Birth of a baby in hospital

Birthing Centers and Hospital Maternity Services (for Parents)

You'll make plenty of decisions during pregnancy, and choosing whether to give birth in a hospital or a birth center is an important one.

Giving Birth at a Hospital

Traditional hospital births are still the most common option. This means the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room.

In a hospital birth:

Pain medicines are available during labor and delivery, if a woman wants them.
Labor can be induced, if necessary.
The baby is usually electronically monitored throughout the labor.

Doctors "manage" the delivery with their patients. A birth plan can help a woman communicate her preferences, and her doctor will abide by these as much possible.

Many hospitals now offer more options for low-risk births, often known as family-centered care. These may include private rooms with baths (called birthing suites) where women can labor, deliver, and recover in one place without having to be moved.

A doctor and medical staff are still on hand. But the rooms create a nurturing environment, with warm, soothing colors and features that try to simulate a home-like atmosphere that can be very comforting for new moms. Rooming in — when the baby stays with the mother most of the time instead of in the infant nursery — also is more common.

Many hospitals offer childbirth and prenatal education classes to prepare parents for childbirth and parenting classes for after the birth.

How many people may attend the birth varies from hospital to hospital. In more traditional settings, the limit might be three support people during a vaginal birth. In a family-centered setting, more family members, friends, and sometimes even kids might be allowed. During a routine or nonemergency C-section, usually just one support person is allowed.

A variety of health professionals oversee hospital births:

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 more years of training after medical school in women's health and reproduction, including both surgical and medical care. They can handle complicated pregnancies and also do C-sections.

Look for obstetricians who are board-certified, meaning they have passed an examination by the American Board of Obstetrics and Gynecology (ACOG). Board-certified obstetricians who go on to receive further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.

If you deliver in a hospital, you also might be able to use a certified nurse-midwife (CNM). CNMs are registered nurses who have a graduate degree in midwifery, meaning they're trained to handle low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.

Registered nurses (RNs) attend births to take care of the mother and baby. If you give birth in a teaching hospital, medical students or residents might attend the birth. Some family doctors also offer prenatal care and deliver babies.

Anesthesia, if needed, will be administered by an anesthesiologist. A variety of pain-control measures — including pain medicine and local, epidural, and general anesthesia — are available in the hospital setting.

Giving Birth at a Birth Center

Women who deliver in a birth center usually have already given birth without any problems or have a low-risk pregnancy (meaning they are in good health and are not likely to develop complications).

Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.

Epidural anesthesia usually isn't offered at birth centers. So women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. Comfort measures (such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques) are often used.

A variety of health care professionals work at birth centers, such as registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care). A doctor usually isn't on-site and medical interventions are rare. But most birth centers work with obstetric and pediatric consultants as a team. Nurse-midwives provide care during a woman's pregnancy, labor, and delivery. The OB/GYN consultants are available if she develops complications that put her into a higher risk category.

The baby's heart rate is monitored often during labor, typically with a handheld Doppler device. Birth centers do have medical equipment available, such as IV lines and fluids, oxygen for the mother and the infant, and other equipment necessary to treat sick babies and moms.

A birth center can provide natural pain control and pain control with mild narcotic medicines. But if a woman decides she wants an epidural, or develops complications, she must be taken to a hospital.

Birth centers provide a homey birth setting for the mother, baby, and extended family. In most cases, they're freestanding buildings, though some are attached to a hospital. They often include amenities such as private rooms with soft lighting, showers, whirlpool tubs, and a kitchen for the family to use.

Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so make sure the birth center you choose has all the proper credentials.

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Which One Is Right for Me?

How do you decide whether a hospital or a birth center is the right choice for you?

Some things to consider:

If you've chosen a health care provider, find out if he or she can only practice at a particular hospital or birth center.
Check with your health insurance carrier to see which options are covered. Often, major insurance companies cover accredited birth centers as well as hospitals.

Some risk factors might mean that you're not eligible to deliver in a birth center, such as:

being older than 35
carrying multiples
having gestational diabetes or high blood pressure
having a breech-positioned baby

And if you want interventions such as an epidural or continuous fetal monitoring, a hospital is probably the better choice for you.

A birth center can be an option for women who:

don't have significant problems in their medical history
have a low-risk pregnancy
want a natural birth with minimal medical intervention or pain control
want friends or family members there for the birth

To help with your choice, arrange a tour of the hospital or birth center. This lets you make sure that the staff is friendly and the atmosphere is one in which you'll feel relaxed.

What happens to a newborn baby in the hospital?

What happens to a newborn baby in the hospital right after birth?

There's a flurry of activity in the delivery room in the seconds, minutes, and hours after your baby's birth. If you've had a vaginal delivery and you and your baby are in good condition, you'll immediately have skin-to-skin contact with your newborn.

Medical staff place your baby directly onto your abdomen and dry them there. (Newborn babies don't have the ability to control their temperature well, so after a baby is born it's important to keep them warm and dry. ) Your baby is covered with a warm towel or blanket and given a cap to keep their head warm.

Skin-to-skin contact also helps keep your newborn warm and lets the two of you start bonding as well. (Don't worry if you can't hold your baby right away due to one of you needing immediate medical care – there will be plenty of time for bonding later.)

The following things also take place immediately or soon after your baby's birth:

The umbilical cord is cut – but not immediately

Your doctor or midwife clamps the umbilical cord in two places and then cuts – or has your partner cut – between the two clamps.

Traditionally in the United States, the cord was cut almost immediately after birth. However, research shows that delayed cord clamping – which allows extra blood to flow from the placenta to the baby – lowers the risk of iron-deficiency anemia in infancy. The American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology recommend delaying cord clamping for at least 30 to 60 seconds.

Blood is collected

If your blood is type O or Rh negative, blood is collected from the cord to identify your baby's blood type. That's because if your child's blood type is incompatible with yours, it can cause an increased risk of jaundice and hemolytic anemia (a type of anemia caused by red blood cells being destroyed faster than they are created).

If you're banking your newborn's cord blood, that will be collected at this time too.

Suction is used, if needed

Your doctor may have suctioned your baby's mouth and nose before the delivery of their shoulders. If your baby still seems to have too much fluid in their mouth or nose, the doctor may repeat the process again after birth.

Apgar assessment

At one and five minutes after birth, an Apgar assessment is done to evaluate your newborn's heart rate, breathing, muscle tone, reflex response, and color. Your doctor should be able to do these simple assessments while your baby is resting on your belly, so you can stay together.

ID bands and footprints

A nurse puts matching ID bands on you, your newborn, and your partner minutes after the delivery (and certainly before taking your baby out of the room for any reason). These bands are checked and matched every time you and your baby are separated or reunited.

The hospital will explain its security procedures to you, including the protocol and form of ID needed for a staff member to take your baby from your room.

Most hospitals routinely make two copies of your newborn's footprints – one for their hospital record and the other as a keepsake for you. If they don't usually do this but it's something you'd like, you can ask for a set to take home.

Eye drops

Antibiotic ointment or drops are placed in your baby's eyes soon after birth. (This may be postponed for up to an hour so that you can breastfeed.) This is required by law in the U.S. to help prevent eye infections, some of which can cause blindness. These infections are caused by bacteria that your baby could have been exposed to during birth, such as gonorrhea or chlamydia.

Weight and other measurements are taken

Your baby is weighed, and their length and head circumference are measured.

Vitamin K shot

An injection of vitamin K helps your newborn's blood clot normally and protects them from a rare but dangerous bleeding disorder.

Hepatitis B shot

Your baby should get their first dose of the hepatitis B vaccine before being discharged from the hospital.

If you're a hepatitis B carrier or your status is unknown, your baby should be vaccinated within 12 hours of birth.
Babies of mothers who are known hepatitis B carriers will receive an injection of hepatitis B immune globulin (HBIG) – which provides short-term protection – within 12 hours of birth.
If your hepatitis B status is unknown, your blood will be drawn for testing, and if you're found to be positive, your child should receive a dose of HBIG as soon as possible.

Baby's first exam

Your baby gets a complete pediatric exam within 24 hours, followed by daily exams after that as long as you're in the hospital. If your newborn is in your room when the doctor is doing rounds, the doctor does the exam there and reviews the findings with you. If your child is in the NICU or nursery, the doctor will do the exam there and then come to your room to talk about the findings.

Circumcision

If you've decided that you want your newborn boy to be circumcised in the hospital, it's usually done a day or two after birth.

When do you start breastfeeding after your baby's birth?

Babies tend to be very alert right after birth, making it a good time to begin breastfeeding if you're both willing. In fact, the AAP recommends that healthy, full-term infants "be placed and remain in direct skin-to-skin contact with their mothers immediately after delivery until the first feeding is accomplished."

Most babies begin to nurse within the first hour or so, given the opportunity. There's no need to panic if your newborn seems to have trouble finding or staying on your nipple right after birth – they may just lick your nipple at first.

Don't be shy about asking for help with breastfeeding while you're still in the birth room (or recovery room, if you had a c-section). Later, when you get to the postpartum unit, there may be a lactation consultant for one-on-one coaching or group breastfeeding support. (It's a good idea to find out ahead of time what resources will be available.) If you're uncertain about anything, ask for help.

What happens after your baby's birth if you have a c-section?

If you have a c-section, your baby is handed to a nurse or doctor as soon as they're delivered and taken to a radiant warmer. They're dried off, their mouth and nasal passages are suctioned, an Apgar assessment is done, and they'll get any other attention they need.

In many hospitals, if you and your newborn are doing well, they are swaddled in a warm blanket and placed on your upper chest for a bit — or they can be brought to your partner, who will likely be sitting near your head. Your partner can hold your baby while you're being stitched up, and you can touch and talk to them while you're still in the operating room.

Afterward, your newborn goes to the well-baby nursery briefly – your partner may be able to go with them – while you head to the recovery room. In the nursery, their vital signs are taken, and they are weighed and measured.

As soon as possible, the two of you will be reunited and you can have skin-to-skin contact. If you plan to breastfeed, this is a good time to start.

What happens after your baby's birth if there are complications?

If there are any birth complications or your baby has any immediate health problems at birth, things happen quickly. The doctor cuts the cord, and your baby is dried off and placed on a radiant warmer. The warmer allows your baby to be left naked without getting cold so that the medical team can do whatever is necessary.

If your baby needs further care after being stabilized, they may be taken to a neonatal intensive care unit (NICU). But if they're doing well and need no further care, they are swaddled in a warm blanket and brought to you.

What tests does a newborn baby in the hospital get?

Blood test: All states require newborn screening tests. Your baby's heel is pricked and a few drops of blood are taken to test for metabolic, genetic, and endocrine problems. Because some signs of the conditions don't show up until the second day of life or later, it's best to do this on day two or three, but no later than day seven. If you and your baby leave the hospital within 24 hours of birth, you'll be given instructions about following up to have the tests completed.

Pulse oximetry (pulse ox): The amount of oxygen in your baby's blood is measured using painless sensors on the hands and feet to check for the possibility of a congenital heart defect.

Hearing tests: Your newborn's hearing should be checked before you leave the hospital.

HIV: If your HIV status is unknown, your baby's cord blood may be tested for the virus. (Some states require this. )

Does a newborn baby get a bath in the hospital?

Yes, your baby will most likely receive a bath while you're in the hospital, but it may not happen as soon as you think. Babies have traditionally been given their newborn bath not long after birth, but research is showing there are advantages to waiting at least 12 hours. A delayed bath:

Promotes breastfeeding. The amniotic fluid that remains on your newborn may provide breastfeeding cues for them. Researchers theorize this may be one reason why delayed bathing in hospitals resulted in increased breastfeeding rates. One study found that delaying a healthy newborn bath for more than 12 hours after birth resulted in a greater rate of exclusive breastfeeding in the hospital and increased rates of mothers planning to breastfeed (either exclusively or in combination with formula) after leaving the hospital.
Keeps your baby warm and reduces stress. Longer skin-to-skin contact with you reduces your baby's stress level and keeps them warm. To keep a newborn warm, the World Health Organization (WHO) recommends delaying a baby's first bath for at least six hours and ideally 24 hours after birth. (Because babies have a hard time regulating their temperatures, baths can easily chill and physically stress them.)
Protects your baby's skin. The waxy white vernix that coats your baby protects and moisturizes their skin and keeps them warm. There's no need to rush to wash it off.
Cultivates good bacteria. Delayed bathing may help a baby develop their microbiome – their normal bacterial flora – which researchers think may play a part in disease prevention.

Ask what the hospital's usual procedure is for bathing newborns, and request a delay if you prefer that. Baths usually take place in the nursery, where the baby is put under radiant heat for warmth.

Depending on your hospital's policy, you may be able to watch and even participate in your newborn's first bath. Some parents find that the hands-on experience gives them more confidence bathing their baby once they get home, especially if it's their firstborn.

Where does a newborn baby sleep in the hospital?

Where your baby sleeps in the hospital – whether it's in your room or in the nursery – is usually up to you. Different hospitals have different policies, so it's good to ask in advance what your hospital's is. That way, you can be prepared to voice your preference if it's different from what the hospital typically does.

Overall, there's been a shift away from healthy newborns spending time in the nursery. Instead, your baby can stay in a bassinet by your bed. This arrangement is called rooming in. That said, the nursery is a resource for you, so don't feel bad if you use it.

Rooming in has benefits for you and your baby:

If you're breastfeeding, it's easier to learn your baby's feeding cues and begin to establish a feeding routine from the start. In fact, the World Health Organization recommends rooming in because research shows it supports successful breastfeeding.
You can practice caring for your newborn and ask questions about what's normal while you have medical experts available to help you.
Research shows that both moms and babies sleep better.
Babies tend to cry less, be more content, and have lower stress hormones.
You have more opportunities to bond and have skin-to-skin contact with your baby.

Moms sometimes have their baby spend time in the nursery because they:

Feel better knowing they'll be monitored while they sleep
Had a c-section or other medical complication and need some extra help
Want to spend some time alone with their other children
Just need a break

When it comes to rooming in or having your baby spend some time in the nursery, the most important factor is what works best for your family.

When do you go home after a baby is born?

After an uncomplicated vaginal delivery, you're likely to stay in the hospital for 24 to 48 hours. If you have an uncomplicated c-section, you'll probably be in the hospital for two to four days. Find out more about how long you may stay in the hospital after childbirth.

Your baby should have a checkup three to five days after birth, or one to two days after going home. The doctor may ask you to bring your newborn in again about two weeks after that. If your child has any health problems – such as unexpected newborn weight loss or jaundice – you may see the doctor more often in the first few weeks. You'll bring your baby in for well-child doctor visits at 1 month and 2 months of age.

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The first days in the hospital - articles from the specialists of the clinic "Mother and Child"

Bogomolova Marina Vadimovna

Embryologist

Clinic "Mother and Child" St. Petersburg

Immediately after childbirth

Immediately after the birth of the child is placed on the mother's stomach , then the umbilical cord is cut and the baby is applied to the mother's breast. Then the skin of the newborn is cleaned, its length and weight, head and chest circumference are measured. The doctor examines the birth canal, if necessary, sews up tears in the soft tissues of the birth canal, assesses the tone of the postpartum uterus, and helps the woman empty her bladder. But even after all these standard manipulations, the mother is not transferred to the postpartum ward, another for two to three hours, the puerperal stays in the maternity block . Why? In the first two hours after childbirth, some complications are possible, primarily uterine bleeding or an increase in blood pressure. Therefore, during these two hours, the mother lies on a stretcher or a bed in the maternity ward, since doctors and midwives are constantly there, and the operating room, in which case, is also located nearby. The child at this time is usually taken to the children's department, where he most often sleeps. And only two hours later, if everything is fine, the mother is transferred to the postpartum ward.

How does a woman feel at this time? Chills may occur, abdominal pain may occur, especially in multiparas.

What should a woman do at this time? Relax and unwind. Take shelter so as not to freeze, especially if chills appear. Place an ice pack on the uterus. If possible, ask the midwife to bring hot tea.

1st day after birth0009 postnatal midwife . She will tell you about the arrangement of the department (where the shower, toilet, dining room are), about the daily routine (the time for visiting doctors, eating) and will help the young mother, if necessary, to empty the bladder using a catheter. If a woman lies together with the baby, then immediately after the transfer to the postpartum ward, the child will be brought to her. The midwife will help the mother to properly attach the baby to the breast and start breastfeeding. Then nurse will come and show you how to swaddle your baby and explain how to take care of him. Do not be afraid that after childbirth there will not be enough strength for the child: most newborns sleep most of the day and wake up only for feeding. In addition, in the maternity hospital, the child is usually washed and dressed by nurses, so that the woman will have enough time to relax. If there is no joint stay of mother and child in the maternity hospital, then every three hours they will bring him to the ward for feeding, and then take him back to the children's department. Over time, the woman herself will pick up and carry the child.

How does a woman feel at this time? On the first day after giving birth, women feel differently. Some experience an incredible elation (this is due to the release of endorphins into the blood - the hormones of pleasure), while others, on the contrary, feel very tired. Some want to call all their friends and announce the birth of a child, they are inspired, full of energy and ready to take care of the baby on their own. Other mothers want to be alone and come to their senses, they still do not have the strength to constantly be with the child.

What should a woman do at this time? In any case, immediately after childbirth, as after any heavy load, you need to restore strength: first eat, and then go to bed or just relax. By the way, the following situation is possible: the birth occurred in the evening or at night, and dinner time has already expired; therefore, in order not to starve, you need to bring something light for a snack (cookies, bread rolls) with you to the hospital in advance.

6 hours after birth, the mother can usually get out of bed.

In general, if the childbirth went without complications, then you should start getting up as early as possible, first with the help of a midwife, and then on your own.

This helps to improve blood circulation, normalize the functioning of the urinary system and intestines, and accelerate healing processes. In addition, very soon the baby will require more attention.

Important point: After childbirth, the tone of the bladder decreases, so the urge to urinate may be absent or it may become painful and frequent. However, you should go to the toilet at least four times a day. Urination can be caused reflexively by opening a tap with water, this helps many people a lot. In the absence of the desired effect, urine is removed by a catheter. Most often there is no stool on the first day after birth.

Next days

Every day, the mother will be examined by an obstetrician-gynecologist : he will evaluate the contraction of the uterus, the condition of the sutures and the amount of discharge, see if colostrum is secreted. The midwife will regularly measure the temperature, pulse, blood pressure and treat the external stitches with disinfectant solutions several times a day. Also, every day the baby will be watched by a pediatrician, after which he will tell his mother about the condition of the child. After a normal birth, a woman, as a rule, is discharged on the 3rd-4th day (after a caesarean section - on the 5th-6th).

How does a woman feel at this time?

After childbirth, a woman may experience pain in the abdomen due to uterine contractions, as well as slight muscle pain in different parts of the body. On the face and on the whites of the eyes, a “rash” may appear - pinpoint hemorrhages that appear due to the fact that small capillaries burst during attempts from tension. Blood pressure can be lowered, so dizziness is possible (to avoid it, you should get up smoothly, without sudden movements). There may be pain in the perineum, even if there were no tears and its incision (pain appears because the perineum was severely stretched during childbirth). If the perineum is sutured, then it will not be possible to sit for at least the first two weeks. Sometimes after childbirth, varicose veins appear in the anus (hemorrhoids), which means discomfort in this place.

What should a woman do at this time? Mom needs to continue to rest and gain strength. And you should also follow the rules of personal hygiene: often change postpartum pads, do air baths for seams (if any), take a shower daily, wash yourself every time after a bowel movement. Well, the most important thing is to establish breastfeeding and learn how to take care of the baby in practice.

Time in the maternity hospital flies very quickly. Try to spend it usefully - restore your strength and acquire useful skills: at home, all this will be very useful to you!

REMINDER

Things to do at the maternity hospital

Have a good rest: sleep all your free time and eat well.
Get complete information about your child's condition: so ask your pediatrician all your questions.
Establish contact with the child: therefore, spend as much time with the baby as possible, ideally being with him all the time. Take the baby in your arms, unfold the diapers, carefully examine the baby without clothes.
Learn how to take care of your baby: so ask your baby nurse to show you how to wash your baby, change clothes, swaddle, change diapers, clean ears and nose, cut nails.
Establish breastfeeding: To do this, feed your baby on demand. Ask the midwife to show you how to properly hold the baby at the breast, how to give and take away the breast.

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registration of newborns outside the hospital. The press service of the Ministry of Justice told RBC that the bill does not contain a ban on state registration of the birth of children born outside medical institutions, and does not introduce a ban on home births.

Photo: Lori

"In the event of a child being born outside a medical institution, a woman will have to apply either to a medical organization, regardless of its organizational and legal form, or to an individual entrepreneur engaged in medical activities and receive a document of the established birth form, which will be be the basis for state registration of birth in the registry office. In this case, there is no need to go to court," the response to RBC's request says.

On Thursday, a bill developed by the Ministry of Justice was published on the Unified Information Disclosure Portal, which proposes not to register children born outside maternity hospitals without a written application. An exception will be made for children born in hard-to-reach or sparsely populated areas, the list of which is established by the government. In such cases, as before, it will be possible to register a child at the request of the person who was present at the birth. However, the Ministry of Justice now proposes to introduce only a written form of applications, the document says.

The Ministry justifies its initiative with the need to combat fraud: some categories of the population, in particular the Roma, register non-existent newborns for the sake of state payments, including maternity capital. The explanatory note notes that "the adoption of this law will encourage women to apply for medical care during and after childbirth and will become a barrier to abuses related to the theft and sale of children. "

www.adv.rbc.ru

The agency emphasizes that the ability to register a child “on the basis of testimonies, regardless of where the child was born, contributes to an increase in the number of births without medical assistance due to the refusal of women in labor to go to doctors, which is extremely dangerous for the life and health of both women and and newborns."

www.adv.rbc.ru

According to the Family Code of the Russian Federation, if a child was not born within the walls of a medical institution, its origin is established on the basis of available medical documents, testimonies of witnesses or any other evidence. Now there is a practice of filing an application from a person who was present at the birth - either orally or in writing. The Ministry of Justice proposes to leave only the second option.

The status of a child not born in a maternity hospital is not specified in the text of the draft law, but it states that the maternal origin of a child can be established on the basis of a court decision.

Pavel Astakhov, Commissioner for Children's Rights under the President, could not comment on the bill to RBC, explaining that he was on a business trip and had not heard about it.

According to RBC's interlocutor in the government apparatus, the initiative of the Ministry of Justice came as a surprise. "The problem with unreliable birth rate records among Roma and in some regions of the Caucasus does exist, but it should not be solved in this way," the source said.

"The bill has not yet been submitted to the government and has not yet passed interdepartmental approvals. It is obvious that it will cause discussion, since there are many other ways to confirm the birth of a child," Deputy Prime Minister Olga Golodets' press secretary Alexei Levchenko told RBC.

Chairman of the Duma Health Committee Sergei Kalashnikov told RBC that the Justice Ministry's initiative is "crazy" and that its committee will not support it. It is not clear from the bill what will be the status of a child not born in a hospital, the MP said. "First of all, it is necessary to put things in order in the state bodies that deal with acts of civil status," Kalashnikov said.

"The vast majority of Russian women prefer to give birth in hospitals - either in public maternity hospitals or in private clinics. Planned births at home are still rare," Andrey Alfimov, deputy director of the Moscow clinic Mother and Child, told RBC. He believes that if the bill is passed, it will put those women who, for medical reasons, cannot give birth outside the home, in a very difficult position. As for the financial side of the issue, then, Alfimov noted, his clinic, most likely, will not feel qualitative changes: if the influx of clients increases, then it will be very insignificant.

Yulia Romadanova, a doctor at the private maternity hospital "Ava-Kazan", agrees with Alfimov. According to her, there are not very many women who prefer to give birth at home, rather than go to private clinics or state maternity hospitals. According to Romadanova, they now stay at home to give birth mainly for religious reasons: for example, Muslim men do not allow their wives to give birth in a clinic with a male obstetrician-gynecologist; some have prejudice against blood transfusions.