The very first precious moments after birth

The birth of a child is a moment of unspeakable joy and wonder. Immediately after the birth, a new phase of life begins for both mother and baby. Understanding the importance of these very first moments can help you make the most of this crucial period.

In the following in-depth discussion, we will focus on what happens immediately after birth, with special attention to skin-to-skin contact and delayed cord clamping.

Skin-to-skin contact: an essential bond

Skin-to-skin contact between mother and newborn baby immediately after birth is an incredibly important moment. This first contact fosters an immediate and deep bond between you and your baby. Research shows its many benefits, including:

• Body temperature regulation: your body heat helps keep your newborn’s temperature stable.
• Stabilisation of heartbeat and breathing: your heartbeat and breathing reassure your newborn, helping to stabilise his or her vital functions.
• Stress reduction: direct skin contact reduces stress levels for both you and your baby, promoting a feeling of calm and security.
• Initiation of breastfeeding: skin-to-skin contact facilitates the initiation of breastfeeding, as the baby is stimulated to search for the nipple and start sucking

Recommendations suggest a duration of uninterrupted skin-to-skin contact of at least 1 hour after birth (also called ‘the golden hour’) or at least until the first feeding. If your baby is well, initial checks can take place with him on you, and there is no reason to interrupt this precious moment.

Delayed cord clamping: a benefit for the baby

Delayed cord clamping is an increasingly common practice supported by all international recommendations (WHO, NICE, ACOG). It consists of waiting a few minutes before clamping and cutting the umbilical cord, allowing more blood (about 1/3 of your baby’s blood!) to flow from the placenta to the newborn. Official recommendations vary slightly, but in general suggest waiting at least 1-3 minutes before cutting (ideally, you should wait until the cord stops pulsating). Benefits of delayed clamping include:

• Increased iron reserves: the ‘extra’ blood, which is part of your baby, is rich in iron, which is essential to prevent anaemia in the first months of life.
• Improved circulation: the ‘extra’ blood helps stabilise the baby’s blood pressure and circulation.
• Developmental support and better extra-uterine adaptation: the stem cells contained in cord blood can contribute to the development and repair of the newborn’s tissues.

The benefits are also important for preterm infants and can also be done in the case of a caesarean section, when conditions permit.

Expulsion of the placenta: the last step in childbirth

After the birth of the baby, the mother’s body must complete the last step of childbirth: the expulsion of the placenta (the organ that nourished your baby during pregnancy). This process, also known as ‘secondment’ or third stage, takes on average a few minutes to half an hour, but can wait up to an hour in the case of physiological management (see below).

During the third stage, the uterus continues to contract to expel the placenta and prevent haemorrhage. Here is what to expect:

• Uterine contractions: you may experience small contractions (less intense than during labour), which are normal and help the uterus expel the placenta.
• Checking by health care staff: your midwife will carefully monitor this process to make sure that the placenta is expelled completely and that there are no signs of excessive bleeding.
• Expulsion: Expulsion of the placenta is not painful. Your midwife will guide you through this phase. If you want, you can ask to see it (it’s fascinating!).

There are two ways of handling the third stage:

• Active management: this consists of the use of uterotonic drugs (oxytocin), which allows the placenta to detach more quickly (usually within 30 minutes) and helps reduce bleeding. This is followed by delayed clamping of the umbilical cord and controlled traction by the midwife once the detachment has occurred.
• This is the method recommended by guidelines because it is associated with a reduced risk of postpartum haemorrhage. However, if the risk is low, you can request physiological management of this phase. Always consult with your midwife to make the best choice for you.
• Physiological management: no drugs are used and the cord stops pulsating before clamping. Detachment occurs spontaneously and no manual traction is applied to the cord. It is usually completed within 60 minutes.

In any case, according to all international recommendations, the cord should never be clamped before 1 minute after the baby is born, if the baby’s condition allows it.

What happens after the secondment (third stage)?

Throughout this phase you can continue to have your baby on your chest to facilitate the start of breastfeeding and to obtain all the benefits described above.

The midwife will check your perineum and assess whether stitches are needed (under local anaesthetic, of course!). At this stage, if you are uncomfortable, you can ask your partner/birth partner to continue skin-to-skin contact with your baby – it is a magical time for him/her too!

Once this phase is over, you will be moved to another room and enjoy a nice, restorative shower.

In the meantime, doctors and professionals will weigh your baby and offer the administration of vitamin K (to promote blood clotting). The paediatrician will do the initial checks and, as soon as possible, you can continue with skin-to-skin contact and offer the breast to your baby. Usually in the first 2 hours after birth, babies are very active, then they will have a good sleep and you can take the opportunity to rest too.

The first bath: It is common to think that a newborn baby should be washed immediately after birth, but it is important to delay the first bath for several hours, if not up to days or weeks afterwards (ideally, wait until the umbilical stump falls off). Contrary to popular belief, babies are not dirty! The midwife will dry your baby as soon as he/she is born so that he/she does not catch cold, but there is no need to wash him/her.

Vernix caseosa (or vernix), the whitish substance that covers a newborn baby’s skin at birth, has protective, antibacterial and moisturising properties. Delaying the bath allows the baby’s skin to absorb these benefits. In addition, the first bath can be stressful for the newborn; therefore, delaying it helps to keep the baby calm and stable during the first hours of life.

Remember to tell the hospital staff that you do not wish the baby to be bathed.

Awareness and knowledge for a positive experience

The moments immediately after the birth of your baby are meaningful and full of important actions that can positively influence the health and well-being of both baby and mother. Skin-to-skin contact, delayed cord clamping, expulsion of the placenta and timing of the first bath are all crucial steps that deserve attention and awareness.

Prepare to experience these moments calmly and joyfully, knowing that every choice and every action is geared towards ensuring the best possible start for you and your baby. Being informed and prepared will allow you to fully enjoy this extraordinary experience and to welcome with serenity the new life that you have just begun together.