5.6 Immediate Care of the Newborn

Directly after birth there should be attention to the condition of the newborn. Such attention is an integral part of care in normal birth, and the World Health Organization stresses the importance of a unified approach to care of the mother and the baby (WHO 1994c). Immediate care involves ensuring that the airway is clear, taking measures to maintain body temperature, clamping and cutting the cord and putting the baby to the breast as early as possible. Each of these elements has been the object of considerable research and debate, but the present Technical Working Group for Normal Birth has the advantage of being able to refer to the work and recommendations of the Technical Working Group on Essential Care of the Newborn (WHO 1996). In the present report only a few aspects of the immediate care of the newborn will be briefly mentioned.

· Immediately after the birth the baby has to be dried with warm towels or cloths, while being placed on the mother’s abdomen or in her arms. The baby’s condition is assessed and the existence of a clear airway is ensured (if necessary) simultaneously. Maintaining the body temperature of the baby is important; newborn babies exposed to cold delivery rooms may experience marked drops in body temperature, and concurrent metabolic problems. A fall in infant temperature can be reduced by skin-to-skin contact between baby and mother.

· Early skin-to skin contact between mother and baby is important for several other reasons. Psychologically it stimulates mother and baby to get acquainted with each other. After birth babies are colonized by bacteria; it is advantageous that they come into contact with their mothers’ skin bacteria, and that they are not colonized by bacteria from caregivers or from a hospital. All these advantages are difficult to prove, but nevertheless they seem plausible. Early suckling/breast-feeding should be encouraged, within the first hour after birth (WHO/UNICEF 1989). The influence of nipple stimulation by the baby on uterine contractions and postpartum blood loss should be investigated. One randomized study has been performed (Bullough et al 1989), but only with traditional birth attendants. The influence of early suckling on blood loss could not be established. However, a study with professional birth attendants is needed.

· Cutting the cord should take place with sterile instruments, either disposable, for instance from the clean delivery kit, or thoroughly decontaminated by sterilization. This is of utmost importance for the prevention of infections.