How to Protect the Golden Hour

Adriana Lozada:

I’m Adriana Lozada and you’re listening to Birthful. So recently we talked about the importance of the golden hour for you and your baby. And today, the topic I want to dive deep into is to know what’s happening with your care providers during this time and how you can best come together to make it as undisturbed as possible. So we’ve established that during that first hour or so after birth, what you and your baby need is undisturbed skin to skin time, to regulate, to imprint and to bond. And what providers are mainly concerned about is making sure that the baby transitions and stabilizes to the outside world, and that your placenta comes out and your uterus shrinks down so there’s no postpartum hemorrhage. So we know that birth is designed to work if there’s nobody there, but it is not infallible. And you probably chose to have a provider with you as a safety net in case something is not going great.

Now, the issue is that a lot of the routine protocols of care are done under the assumption that there will be a problem. And often providers, they intervene without giving physiology a chance or helping to support what physiology needs instead of disrupting it. Basically, providers tend to act before you or your baby get a chance to sort it out on your own. So then what are some of the interventions that happen in the name of that overabundance of caution? So for baby, one of the things that happens right after they come out, is there some vigorous drying and rubbing with a towel, making sure that they cry and in some cases continue to cry. Is this necessary? Well, for obvious reasons, babies come out all wet when they’re born and they aren’t great at regulating their temperature. So it is important to dry them. And a great place for this to happen is directly on the breathing parent’s chest since that is a beautiful place to keep them warm. Remember, you are more responsive than a heat lamp.

Now, does this drying need to be really vigorous, trying to get them to cry and continue to make sounds? No, not really. If you remember from my last episode on the golden hour, the birth cry is the first instinctive stage of the newborn. When they give that first cry, they expand their lungs, start breathing, pink up, and it usually happens rather immediately. But if it takes a moment, babies are still getting oxygen via the blood pulsing from the placenta, because hopefully the cord has not been clipped yet. If your baby gave that first good cry and is otherwise vigorous, meaning pinking up, moving their arms or legs and continuing to breathe then they shouldn’t need all that continued rubbing and stimulation. I find that this drying of the baby is usually done in this vigorous frenzy that is kind of anxiety producing and isn’t necessarily in line with what the baby needs in order to activate their own instincts.

Another thing that can possibly happen is the suctioning of the baby’s nose and mouth, but that is really not aligned with evidence and no longer recommended. The current recommendation is that just wiping their faces down is enough. There used to be a guideline from the American College of Obstetricians and Gynecologists before 2005 for newborns that had meconium in their amniotic fluid, of having providers use a bulb syringe to suction their nose and mouth right after the head was born but before the body was delivered, because there is a pause between there usually. That is no longer a recommendation and neither is the deep routine intubation and suctioning for any baby born with meconium stained amniotic fluid, whether they’re vigorous or not.

Now ACOG’s recommendation is in line with the American Academy of Pediatrics’s recommendation that for uncomplicated term and preterm newborns, that clamping of the cord should be delayed and the baby placed immediately on the birthing parent to be dried and assess for breathing tone and activity without suctioning. One really good reason to not do all that unnecessary suctioning is that it can interfere with the baby’s ability to breastfeed. So I encourage you to listen to our episode with resuscitation specialist and educator, Karen Strange, who is a huge advocate for respecting newborns during their needs for this calm transition even if there is a need for some resuscitation. In that episode, we also talk about whether newborns need a hat and the short answer is no, but they’re going to get one anyway. So feel free to take off your baby’s hat so you can check out how much hair they have and give a big inhale of that new baby smell, which will help trigger your mammalian responses and you can put the hat back on after if you want.

Okay. So once baby is stable, providers are going to continue to check their temperature to ensure they stay warm and most newborns really dislike this process and show it with a big cry. There’s also going to be a bunch of other finicky things that vary depending on where you live, but some examples are getting antibiotic ointments in their eyes, having a heel prick for blood tests, getting a vitamin K shot, being weighed and measured and getting footprints, which by the way, the footprints are only for you as a keepsake. There is no medical reason for those. All of these checks can wait until after the golden hour and except for the weighing and measuring, they can also all happen while your baby is on your chest.

Okay. So while all that is going on with the baby, then the providers are also on high alert for you specifically, making sure you don’t hemorrhage. Now it is normal to have some bleeding after birth and up to half a quarter during a vaginal birth can be fine and normal. And because your blood volume went up about 50% during pregnancy, you have a reserve to account for this loss and then some. But more important than the amount, what’s worrisome is the speed at which the blood loss happens. Because if you lose a lot of blood quickly, that can cause a severe drop in blood pressure. And if not treated, it can lead to shock. So of course that is an important concern, but it’s still a rare condition that happens in only 1 to 5% of cases.

In terms of the protocols, a lot of hospitals have started to give routine high doses of Pitocin, right after birth to get the uterus to contract and lessen the chance of bleeding, even though that can interfere with your own oxytocin production. And in some cases make the delivery of the placenta more difficult and eliminate a first line of action if you were to have a hemorrhage. Providers will also be focused on repairing any tears that may have happened during birth, the delivery of the placenta and ensuring that the uterus is shrinking and staying small by doing what is called a “fundal massage.” And I’m doing air quotes, every 15 minutes or so during that first hour. If you’ve ever had this done, you know that massage is the wrong name for it. There is nothing relaxing about it, and it’s actually quite uncomfortable.

But while this is going on, the nurse is going to continue to take your blood pressure and temperature, and they’re going to work on cleaning up the bed and after the placenta is delivered and any repairs that need to be done are done, then they’re going to be focused on cleaning up the bed and cleaning you as well. And for that, you will probably have to shift your hips or lift your bottom a few times. If they say they want to place baby on the warmer, in order to clean you up, know that they can totally do the tiding up while your baby is still on your chest. So feel free to say that you’d rather hang on to your baby while they do that if you want. And also that there’s no rush to do this.

So even though your baby will likely be skin to skin on your chest during that hour, and you may not care about, or even remember a lot of these protocols as you focus on your newborn, the fact is that that hour is going to be far from undisturbed. Research from 2014 and 2016 say that, “New mothers view these as exhausting, stressful, and detrimental to bonding.” So then how do you navigate all of these interventions and interruptions?

Well, now that you know, you can prepare for them. I would suggest you schedule an appointment with your provider to have an honest conversation about what they usually do during this time and share your wishes for a truly undisturbed, immediate postpartum, if that’s your case, and then brainstorm with them how these wishes can be honored within the protocols of the birth space. So let them know that you’ve done your homework and understand the need to keep baby dry and warm and to make sure that you’re not hemorrhaging. But that you also want to minimize interruptions so that you can have a more undisturbed third stage than the usual norm.

During your conversation, you may ask questions, like how long do you feel comfortable waiting for my placenta to come? Or could I kneel, squat or stand so that gravity can help bring the placenta out first? Is there any reason why my partner couldn’t be the one to dry the baby with only verbal help from you or the nurses? And would you be open to waiting to see if I need Pitocin before giving it to me? And so on. You may get a blanket yes response with the caveat of as long as you and the baby don’t need interventions then yes. So you may want to pinpoint what would qualify as a need. Try to quantify it, have them run the scenario. This is probably going to be uncomfortable work because you’re asking them to step out of what they automatically do, but it is worth it.

Whatever you agree on, put it on your birth plan and then make sure you have a similar conversation again with the nurses once you are admitted. They are usually the ones in charge of drying the baby. So ask if you or your partner could do that yourselves and have them show you how to do it ahead of time. Then remind your provider again, before you start pushing and do a rundown of what you envisioned, make a ceremony of it if you want and get everybody on your team. Truthfully, you can’t repeat this enough because you’re asking them to do something different than what they’re used to doing. Also, know that this job of advocating for an undisturbed golden hour could be a very suitable one for your partner or your doula since you are going to be busy with the actual labor and birth. What research clearly shows is that when health professionals respect, honor and support the physiologic needs of babies and birthing people after the birth, then they also improve the short and longterm health outcomes for both of them and how they interact with each other.

So I hope you have a wonderfully undisturbed golden hour. You can connect with Birthful on Instagram at Birthful Podcast, and to learn more about Birthful and my birth and postpartum preparation classes go to birthful.com. Let’s get you birth and postpartum ready.

Birthful was created by me, Adriana Lozada, and this episode was produced by LWC Studios: Paulina Velasco, Jen Chien and Kojin Tashiro. Thank you for listening to and sharing Birthful. Be sure to follow us on Apple Podcast, Goodpods, Amazon Music, Spotify, and everywhere you listen, and come back for more ways to inform your intuition.

CITATION: 

Lozada, Adriana, host. “Birthful: How to Protect the Golden Hour” Birthful, Birthful., March 16, 2022. Birthful.com.