What Happens After You Deliver Your Baby? - dummies

What Happens After You Deliver Your Baby?

By Joanne Stone, Keith Eddleman, Mary Duenwald

Women may experience any and every kind of emotion after their babies are born. The spectrum of feelings is truly infinite. Most of the time, you’re completely overcome with joy when your long-awaited baby finally is born. You may be incredibly relieved to see that your baby appears healthy and obviously okay.

If your baby requires extra medical attention for some reason and you can’t hold her right away, you may be upset or, at the very least, disappointed. Just remember that very soon you’ll have her to hold and enjoy for the rest of your life.

Some women feel too scared or overwhelmed to care for their baby right away. Don’t feel guilty about any such feelings — they, and most others, are completely normal. Just take one moment at a time. You’ve come through a phenomenal event.

Shaking after delivery

Almost immediately after delivery, most women start to shake uncontrollably. Your partner may think that you’re cold and offer you a blanket. Blankets do help some women, but you aren’t shivering because you’re cold. The cause of this phenomenon is unclear, but it’s nearly universal — even among women who have cesarean deliveries.

Some women feel nervous about holding their babies because they’re shaking so much. If you feel this way, let your partner or your nurse hold your baby until you feel up to it.

Understanding postpartum bleeding

After delivery — either vaginal or cesarean — your uterus begins to contract in order to squeeze the blood vessels closed and thus slow down bleeding. If the uterus doesn’t contract normally, excessive bleeding may occur.

This condition is known as uterine atony. It can happen when you have multiple babies (twins or more), if you have some infection in the uterus, or if some placental tissue remains inside the uterus after the placenta is delivered. Then again, in some cases, excessive bleeding happens for no apparent cause.

If it happens to you, your doctor or nurse may first massage your uterus to get it to contract. If massage doesn’t solve the problem, you may be given one of several medications that promote contracting, like oxytocin, methergine, or hemabate.

If you have some placental material remaining in your uterus, it may need to be removed by reaching inside the uterus or by a D&C (dilation and curettage), which involves scraping the uterus’s lining with an instrument. The vast majority of the time, the bleeding stops without a problem. However, if it doesn’t stop with these medications and procedures, your doctor will discuss other forms of treatment with you.

Hearing your baby’s first cry

Shortly after delivery, your baby takes her first breath and begins to cry. This crying is what expands your baby’s lungs and helps clear deeper secretions. In contrast to the stereotype, most practitioners don’t spank a baby after she’s born, but instead use some other method to stimulate crying and breathing — rubbing the baby’s back vigorously, for example, or tapping the bottom of the feet.

Don’t be surprised if your baby doesn’t cry the very second after she’s born. Often, several seconds, if not minutes, pass before the baby starts making that lovely sound!

Checking your baby’s condition

All babies are evaluated by the Apgar score, named for Dr. Virginia Apgar, who devised it in 1952. This score is a useful way of quickly assessing the baby’s initial condition to see whether she needs special medical attention.

Five factors are measured: heart rate, respiratory effort, muscle tone, presence of reflexes, and color, each of which is given a score of 0, 1, or 2 for each parameter with 2 being the highest score. The Apgar scores are calculated at both one and five minutes following birth and each parameter is added up. The lowest is a 0 (very rare) and the highest a 10.

An Apgar score of 6 or above is perfectly fine. Because some of the characteristics are partially dependent on the infant’s gestational age, premature babies frequently get lower scores. Factors such as maternal sedation also can affect a baby’s score.

Many new parents anxiously await the results of their child’s Apgar score. In fact, an Apgar score taken one minute after the baby is born indicates whether the baby needs some resuscitative measures but is not useful in predicting long-term health. An Apgar score taken five minutes later can indicate whether resuscitative measures have been effective.

Occasionally, a very low five-minute Apgar score may reflect decreased oxygenation to the baby, but it correlates poorly with future health. The purpose of the Apgar score is merely to help your doctor or pediatrician identify babies who may need a little extra attention in the very early newborn period. It certainly is no indication of whether your baby will get into Harvard or Yale.

Cutting the cord

After the baby is actually delivered, the next step is to clamp and cut the umbilical cord. Some practitioners may offer your labor coach the opportunity to cut the cord — but your partner is under no obligation to do so. If having the opportunity to cut the cord is something you feel strongly about, let your practitioner know ahead of time.

At the time of this writing, there has been a lot of discussion about the risks and benefits of delayed cord clamping. The idea is that by delaying the clamping of the cord by 2 or 3 minutes, you can give your baby more blood that is stored within the cord and placenta.

Recent data based on an analysis of about 15 different studies showed a significant benefit in premature infants. For these preemies, delayed cord clamping showed lower rates of transfusion for anemia, lower rates of a complication called necrotizing enterocolitis, and lower rates of intraventricular hemorrhage (known as IVH, a potentially serious complication in very preterm babies).

While the levels of bilirubin (a breakdown product of hemoglobin, which in high levels can cause problems) were higher, there was no greater need to treat these babies with phototherapy (a way of breaking down bilirubin).

In contrast, in full-term babies, the studies did show that while hemoglobin levels were higher in the immediate newborn period, and there was less iron deficiency at 3 and 6 months, there was a 40 percent increase in the need for phototherapy for high bilirubin levels and jaundice. Therefore, the decision to perform delayed cord clamping should be individualized.

After cutting the cord, your practitioner either lays your baby on your abdomen or gives the baby to your labor nurse to put under an infant warmer. The choice depends on your baby’s condition, your doctor’s or nurse’s standard practice, and the institutional policy where you’re delivering.