Information for parents in hospital, on what to expect in the first six hours after birth

Caring for your newborn baby following birth

This leaflet is for all parents and birth support partners who choose to have their babies in the Rosie Hospital.

Immediately following birth

Immediate drying Your baby will be immediately dried with a warm towel, including their head, usually whilst still attached to their umbilical cord. Whilst being dried your baby will be on a warm dry surface – either on skin to skin on your chest or tummy or on a prewarmed towel on the bed (depending on your preferences). The wet towel will then be discarded and your baby will be covered or wrapped in a new warm towel and a hat put on your baby’s head.

Cutting the cord This is dependent on your choice of third stage management. If you have physiological (natural) delivery of the placenta then the cord will not be cut until after the placenta is delivered. If you have an injection to assist delivery of the placenta, the cord will be cut after a few minutes.

Safe ‘Skin to Skin’ care Once your baby is born hold them against your skin as soon as possible for as long as you want. Your baby should be naked apart from a nappy and a hat and covered over their back with towels or blankets. Skin to skin contact helps to calm your baby, regulate their heart rate, breathing and temperature, as well as release hormones to help you bond with your baby. It is really important that your baby’s head is upright and their neck is straight during skin to skin contact. This is so that your baby can breathe easily and also that you can see your baby’s face at all times to make sure they are ok (and your baby will love to be able to see your face too). If you are in theatre, or unable to position your baby yourself, you will be supported to have skin to skin safely with supervision. If you do not wish to have skin to skin contact or feel too unwell for this immediately after the birth, your birth partner can have skin to skin contact instead if you both would like to do this. Skin to skin contact is recommended anytime in the early months with your baby, not just immediately after birth.

Early feeding Feed your baby soon after birth, ideally within the first hour. However you choose to feed your baby we recommend that the first feed is given in skin to skin contact. Your midwife or a maternity support worker will provide you with the support required to initiate your chosen method of feeding.

It is time to dress your baby when:

• You have had at least one hour of skin-to-skin; or
• After your baby has had their first feed; or When you, as a parent, are ready to.

To avoid your baby getting too hot or cold, there are posters in all areas of The Rosie hospital to help guide you with how many layers your baby needs. The number of layers required will also depend on the temperature of the room. As a general rule, babies should be dressed in a dry vest and babygrow with one or two light blankets over them. A folded blanket counts as two layers. It is recommended that your baby wears a hat for the first 24 hours of life. We have plenty of knitted hats you can use. Please bring in enough vests and babygrows to dress your baby and, if you wish to use your own blankets to cover baby with, you are very welcome to bring these in too. It is important to place your baby in a cot with your baby’s feet at the bottom of the cot, with the blankets tucked into the cot safely, so they can’t cover your baby’s neck and face.

Other things to expect

• Your midwife will weigh your baby following birth and complete an initial top to toe check, including taking your baby’s temperature at one hour of age. Some babies will also have their heart rate and breathing rate checked if it has been recommended that they need extra observations for the first 12-24 hours of life.
• If you have consented for vitamin K to be given to your baby, your midwife will do this soon after birth.
• At four to eight hours of age your midwife will check your baby’s oxygen saturation level.
• If you want an early discharge your midwife will complete the Newborn Infant Physical Examination (NIPE) screening check before you are discharged home.
• Before you go home you may be offered a hearing test for your baby. If you wish to go home before this is done, an outpatient appointment will be arranged for your baby instead.
• If you require further postnatal care for you or your baby, or would like to stay for feeding support, you and your baby will be transferred to the postnatal ward (Lady Mary Ward).
• If your baby requires any specialist neonatal support, your midwife and staff from the neonatal unit will explain this to you at the time.

References/ Sources of evidence

East of England Neonatal ODN (2020) Clinical Guideline: Thermoregulation. Cambridge: East of England Neonatal Operational Delivery Network

WHO (1997) Thermal protection of the newborn: a practical guide. Maternal and Newborn Health/Safe Motherhood Unit. WHO, Geneva