As we’ve talked about in previous posts, we are very protective of that first hour of skin to skin between baby and mom. During that time, we keep a close eye on the baby’s condition, but we do it as unobtrusively as possible, so as not to disturb while bonding is happening and breastfeeding is being established.
There will come a time, though, when we will need to do a head to toe exam of your little one, to make sure all is well. Sometime around that hour mark, when there is a natural pause in feeding, we will gently lift your baby from your chest and lay them down on the warm towel that we have arranged at the foot or the side of your bed. We do the exam here so that you can see everything we do and be within touching distance.
The order varies, but it is typical to begin with gentle palpation of the baby’s head to assess the sutures of the skull, and feel for swelling. From here, we will work our way down the body, checking the eyes and face, the palate, the suck, the collar bones, the abdominal structures, the reflexes, the fingers, the spine, the genitalia, and the legs, feet and toes. We are looking for lots of things along the way, including clues that tell us the baby’s gestational age, and that the formation of all of the parts that make up your baby’s body are typical. Sometimes they are not typical, in which case we would discuss this with you, and recommend follow up care as needed.
After this head to toe check, we will move on to listening to baby’s heart and lungs with a pediatric stethoscope. We are checking for a normal rate and rhythm of the heart, and listening for any variations, such as murmurs. Then we listen to make sure the lungs are clear and the respiration rate is normal. By about an hour after birth, most babies will have nice, clear lungs and a normal respiration rate – if they don’t, the baby will require some extra monitoring and medical assessment. To wrap up this part of the exam, we check the baby’s temperature.
At this time, we will administer typical newborn medications according to your wishes, which might include vitamin k and eye ointment.
And last, but not least – the moment you’ve all been waiting for: the measurements! It is not uncommon at all for us to be asked by family members in the first moments after birth, “What does the baby weigh?”, in answer to which we might throw out our best guesses, but explain that we won’t have that information until baby has had that undisturbed first hour.
During this most highly anticipated portion of the newborn exam, we will use a paper measuring tape to measure the circumference of the head, chest, and abdomen. Then we will use the same tape to measure baby’s length (as you can see below, we often need an expert assistant for this part, as it’s hard for one person to hold the tape on both ends, and the baby’s wiggly legs, all at the same time). After this, we weigh the baby in a cloth hanging scale, usually to the sound of last-minute guesses being called out.
When the clinical exam is all finished, we will help diaper the baby (or hand this job off to another eager person), and get them back in your arms quickly to continue skin to skin contact. After being (gently) poked and prodded, your baby is ready for some snuggling and another try at mastering breastfeeding.
Photo credits: Rabbit and Fox Photography; Monet Nicole Photography.