Afterbirth Resources

January 14, 2023 Kristin Reiswig

APGAR Score

Let's go over the APGAR score! It’s a newborn’s first test and measure of well being, developed during the 1950’s by Dr. Virginia Apgar. The score is used by doctors and midwives to assess a newborn baby’s health at 1 minute, 5 minutes, and 10 minutes after birth. It usually indicates whether or not a baby requires medical assistance in the first few moments after birth. Five criterias are assessed and given a score of 10: skin color, heart rate, response to stimulation, muscle tone, and respiration rate. If your baby doesn't get a 10 at 1 minute or even after 5 minutes, don't worry! Very few babies get a perfect score. Most newborns lose at least a point for color as it is normal for a baby's hands and feet to be a little blue right after birth.

Point System:

> or equal to 7 is normal

3-6 indicates moderate neurologic/cardiorespiratory depression

< 3 indicates severe neurologic/cardiorespiratory depression

A- Appearance (skin color) | Blue/Pale - 0 points | Pink body/Blue hands/feet - 1 points | Pink - 2 points

P- Pulse | Absent- 0 points | Below 100 bpm - 1 points | Above 100 bpm - 2 points

G- Grimace (reflex irritability) | Absent - 0 points | Minimal response to stimulation - 1 point | Prompt response to stimulation - 2 points

A- Activity (muscle tone) | Limp - 0 points | Some arm/leg flexing - 1 points | Very active - 2 points

R- Respiration | Absent - 0 points | Slow, irregular, weak cry - 1 points | Vigorous crying - 2 points

Delayed Cord Clamping

Another thing that happens after birth is cord clamping. You can choose to have what is called a delayed cord clamping.

Delayed cord clamping means that doctors don't immediately clamp and cut the umbilical cord. Instead, they allow extra time for the blood in the cord and placenta to flow to the baby. Keeping the umbilical cord intact by delaying cord clamping for at least 3 minutes (you can go longer) improves iron stores during infancy and supports health and development for the growing newborn. In preterm infants this reduces mortality by approximately 30%!! For many years it has been a common practice to cut the cord almost immediately after a baby is born, but we now know and understand that delaying this for a few minutes is beneficial for babies. Waiting for the cord to go white and stop pulsating (optimal cord clamping) is even more beneficial and can be an option.

Vitamin K

Another option you have after birth is whether you want you baby to receive Vitamin K and eye ointment.

Should you give your baby vitamin K? The best decision is the one that is right for you and your family. Know that you have the right to decline. It’s used for the complex process of blood clotting, and is found naturally in food such as green leafy veggies. A small number of babies will experience vitamin k deficiency bleeding (around 1 per 11,000). If you're looking for alternatives: vitamin k drops, homeopathics, eat vitamin k enriched foods during pregnancy if breastfeeding(vitamin k levels are higher in colostrum).

Side effects of vitamin k shot can include:

- respiratory distress

- hepatitis

- cystic fibrosis

- chronic diarrhea

- bile duct atresia

Here are 6 food sources to consider for Vitamin K during pregnancy:

- brussel sprouts

- kale

- asparagus

- pork chops

- chicken thighs

- cheese

Eye Ointment

Eye ointment is the goop they put in your newborn's eyes after birth, another intervention we don’t always think about. It’s applied to your baby's lower eyelids to protect your baby from developing an eye infection after birth. It is more specifically to prevent the baby from developing “pink eye”. It’s typically contracted from chlamydia or gonorrhea if the mom has either one and is untreated prior to giving birth. If you don't have either of these, it’s probably safe to say your newborn doesn't need this ointment. Side effects can include increasing antibiotics resistance, blurred vision (which has the potential to negatively impact the bonding of the newborn with parents), can cause allergic reaction, eye irritation and chemically induced pink eye, peeling, itching, stinging or burning.

Newborn Hats - Why We Say “No Thanks”

It is common for your baby to get a hat put on them shortly after birth. We say, don't put a hat on baby.

Throwing hats on newborn babies seems to be a pretty normal thing to do. In the past, it was considered standard practice to put hats on the heads of all newborn babies to retain warmth, though many hospitals now only offer hats to premature or low birth weight babies. The smell of a newborn baby’s head triggers a chemical reaction in the mother’s brain. When that newborn baby smell is covered up by a hat and replaced with a detergent smell, this process may not occur as smoothly.

Reason newborn babies don't need hats:

#1- It covers up the all-important, oxytocin triggering newborn baby smell (from the moment your baby is born, they recognise your smell, you are also biologically primed to recognise the scent of your baby, this could cause bonding to not be as strong between baby and you).

#2- Your baby doesn't need it (there is no need to rely on hats to keep your baby warm, because you will be keeping your baby warm).

#3- Increased benefits of skin-to-skin contact extend beyond simple temperature regulation (not only does skin-to-skin contact facilitate thermal regulation of the newborn and mother, but it also improves rates of exclusive breastfeeding.

Vaginal Tearing

The not so fun part after birth is getting stitched up for any vaginal tearing you may have experienced. You can still have your baby with you while your care provider takes care of your vaginal tears.

Vaginal tearing- also known as perineal tearing, is common during childbirth and takes place in the perineum (the area between vagina and the rectum). When giving birth for the first time, the birthing parent is more likely to experience tearing due to lack of flexibility in their tissues. To reduce your chances at tearing there are a few things to try while still pregnant and during labor that can help. Relax your upper body, especially your jaw, when you are giving birth (tension in your jaw creates tension in your birth canal and stops your vagina from stretching effectively). Don't push your baby lying down. Do perineal massage in pregnancy to stretch the walls of your vagina and your perineum in preparation for your baby’s birth. Don’t be told when to push (your body intuitively knows when to push with your contractions). Stay mobile and active during pregnancy. Make sure you are breathing deeply and slowly during the pushing stage. Warm compress on your perineum helps with counter pressure, feels super soothing and encourages natural stretching.

There are 4 degrees of perineal tearing:

- 1st Degree - small vaginal tears that only affect the skin (mild pain, recovery is typically simple and heals quickly without treatment

- 2nd Degree - perineal tears that involve the vaginal lining and tissues of vagina (will likely require stitches, a longer recovery time, discomfort when doing anything that causes pressure)

- 3rd Degree - vaginal tears that go into deeper layers of the vagina and muscles that make up the anal sphincter (repaired by healthcare provider with anesthesia, pain for a few weeks, can experience occasional discomfort and sensitivity)

- 4th Degree - extends right through the rectal lining (can lead to pelvic floor dysfunction and prolapse, least common tear)

Preparing yourself for what to expect puts you in a great place when it comes to knowing what you do and don’t want to do in the first few minutes of your newborn’s life.

DISCLAIMER: All information on this website is for informational and educational purposes only and does not constitute medical advice, and does not establish any kind of patient client relationship by your own use of this website. We strive to provide accurate general information, the information presented here is not a substitute or any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the area of your particular needs and circumstances prior to making any medical decisions.