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 are placed into the eyes to prevent infection from any harmful organisms that the newborn may have had contact with during delivery.

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. 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.

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Apgar Score Characteristic Mnemonic Score* 0 1 2 Color of skin Appearance All blue, pale Pink body, blue extremities All pink Heart rate Pulse Absent Less than 100 beats/minute More than 100 beats/minute Reflex response to nasal stimulation (by touch or a catheter) Grimace None Grimace Sneeze, cough Muscle tone Activity Limp Some flexion of extremities Active Breathing Respiration Absent Irregular, slow Good, crying *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, intermediate; and 0 to 3, low. Apgar Score Characteristic Mnemonic Score* 0 1 2 Color of skin Appearance All blue, pale Pink body, blue extremities All pink Heart rate Pulse Absent Less than 100 beats/minute More than 100 beats/minute Reflex response to nasal stimulation (by touch or a catheter) Grimace None Grimace Sneeze, cough Muscle tone Activity Limp Some flexion of extremities Active Breathing Respiration Absent Irregular, slow Good, crying *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, intermediate; and 0 to 3, low.

Last full review/revision November 2006 by Ruth A. Lawrence, MD