You’ve given birth – now what? (by Marie Louise, The Modern Midwife)
Sometimes it seems that all the information available on birth is just leading up to that one big event – labour! You’ll have found so much information on each stage of pregnancy, read up on the possibility and methods of induction, seen articles about what to expect if you need a c-section or assisted birth, made your birth plan, and packed your hospital bag (even if your plan is to give birth at home). You’ve picked your baby’s first outfit or ‘coming home’ clothes, and are fully prepared with a pram, basket, cot, baby monitor, car seat and other essential items. But what happens immediately after giving birth? New mums can suddenly feel adrift. How will you know what to do with your baby now they are here? Are you just left to get on with things? What effect will birth have on your body and your mind? The Modern Midwife is here to talk you through it.
The APGAR Score
You may not even notice, but in the first minute after your baby emerges into the world, the midwife or doctor will be doing a quick check called the APGAR score. This run through of basic observations is named for the anaesthetist Virginia Apgar who published it in 1953, but also acts as an acronym. Each aspect will be rated from 0 to 2, giving a total score out of 10.
Appearance (baby’s skin colour) pale or blueish*/blueish hands & feet/good colour
Pulse (heart rate) absent/slow/fast
Grimace (response to stimulation) none/when stimulated/crying or coughing
Activity (muscle tone) limp/some stretching of limbs/active movement
Respiration (breathing) absent/weak/good – includes crying
*If your baby is Black or Asian it can be harder to detect a blueish skin colour so your doctor or midwife may also check their hands, feet, nailbeds and gums.
The vast majority of babies are unlikely to need any immediate treatment, and often those who score low in the first check are improved quickly.
The Golden Hour
Once basic but vital health checks are done, assuming there are no issues that require immediate medical attention, it’s no longer considered essential to immediately whisk your baby away from you for weighing, measuring and dressing, and NICE guidelines support this. The ‘golden hour’ is the first hour after birth, and the ideal is for it to be as undisturbed as possible, so you and your baby have the time and space to reflect and recover from the enormity of what just happened. There’s a whole new person in the world!
This time is ideal for beginning skin-to-skin contact, which has been proven to release hormones to calm and relax you both: regulating the baby’s heartbeat and breathing, supporting breastfeeding, and promoting healing – amongst other benefits. Midwives have known for years that breastfeeding and skin-to-skin contact can reduce the risk of bleeding after birth, as well as producing natural oxytocin, but thanks to research there is now a name for this unique physiological process – ‘pronuturance’.
If you’re in hospital for your birth you’ll probably stay in the birthing room for at least an hour, maybe more, before your midwife asks if you are ready to have your baby weighed, and offer vitamin K. The benefit of vitamin K at birth is that it can prevent a rare bleeding disorder in babies called Vitamin K Deficiency Bleeding (VKDB). If given by injection they will very probably cry briefly, and there may be a small bruise to on follow your baby’s thigh. The downside to Vitamin K is still unknown, for example we are not sure why babies have low levels of vitamin K and if there is a reason for this. It is possible that there is a benefit for babies to have these lower levels compared to adults. Dr Sara Wickham has an information hub all about this on her website and you can always speak to your midwife too so you can make an informed decision.
As new mama, you will be receiving some attention too. In addition to bringing you the absolutely vital tea and toast (you’ll no doubt be very hungry by now!), your midwife will want to know that you are feeling generally OK and then check your pulse, blood pressure, respiratory rate, oxygen saturation and temperature. She will also check your perineum and bleeding, and give you any pain relief needed to help you feel comfortable. Your midwife will also be able to give you advice on breastfeeding, if you chose to, checking that your baby’s latch and positioning are optimal. Do take this opportunity to ask any other questions you might have.
If you had a straight-forward birth at a hospital or Midwife-led Unit (MLU), you’ll be asked if you want to go home, or to the postnatal ward. Sometimes the paperwork can take a little time, but if you’ve had a vaginal birth with no complications you could quite possibly be home the same day. A stay on the postnatal ward might be needed if you or your baby need more clinical care, or help with feeding over-night, and a C-section will definitely necessitate a stay of at least one night, maybe longer. When you are discharged, you’ll be given a pack with all the contact details you might need – for example, how to get in touch with your community midwife – and other useful information. You might also be given your baby’s ‘red book’ (or digital access to it), which is record of their growth, development and immunisations, and should be taken to subsequent appointments.
If you had a homebirth, your midwife will only depart once she has checked you and baby are settled and have support on hand, all the vital contact details as above, and has let you know when to expect a follow-up visit.
The NIPE Check
Your baby will have already been looked over immediately after birth for that initial APGAR score, but the Newborn and Infant Physical Examination (NIPE) will also be carried out within 72 hours. This is basically a full MOT for your baby, from the top of their head all the way down to their tiny toes, and checks things like their eyes, reflexes, genitalia, and the sound of their heart, amongst other things. Try not to feel too anxious – this is all routine.
What about you?
You’ll be visited again at home by your midwife (or possibly at a clinic) in order to check how you and your baby are getting on. These visits are NOT designed to catch you out or judge you for unwashed dishes or a big pile of dirty laundry! This is normal. You absolutely don’t need to wait on them or treat them like a special guest. By this time it’s quite likely you will be tired, and you may be feeling tearful or overwhelmed. This is very normal, but do let your midwife know how you are feeling. Again, there will be no judgement. ‘Baby blues’ affect almost all women, as there is still a mass of hormones swirling in your body, combined with the shock of new parenthood and more often than not extreme tiredness. Being open about your feelings and how you are coping can mean that any later Postnatal Depression (PND) can also be picked up on. The sooner it’s caught, the sooner strategies can be put in place to help you. Know that professionals will only want to help and support you, there will never be any assumptions or judgement.
Physically, the midwife will check:
- The healing of any wounds such as a C-section or perineal tearing/episiotomy.
- Your post-birth blood loss (lochia). This is the used lining of your womb coming away after a full nine months, so it is likely to be heavier and include more clots than a regular period. However, if any seem particularly large or look like tissue, there may be a small bit of retained placenta. Don’t be worried to show your midwife the sanitary towel if you think anything doesn’t seem right – it’s useful for diagnosis and they won’t be grossed out!
- Your breasts and whether there are any signs of mastitis. Also if you are breastfeeding and having any difficulties.
- Your abdomen. You are quite likely to have period-like after-pains, caused by the shrinking back down of your uterus. This is often most noticeable whilst breastfeeding.
- If you are able to wee and poo okay. It’s normal for it to feel weird for a few days, or for there to be some constipation. Again, there’s no need to feel embarrassed.
- Your legs and calves. They will be checking for painful, hot, reddened or swollen areas which could be signs of a blood clot.
When you are back at home without a midwife, it’s important that you are aware of some important symptoms that could present. These are rare, but there are some post-birth complications which would need prompt attention, so look out for:
- Sudden and profuse, or persistent increased blood loss
- Faintness, dizziness, palpitations or a racing heart
- Fever, shivering, abdominal pain, smelly vaginal loss
- Headache accompanied by any of the following: nausea/vomiting/visual disturbances
- Calf pain, redness or swelling
- Shortness of breath or chest pain
All are treatable, but your midwife should be alerted straight away.
A final thought
Don’t expect too much from yourself! Adapting to the new normal takes time. There should be no expectation to ‘bounce back’, to host guests (when Covid rules allow) or to be getting out and about immediately. Cuddle, nest, and sleep when you can. Lower your standards around the house. As long as baby paraphernalia such as bottles are properly clean, it doesn’t matter when you last hoovered. Enjoy the process of learning more about your baby every day, as you get to know yourself as a new mother. The journey lasts a lifetime, so don’t rush. You’ve got this!
For lots more information on pregnancy, birth and the first few weeks with your newborn, Marie Louise has put together her online ‘Pregnancy, Birth and Beyond’ antenatal and postnatal courses, which can be purchased here. Sign up today, and watch in the comfort of your own home, at your own pace.