First Reactions

'You can never really believe, all through pregnancy, and even during labour, that you are actually going to end up with a baby. I remember the shock of seeing what seemed like this huge, healthy baby, and thinking that just a second ago it had been inside me. It really is a miracle.'

'I must admit I didn't feel anything special towards the baby straight away. The birth had been so awful I was just thankful it was all over. I remember saying to my husband: "I suppose I've got to feed it now."It wasn't until about six hours later, when I'd been stitched up and moved to the ward, that I looked and saw him lying perfectly peacefully but awake, staring at me with little dark eyes. I began to feel something towards him.'

'I just felt a sense of wonder when I saw her for the first time. I still feel that often when I look at her now.'

T hat moment, after the birth, when you first see, touch and hold your new baby, is very special and highly personal. Everyone reacts differently and while many mothers feel an immediate rush of love and intense excitement, others can feel more detached and need time to adjust. Many women need time to recover from the labour and delivery, and this is especially true when they have had a difficult or painful birth. Ambivalent feelings can also be just as true of mothers who desperately wanted a baby as with those whose pregnancies may have been unplanned. Take your time. There is no 'right' or 'wrong' way to feel and such a major change in your life as becoming a parent will provoke very many different emotions in both of you at varying times.

Bonding

Much has been written and said about the importance of keeping mothers and babies together from birth and the way in which a sympathy, a bond, begins to develop between them as they learn about each other by looking and touching. The baby is already familiar with the pattern and pitch of his mother's voice from his months in her womb. He soon learns to put a face, a smell and a feel to the voice. A mother in turn begins to learn about her baby's needs from his cries and how to soothe and comfort him.

Suggesting there is a need for parents and their baby to be alone together after the birth makes it sound as though during those first few minutes a magical process should take place that a woman will immediately recognise and which will equip her to cope with the many and varied demands of motherhood. In fact, of course, a relationship between parents and children evolves gradually, in a different way and at a different pace for everyone. However, it does seem true that in many cases we are especially sensitive to our newborn in the period immediately after birth - a period which often coincides with a particular awareness and alertness in the baby. Often animals whose babies are taken away at birth reject them if they are returned some time later and, although our reactions and emotions are far more complex and sophisticated, it is the most natural desire for a mother to want to keep her new baby close by her side. That is why medical staff do all they can to keep them together as much as possible, even when the baby is ill and may need special care. This idea of a sensitive period, when we are especially ready to learn something, seems to apply at other stages of development, too. Thus, there is a certain stage when learning language is easier, and children who miss out at this time - perhaps because they are temporarily deaf, or are not spoken to enough - will find it harder to learn to talk later, while babies who are not introduced to solid food at the right stage may be very resistant to eating it later. It does seem certain that the beginnings of a close relationship between parents and child are helped by time alone together after the birth, though it is also important to recognise that it is perfectly possible to form good relationships later on if the mother and the baby do have to be separated, for example because the baby has to be in intensive care, or because the mother is ill after a complicated delivery or a Caesarean section.

First Contact with Your Baby

These days many midwives will ask if you want the baby delivered on to your stomach. This immediate skin-to-skin contact can be very soothing and reassuring for both you and your baby. Many mothers, however, want time to recover from the birth itself and will enjoy having their baby in close contact with them a few minutes later. Equally, some women may not like the idea of the baby being delivered directly on to their stomach because they are worried by the idea that the baby will be covered with mucus or blood. In fact there is not usually very much blood, although the baby will be wet from the amniotic fluid, but the midwife can easily wipe him clean and dry him and wrap him in a cloth before handing him to you or placing him on your stomach. The important thing is not to feel pressurised to behave in a certain way but to make your wishes known and do what comes naturally. In your own time you can enjoy a feeling of closeness by laying him on your stomach or between your breasts with a cloth over his back to help keep him warm. Keeping a newborn baby warm is important because even though the delivery room may feel very hot it is still about twenty degrees colder than the temperature the baby has been used to inside your womb. He will also lose heat more quickly at first because his skin will still be damp from the amniotic fluid.

Taking a Hold on Life - Your Baby's First Breath

Inside the womb your baby's lungs are filled with fluid, though he does practise breathing movements by moving amniotic fluid in and out in small amounts. After the birth the fluid is absorbed and the lungs can collapse inwards if they are not filled with air. Imagine the difference between a balloon filled with air and then shrivelled up after it is emptied. The sides of the shrivelled lungs are stopped from actually sticking together by important surface film called 'surfactant' which begins to cover them from about the 22nd week of pregnancy. This also makes the lungs more elastic and better able to expand. The biggest problem for babies born too soon is that they often do not have enough surfactant to help the lungs to work properly.

We do not know exactly what makes the baby take his first breath and draw air into his lungs - most probably it is a survival response as oxygen-carrying blood no longer flows through the umbilical cord. As explained in chapter 3, this normally happens at a point before the cord is actually cut - usually as the placenta begins to separate away from the uterus wall. Imagine the lungs like a bunch of grapes running off a central stem - the stems are the bronchial tubes and the grapes are the little air sacs, or alveoli. When your baby takes in his first breath, the air rushes down the tubes, filling out the alveoli. The remaining amniotic fluid which has not been squeezed out during the birth is absorbed into the bloodstream.

At the same moment as your baby begins to take in oxygen through his lungs, there is also a major change in the way his heart works. Inside the womb the two sides of the heart beat together, with oxygenated blood from the umbilical cord flowing into both sides, though the right side does most of the work. When the baby begins to breathe himself, then the pressure in the lungs decreases and the arteries which used to bring blood from the cord close down because there is no blood flowing through them any longer. These changes make ducts in the heart close so that the two sides are functioning separately as in normal life. One side receives blood-carrying oxygen from the lungs and sends it round the body, and the other side receives the 'used' blood which is coming back from the body without oxygen in it and sends it on to the lungs. This is the ordinary pattern for the rest of life. In the vast majority of babies, this seemingly complicated process happens without any problems and they begin to breathe as soon as they are born. But a few, for various reasons, may need help which can usually be given very easily.

Clearing the Airways

Your baby will still have some fluid in his nose and throat when he is born. Often it is enough to wipe his face gently and then lay him face down on your stomach or thigh so that it will drain naturally. If his airways seem blocked or he does not start breathing, any fluid can be sucked out of his nose and throat gently with a soft suction tube called a 'mucus extractor'. The midwife or doctor just inserts one end into the baby's nose and throat and gently sucks so that fluid is cleared and caught inside the tube. This takes only a few seconds and can either be done when the baby's head is born and while waiting for another contraction to deliver the body, or after the delivery itself.

Crying

A cry is proof that the baby is breathing, and the traditional way to ensure that this happened used to be to hold him up by his heels and smack him on the bottom. This rather traumatic introduction to life has since been shown to be unnecessary, and gentle stimulation and drying of the skin alone is usually enough to ensure he has begun to breathe, with or without crying. If your baby doesn't cry, don't worry, because he is probably breathing perfectly well. Some babies come out crying right away and others begin to cry soon after the birth, which is entirely normal. Holding your baby close to your skin and stroking, cuddling and soothing him will calm him down.

Is My Baby All Right?

This is the question that floats in and out of all parents' thoughts at times during the long nine months of pregnancy. It is the question they want answered first with the proof of their own eyes at birth. A full, detailed examination of your new baby will wait until a little later, usually the following day, because newborn babies can easily get cold, but the doctor or midwife will automatically check for any obvious problems at birth. This is the point at which any mistakes in the development of the baby, such as extra fingers or toes, club foot, extra earlobes or hypospadias (a faulty position of the opening of the penis in boys), will be detected. Most of these can be corrected, some very simply by a small surgical operation. In addition they will also look at his overall condition, to see whether he is a vigorous, active baby with a good colour and able to suck well. A method has been worked out so that the doctors and midwives all make the same checks in a standard way with every new baby and record what they find. This is called the 'Apgar score' after an American paediatrician, Dr Virginia Apgar, who devised it as a method of assessing the condition of a new baby. At one minute after birth, and then again at five minutes, the midwife or doctor checks the baby's heartbeat, breathing, muscle tone, reflexes and colour and scores them 0, 1, or 2. A total score of ten means a baby is in the best possible condition, but seven and over is normal. Between five and seven means the baby is all right, but will probably improve with some simple treatment like clearing his airways, or he may be slightly dozy from the effects of pethidine given late in labour. Babies with a score of less than five need extra oxygen to help establish better breathing (related Topics)

The two other important statistics to be recorded about your child's delivery will be his birthweight and the circumference of his head.

A low birth-weight baby is classified as weighing less than 2,500 grams (5H lbs) at birth, which is an important indication of the baby's health. Very small babies may need extra care and there are a number of ways of telling whether their size is because they are premature or have not grown enough in the uterus, or both. Obviously other factors influence the baby's size - not least the size of the parents and the mother's own birthweight which often corresponds with her baby's. Ill health during pregnancy and other environmental factors like smoking, drinking excessive alcohol or drugs can all retard the unborn baby's growth. At the other end of the scale, if a baby is very large, usually thought of as weighing 4,000 grams (10 lbs) or more, this may be an indication that his mother either has diabetes or has become temporarily diabetic during pregnancy (related topics). Recording a baby's weight at birth also helps doctors to see how he is progressing later. Newborn babies usually lose between five to ten per cent of their weight during the first four days of life. This is mainly due to fluid loss until the mother's milk supply is established. Most babies have regained their birthweight by the tenth day and go on to gain around 150 to 200 grams (5 to 7 oz) a week, or approximately 30 grams (1 oz) per day.

Head circumference will obviously be related to your baby's overall size, thus large babies will have large heads and vice versa. An unusually small head, out of proportion to the rest of the baby's body, may be a sign of mental retardation and an unusually large head can be a symptom of hydrocephalus, a condition where fluid which normally bathes the brain collects in the head because the tubes that drain it are blocked. In some families head size may be larger than average, but intellectual function is entirely normal. An average head circumference for a baby weighing 3,300 grams (7H lbs) would be around 35 cm (14 in). As with the baby's birthweight, one of the important aspects of this single statistic is to follow the way the baby develops so that subsequent measurements can show if the head is growing at the expected rate.

The actual shape of your baby's head will be influenced by the kind of birth as much as his inherited features at first - thus babies born by Caesarean section have perfectly formed heads, but babies who have had a long second stage or were a tight fit through the mother's pelvis will often have had their heads moulded into rather odd-looking shapes. This will correct itself fairly quickly. At the same time as measuring your baby's head, the midwife or doctor will feel the fontanelles, or 'soft spots' (releated topics).

Many hospitals also measure the baby's length, either at birth or on the second day of life. The average length for a normal weight baby is 50 cm (20 in).

Sucking

In the period soon after birth your baby has a strong sucking reflex. If you touch his cheek with your nipple he will turn his head towards it - this is called 'rooting'. He will probably need help to latch on properly. Your partner can help you to get comfortable so that your arm is supporting the baby's head at the right level or he can support the baby's head himself. The baby's head needs to be very close to the breast to enable him to take the nipple fully into his mouth so that, as he sucks, the pressure of his mouth and gums is on the areola, not the nipple itself (related Topics) Some babies suck strongly straight away, others may just lick and nuzzle. If he does not seem interested at once this may be because he has either swallowed a lot of mucus or still has some mucus in his throat, or he may be sleepy because of pethidine given to you during labour. Try expressing a drop of colostrum - the extra-rich creamy substance which is present before the milk comes in - and putting it on to his lips to encourage him. At this first feeding session the baby will probably suck for only two or three minutes - if he does not release his hold on the nipple, or you want to transfer him to the other breast, break the suction by gently inserting your little finger into the corner of his mouth. Fixing the baby properly to the breast, and taking him off properly, are important safeguards against sore nipples (related Topics)

Early sucking is important for three reasons. First, it stimulates your body to produce the hormone oxytocin, which helps the womb contract to the size it was before pregnancy and causes the placenta to separate. Second, it is a good start to establishing breastfeeding. Although the baby is getting protein-rich colostrum, not milk at this stage, the more he sucks, the sooner an ample supply of milk is established, and while he has a strong sucking reflex it is easier to get him to feed. Studies show that feeding within an hour of birth is an important stimulus to successful breastfeeding. Lastly, it helps to establish a closeness between you and your baby that you can both enjoy. (For a full discussion of breastfeeding click here)