**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 birth some call the golden hour [9].

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

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 newborn (**Table 1**).


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

The first stage is the birth cry. This distinctive cry occurs immediately after birth as the baby's lungs expand. The second stage is the relaxation stage. During the relaxation stage, the newborn exhibits no mouth movements and the hands are relaxed. This stage usually begins when the birth cry has stopped. The baby is skin-to-skin with the mother and covered with a warm, dry towel or blanket. The third stage is the awakening stage. During this stage, the newborn exhibits small thrusts of movement in the head and shoulders. This stage usually begins about a few minutes after birth. The newborn in the awakening stage may exhibit head movements, open his eyes, show some mouth activity and might move his shoulders. The fourth stage is the activity stage. The newborn begins to make increased mouthing and sucking movements as the rooting reflex becomes more obvious. This stage usually begins about 8 min after birth. At any stage of the phase, the baby may rest. He may have periods of resting between periods of activity throughout the first hour or so after birth. The sixth stage is the crawling stage. The baby approaches the breast during this stage with short periods of action that result in reaching the breast and nipple. This stage usually begins about 35 min after birth. The seventh stage is called familiarization. During this stage, the newborn becomes acquainted with the mother by licking the nipple and touching and massaging her breast. This stage usually begins around 45 minutes after birth and could last for 20 minutes or more. The eighth stage is suckling. During this stage, the newborn takes the nipple, selfattaches and suckles. This early experience of learning to breastfeed usually begins about an hour after birth. It may take more time with skin-to-skin for the baby to complete the stages and begin suckling, especially for mothers who gave birth by cesarean section. The final stage is sleep. The baby and sometimes the mother fall into a restful sleep. Babies usually fall asleep about 1½–2 h after birth [11].

two months of a child's life. Oxytocin receptors in a woman's brain increase during pregnancy. When baby is born, mother is more responsive to this hormone that promotes maternal behavior. Oxytocin is produced in large amounts when breastfeeding and holding babies are close skin-to-skin. Initial attachment has a positive effect on the formation of self-esteem of both parents, because the parents more quickly identify the child's needs and can respond on it. From the child's perspective, the separation from his mother is life-threatening. Keeping mothers and babies together beyond the moment of birth protects the child against the negative consequences of segregation. The frequency of crying and the quantity of stress hormones are lower if child is in skin contact with his mother. In this way, the mother's body heat is also transmitted to the newborn, who is better able to regulate self body temperature and respiration [15]. Skin-to-skin contact heightens response, stimulates behaviors that help to meet the newborn's basic biological needs, activates neuroprotective mechanisms and enables early neurobehavioral self-regulation. Skin-to-skin care reduced maternal physiologic stress and depressive feelings after hospital discharge, which may help to empower women in their role as mothers [16].

Neonatal Care in the First Hour of Life http://dx.doi.org/10.5772/intechopen.69600 13

Blackburn [17] sees hormones as a chemical messengers which either in the body fluids or in blood excert a physiological effect on other cells in other places in the body. The hormones interplay in labor and birth is often compared to an orchestra where every instrument knows exactly how to play perfect notes to create a beautiful melody. If the melody is played well, it sets the stage also in a more immediate way for the postpartum process for both the mother and her baby, because all the different hormones released by mother and fetus during the first

One of such hormones is already mentioned oxytocin, which is relatively well studied in relationship to behaviors after birth [18] but still not fully understood [19]. As Phillips [18] notices, it has been shown to increase relaxation, attraction, facial recognition and maternal care-giving behaviors which are all necessary to ensure infant survival. Odent [19] recognizes that oxytocin is never released in isolation. It is always part of a complex hormonal balance in our metaphor part of an orchestra. That means that in the hour following birth, in physiological conditions, the high peak of oxytocin is associated with a high level of prolactin, which is also known as the 'motherhood hormone.' It is known to affect mothering behavior in animals. In humans, oxytocin induces a state of calm and reduces stress [20]. Love and affection between the mother and a child is enhanced, and bonding is optimal. These pleasant moments stimulate the secretion of oxytocin, and also prolactin, and skin-to-skin contact between mother and baby after delivery helps both breastfeeding and emotional bonding [6]. Odent [9] sees this as the most typical situation for inducing love of babies. Oxytocin and prolactin complement each other and are released in response to stimulation by the baby's sucking at the breast. When a baby suckles at the breast, sensory impulses pass from the nipple to the brain. In response, the anterior lobe of the pituitary gland secretes prolactin and the posterior lobe secretes oxytocin [21]. If a mother is in severe pain or emotionally upset, the oxytocin reflex may become inhibited, and her milk may suddenly stop flowing well. In

and second stages of labor are not yet eliminated during the hour following birth.

**3. Behavioral hormonal effects**

Continuous skin contact between newborn and mother should not affect on the work of the professional staff in the birth hospital. For example, procedures as it is control postpartum bleeding or disruption of the umbilical cord should be carried out without separation of the mother and newborn. If the birth was spontaneous and the child is not under the influences of medicines, keeping mother and newborn together beyond the moment of birth enables the child to be in a state of openness and vigilance and the most susceptible to the first impressions of the outside world. In the opinion of many eminent scientists of the child to design a basic response patterns, intimacy and sociality, which are matrix for all life [9, 12], 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 [9, 11, 13]. Preventing separation except for compelling medical indications is an essential safe and healthy birth practice and an ethical responsibility of health-care professionals [14].

During the first hour after birth, many of hormones are releasing: dopamine, oxytocin, prolactin and estrogen. All these hormones initiate maternal instincts. Skin-to-skin contact allows that the mother and child are more relaxed and connected to each other. Whatever promotes the attachment between mother and child: touching, dermal contact, frequent eye contact and so on also promotes the development of a child's brain. Skin contact activates the amygdala, which is a part of the limbic system in the brain that regulates emotional learning, memory processing and detection appetite. This part of the brain is the most developed in just the first two months of a child's life. Oxytocin receptors in a woman's brain increase during pregnancy. When baby is born, mother is more responsive to this hormone that promotes maternal behavior. Oxytocin is produced in large amounts when breastfeeding and holding babies are close skin-to-skin. Initial attachment has a positive effect on the formation of self-esteem of both parents, because the parents more quickly identify the child's needs and can respond on it. From the child's perspective, the separation from his mother is life-threatening. Keeping mothers and babies together beyond the moment of birth protects the child against the negative consequences of segregation. The frequency of crying and the quantity of stress hormones are lower if child is in skin contact with his mother. In this way, the mother's body heat is also transmitted to the newborn, who is better able to regulate self body temperature and respiration [15]. Skin-to-skin contact heightens response, stimulates behaviors that help to meet the newborn's basic biological needs, activates neuroprotective mechanisms and enables early neurobehavioral self-regulation. Skin-to-skin care reduced maternal physiologic stress and depressive feelings after hospital discharge, which may help to empower women in their role as mothers [16].
