**Neonatal Care in the First Hour of Life**

**Neonatal Care in the First Hour of Life**

#### Teja Škodič Zakšek, Anita Jug Došler, Ana Polona Mivšek and Petra Petročnik Ana Polona Mivšek and Petra Petročnik Additional information is available at the end of the chapter

Teja Škodič Zakšek, Anita Jug Došler,

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69600

#### **Abstract**

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00000000592

8 Selected Topics in Neonatal Care

journal.pone.0116255

The very first hour in a baby's life can have a significant—lifelong—impact on the health of the baby and on the bond between the mother and a baby. Keeping mothers and babies together is a safe and healthy birth practice. Childbirth and the first hour after birth is a time of many changes for both mother and child. Changes are also physiological, as well as psychological. Creating an optimal environment for birth boosts the right hormones for natural birth, which reduces the need for interventions that could cause early mother-baby separation. One of the major challenges in the birth hospital is how best to combine a midwifery care and those medical procedures that are not necessary, to right form the birth as a family intimate and privacy event, if, of course, the child and maternal health would allow this. The first hour after birth is a once-in-a-lifetime occasion for both the baby and the parents, a unique experience, and once lost, it can never be relived.

DOI: 10.5772/intechopen.69600

**Keywords:** newborn, transition, golden hour, breastfeeding, skin-to-skin contact

#### **1. Introduction**

The transition to extrauterine life is a remarkable physiological event that involves a series of modifications that depend on the degree of maturation in late gestation, the process of delivery itself and establishment of independent physiological processes for regulating homeostasis after placenta lost its function. These processes are establishment for respiration, change from parallel to serial circulation, oral feeding, thermoregulation and glucose homeostasis [1]. Respiratory and cardiovascular changes occur simultaneously and are mutually dependent. The triggers of initial first breath are complex and not fully understood yet. Many factors play role in the initiation of breathing, and some of them derive already during the birthing process [2].

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

We must admit that these are great and demanding changes that need to occur in a short period. However, it is not the purpose of this chapter to describe the processes that occur in the body of the newborn. The main purpose is to remind the readers how to support these natural processes and not disturb them with unnecessary interventions.

to the postpartum ward [7]. As Gunn et al. [8, p. 765] acknowledge 'in a situation where both, mother and a child are healthy and well, any actions on the part of the midwife should be made unobtrusively and with fully informed consent of the parents.' More importance should be given to the establishment of mother-infant bond, since contact with mother and baby in the hours after the birth not only fosters attachment, but at the same time fosters child's

Neonatal Care in the First Hour of Life http://dx.doi.org/10.5772/intechopen.69600 11

**2. Keeping mothers and babies together beyond the moment of birth**

The first hour after birth, it is extremely sensitive and important for the stabilization of vital functions (breathing, saturation, blood pressure, thermoregulation, blood sugar stability, the newborn must establish pulmonary and cardiac function, etc.) in both mother and child, as well as the process of attachment between them and father. That is why the first hour after

Family bonding and baby's first breastfeed is very important act after delivery. If mother or baby needs some help or medical advice during first breastfeed, then medical staff should help them at this essential time of birth, for both vaginal and cesarean births. If the mother has general anesthesia, we can put a newborn immediately after birth on father's chest. This increases the effectiveness of breastfeeding, the process of attachment between mother and

At the moment of birth time, a mother needs a quiet, dim lighting, warmth and calm environment. She is still in labor. Her uterus needs to contract down. With smooth first hour after birth and mother's skin-to-skin contact to a newborn, we allow the newborn to pass through nine instinctive phases in their behavior. These phases are innate and naturally given to every

**Phase Naming Baby's instinctive behaviors—explanation** 1 Crying during the birth Because of lungs expansion, baby starts crying

5 Baby's rest Phase without baby's activities

9 Baby's sleeping Baby's restful sleep

6 Baby's crawling Baby's recognizing the breast and nipple

8 Sucking nipples Baby is attached and is sucking the nipples

**Table 1.** Baby's instinctive behaviors during bonding and 'skin-to-skin care' after delivery.

2 Relaxation Baby shows relasxed hands without mouth movements

4 Baby' activity Baby shows mouthing, suckling and way of movements

3 Awakening Baby shows some movements with hands, heads and shoulders

7 Recognizing with familiarization Baby familiarizes the nipple and breast. He also licks, touches and massages it

development [8].

newborn (**Table 1**).

birth some call the golden hour [9].

child, and reduces stress in their child [10].

When we speak of mature healthy newborn, midwives have to be alert to observe possible complications; however, the newborn in this case does not need any special interventions. On the contrary, the most precious ingredient for the baby in this immediate postpartum period is time. Midwife has to permit natural processes to occur spontaneously and not force them.

The smooth physiological transition can be promoted already by enabling natural processes of the first and second stages of labor; however, we can claim that physiological third stage is even more directly connected to the newborn. Expectant (physiological) third stage of labor is connected to many advantages; because of the delayed cord clamping, baby gets more red blood cells and hematopoietic stem cells and 30% of additional blood volume that is important for respiratory function. At birth, this blood moves into the infant's lung; the cardiac output to the lung changes from 8–10% in utero to 45% in the immediate newborn period and demands an increased blood volume. An adequate red cell volume is necessary for oxygen delivery and consequently effective tissue functioning, normal pH and circulator integrity.

Right after the birth, remarkable changes in respiration and circulation are occurring in the newborn body. Therefore, midwife has to give the baby time for these adjustments. First minute after the birth of the baby, midwife has to observe and wait, and not overstimulate the baby and manipulate with him/her in order to provide the preconditions for these major and dramatical physiological changes. The decision for procedures of stabilization are suggested to be done after the 1st minute Apgar estimation.

When there is no need for resuscitation, the best place for the baby is by her mother. Separating mother and baby can have harmful effect on breastfeeding and their relationship [3]. Skin-to-skin prevents heat loss. Ludington-Hoe et al. [4] confirmed that mother and baby can synchronize body temperatures, when skin-to-skin is practiced; the energy saved can be used to stabilize heart and respiration rates. With kangaroo method also the initiation of breastfeeding is eased. Evidence suggests that the baby, when undisturbed, usually takes about 45–55 min to find the way to its mother's breast, using the primal reflexes [5]. With the birth environment that provides warmth, safety and intimacy, the baby is able to make essential physiological adaptations. Midwives need to follow these physiological transitional processes.

World Health Organization and United Nations Children's Fund [6] say that all mothers and babies should be kept together after the birth and should be encouraged to practice skin-to-skin in the first hour after delivery, even if mothers do not intend to breastfeed. This opportunity should be offered to all, also mothers and babies after cesarean section or vacuum extraction.

World Health Organization and United Nations Children's Fund [6] recommended that all healthy mothers and babies, regardless of feeding preference and method of birth, have uninterrupted skin-to-skin care beginning immediately after birth for at least an hour, and until after the first feeding. All other procedures of initial newborn care can wait until the end of the fourth stage of labor (3 h after the birth), when the woman and the baby are to be discharged to the postpartum ward [7]. As Gunn et al. [8, p. 765] acknowledge 'in a situation where both, mother and a child are healthy and well, any actions on the part of the midwife should be made unobtrusively and with fully informed consent of the parents.' More importance should be given to the establishment of mother-infant bond, since contact with mother and baby in the hours after the birth not only fosters attachment, but at the same time fosters child's development [8].

We must admit that these are great and demanding changes that need to occur in a short period. However, it is not the purpose of this chapter to describe the processes that occur in the body of the newborn. The main purpose is to remind the readers how to support these

When we speak of mature healthy newborn, midwives have to be alert to observe possible complications; however, the newborn in this case does not need any special interventions. On the contrary, the most precious ingredient for the baby in this immediate postpartum period is time. Midwife has to permit natural processes to occur spontaneously and not force them. The smooth physiological transition can be promoted already by enabling natural processes of the first and second stages of labor; however, we can claim that physiological third stage is even more directly connected to the newborn. Expectant (physiological) third stage of labor is connected to many advantages; because of the delayed cord clamping, baby gets more red blood cells and hematopoietic stem cells and 30% of additional blood volume that is important for respiratory function. At birth, this blood moves into the infant's lung; the cardiac output to the lung changes from 8–10% in utero to 45% in the immediate newborn period and demands an increased blood volume. An adequate red cell volume is necessary for oxygen delivery and consequently effective tissue functioning, normal pH and circulator integrity.

Right after the birth, remarkable changes in respiration and circulation are occurring in the newborn body. Therefore, midwife has to give the baby time for these adjustments. First minute after the birth of the baby, midwife has to observe and wait, and not overstimulate the baby and manipulate with him/her in order to provide the preconditions for these major and dramatical physiological changes. The decision for procedures of stabilization are suggested to be done after

When there is no need for resuscitation, the best place for the baby is by her mother. Separating mother and baby can have harmful effect on breastfeeding and their relationship [3]. Skin-to-skin prevents heat loss. Ludington-Hoe et al. [4] confirmed that mother and baby can synchronize body temperatures, when skin-to-skin is practiced; the energy saved can be used to stabilize heart and respiration rates. With kangaroo method also the initiation of breastfeeding is eased. Evidence suggests that the baby, when undisturbed, usually takes about 45–55 min to find the way to its mother's breast, using the primal reflexes [5]. With the birth environment that provides warmth, safety and intimacy, the baby is able to make essential physiological adaptations.

World Health Organization and United Nations Children's Fund [6] say that all mothers and babies should be kept together after the birth and should be encouraged to practice skin-to-skin in the first hour after delivery, even if mothers do not intend to breastfeed. This opportunity should be offered to all, also mothers and babies after cesarean section or vacuum extraction. World Health Organization and United Nations Children's Fund [6] recommended that all healthy mothers and babies, regardless of feeding preference and method of birth, have uninterrupted skin-to-skin care beginning immediately after birth for at least an hour, and until after the first feeding. All other procedures of initial newborn care can wait until the end of the fourth stage of labor (3 h after the birth), when the woman and the baby are to be discharged

Midwives need to follow these physiological transitional processes.

natural processes and not disturb them with unnecessary interventions.

the 1st minute Apgar estimation.

10 Selected Topics in Neonatal Care
