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Q: What will happen once my baby is out?
A: The doctor or midwife will first check your baby's breathing and assure that the airway is clear of mucus or amniotic fluid. A few babies need help with breathing and are given oxygen after birth. This may be done while the baby is on your abdomen or in a special warmer close by. If only mild stimulation and oxygen are needed, baby pinks up quickly and is dried and wrapped and given directly back to you. An initial assessment (Apgar scoring) is performed by the nurse at one and five minutes and can be done right on your abdomen or in the warmer.

At this point, the midwife may place a hand on your uterus, called the fundus, to assure that it is contracted. In “active management” of the third stage of labor, oxytocin via an injection or in the IV is administered causing a firm contraction and the placenta is delivered or expressed. If a more conservative approach is favored by your caregiver, signs of placental separation are noted and you will be asked to push the placenta out into a basin. After the third stage is complete, an assessment of the perineum and vagina are made and stitches, if any are needed, are placed under local anesthetic.

Q: What is the Apgar score?
A: Apgar is an assessment tool performed at one and five minutes after birth to assess the health of a newborn baby and whether they need additional care . It was developed in the 1950s and still used as a simple, quick, effective, assessment.
Q: What if there is a problem with my baby's breathing?
A: If there are signs that your baby is having problems breathing, the midwife will give immediate treatment and also ask a pediatrician or neonatal nurse to check your baby. Sometimes just gently rubbing a baby's skin can improve breathing or a baby may need a little more oxygen. If you received labor analgesia, this can have an effect on the baby's breathing and your baby may have to be given an injection of a drug called Naloxone to reverse the effects. If there are continued concerns about a baby's breathing, the baby will be transferred to the neonatal care unit for a short time for observation .
Q: Will I be able to have skin-to-skin contact with my baby after the birth?
A: This shouldn't be a problem, especially if you have had a normal delivery. It is thought that skin-to-skin contact shortly after the birth has many beneficial effects for both the mother and baby. As well as assisting the bonding process, it helps regulate a baby's temperature, breathing, and heart rate. Skin-to-skin contact also helps establish breast-feeding, since this is a time when most babies show their natural instincts and root around looking for food, latching on for their first feeding. The first hour of life the baby is quietly alert, eyes are open and very receptive to breast-feeding and the sounds of parents' voices.
Q: Will they clean up my baby first?
A: This is something to discuss with your midwife or doctor before the birth. She will ask your preferences for whether to deliver your baby right onto your belly or, as some women prefer, onto the bed to be cleaned and dried before being handed over to you.
Q: When will my baby be weighed?
A: Your baby will have a head-to-toe checkup, be weighed, and will have his head circumference and body length measured. This may be done very quickly after the birth, but more usually it is done once you have had the opportunity to snuggle with your baby.
Q: What is vernix?
A: Most babies born before 40 weeks have some vernix, a white waxy substance, on their skin that protects them while they are in the amniotic fluid. After 40 weeks this begins to disappear. If it is present after birth, it doesn't need to be wiped off since it will gradually be absorbed into the skin.
Q: How will the cord be cut?
A: Once your baby is born, the usual practice is to place a plastic cord clamp on the cord about 2–3 cm away from the baby's tummy, and then to clamp another about 3 cm away from the first cord clamp using forceps; the cord in between the clamps is then cut using cord scissors. There has always been some debate about the best timing for clamping the cord. The most recent research suggests that delaying the clamping of the cord for 2–3 minutes is most beneficial for the baby. This is because the cord continues to pulsate for several minutes after the birth so delaying cutting it allows more blood to pass from the placenta to the baby. This boosts the baby's oxygen supply and blood volume, which in turn raises iron levels and reduces the risk of newborn anemia.

If you are Rh negative the cord is clamped immediately. If you are Rh positive you have a preference as to the timing of clamping and cutting the cord, you can include this in your birth plan. If your birth partner would like to be involved in cutting the cord with the midwife, discuss this prior to the birth; this should be possible, providing all is well at the delivery.

Q: Do all newborn babies look the same?
A: Babies vary in appearance at birth and a variety of factors play a part. Sometimes parents are surprised that instead of a soft-skinned baby they are faced with a red-faced, wet, screaming individual. Some aspects of your baby's appearance may be temporary and related to the birth or your baby adapting to life in the outside world, such as the shape of his head, which may have been affected by the birth, or the color of his skin (see Your newborn's appearance). If your baby is born post dates, at around 42 weeks, he may have drier, flakier skin than babies born around 40 weeks; if he is born prematurely, he may still be covered in the fine downy hair called lanugo, which will gradually disappear. Also, the type of delivery can affect the way your baby looks after birth. If you have a cesarean, your baby is less likely to have a distorted or “squashed” appearance to his head since he has not had to squeeze through the birth canal.
Q: I've heard that sometimes the genitals are quite swollen. Why is this?
A: The hormones produced by your body in pregnancy, namely estrogen and progesterone, cross the placenta and so are present in the baby during pregnancy and immediately after the birth. One of the side effects of these hormones can be swollen genitals in both newborn boys and girls. In girls, the swelling can be accompanied by a reddening of the skin and some baby girls may have a vaginal discharge. As the hormone levels drop, the discharge may include a small amount of blood, all of which is normal. Hormone levels can also cause swelling of the breasts in both boys and girls. After the birth, any swelling and discharge goes away quite quickly since the baby does not produce hormones and levels drop to zero in the first week.
Q: Will he be wrinkly?
A: A newborn baby's appearance changes over the first hours and days of life. Immediately after birth, babies tend to have a wrinkly appearance because they have been in a bag of fluid for the last nine months, much the same as we get if we stay in the bath for too long. As their skin adapts to being in the outside world, the wrinkles disappear. If a baby is very overdue, the skin can appear quite dry and in most cases will flake. In this situation, it will also appear wrinkly due to a lack of moisture. Once a newborn baby's skin starts to flake, there is nothing that can be done to stop it, and you should not use any moisturizing products to try to prevent it. Rest assured that the layer of skin underneath will be fine.
Q: My baby's face is covered in spots. Will they go away?
A: Newborn babies have very sensitive skin. They have been protected in a safe environment in pregnancy and following the birth their skin needs to adjust to the outside world. That is why rashes and spots may occur. The most common rash in newborns is called erythema toxicum neonatorum, which occurs in around 50 percent of newborn babies and is usually noticeable around 1–5 days after the birth. This consists of small red spots that appear and disappear all over the skin except for on the palms of the hands and soles of the feet. It isn't harmful and it doesn't indicate an infection. It can't be passed on to others and it usually disappears within two weeks without any treatment. Milia is another noticeable skin change occurring in about 40 percent of newborn babies. These are pin-head-sized white spots, which usually appear over the nose and cheeks, but can also occur on other parts of the face. These are blocked pores containing some sebum (an oily substance produced by the skin) and, again, they disappear without treatment.
Q: My baby has a big red strawberry mark on his head. Will it be there forever?
A: Birth marks are fairly common and most disappear in the first few years of life. Strawberry birth marks start as a red dot and tend to grow in size for about a year, but usually disappear by five years. Other marks include pink patches of skin, called stork bites, and Mongolian spots, which are patches of skin with a bluish tinge that occur on babies of African or Asian descent. They usually occur at the bottom of the back but may extend over the bottom and are due to the concentration of pigment cells in the skin; they often disappear by three to four years of age. Port-wine stains are larger red marks that tend to occur on the face and neck. These birth marks are permanent, so you may want to talk to a skin specialist about whether there are treatments to reduce them.
Q: Should I be careful about using products on my baby's skin?
A: Yes, you do need to exercise caution. Since a baby's skin is very sensitive, it can react to any chemicals that it comes into contact with, including some baby bath products. The very best option is to use nothing other than plain water on a baby's skin until he is at least a month old, and to continue to be careful about which products you use on your baby in the following months.

You can use oils to massage your baby. Pure vegetable oil or olive oil is best; avoid aromatherapy or mineral oils, which may be harmful to a baby's skin, and nut-based oils, as there is a possible link between these and the development of nut allergies.

Q: Will my baby have any blood tests before we leave the hospital?
A: Besides the newborn blood spot tests (see Newborn tests and checks), other occasions when a blood test may be required include:
  • If a baby is lethargic or jittery a blood glucose test will be performed.

  • If a baby shows significant signs of jaundice, to check the bilirubin levels and rule out a more serious underlying condition in the baby, such as anemia or an infection.

  • If the mother is Rhesus negative , although if this is the case then a sample of blood is usually taken from the umbilical cord at the time of birth to determine the baby's blood group and the baby's Rhesus factor.

If the hospital does suggest taking blood from your baby, then a midwife, doctor, or other health professional should clearly explain to you the reasons why they recommend this course of action and ask for your consent prior to blood being taken from your baby.

Q: I've heard that they check babies' hips. Why is this?
A: Hip checks are performed on all babies, initially after birth and then at the time of discharge and at the well-child checkups.

There are two conditions that are being looked for. One is a congenital dislocation of the hip. The other is developmental hip dysplasia which causes the hips to “click” or “pop” when the baby's legs are rotated outward. The screening for these conditions may be carried out by your pediatrician or the midwife. If a problem is found, a splint may be recommended to align the hip correctly and ensure the socket develops normally.

Q: Why do they measure the baby's head?
A: Measuring a baby's head is done to assess development, and brain growth. Most babies have their head measured immediately after the birth, but this probably isn't the most accurate measurement since the head may have changed shape as it passed through the birth canal. It is not until a few days later that it settles into its normal shape. Your pediatrician repeats the measurement at the two-week checkup in the first few weeks after the birth and this is generally used as the baseline measurement on your baby's growth chart. Measurements taken throughout the first year are recorded by your doctor at each visit.
Q: Why do some newborns have jaundice?
A: Just over half of all newborns suffer from jaundice. Usually it isn't noticeable until 2–3 days after the birth and clears by 14 days. The most common cause is high levels of hemoglobin (the oxygen-carrying part of the blood) before birth. Once babies are born and breathe for themselves, their hemoglobin count doesn't need to be so high; these blood cells die off and are processed as waste by the liver. In small babies, the liver is immature and takes a while to cope with the workload. The result is that instead of this waste product, known as bilirubin, being passed in the urine and stools, it stays in the body for a while and gives the skin a yellow/orange color. In a healthy full-term baby who is feeding well, jaundice will resolve on its own without any treatment. Sometimes, if there has been bruising, the baby is slow to feed, or is premature, the bilirubin levels continue to increase, and in these cases phototherapy (ultraviolet light treatment) is needed to reduce the bilirubin levels in the baby.

Any jaundice that occurs within 24 hours of birth and any that continues after 14 days is investigated to rule out and treat any medical problems.

Q: How much will he cry, or will he be asleep all the time?
A: Many factors influence your baby's sleep pattern, such as the type of delivery you had; the gestation of your baby; his health at birth; and the method of feeding your baby, with bottle-fed babies tending to sleep for longer stretches. However, all babies need a lot of sleep, approximately 16 hours each day, which consists of short intervals of sleep intermingled with shorter periods of wakefulness through the day.
Q: My baby's foot is turned in and we've been told he may need a splint. What is wrong with him?
A: This is known as talipes and affects 1 in 1,000 babies. It's more common in boys and affects one or both feet. Talipes may be positional or structural. Positional talipes is caused by pressure compressing the foot while it's developing, as a result of its position in the uterus. This may be resolved with exercises to help the foot regain its natural position. Structural talipes is more complex and is caused by several factors, including a genetic predisposition. This needs prompt treatment while the tissues are soft to manipulate the foot. Splints, strapping, or casts may be used to hold the foot in place. In some cases, if this is not effective, surgery to straighten the foot may be suggested. Both surgical and manipulation methods have a good success rate. Your child will have regular reviews in childhood and adolescence, particularly during growth spurts, and more surgery may be needed in adolescence. There are organizations to contact for support and advice 
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