You arrived at the hospital, persevered through hours of labor, and finally met your little one. You knew what to expect for the birthing process – but what happens next? What tests are performed on your baby? What care should you expect to be provided? This article discusses what you need to know about the care you and your child will receive in the first 24 hours after giving birth.
After you deliver, one of the first things that will happen is skin-to-skin contact: when your baby is placed on your chest, belly down, immediately after birth. In the case of a c-section, skin-to-skin contact is typically initiated after delivery if the mother is awake with an epidural or as soon as a mother is awake and alert. Skin-to-skin contact after birth can help the mother by increasing oxytocin levels and reducing blood pressure. For the baby, skin-to-skin contact helps keep the baby warm and can regulate the baby's heart rate and breathing. For both mother and baby, it helps with mutual bonding, decreasing stress, and facilitating successful breastfeeding.*All these benefits are important for overall well-being and can help ensure a favorable Apgar score.
*In the first 24 hours, breastfeeding can be especially frustrating, and you may only produce a little bit of colostrum and successfully feed a couple of times - which is normal and ok! In a hospital setting, you are usually provided with education and support from your healthcare provider, and lactation consultants may also be available to you.
Named after Virginia Apgar and developed in the 1950s, the Apgar score is a standardized test used to help determine if newborns need any additional medical intervention, and can be done during skin-to-skin contact. The test is typically administered to the baby one minute after being born and then five minutes after the initial administration to confirm that the baby is in good health. “Apgar” also serves as an acronym for the five categories of the test, which are laid out below:
In order for your healthcare provider to figure out the total Apgar score, each category is individually scored between 0 and 2 and then added to get a total score between 0 and 10. Generally, a baby who scores 7 or above is considered to be doing well. The score serves as a way for your provider to quickly assess your child and ensure they receive the appropriate care!
In addition to the Apgar test, your baby will be administered the vitamin K booster shot within six hours of birth. In 1961, the American Academy of Pediatrics recommended that newborns be given a vitamin K shot after delivery because babies do not have much vitamin K in their systems. This makes the booster vital because it helps the body form clots. The vitamin K shot protects against the increased risk of “vitamin K deficiency bleeding” (VKDB), which leads to severe and potentially life-threatening conditions.
We’ve covered your little one; what about you? One of the first things that happen after giving birth is the delivery of the placenta. During a vaginal delivery, roughly 30-60 minutes after you give birth to your child, your body will begin to experience contractions again in preparation for placenta delivery. Placenta delivery is usually managed in one of two ways:
Active Management: Active Management is where your healthcare provider administers a uterotonic to encourage contractions and reduce your risk of heavy bleeding. The uterotonic is typically Pitocin (a synthetic form of oxytocin) or sometimes misoprostol. Your healthcare provider will then clamp the cord and the person of your choosing (your healthcare provider, support person, or yourself) will cut the cord. Then, once the placenta has separated from the uterus wall, the provider will remove it.
Physiological Management (also known as Expectant Management): Physiological Management is a similar process to Active Management, except it involves no medication. Your healthcare provider might also massage your lower abdomen to encourage contractions for the placenta to deliver naturally. If you choose the route of Physiological Management for the third stage of your labor, it may take longer for your placenta to exit your body. If you have not delivered your placenta within an hour, you will likely be advised to have uterotonic administration. However, you may be able to speed things along by being in a relaxed environment and having skin-to-skin contact with your baby so that your body can naturally produce as much oxytocin (uterotonic) as possible!
How does this change if you are giving birth via cesarean section? The main difference is that mothers with c-sections have the placenta taken out of the same incision made for the baby. Your healthcare provider will cut the umbilical cord, carefully and gently remove your placenta, and conduct a check of your reproductive organs. You will then receive stitches to close the incision.
Your healthcare provider will conduct a well-being assessment of your vaginal and perineal areas after birth to ensure a stable recovery in your fourth trimester.
You are examined for lacerations or abrasions, also referred to as perineal tears. There are four grades of perineal tears, with a first-degree tear being the least severe and a fourth-degree tear being the most severe (and least common). Tears and episiotomies, which are surgical cuts that may be made during childbirth, are assessed and, if needed, sewn up with dissolvable stitches. You may be provided with witch hazel pads, numbing spray, ice packs, and pain medication to help with the healing process and manage pain and discomfort.
In the case of a cesarean section, once your uterus and abdominal skin have been sutured, the well-being assessment revolves around your incision. You will likely stay in the hospital for at least 2-3 days to ensure that your incision is healing well. During this time, you can talk to your doctor about your pain management plan, drink plenty of fluids, and walk around once you feel up to it.
When it comes to having a baby, there is often a significant emphasis on pregnancy, labor, and delivery; what happens after you give birth is often glossed over and not discussed enough. With all the physical and emotional stress that accompanies labor, knowing the details regarding what to expect after childbirth will allow you to focus on bonding with the little one that you’ve just brought into the world!