As you’re creating your birth plan, it’s important to consider the time immediately after you’ve given birth. There are decisions to make, and things you should know are coming!
This is a little different for a vaginal or cesarean birth, so we’ll discuss those separately.
What Happens After a Vaginal Birth
The moments after your baby arrives are beautiful and amazing! Your midwife or OBGYN might often place your baby on your belly, and if you’re like many new mothers I’ve seen over the years, you’ll be in a bit of disbelief. You’ll likely be in awe, and in love with your baby. You may also be a bit overwhelmed. All of this is normal.
The Golden Hour and Skin to Skin
You may have heard of the golden hour, an important time for bonding with your newborn.
During this time, you can hold your baby close and allow for lots of direct skin to skin contact. This helps with her breathing, heart rate, temperature, and, if you’re planning to nurse, helps this process begin.
You might choose to delay bathing, and only have their baby wiped off. This rubs in the vernix and other “good bacteria” that come from a vaginal birth. You can decide if you want to delay bathing for the first hour, the first day, or longer, and put this in your birth plan.
While your newborn is on your chest, the nurses will likely cover both of you with blankets to provide extra warmth. She may also get a little hat.
In your birth plan you can ask for:
- All newborn procedures to be done after the initial first hour
- Any procedures that must be done to be done while baby is skin to skin with you
- To delay bathing
Clamping the umbilical cord
When the baby is born, they are still attached to the placenta by the umbilical cord. This cord pumps oxygen and iron rich blood to the baby even once the baby is out of the womb. Delayed cord clamping means that rather than stopping the blood flow immediately, your provider waits to clamp and cute the cord.
By delaying cord clamping, studies have found that babies have higher levels of iron and more blood supply. This has been found especially beneficial for small babies, or those born early. There is also a possibility that more blood increases the chance of jaundice, but perhaps not to levels that are concerning. This is something to discuss ahead of time, and put in your birth plan. ACOG recommends delaying cord clamping for xx amount of time.
When thinking about delayed cord clamping, you can ask for your provider to:
- Follow whatever their procedure is
- Allow the cord to stop pulsing allow the cord to stop pulsing
Your partner or support person will also likely be asked by your provider if they want to cut the cord.
Your baby’s APGAR score
Within the first minute after your baby arrives, your provider will assess your baby with the APGAR score. This gives information on her well-being and can be done on your chest. APGAR stands for Appearance, Pulse, Grimace, Activity, Respiration. This score will be done again at five minutes, to ensure that your baby is adjusting well. You can ask your provider to share the scores with you.
Placenta
Soon after your baby is born, it will be time for your placenta to be delivered. This is called the third stage of labor. Often, doula clients will ask if delivering the placenta hurts, and if they will have to push again.
Compared to your baby’s birth, delivering your placenta is a much easier process. It may take a bit of effort, but because thankfully placentas don’t have bones, it’s fairly simple- often just one push. Your OBGYN or midwife may do a few things to assist you in delivering your placenta:
- Give you artificial oxytocin soon after your baby is born to allow your uterus to contract. This helps with both the placenta, and reducing postpartum bleeding.
- Pulling on the umbilical cord (some believe this is unnecessary).
Your provider will check to see if your placenta is whole, since it is important that all of it leaves your body. You may have a provider that chooses to pull on the umbilical cord to deliver the placenta.
In your birth plan, you can ask:
- A natural third stage (though most providers, regardless of a medicated or unmedicated birth) will want to use some Pitocin at this point to prevent hemorrhage
- To see your placenta
- To take your placenta home
If you have a tear on your labia or perineum
Once the placenta is out, the provider will check your labia and vulva to see if there is any tearing. If you do have a tear, then your provider will assess to see if you need stitches and how many. It is common for you to experience a first-degree tear (this may not require stitches), or a second-degree tear.
In your birth plan, you can ask your provider to:
- Apply medicine for numbing, even if you have had an unmedicated birth (this tends to be standard)
- Discuss what you’d prefer to manage the pushing phase, such as a warm compress, you can discuss a warm compress or perineal massage
Continued monitoring after birth
After birth, you’ll continue to be monitored to make sure that you’re recovering well. This will usually be done in your labor room for the first 1-3 hours (depending on your hospital and how birth went). You can expect the following:
- Uterine massage called a fundal massage. (The fundus is top of your uterus, but this massage is not fun.) A nurse will apply pressure to see that your uterus is closing well, and will also check on your postpartum bleeding. This often happens every 15 minutes within the first hour.
- Your vital signs will be monitored. Specifically, your blood pressure, pulse and temperature in addition to your bleeding will be checked on.
- Your baby’s vital signs will be checked as well.
If you’re planning to breastfeed, the first latch is usually encouraged within the first hour after birth.
Skin to skin time with your baby helps this, and they will often show hunger cues. How you plan to feed your baby is something to put in your birth plan, including if you are planning on exclusively pumping or formula feeding from the beginning, this is something to put in your birth plan. If you have any challenges, request to see a lactation consultant (or ask your doula for help.)
Newborn procedures
A few newborn procedures will usually take place while you’re in your labor room. Typically, these are:
- The hepatitis B vaccine
- Vitamin K injection
- Erythromycin eye ointment
Other procedures, such as a hearing test, blood tests, and circumcision (if your family decides to do this) take place later.
You are likely to move to a different postpartum room within 2-3 hours.
If you have a cesarean birth, there are a few differences after birth, which we will discuss in our next post.
