The First Hour of Life

The first hours after birth are a developmentally distinct period of time for the mother and baby. Research now supports what birth-workers have known for several years: there are distinct advantages of a baby being held skin-to-skin during this time. Providers and parents should work together to facilitate this bonding time bypassing the newborn to the mother immediately after birth. All drying, stimulating, and assessment of a vaginal full-term infant can be done on the mother’s abdomen. Ideally, the MotherBaby should not be separated for non-medically necessary procedures. Infant measurements, bath, and vaccinations can wait until the baby has bonded, breastfed, and is about one hour old.

This time with baby is especially important for the PAL mom. It is not uncommon for the PAL mom to struggle to attach to the baby during pregnancy, due to fear of losing this baby too. When given this bonding time, the PAL mom has immediate validation that this is a different baby. Understanding the stages of the first hours of life can help the PAL mom prepare for this bonding time.

Widstrom, et al, documented the nine instinctive stages of a newborn. These observable stages happen in a very specific order, building on each other as the baby becomes aware of their new environment and bonds with his/her parent.

Stage one is the birth cry. It is a distinctive cry immediately after birth. Its clarity shows the birth team that the baby’s lungs are clear and the baby is breathing on his/her own. If the baby is not crying your team can stimulate the baby on the mother’s abdomen. Only if the baby is struggling to breathe spontaneously should be baby be moved to the isolette for assistance. Skin to skin contact is also critical for the baby, in order to help regulate his/her temperature as the mother’s skin is nature’s best heating blanket.

Stage two begins when the birth cry has stopped. In stage two the baby relaxes his/her body softens, hands and mouth relax as the mother’s skin is keeping them warm and her heartbeat is keeping them calm. Your birth team may reposition the baby on your chest and cover him/her with a blanket and hat as they adjust to being on their own. Most parents use this time to adjust and comprehend that their baby is truly here.

The baby becomes more alert in the awakening stage. They will start to make small movements with their upper body. They may open their eyes, look around, and stick out their tongues to taste the air. Although it may have seemed forever the baby is about 3-5 minutes old at this stage.

The fourth stage is the newborn activity. About eight minutes after birth the baby will begin to move more vigorously on their mother’s abdomen or chest. Mouthing and even suckling whatever is closest, whether it is a fist, the breast, or just air.

The first hour of life

About nine minutes after birth the baby enters stage five: rest. Birth is hard work for both the mother and the baby, so babies use this time to alternate between activity and resting.

The sixth stage is the one we have all been waiting for as the baby starts to crawl. About 35 minutes after birth the baby will have spurts of inching or kicking as they approach the nipple. The crawl stimulates the release of prolactin which is critical to milk production and MotherBaby bonding. The crawl also stimulates oxytocin which encourages further contractions in order to release the placenta.

Once they reach the nipple they enter stage seven, called familiarization. During this stage, the baby becomes acquainted with the breast and the nipple. Sometimes the baby will lick the nipple, bob at the breast, and even massage it with their hands and feet.

Suckling is in stage eight. During this stage, the baby will self attach at the breast and suckle. The baby is about an hour old at this time. Some babies will latch earlier and others may need more time to begin suckling.

Once your baby has breastfed they will fall into a deep sleep which is stage nine. In my experience when most babies are about 90 minutes old or older before they fall asleep. Sleep is healing, and this first sleep is very deep, lasting for two hours or longer. Use this time to sleep in order to heal yourselves as well, for once your baby wakes, they will want to be fed every 2-3 hours all day long.

In the event that the mother cannot or is not interested in holding her newborn, the partner should do skin to skin contact instead. The baby also knows the partner’s voice, smell, and heartbeat from pregnancy. Skin to skin promotes bonding for everyone. If the baby requires a NICU stay, then parents should try to do skin to skin as soon as the baby is stable enough to do so. Skin to skin bonding should continue even past the newborn period.

Reference: Widstrom A, Wahlberg V, Matthiesen AS. Short-term effects of early suckling and touch of the nipple on maternal behavior. Early Hum Dev. 1990;21:153–163.

Photo Source: “skin to skin with baby” by Nelson Kwok, Creative Commons