will be shown how to make up the feed, clean and sterilise bottles and teats, and store the expressed milk or formula.

Safe sleeping for your baby

Your midwife and maternal child health nurse will give you information on how to create a safe sleeping environment for your baby. There are a number of simple steps that will help minimise the rare but potential risk of sudden unexpected death in infancy (SUDI), including Sudden Infant Death Syndrome (SIDS).

If you want your baby to share your bed in hospital or at home, let your midwife know so they can help with safety advice.

For more information see the Sudden unexpected death in infants (SUDI and SIDS) fact sheet.

Newborn care

It is natural to be nervous when looking after a small baby. Hospital nurses or a midwife will take you through daily care to prepare you for going home, including:

• cues from your newborn when they are hungry or tired
• bathing safely
• skin care
• holding a newborn
• dressing for the weather
• putting on a nappy
• weight loss and gain
• feeding and sleeping patterns
• umbilical cord care
• managing common health concerns such as jaundice, skin rashes, and changes in urine or bowel movements.

Health records and birth paperwork

Before you leave hospital, the following documents will be provided to you and explained:

• My Health and Development Record child health record and guide to parenthood and child health for the first five years
• Parent Pack resource kit with information on community services and programs
• Family Assistance application forms
• Medicare application forms
• birth registration forms.

Tests, checks and vaccinations for newborns

Your midwife or doctor will talk to you about the following tests, screens or vaccinations for your baby. These are done before you leave hospital or in the first week:

• newborn physical exam – an initial physical exam is done soon after birth to detect significant abnormalities, birth injuries or cardio-respiratory disorders; a more thorough exam is done during the hospital stay, usually more than 24 hours after birth
• hepatitis B vaccination to start long-term protection against this disease – best given within 24 hours after birth
• vitamin K injection or oral dose to help blood clotting and prevent serious bleeding – this is best given within a few hours after birth
• universal newborn hearing screening (UNHS) to detect permanent hearing impairment (PHI) – should be done within the first week
• newborn screening test or ‘heel prick’ to screen for rare genetic conditions such as phenylketonuria, hypothyroidism and cystic fibrosis – usually done between 48 and 72 hours after birth.

For more information see the Tests, scans and checks for newborns fact sheet.

Leaving hospital after birth

You are ready to leave hospital when you (and your baby) are medically fit, can confidently feed your baby and have enough home support in place. Make sure you car is fitted with an appropriate child restraint.

Some women choose to go home as early as six hours after birth. Others choose to spend a day or two in a maternity ward. If you decide to stay, let hospital staff know when you would like to go home. There are a number of things that need to be planned and organised before the morning of your discharge.

If your labour or birth was assisted, you will stay longer at hospital. After a caesarean section, women usually stay two to five days in hospital.

For more information see the Hospital birth fact sheet.

Home and community support

Your midwife will be able to tell you about healthcare support services that you can access when you get home. For example:

• home-based postnatal care visit
• breastfeeding support
• lactation consultants
• physiotherapists
• maternal and child health services
• where to go for your six week check-up
• mental health and postnatal depression support.

Most hospitals will offer a home-based postnatal care visit from a midwife within the first week of being at home with your new baby. The midwife will check:

• how you are coping
• how you are managing with breastfeeding
• how your wound is healing (if you have one)
• that your uterus is contracting well – this is checked by examining your tummy
• your baby’s health and weight.

When to call for help

Parenting helplines, your GP or your maternal and child health nurse can help if you have questions about your baby or your own health during the first few days at home.

For telephone support and information, call:

• ParentLine telephone helpline on 13 22 89 (8 am to midnight, seven days a week)
• Maternal and Child Health (MCH) Line on 13 22 29 (24 hours per day, seven days a week).

Where to get help