The moment a baby is born, the primary objective is to facilitate the transition from intrauterine to extrauterine life. Midwives must act swiftly yet calmly.
Most newborns establish effective breathing spontaneously and require no airway intervention. Suctioning the mouth and nose with a bulb syringe is no longer recommended for vigorous babies, as it can cause laryngeal spasm or slow down the heart rate.
If a newborn is limp, apneic, or failing to breathe adequately, gentle suctioning may be indicated before initiating positive pressure ventilation. Midwives must always keep suction equipment tested and ready at every delivery, while remembering that routine deep suctioning causes unnecessary harm.
Delayed cord clamping, performed after 1 to 3 minutes, significantly improves infant iron stores and reduces the risk of anemia in early infancy.
Before cutting, the midwife must inspect the cord loops to ensure there are no hidden structures like a persistent loop of bowel in an omphalocele. Two clamps are placed on the cord, about 5 centimeters and 10 centimeters away from the baby's abdomen. The midwife cuts between the clamps using sterile scissors, then checks the cut surface for the classic three-vessel appearance: two arteries and one vein.
The Apgar score provides a quick method for evaluating the physical condition of a newborn at precisely one minute and five minutes after birth. Five physiological signs are assessed, each earning a score of 0, 1, or 2:
Scores below 7 at five minutes require continued scoring every five minutes up to twenty minutes alongside resuscitation protocols.
Newborns are prone to hypothermia through conduction, convection, radiation, and evaporation. Maintaining a neutral thermal environment is vital to prevent metabolic acidosis and hypoglycemia.
Once the initial drying and assessment are complete, the midwife dresses the baby in a soft cap and wraps them snugly in warm blankets if skin-to-skin is paused. A brief head-to-toe physical inspection follows to identify any gross congenital anomalies, verify patency of the anus, and ensure the eyes are treated with prophylactic antimicrobial ointment according to local protocol.
Accurate record-keeping is the final legal and clinical duty in the immediate care process. The midwife must document the exact time of birth, Apgar scores, gender, weight, vitamin administration, and any interventions performed.
Before transferring the mother and baby to the postnatal ward, a structured handover must occur with the receiving team. Highlight any risk factors, such as meconium-stained liquor or delayed cry, ensuring continuity of observation for the first crucial hours of life.