Abstract: The Golden Hour encompasses a set of evidence-based practices that contribute to the physiological stabilization of the mother-new-born dyad after birth. Important elements of the Golden Hour include delayed cord clamping, skin-to-skin contact for at least an hour, the performance of newborn of assessments on the maternal abdomen, delaying non-urgent tasks such as bathing the newborn, weighing etc, and the early initiation of breastfeeding.
The Golden Hour contributes to neonatal thermoregulation, deceased stress levels in a woman and her newborn, and improve mother-newborn bonding. Implementation of these actions is further associated with increased rates and duration of breastfeeding. http://dx.doi.org/10.1016/j.nwh.2017.10.011
There are 2 phases after birth:
- The 4th stage or otherwise known as immediately after (1-3 hours)
- The postnatal or puerperal phase – the hours, days and up until 6 weeks post birth
Immediately after birth if there are no complications requiring baby to be removed for medical care, your baby should be put gently on your chest skin to skin. A warm towel will be put over baby to ensure he/she is kept warm. This is ideally how baby and mom should remain for at least an hour post birth. The light should be dim, room warm and quiet with only mom and dad’s voices being heard. As you have read above, these are the optimal conditions for baby to recover and adapt to life outside of the uterus.
After your baby is born and everyone is stable and settled you will rest up for a couple of hours in the place you gave birth; the labour ward, in the birth unit, birth house or in your own bed at home. This time is spent bonding, breastfeeding, celebrating and allowing that adrenaline to settle.
In reality, if you have birthed in the water you will need to get out the water at some point and at this stage your baby will have to be taken from you for safety sake as you exit the bath. Usually we will hand your baby to his/her dad to do a short stint of skin to skin with them whilst we get you back into bed and comfortable when we will immediately give baby back to mom to continue with the mom-newborn golden hour that is so important.
At this stage we will also have to quickly check mom to ensure that there is no excessive bleeding and to see whether you have any tearing and suturing necessary. Usually we would quickly do the suturing whilst baby is skin to skin with mom relatively soon after birth before the area starts swelling.
Once this is all done we leave you to settle and be alone as a new family offering you some refreshments and leaving you to it, just popping in here and there to check you are still ok. (We won’t be leaving, we are simply giving you time alone and are catching up on our paperwork outside)
If baby is battling to latch or mom needs assistance this will be provided but we do aim at uninterrupted self-attachment as an ideal.
If you had a c/section we aim at ensuring you get your skin to skin uninterrupted time as soon as possible after birth. This generally means once you are out of theatre which is around 40 minutes after birth. Whilst in theatre you would be holding your baby but not necessarily be able to skin to skin or breastfeed yet.
Once the Golden Hour has passed and baby has had a good feed and settled down (and the parents are ready) the midwives return to assist the mom up to the bathroom to empty her bladder and shower.
The backup midwife would usually do a full newborn check on baby around now too. This is a head to toe checkup assessing baby including weight, length and circumference of baby’s head. We check baby’s reflexes and well as all the vitals and general appearance.
If your baby was born at the birth house:
Once the morning comes or you have had a couple of hours of rest and recovery and your midwife deems you stable (see below) you can head off home to recover in your own bed.
If you birth in the Hospital / Midwife unit in a hospital:
You have a choice to either go home and rest in your own bed or get transferred to the postnatal ward at the hospital.
If you prefer to stay over in the postnatal ward we will assist you to have a nice shower or bath before moving you via wheelchair to the ward were you will spend the next 24 – 48 hours.
Your baby will go with you and remain with you for the duration of your stay assuming everything is well with baby. Routine hospital care will be given in the postnatal ward.
If you prefer to go home and we are satisfied with your condition we will discharge you to the warmth of your own home usually within 6 – 8 hours post birth depending on condition.
We will only discharge you home if we are sure you are both stable. The length of stay depends on your condition as well as time of day. Even though we have checked baby thoroughly we will still offer you the choice of having a pediatrician to check baby whilst in hospital.
If you give birth at home:
Your midwife will remain with you to establish that you and your baby are stable and settled (as above). She will assist with the clean up after the birth and once she is satisfied that you are fine will leave you settled in your own bed.
Before we discharge you home or leave you we need to be satisfied that:
- Birth was not complicated;
- You didn’t bleed excessively;
- It is a reasonable time of day/night;
- Baby is warm and has breastfed;
- You have emptied your bladder;
- You are able to go home to bed for the next 3 – 4 days;
- You don’t live too far from your midwife/the hospital for postnatal visits.
Important things to do over the first few days:
Newborn vaccinations – BCG / Oral Polio drops + your baby’s clinic card. This is done usually whilst still in hospital if you decide to stay overnight. If you go home soon after birth we arrange for your to return for this vaccination to either the hospital of birth or to our clinic sister who administers this first vaccination.
Birth registration – you need to register your baby’s birth at the Department of Home Affairs. Most hospitals have a small satellite home affairs office where you can go to get baby’s birth certificate. You’d need to take both parents ID documents and marriage certificate (if applicable) as well as the Notification Of Birth which will be given to you by your midwife after the birth.
Your midwife or one of the other midwives will do postnatal visits to check on you and your baby either at home or at the practice around 2 – 4 times within the first week/s of birth.
You will be assisted with all the bits and pieces that may concern you and may including but not limited to:
- Baby bath;
- Birth registration;
- Cord cleaning;
- Weight checks;
- Hearing screening;
- New born Immunization.
- General check up
- Breast care
- Emotional support
- Birth debriefing / trauma support
- Baby care advice / education
5-6 Weeks after the birth
A full 5-6 week check on for both you and your baby is a very important visit.
This checkup is either done by our well woman’s sister at the Birth House or by your back up obstetrician and baby’s pediatrician.
This is a very important checkup for both mom and baby and covers the following:
Emotional wellbeing – assessment for postnatal depression and a check to ensure you are dealing with your birth experience or whether there is any trauma associated with your birth.
Physical checkup including assessing how your stomach is working, bladder control, healing of tears/episiotomy, bleeding, pain.
A pap smear will be done and full healing will be assessed including any tears you may have sustained and to check your uterus is back to its normal size and bleeding has stopped.
Family planning will also be discussed at this visit.
Milestones – is baby smiling, has baby gained some muscle control, are their eyes focusing/following
Feeding patterns and growth of baby – weighing, measuring of length and head comparing it to birth measurements
Checking the fontanelles/sutures to see they the normal size they are meant to be at 6 weeks.
A full head to toe check up
Baby’s heart will be carefully listened to at this stage to ensure it is fully functioning on extra uterine circulation and the foetal circulation has ceased. They will listen to hear if there are any murmurs.
Vaccination schedule is usually discussed at this visit so you can be fully aware of what the schedule is and can have an opportunity to discuss any concerns prior to vaccinating.
If a newborn hearing screening was not done within the past few weeks this would also be a good time to do it to avoid any undetected hearing problems. An audiologist visits our practice at the same time as our well woman and baby clinic sister so we would usually book these 2 visits together.
Other support services to consider joining in your babymoon period:
Post Birth Reflection Workshops:
On the last Friday of each month we host our Post Birth Reflection workshop which is a gentle way of helping your to process your birth experience and start the process of healing as a few woman get together to share their birth stories. This is a very special workshop with sharing, laughter, tears and connection.
Mom and baby yoga:
On Wednesday mornings we host a mom and baby yoga group which is greatly enjoyed by all as once again there is sharing, laughter and some good stretching and breathing together with other mom’s and their baby’s.
Every 2 months we offer a workshop including:
- Starting of solids
- Baby sexuality
- Baby signing
- Coping with sick babies
- Baby reflexology
CRP and Choking:
This is a 2-3 hour one off workshop we offer twice a month on a Tuesday and a Saturday. It is recommended that anyone who is caring for a baby does this workshop as it will be the most valuable investment you can make in your baby’s life.