This blog is meant to create awareness about all the right things to be done during day 1 and 2 (unarguably the most important days in every baby’s life)
Day 0: Before the adventure:
- Know how to read the monitor: The pulse oximeter is the most commonly used monitoring device on the baby after birth.
- You can request the hospital staff to show you a pulse oximeter so that you are aware of what to look at when your baby comes into this world. It can contribute in reducing your stress as you are able to read the numbers. And, in case your baby needs resuscitation, you can very well absorb the inputs given by the pediatrician. It is important to know that a newborn can take up to 10 minutes to reach to a saturation level of 95%. Until then, if she is crying and moving her limbs, she is transitioning well.
- Normal heart rate on CTG (fetal heart rate monitor) : Normal fetal heart rate is 120-160/ min. It is influenced by a number of factors. However, a heart rate of less than 120/min or more than 160/min if sustained, is abnormal. So, when you are waiting for the labor to progress, any such change in FHR (fetal heart rate) should be immediately addressed by your caregiver.
- Request to keep delivery room temperature at 23-25 deg C: Modern day hospitals are usually fully air-conditioned. The room temperature in all labor rooms can be controlled in almost every set-up. As delivery is a tiring process, mum may perspirate. The hospital staff would be wearing drapes, which will increase their perspiration too. It applies both during normal delivery and C-section. But it is so important to remember that your baby comes out naked and wet. Therefore, a room temperature of at least 23-25 degrees is optimal for caring your baby after birth.
- Make sure that a Pediatrician or Neonatologist is attending the delivery: It is critical that personnel with neonatal resuscitation skills be available for every birth.
Aside from the healthcare professional responsible for the birth (i.e., the physician or midwife), a second healthcare professional should be present whose primary responsibility is the baby and is capable of performing the initial steps of neonatal resuscitation, including effective ventilation and chest compressions. If this person cannot perform more extensive resuscitation (endotracheal intubation and administering medications), additional personnel with these skills should be available in the facility to assist immediately when called.
- Day 1:
- Delayed cord clamping: The world health organization (WHO) recommends late cord clamping at 1-3 minutes after birth. It should be done for all births while initiating simultaneous essential newborn care. It increases iron levels by providing extra red blood cells. This ultimately leads to 50% reduced risk of anemia at 6 months of age in your child. There is a transfer of extra stem cells and white blood cells which provide immunity.
- Cried well/required help?: 10% babies require help at birth. The single most important determinant of baby’s condition is the heart rate. Any baby with a heart rate <100/min needs help. If the heart rate is <60, it is an emergency.
- Color( pale/ blue): Any skin color other than pink is abnormal. The skin color is also dependent on the race and ethnicity of the baby.
- APGAR: The Apgar score is a scoring system that assesses new born babies’ well-being using five different factors: heart rate, breathing, muscle tone, reflexes, and skin colour. Your new born baby will go through a number of assessments when they are first born, to make sure that they are in good health. Their first assessments, called the Apgar score, occur when they are just one minute and five minutes old.
- Weight, Gender: Make sure to make a note of these important things about your baby.
- Skin to skin contact: Skin-to-skin means your baby is placed belly-down, directly on your chest, right after birth. Your care provider dries your baby off, puts a hat on him or her, covers him or her with a warm blanket, and gets your baby settled on your chest. The first hours of snuggling skin-to-skin let you and your baby get to know each other. They also have important health benefits
• Calms and relaxes both mother and baby
• Regulates the baby’s heart rate and breathing, helping them to better adapt to life outside the womb
• Stimulates digestion and an interest in feeding
• Regulates temperature
• Enables colonisation of the baby’s skin with the mother’s friendly bacteria, thus providing protection against infection
• Stimulates the release of hormones to support breastfeeding.
- First breast feed: Should ideally be done within 1 hour of birth. Skin to skin contact provides plenty of opportunities for the little one to breast feed.
- Detailed examination: after skin to skin time
• How many arteries in Umbilical Cord? : The umbilical cord contains two umbilical arteries and one vein. Sometimes there is a single umbilical artery and recognized associations are found in 25-40% of cases with maternal and fetal implications. There is an increase in the incidence of congenital anomalies in such babies. Single umbilical artery can be diagnosed in antenatal scans, but if missed, examination at birth is the only chance to identify it.
• Vitamin K injection: prevents hemorrhagic disease of newborn
• Anal opening: The incidence of imperforate anus or anal atresia is 1 in 5000 live births. This disorder is frequently associated with other congenital anomalies such as VACTERL sequence (vertebral anomalies, anal atresia, cardiac malformations, tracheoesophageal fistula, esophageal atresia, renal anomalies and radial aplasia, and limb anomalies). An unidentified anal atresia usually results in disastrous outcomes for the baby.
• Swelling over scalp: The very process of birth causes accumulation of fluid and blood over various layers of scalp. The collection of fluid under the scalp skin is called as caput succedaneum and usually resolves in a week. But the collection of blood under the periosteum (the covering of scalp bones) is called as cephalhematoma and it takes 6-8 weeks to resolve. A traumatic delivery may result in a large collection of blood over scalp known as sub galeal hemorrhage; and this could lead to a low blood pressure and make your baby very sick. For both cephalhematoma and sub galeal hemorrhage, make sure to ask for a pain reducing medicine for your baby and get her bilirubin level checked before discharge.
• Molding: To facilitate delivery, baby’s head may undergo change in shape with the help of its mobile skull bones. The normal shape of head is usually restored within 48-72 hours of life.
• Bruise on face: Use of forceps during delivery can result in bruising over the area of contact. This is usually self-resolving and requires no intervention.
• Naso Gastric tube passes well? : A slender soft tube is usually passed through the baby’s nose into the stomach to ensure the patency all through. In conditions like choanal atresia wherein the baby’s internal nares fail to develop, the ng tube cannot be passed through the affected nostril. The tube may coil on itself if there is an underdeveloped food pipe- the most common defect of the esophagus in newborn. Early detection of these anomalies result in early referral for corrective procedures.
All the actions listed above is supposed to be performed by your caregiver. You can refer to this list to make sure that your baby has been thoroughly screened and manged well. I strongly believe that every baby has a right to quality health care. If unfortunately, it is not provided, being a parent you have the right to obtain it. Awareness to simple things leads to major changes in the neonatal outcome.
The part 2 of this blog will discuss about the important things which should not be missed on day 2 of life.