How a midwife checks the baby’s health
So you’ve decided to have a home birth and feel confident about your prenatal care and labor choices. But what about after the baby arrives?
During the immediate postpartum period I am assessing vital signs on mom and baby regularly, helping to initiate breastfeeding and giving adequate time and support for mother/baby/family bonding. During the time of active recovery, we are following baby’s cues that he/she is interested in nursing because first and foremost, in the absence of complications or the need to intervene, this is of vital importance.A complete newborn exam is performed in order to assess baby’s gestational age and to verify everything is within normal limits, from head to toe. Any concerns will be discussed with the parents and a plan for next steps established. In the case of an emergent concern, we would transport to the hospital; however, most situations identified during the newborn exam are truly non-emergent and may be referred to the baby’s pediatrician during normal business office hours.
Acting within the scope of my license, a midwife is able to care for the newborn within the first six weeks of birth. I do discuss with all of my clients however, that I am not a pediatrician and I recommend the baby be seen by a doctor within the first two weeks of birth, unless they elect to do so sooner or the doctor requests an earlier visit. What I provide for the pediatrician is a one-page document containing applicable pregnancy or birth events as well as any newborn procedures prior to the first visit so that they have any information they may need easily at their disposal.
Now that you have an overview, let’s take a closer look at the details of newborn care for home birth. Assuming a normal birth, baby’s AGPARS were great and baby is robust, crying and alert, the baby spends time skin to skin with mom, dad or another family member. Midwives regularly practice delayed cord clamping; many of my clients have not had the baby’s cord cut until after the placenta has delivered, ensuring baby gets his/her blood!
Vital signs are done hourly or as needed and include assessing heart rate, breathing and temperature. Typically the newborn exam is done between 1-2 hours after birth (it is at this time that baby is weighed and measured and newborn procedures are done according to law and parents’ informed choice) and includes the Ballard Exam which helps to assess overall gestational age and is comprised of neuromuscular maturity as well as physical maturity.
It is usually at the conclusion of this exam that mom and baby are helped into an herbal bath. Once out of the bath, the baby is dried, and I demonstrate the application of olive oil to the bottom (to help ease the changing/cleaning of dirty diapers), diapering, cord care, dressing and swaddling. One last set of vital signs is taken prior to the midwife’s departure.
What’s next? You’re left alone?!?
Not to worry, during the prenatal period, as part of your care, I will have already taken the time to review what to expect and what to look for. Between 34-36 weeks I send a document about the first few days postpartum and how to care for the baby. The document includes a chart where the parents, or other elected family member or friend, write in the information requested. During the first 24 hours, vital signs are to be assessed every 4 hours. This means taking the baby’s temperature, counting respirations and heartbeat.
Does that sound scary or overwhelming? This document is reviewed at the home visit and again after the delivery prior to the midwife’s departure. I will teach you, so you can be sure of what to do! I return for a postpartum home visit between 24 – 48 hours after the birth and am on call 24/7 during those first days after the birth.
It is at the initial postpartum home visit that the first newborn screen is performed (testing for metabolic diseases) as well as the CCHD (critical congenital heart defect screening). I check vital signs for mom and baby again at this visit as well as provide breastfeeding support. The baby is weighed again to verify he/she has not lost too much weight. We discuss the number of wet & dirty diapers, sleep & eating patterns and assess baby’s skin color for jaundice. Goldenseal is applied to the baby’s umbilical cord as needed.
There are 2 additional postpartum visits that follow; both are back at my home office and include weight and vital sign assessment. I am able to perform the second newborn screening should you choose to have me do it instead of your pediatrician around 14 days postpartum. We review the items discussed at your postpartum home visit, plus anything new that may arise!
As you can see, I do my best to help prepare you for the next tasks of caring for your baby. I want you to feel educated, supported and encouraged each step of the way.
What questions do you have about newborn care at home?
If you’ve given birth in a hospital, what was your newborn care experience like? What would you change? Comment below!