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Post partum

Your baby after delivery

Going from the womb to the outside world is a challenging journey for both mother and baby. Both undergo a variety of physical changes that make this transition possible. The most important adaptation, as well as the most sophisticated, is the baby’s transition to breathing air. In order to accomplish this, the baby must undergo changes in circulation, heart anatomy, lung function, and hemoglobin structure.

In order to breathe air, the circulatory system must start delivering a great deal of blood to the lungs. The increased blood to the lungs means that less blood is sent to the rest of the body. This disproportionate need for blood in the lungs stresses the heart to pump harder. As this happens, other changes are taking place in the heart. Two small openings in the newborn heart, the foramen ovale and the ductus arteriosus, begin to close. This closing completes during the first few days of life.

Appearance

Immediately after birth, your newborn may look wrinkled and red. Their skin often peels after birth because it has been surrounded by fluid in your uterus. You may see a white-yellow coating on the skin -- especially in skin folds such as the armpits, groin and around the neck. This is called vernix. The hands and feet may appear blue or dusky, as their circulation is not as good at getting blood to their extremities yet. Another common skin appearance is milia, which are white spots that look like pimples. Milia are often found on and around the nose. They disappear after a couple of weeks. Your newborn may be covered with downy hair or lanugo on the back, ears and forehead. This serves to protect the skin while growing in the uterus, but it gradually falls out in the weeks following birth.

A newborn’s head will appear larger than the rest of their body. This is normal for newborn development. There are also soft spots on the infant’s head located in the back and on the top. A newborn’s skull is soft to allow it to be flexible and overlap while passing through the birth canal. The head often looks misshapen, even cone-like, immediately after vaginal delivery. With normal growth, protective plates of skull bone will cover the soft spots (fontanels) and the cone-like appearance will subside.

Infant eye color may appear dark blue or brown. For many babies, the eye color will change and often the true eye color is not known for several months following birth.

APGAR score

Designed by Dr. Virginia Apgar, the APGAR score is used to determine the basic well being of the newborn at one minute and five minutes after birth. It measures five areas and scores them from 0-2 for a possible high score of 10. The letters of APGAR are used as an abbreviation to remember the five areas : Appearance, Pulse, Grimace, Activity, and Respiration.

Appearance looks at the color of the infant. The most desirable color is completely pink from head to toe, which scores two points for appearance.

Pulse is scored similarly. A pulse over 100 beats per minute gets the highest score of two points here, as well.

Grimace is a measure of reflexes when stimulated by a catheter (or tube) placed in the nostril. A facial grimace gets one point, while a cough or sneeze gets two points.

Activity is a measure of muscle tone. If there is some extension of the arms of legs, it earns one point, while an active moving baby gets two points

Respiratory effort is measured according to how fast and regular your baby is breathing. This is where crying scores well – getting two points for active and regular respiration.

Overall, an APGAR score of 7-10 indicates a very healthy baby. If the score is lower, interventions such as giving oxygen or medication may be used to help the baby along.

Hormonal Changes - maternal hormones are passed through the placenta to the baby. Newborns show hormonal signs on their breasts. Both sexes will have swollen breasts after delivery. A male may have swollen scrotum, and a female infant may have a slight bloody vaginal discharge. These symptoms are normal and will go away in a few days.

Male Genitalia: The foreskin is the skin that covers the glans (tip) of the penis. There is an outer and inner layer of foreskin. Foreskin acts as a protective cover to the glans. On a circumcised male, this outer foreskin is cut. In an uncircumcised male, the inner foreskin is fused to the glans. Over the course of years, the inner layer of the foreskin separates from the glans. Routine cleaning of an uncircumcised penis involves gentle cleaning with soap and water. Do not pull back on the foreskin, as it will cause skin separation, bleeding and risk of infection.

Medication and Testing

Another routine procedure following birth involves prophylactic (preventive) treatment of the newborn’s eyes for gonorrhea infection. Erythromycin antibiotic or silver nitrate ointment is placed in the eyes to kill any bacteria that might not have been removed prior to delivery. This is done to prevent possible blindness due to gonorrhea infection of the eye. Another medication given to the newborn is an injection of vitamin K to help with blood clotting. If gestational diabetes had been a problem during pregnancy the newborn might have his or her blood sugar level tested with a quick heel stick. If Rh-incompatibility is a concern, blood type may be checked at this time as well.

Warming

The newborn enters the world approximately half a degree warmer than the temperature in the uterus. This heat is quickly goes away if the newborn is not kept warm. Shortly after birth the baby will be dried off with a towel. Soon thereafter he or she will have a knit cap placed on his or her head to prevent heat loss. The baby will be placed in a warmer during the pediatric examination to maintain his or her temperature. When the exam is complete, you will be able to hold your baby. One of the best places for a baby to be is against your skin. Skin to skin contact with your baby is a great way to keep your baby’s temperature up and for you to get to know each other. Full-term babies can shiver to keep their body temperature up but this is not true for premature babies who need even more help staying warm. You or your birth partner can provide skin to skin contact for your baby. Your particular clinician will work with you and your partner on the process best for your delivery.

After 48 hours all babies are tested for phenylketonuria (PKU) and other metabolic disorders that all state departments of health require. PKU is a genetic disease that affects protein metabolism. In this disease the enzyme that converts phenylalanine to tyrosine is absent or not adequate. If not treated, children can develop mental retardation and seizures. This can be partially prevented by a special diet that is low in phenylalanine. Because the effects of this disease are so serious, all babies are screened for it at birth so that the proper diet can be started right away.

Excretion

Stool: The first stools your baby produces look dark green to black and are very sticky like tar. This is called meconium.

Urine: Your newborn’s first urine will be dark amber. A newborn should have at least one wet diaper in the first 24 hours. Once your baby begins frequent feedings you should see about 6-8 wet diapers within the first week of life.