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What to do for the baby

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HealthWiki > A Book for Midwives > Chapter 13: The birth of the placenta: stage 3 of labor > What to do for the baby: The birth of the placenta


When the baby is born, even before you cut the cord, put him on his mother's belly. The mother's body will keep the baby warm, and the smell of the mother's milk will encourage him to suck. Be gentle with a new baby.

Note: In many medical centers, doctors or nurses take the baby away from the mother to check his health. This is easier for the doctors and nurses, but it is not best for the baby. The baby should not be taken from the mother unless there is an emergency.

Contents

Keep the baby warm and dry

As you move the baby to the mother's belly, dry his whole body with a clean cloth or towel. Babies become cold easily and this can make them weak or sick. Cover the baby with a clean, dry cloth. Be sure to cover his head and keep him away from drafts.

If the weather is hot, do not wrap the baby in heavy blankets or cloths. Too much heat can cause the baby to get dehydrated. A baby needs only one more layer of clothes than an adult does.

Check the baby's health

Some babies are alert and strong when they are born. Other babies start slow, but as the first few minutes pass, they breathe and move better, get stronger, and become less blue.

To see how healthy the baby is, watch her:

  • breathing
  • heartbeat
  • muscle tone
  • reflexes
  • color


All of these things can be checked while the baby is breastfeeding.

Breathing

Babies should start to breathe normally within 1 or 2 minutes after birth. Babies who cry after birth are usually breathing well. But many babies breathe well and do not cry at all.

A baby who is having trouble breathing needs help.

a baby making noise while breathing.
Unh...unh...
unh...unh...

Watch for these signs of breathing problems:

  • Baby's nostrils open wide as she tries to breathe.
  • Skin between the baby's ribs sucks in as she tries to breathe.
  • Baby breathes very fast — more than 60 breaths a minute.
  • Baby breathes very slow — fewer than 30 breaths a minute.
  • Baby grunts or makes noise when she breathes.


If the baby is having trouble breathing, leave her on her mother's belly and rub your hand firmly up and down her back. Never hit or hurt a baby or hold her upside down to make her cry. If you have it, give oxygen to a baby who continues to have breathing problems. Watch the baby closely — if these problems do not improve, she may need medical help.

To give oxygen to a baby who is not breathing well
  • give 5 liters (L) of oxygen
each minute, for 5 to 10 minutes
If you have a small oxygen mask for a baby, put it on the baby's

face. If you do not have a mask, cup your hand loosely over the baby's face and hold the oxygen tube near her nose (1 or 2 centimeters away from her face).

When the baby is breathing better, turn the oxygen off slowly, over a few minutes.


Suctioning a baby who is not breathing well will probably not help and may actually make breathing more difficult.

Baby does not breathe at all

A baby who is not breathing at all one minute after birth, or who is only gasping for breath needs help immediately. If she does not breathe soon after birth, she may get brain damage or die. Most babies who are not breathing can be saved. If you use the following steps, the baby will probably recover well.

Rescue breathing

  1. Lay the baby on her back. She should be on a firm surface — like a firm bed, a table, a board, or the floor. Keep the baby warm. Put a warmed cloth under her, and a cloth on top of her, leaving her chest exposed.
  2. Position the baby's head so that it faces straight up. This opens her throat to help her breathe. You can easily get the baby into this position by putting a small rolled-up cloth under her shoulders. Do not tilt the head back far — it will close her throat again. The baby may start breathing after you put her in this position.
  3. If the baby had thick meconium at birth, quickly suction her throat.
  4. Put your mouth over the baby's mouth and nose. Or close the baby's mouth, and put your mouth over her nose.
  5. Breathe into the baby using only as much air as you can easily hold in your cheeks. Do not blow. Too much air can injure the baby's lungs. Give 3 to 5 slow breaths to start. This clears fluid from the baby's lungs. Then give small, quick puffs about 3 seconds apart.
  6. a woman with her mouth on a baby's face while thinking.
    Breathe...
    the woman counting seconds between breaths.
    ...2...3...
    the woman with her mouth on the baby's face again.
    Breathe...
    the woman counting seconds again.
    ...2...3...
  7. Look at the baby's chest.
    It should rise as you breathe into the baby.
  8. If the baby's chest does not rise, reposition the baby's head
    — the air is not getting into her lungs.
  9. Breathe about 30 breaths every minute. But it is not so important to get exactly the right number of breaths.
  10. Check for breathing. If the baby starts to cry or breathe at least 30 breaths a minute, stop rescue breathing. Stay close and watch to be sure the baby is OK.

If the baby does not breathe, or breathes less than 30 breathes a minute, keep rescue breathing until she breathes.

WARNING!    The baby's lungs are very small and delicate. Do not blow hard into the baby's lungs, or you can break them. Breathe little puffs of air from your cheeks, not from your chest.

If the baby does not breathe on her own after 20 minutes of rescue breathing, she will probably not be able to. She will die. Stop rescue breathing and explain to the family what has happened.

Note: Doing rescue breathing has a small risk of passing infections between a baby and a midwife. Using gauze or a very thin piece of cloth to cover a baby's mouth may help reduce that risk. Or you may be able to buy a mask for rescue breathing. It goes over the baby's nose and mouth and the midwife breathes into it. Only use these masks if they are made specifically for this use.
You may also be able to buy a bag and mask for rescue breathing. These bags can easily give just the right amount of air to the baby, but you must be trained how to use them.

Heartbeat

A new baby's heart should beat between 120 and 160 times a minute — about twice as fast as an adult heartbeat. Listen to the baby's heart with a stethoscope, or place 2 fingers over her heart. Count the heartbeat for 1 minute.

Listen to every baby's heartbeat so you learn what is normal and what is not.

If the baby's heartbeat is slower than 100 beats a minute, or if she has no heartbeat at all, give rescue breathing.

If her heartbeat is faster than 180 beats a minute, get medical help. She may have a medical problem with her heart.

a baby with arms and legs bent and held close to the body.
This baby has
good muscle
tone.
a baby with arms and legs loose and open.
This baby
is limp.

Muscle tone

A baby who holds his arms and legs tight and close to his body, and his elbows and knees bent, has strong and healthy muscles, or good muscle tone. A limp baby has weak muscle tone. His arms and legs are loose and open. Some babies are born limp if they did not get enough oxygen before they were born. But a healthy baby should gain strength in his arms and legs within a few minutes.

The longer the arms and legs stay limp, the more likely it is that the baby is in trouble. A limp baby will not breathe well. If the baby is just a little limp, try rubbing his back and talking to him. This may help the baby wake up and try harder to breathe. If the baby is very limp, especially after the first minute, suction or wipe out his mouth and nose. He may need oxygen as well.

Reflexes

Reflexes are the body's natural reactions. For example, when you fall down, you put your hands out to catch yourself — without even thinking about it. Or, when an insect flies at your eye, you blink. Strong reflexes are a sign that the brain and nerves are working well.

Moro reflex:
arms open wide

At birth, a healthy baby should have these reflexes:

grimace
  • Grimace. The baby should make a face if you suction his mouth and nose.
  • Moro reflex. If the baby is moved suddenly or hears a loud noise, he stiffly flings his arms wide and opens his hands.
  • Sneeze. A healthy baby will sneeze when there is water or mucus in his nose.

If the baby does not have any of these reflexes but he is breathing and his heartbeat is more than 100 beats in a minute, get medical advice.

Color

Most babies are blue or even purple when they are born, but they quickly become a more normal color in 1 or 2 minutes.

Babies who have darker skin do not look as blue as babies with lighter skin. Look at a dark-skinned baby's hands and feet to see if they are bluish. All babies can look dusky or pale if they are not getting enough air in their lungs.

Baby is very pale or stays blue after the first few minutes

It can be OK for a baby's hands or feet to stay a little blue for many hours. But it is not normal for a baby's body to stay pale or blue for more than 5 minutes.

Most of the time, babies stay pale or blue because they are not breathing well.

Babies can also be blue:

  • when they are cold.
  • when they have an infection.
  • when they have heart problems.

Check the baby's temperature or touch him to see if he is warm. Wrap the baby in blankets or cloths, and cover the baby's head. Put a hat on the baby if you have one.

If the baby is still blue or pale when he is warm, he needs help breathing. If you have oxygen, give it now. Check the baby's heartbeat and breathing. See information about the baby having a hard time breathing.

If the baby is still blue or pale after you give him oxygen, get medical help.

Help the baby breastfeed

If everything is normal after the birth, the mother should breastfeed her baby right away. She may need some help getting started. Chapter 16 is about breastfeeding, and explains what breastfeeding positions work well.

The first milk to come from the breast is yellowish and is called colostrum. Some women think that colostrum is bad for the baby and do not breastfeed in the first day after the birth. But colostrum is very important! It protects the baby from infections. Colostrum also has all the protein that a new baby needs.

Early breastfeeding is good for the mother and baby.

  • Breastfeeding makes the womb contract. This helps the placenta come out, and it helps prevent
    heavy bleeding.
  • Breastfeeding helps the baby to clear fluid from his nose and mouth
    and breathe more easily.
  • Breastfeeding is a good way for the mother and baby to begin to know each other.
  • Breastfeeding comforts the baby.
  • Breastfeeding can help the mother relax and feel good about her new baby.

If the baby does not seem able to breastfeed, see if he has a lot of mucus in his nose. To help the mucus drain, lay the baby across the mother's chest with his head lower than his body. Stroke his back from his waist up to his shoulders. After draining the mucus, help put the baby to the breast again.


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