Childbirth is a hectic time, and I know it was a wonder to me how the dance of nurses and doctors happens in the delivery room. Everyone seems to have a job and they move with effortless ease, even if you can't tell what they're doing. Rest assured — they are evaluating everything, including your baby. But what do nurses do to the baby right after they're born? There's a lot of moving around and knowing how your team evaluates your baby can help allay any worries you might have.
I called up my OB-GYN to ask her about how babies are cared for after they're born, and she immediately told me, "You have to talk to a labor and delivery (L&D) nurse." Apparently, while the OB-GYN assesses the baby immediately following childbirth, the nurses are the ones who really look over your baby and make sure that he or she is safe and sound. This is especially true in the case of cesarean births, when the OB-GYN is fully concentrated on the health of the mother after the baby has been delivered.
I spoke with Nicole Herskowitz, an L&D nurse in the Portland area about babies and childbirth, and she shared the checklist your labor and delivery nurse goes through when evaluating your baby after they're born. Herskowitz tells Romper, "The very first thing we do is look at the baby's ABCs, even knowing the doctor has already done this." ABC stands for airway, breathing, circulation.
"It's just a fast check before we get to the more in-depth Apgar scoring. That is when we evaluate and score the baby's heart rate, breathing ability, muscle tone, their reflexes, and their color," she says. "Each of these are rated between zero and two, and will add up to a 10 or less. If the baby is under a seven, we determine what measures must be taken to improve whatever issue seems to be causing the problem. For instance, the baby may need oxygen supplementation or additional suction. If the baby's score is really low, we sound the alarm and get our neonatologist there stat. Minutes count. We score babies more than once as well, and often the scores come up on the second or third round."
Herskowitz tells Romper that after the Apgar score is completed, there are many smaller checks and measurements that they complete and document that aid the pediatrician later when they evaluate the baby. These include head circumference, belly circumference, length, weight, respirations, heart rate, and temperature.
"After we've taken all our measurements and documented them, we then check the baby over completely. We check everything from the suture lines in their skull (where the skull comes together) to their fontanelle (soft spot) to the density and amount of cartilage in their ears. We listen to their heart, evaluate their genitalia for abnormalities or issues, make sure their umbilical stump is clean and that the clamp is secure. We look at their skin, their hair, the little lines on the bottom of their feet, everything."
Herskowitz notes that the little things they evaluate can clue them into something more that may be going on with your baby. "It may look like we're doing baby yoga or aerobics with your baby, but we're looking at the maturity of the nerves and muscles of the baby when we're pulling their arms across their chest or putting their feet near their ears. We're also checking the range of motion of their hips for possible dysplasia. It doesn't hurt them, though I have been pooped and peed on when I pull their legs up," she adds. (My daughter peed every time I changed her diaper and pulled her legs up, and now I feel like I need to know if she peed on the nurse.)
Herskowitz also notes that all of this is happening very quickly and the goal is to get your baby back to you as soon as they can, so you can bond and breastfeed if you're choosing to do so. I don't remember it taking any more than a few moments, and they were right there in the room with me as the doctor stitched up my downtown. Soon enough, my babies were tucked back on my chest, probably confused as heck as to what the crap just happened in the past few hours, but soft and cozy next to me. Those L&D nurses make a lot of rounds, but in the end, it's all to make sure you have something everyone in the room wants: a healthy baby.
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