Find information on medical topics, symptoms, drugs, procedures, news and more, written in everyday language.

* This is the Consumer Version. *

Initial Care of the Newborn

by Deborah M. Consolini, MD

Immediately after a baby is born, the doctor or nurse gently clears mucus and other material from the mouth, nose, and throat with a suction bulb. The newborn is then able to take a breath. Two clamps are placed on the newborn's umbilical cord, side by side, and the umbilical cord is then cut between the clamps. The newborn is dried and laid carefully on the mother's abdomen with skin-to-skin contact or on a sterile, warm blanket.

Cutting the Umbilical Cord

Soon after a baby is born, two clamps are placed on the umbilical cord, and the cord is cut between the clamps. The clamp on the cord's stump is removed within 24 hours after birth. The stump should be kept clean and dry. Some doctors recommend applying an alcohol solution to the stump daily. The stump falls off on its own in a week or two.

The doctor examines the newborn for any obvious abnormalities or signs of distress. A full physical examination comes later. The newborn's overall condition is recorded at 1 minute and at 5 minutes after birth using the Apgar score. A low Apgar score is a sign that the newborn is having difficulty and may need extra assistance with breathing or blood circulation. Once the newborn is stable and has breastfed, the nurses obtain the weight and length.

Keeping the newborn warm is critical. As soon as possible, the newborn is wrapped in lightweight clothing (swaddled), and the head is covered to reduce the loss of body heat. A few drops of an antibiotic, such as erythromycin, tetracycline, or silver nitrate, are placed into the eyes to prevent infection from any harmful organisms that the newborn may have had contact with during delivery.

Immediately after a normal birth, the mother and father or the mother's partner are encouraged to hold their newborn. Some experts believe that early physical contact with the newborn helps establish bonding. However, parents can bond well with their newborn even when the first hours are not spent together. The mother and newborn usually recover together in the delivery room. If the delivery is in a birth center, the mother, father or mother's partner, and newborn remain together in the same room. Mothers who are breastfeeding put their newborn to their breast within the first 30 minutes after delivery. Breastfeeding stimulates oxytocin , a hormone that helps the mother's womb to heal and promotes development of the milk supply. Once transported to the nursery, newborns are placed on their back in a small crib and kept warm. Because all babies are born with low levels of vitamin K, a doctor or nurse gives an injection of vitamin K to prevent bleeding (hemorrhagic disease of the newborn).

About 6 hours or more after birth, newborns are bathed. The nurse tries not to wash off the whitish greasy material (vernix caseosa) that covers most of the newborn's skin because this material helps protect against infection.

Apgar Score

Characteristic

Acronym*

Score

0

1

2

Color of skin

A ppearance

All blue, pale

Pink body, blue hands and feet

All pink

Heart rate

P ulse

No pulse

Less than 100 beats per minute

More than 100 beats per minute

Reflex response to stimulation of the nose (by touching it with a finger or a catheter)

G rimace

No response to stimulation

Grimace

Sneeze, cough

Muscle tone

A ctivity

Limp, no movement

Some bending of arms and legs

Active movement

Breathing

R espiration

No breathing

Irregular, slow

Good cry

*The word "Apgar" is an acronym. The letters A, P, G, A, and R correspond to the bold letters in this column.

The baby is given a score from 0 to 2 for each of 5 characteristics. A total score of 7 to 10 at 5 minutes is considered normal, 4 to 6 is intermediate, and 0 to 3 is low.

Resources In This Article

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • PITOCIN
  • ACHROMYCIN V
  • ERY-TAB, ERYTHROCIN