Chapter 1 Delivery and the First Moments It's hard to imagine any life event that matches childbirth for the anticipation, excitement, and anxiety involved. It's inevitable that you will enter into this moment with expectations from stories, books, television, movies, and even your own prior experiences. It is also inevitable that each birth will be unique, and that no one can predict exactly what will happen. Routine Vaginal Delivery In the weeks leading up to the birth of your baby, you'll probably feel some apprehension along with your excitement. Then, usually between the thirty-seventh and forty-second weeks, you'll go into labor. Although no one knows for certain what triggers this process, shifts in hormone levels appear to play a role. Your amniotic sac may rupture on its own or your doctor or midwife will do it (commonly referred to as "breaking your water") at some point before delivery. As you proceed through labor, your uterus will contract rhythmically, or squeeze, which moves your baby down the birth canal. At the same time, these contractions will completely efface, or thin, and then open, or dilate, your cervix to about 10 centimeters (4 in.). In a routine vaginal delivery, your first view of your child may be the top, or crown, of their head, which may be seen in a mirror if you choose. After delivery of the head, there is usually one last pause before the push that sends your baby's body into the doctor's or midwife's arms. Sometimes a vacuum or forceps, special supplies used by obstetricians, are used to help pull the baby out. For well-appearing infants, it is now common to wait at least thirty seconds to one minute after delivery to cut the umbilical cord (also called delayed cord clamping or timed cord clamping), during which time the obstetrician or midwife may place the baby on your lower abdomen. Once the pulsing in the cord stops, the cord will be clamped and cut (there are no nerves in the cord; the baby will feel no pain). The clamp remains in place for twenty-four to forty-eight hours, or until the cord is dry and no longer bleeds. The stump that remains will usually fall off between one and three weeks after birth. Most of the time, after delivery and delayed cord clamping, your baby will be placed directly on your chest, belly down, for skin-to-skin care. Your provider will dry your baby, put a hat on your baby, and cover your baby with a warm blanket while your newborn settles on your chest. This first hour of skin-to-skin contact allows you and your baby to get to know each other and has other important health benefits. Sometimes babies need to be evaluated and brought to a warmer immediately after birth. If that happens, when your infant is stabilized they can be brought to you for skin-to-skin care. Even if you've seen pictures of newborns, you're bound to be amazed by the first sight of your own. When your baby's eyes open, they will meet yours with curiosity. All the activity of birth may make your baby alert and responsive to your touch, voice, and warmth. Take advantage of this attentiveness, which may last for a few hours. Watch how the baby moves toward your breast, seeking that first feeding. These moments are magical for you and your baby. They should be allowed to happen. Attendants should not wash you or the baby or otherwise interfere. The smell and feel of you at that moment will guide the baby to their first feeding. As with many birth parents, you may find that putting your baby to your breast creates an intense emotional bond between you and your newborn. Fresh from birth, your child may be covered with a white cheesy substance called vernix. This protective coating is produced toward the end of pregnancy by the sebaceous (oil-producing) glands in your baby's skin. Your baby may also be wet with amniotic fluid. If there was tearing of tissue in the vaginal area, you may see some blood on the baby's skin. Your newborn's skin, especially on the face, may be quite wrinkled from the wetness and pressure of birth. Nursing After Delivery We recommend that you plan to breastfeed your baby. Today, most hospitals encourage immediate breastfeeding within the first hour following routine delivery, while the baby is held skin-to-skin, unless the baby is having difficulty breathing or other medical problems, which may require monitoring. (See page 8 for detailed information on Apgar scoring.) Breastfeeding right away benefits the mother by causing the uterus to contract, reducing the amount of uterine bleeding, and it benefits the newborn by giving protection against infections. (The same hormone that stimulates the milk ejection reflex, or let-down response, triggers uterine contractions.) The first hour or so after birth is the ideal time to begin breastfeeding. Your baby is alert and eager. When put to the breast, your baby may first lick it. Then, with a little help, your newborn may latch on to the areola (not the nipple) and suck vigorously for several minutes. If you wait until later, your baby may be sleepier and have more difficulty latching effectively. For the first two to five days after delivery, your body produces colostrum, a thin, yellowish fluid that contains protein and antibodies that protect your baby from infection. Colostrum provides all the nutrients and fluids your baby needs in those first few days after birth. (For a complete discussion of breastfeeding, see Chapter 3.) Many hospitals have lactation consultants (professional experts to help mothers with breastfeeding); ask for their help if you are having any difficulty in establishing successful breastfeeding, especially if this is your first baby. Birth by Cesarean Section There are many reasons why your baby may need to be delivered by Cesarean section (C-section), a surgery where an incision is made in the abdomen and uterus to birth the baby. Delivery by Cesarean section is more common if the birth mother had a previous C-section, if the baby is in a breech (head-up) position, if the cervix does not adequately dilate, if the obstetrician feels that the mother's or baby's health might suffer if the child is born vaginally, or if the baby's heart rate slows or becomes abnormal and the baby needs to be delivered urgently. The birth experience with a C-section is different from that of a vaginal delivery. Typically, the entire operation takes no more than an hour, and depending on the circumstances, labor may not be experienced. Another important difference is that medication may be needed to numb the spinal nerves of the mother from the waist down prior to surgery. Rarely, general anesthesia may need to be used. In some cases, these medications may slightly affect mom and baby, but your obstetrician and anesthesiologist can discuss this all with you. Even with a C-section delivery, as long as the baby is healthy and stable, immediate skin-to-skin care is still encouraged for bonding and breastfeeding if desired. Bonding If you deliver without complications, you'll be able to spend the first hour or so with your baby. Because babies are usually alert and very responsive during this time, researchers have labeled this the sensitive period. The first exchanges of eye contact, sounds, and touches between the two of you are all part of a bonding process, which helps lay the foundation for your relationship as parent and child. Although it will take months to learn your child's temperament and personality, many of the core emotions you feel may begin to develop immediately after birth. It's also quite normal if you do not immediately have tremendously warm feelings for your baby. Labor is a demanding experience, and your first reaction may well be a sense of relief that it's over. If you're exhausted and emotionally drained, you may simply want to rest. Give yourself some time, until the strain of labor fades, and then request your baby. Bonding has no time limit. Also, if your baby is taken immediately to the nursery for medical attention, or if you were sedated during delivery, or if you didn't give birth to your child, don't despair. You needn't worry your relationship might be harmed because bonding didn't occur in this first hour. You can love your child just as much, even if you couldn't watch their birth or hold them immediately afterward. Your baby will also be just as loving and connected to you. Excerpted from Caring for Your Baby and Young Child, 8th Edition: Birth to Age 5 by American Academy Of Pediatrics All rights reserved by the original copyright owners. 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