**3. Behavioral hormonal effects**

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

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

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

practice and an ethical responsibility of health-care professionals [14].

about 1½–2 h after birth [11].

12 Selected Topics in Neonatal Care

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

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 animals also prolactin is responsible for mothering behaviors [18]. During the first few weeks, the more a baby suckles and stimulates the nipple, the more prolactin is produced, and the more milk is produced. This effect is particularly important at the time when lactation is becoming established, right after the birth.

• Her first preoccupation is the survival of the baby.

babies communicate nonverbal, they respond to parents.

internal representation of the attachment relationship [32].

tance that woman is relaxed and in touch with her own feelings.

usually gets to sleep that can last even 6 h [30].

ance (for habituation to noise, light, etc.) [34].

physical resemblance.

• Then, she needs to know that everything is fine with the baby.

• Once reassured that the baby is healthy, mother wants to make the baby her own. She seeks

Neonatal Care in the First Hour of Life http://dx.doi.org/10.5772/intechopen.69600 15

These steps are crucial for every new mother; however, this is not yet a relationship [24]; attachment is much more complex and takes more time to be established. The initial emotional connection that mother establishes with her newborn baby is called bonding [25]. It was believed that bonding is one-way relationship (from parents toward child), under the strong influence of important maternal and infant oxytocin that promotes empathy. Other neurotransmitters such as opioids and dopamine also play role in the bonding process [26–28]. It can be therefore concluded that bonding is eased when the birth process is natural and all these hormones are expressed. Within the context of the results of latest research, the experts began to question whether bonding is really a one-way relationship. Feldman et al. [29] found synchronic levels of oxytocin in infants and mothers who interacted with them. These high levels of oxytocin in baby help her/him to adapt to extrauterine life [16]. Despite the fact that

Also, the baby responds facially to mother's voice, especially in the case of physiological birth, right after the birth, when the baby is in a quiet alert state, aware of the surrounding and uses all his/her senses. The baby has competencies to develop ties with parents [24]. Besides voice, his/her strongest sense is scent, necessary to find the mother's breast. After the first feed, baby

All these (nonverbal, mostly facial) responses of the baby evoke interaction with parents that sets grounds for developing a bond among them. They were acknowledged already by Bowlby [31]. He proposed that there is an attachment system that is biologically based and promotes survival. He claimed that infants have specific behaviors that attract proximity of the caregiver in order to survive or to be emotionally connected, so-called proximity-seeking behavior. Repetitions of such interactions by the caregiver lead to 'internal working model' or

The infant, despite that he/she is not verbal yet, generates these affective, sensorimotor activities from parents. He cannot self-regulate yet, but can learn this capacity through parental care-giving behaviors and his own ability to self-regulate [32]. It is therefore of crucial impor-

Reid and Freer [33] wrote that maternal role develops smoothly when mothers' self-esteem in mothering abilities is enhanced. Midwife can strengthen her perception with different interventions. If they make parents aware of babies' behavioral and autonomic cues, they can be more confident in caring for their newborn, taking into account the child's individual toler-

Benefits of skin-to-skin for attachment, breastfeeding and thermoregulation are well known, and new insights, however, revealed even other advantages. Colonization of the baby with the mother's microbiome occurs first during vaginal delivery, later on with her skin microbes,

Oxytocin is responsible for increasingly strong and effective contractions during the labor. And when, during the labor, levels of oxytocin rise, endorphins (sometimes called natural opiates) are released. Beta-endorphin is secreted by the pituitary gland in times of pain and stress. It activates the mesocorticolimbic dopamine reward system and produces pleasure in association with sex, birth and breastfeeding. It is known by now that after birth, both mother and a baby are saturated with natural opiates if the birth is physiological. They reinforce the mother-infant bond and contribute to ecstatic feelings for both [21]. Endorphins also help make the transition to extrauterine life easier for the baby, facilitating relaxation and calm [18].

As the baby descends during the labor, in fact close to the actual birth also catecholamines are released. Sometimes they are called 'fight or flight' hormones: epinephrine (adrenaline) and norepinephrine (noradrenaline).They are secreted from the adrenal gland above the kidney in response to stresses such as fright, anxiety, hunger or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight. During birth, when women are scared or have difficulty coping with pain, they can be overproduced and can inhibit production of oxytocin. However, normal values ensure mother is alert when baby is born; also, baby is alert, with eyes wide opened and trying to make eye contact with mother [19].

To our current knowledge, many *different hormones* can *influence* several *types of behavior*, but for the purpose of getting to know the behavioral effects of different hormones involved in the birth process, four most important ones were described. It is known by now that all the different hormones released by the mother and by the baby during labor and delivery are not eliminated immediately. By knowing that, we realize it is essential to promote best practices already in labor processes.
