Keeping the Baby Warm
You'll notice that your child is covered with a whitish coating that protected his skin in utero. Delivery-room personnel wipe away this substance as well as clean off the amniotic fluid. This keeps the infant from getting chilled as the wetness evaporates. For the past nine months your child has been in a balmy, tropical 98.6-degree climate. Now he has to cope with varying, and much lower, temperatures. Explains Dr. Laing, "Babies have more skin in proportion to their weight than adults do. This means babies have a greater area to lose heat from. Since they also have bigger heads proportionally, and relatively little hair, the head can be another source of heat loss."
To help ward off a chill, your child is placed on a warming table and given a fast once-over by the delegated nurse or pediatrician. Antibiotic eye drops, such as erythromycin, are often put into the baby's eyes, primarily to protect them against gonorrheal infection. An identifying band is placed on his wrist and/or ankle, and in many cases, the infant's footprint is taken.
Then the child gets an intramuscular vitamin K shot in the thigh. In the past, newborns had a tendency to bleed internally during the first 24 to 48 hours of life. "It was due to a deficiency in the liver's ability to produce vitamin K-dependent clotting factors," says Dr. Laing. "This simple intervention—giving the child a shot of the vitamin—has virtually eliminated the problem."
The baby is assigned an Apgar score when she's one minute old and again at five minutes. This assessment system was developed by and named after physician Virginia Apgar. At minutes one and five, five different qualities—the child's color, breathing ability, muscle tone, heart rate and response to stimuli—are evaluated (see chart)and awarded zero, one or two points (two being the best). The maximum number of total points is 10.
"The most common score is eight at one minute and nine at five minutes," says Dr. Harvey. She believes that a low Apgar has more significance than a high one. "If the one-minute Apgar is four, then you know the baby had a tough time during the delivery and may have been temporarily deprived of oxygen; however, if the five-minute score is adequate, then the problem's been corrected and the child will most likely be fine."Apgar Scoring Chart
|Skin Color||Blue||Body: pink; extremities: blue||Completely pink|
|Muscle Tone||Limp||Some movements||Active movements|
|Relax Response||Absent||Grimace||Cry, cough or sneeze (response to catheter in nostril)|
|Heart Rate||Absent||Below 100 beats per minute||Over 100 beats per minute|
After these initial procedures, a nurse diapers the baby, wraps him in a blanket, and hands him to you or your spouse. Depending on the hospital, this initial getting-to-know-each-other ritual may last minutes or even hours. "It's important for the family to be left alone and given a feeling of togetherness," says Dr. Laing. "We like to give them time to be as proud of each other as possible."