by Maggie Goins

Created on: May 09, 2008

What nurses do with newborns right after birth

Not long ago, the clich of "we do it this way, because we've always done it this way" was said with authority by many experienced nurses. Today's nurses find it as strange a concept as starched white caps and standing up when a doctor enters the area. When I go to work after time off and say, 'what's new,' I'm not just making conversation. Changes will have happened.

Many of the changes in first newborn care are good for babies and their families. Family Centered Care is the current goal of many, many hospitals these days. In addition to caring for our admitted preemies and sick babies, RNs from my NICU attend all deliveries. Our goal is to keep the family together through the transition baby makes. Here's how we like it to go in the first two hours of the new life.

Our birthing center calls a nursery nurse to set up when delivery is close. This entails turning on a warmer bed, getting supplies in easy reach, checking on oxygen and suction equipment, and making sure warm blankets and a knit hat are available. We are then ready to help any baby with unexpected problems breathing or a low heart rate. In an unforeseen emergency, an MD or Neonatal Nurse Practitioner is in the hospital, a phone call away.

With few exceptions, parents are concentrating on their labor and unaware of us at this point. Introduction is done when they are ready. When the baby is born, he or she is placed directly on mother's abdomen by the delivering doctor or midwife. The cord is cut by the father or significant other. The nursery nurse has turned on a timer and begun to assess the baby. With a warm blanket, the baby is dried of blood and amniotic fluid, heart rate and breathing effort assessed with a stethoscope while observing baby's tone, response to us, and color. Each of these five areas is assigned a value of 0-2 at one and five minutes of life. At our high altitude, the color part is usually marked down as pink happens with good circulating oxygen in baby's body, more easily accomplished at sea level than a mile up. One doctor teased that in order to get a perfect score of 10, the baby needs to walk out of the delivery room. Well, not quite, but we do get the not so pink.

Baby continues to bond 'skin to skin' with mother, covered with a dry, warm blanket if all is well, breastfeeding if ready. When family wants the weight and length, baby goes to a scale in the room then placed on the warmer for footprints and identification bands. While there, the RN does a quick assessment, checks baby's eyes for congenital cataracts, applies antibiotic eye ointment and gives a vitamin K injection, as babies need help with their blood clotting ability when first born. Baby is returned to mother, skin to skin, for more bonding and breast feeding time. We check heart rate, respiratory rate, and temperature every half hour. If baby is warm and parents are ready to have the bath done, we bathe baby on the warmer. If they aren't ready, it can be done later, after transfer to the postpartum unit where the family will have a room together. Very nice.

Gone are the days of mother delivering flat on a hard table, healthy babies disappearing until the next day, given formula every four hours by nurses round the clock. Today's healthy baby stays with its family, even when born in the hospital. What could be better?

Learn more about this author, Maggie Goins.
Click here to send this author comments or questions.