Normal Vaginal Delivery In a routine vaginal delivery, your first view of your child may be the top or crown of his head seen with the help of a mirror. After the head is delivered, the obstetrician or nurse-midwife will suction the nose and mouth, and your baby will take his first breath. He doesn't need to be slapped or spanked to begin breathing, nor will he necessarily cry; many newborns take their first breath quietly. With the most difficult part of the birth now over, there is usually one last pause before the push that sends the rest of your child's body, which is smaller than his head, gliding smoothly into the doctor's waiting arms. After another, more thorough suctioning of his nose and mouth, your child may be handed to you to hold and behold. Even if you've seen pictures of newborns, you're bound to be amazed by the first sight of your own infant. When he opens his eyes, they will meet yours with curiosity. All the activity of birth may make him very alert and responsive to your touch, voice and warmth. Take advantage of this attentiveness, which may last for the first few hours. Stroke him, talk to him and look closely at this child you've created. Baby's Appearance after Routine Vaginal Delivery Fresh from birth, your child may be covered with a white cheesy substance called vernix. This protective coating is produced toward the end of pregnancy by the sebaceous (oil-producing) glands in his skin. He'll also be wet with amniotic fluid from the uterus. If there was an episiotomy (surgical cutting) or tearing of tissue in the vaginal area, he may have some of your own blood on him. His skin, especially on the face, may be quite wrinkled from the wetness and pressure of birth. Your baby's shape and size may surprise you, especially if this is your first child. On the one hand, it's hard to believe that a human being can be so tiny; on the other, it's incredible that this "enormous" creature could possibly have fit inside your body. The size of his head in particular may alarm you. How could it possibly have made it through the birth canal? The answer lies in its slightly elongated shape. The head was able to adapt to the contour of the passageway as it was pushed through, squeezing to fit. Now free, it may take up to several days to revert to its normal oval shape. Your baby's skin color may be a little blue at first, but will gradually turn more pink as his breathing becomes regular. His hands and feet will be cold, and may remain so, on and off, for several weeks until his body is better able to adjust to the temperature around him. You may notice that your newborn's breathing is irregular and very rapid. While you normally take 12 to 14 breaths per minute, your newborn may take as many as 60. An occasional deep breath may alternate with bursts of short, shallow breaths followed by pauses. Don't let this make you anxious. It's normal for the initial days after birth. Delivery Room Procedures Following a Normal Vaginal Birth As your baby lies with you following a routine delivery, his umbilical cord will still be attached to the placenta. For several minutes the cord may continue to pulsate, supplying the baby with oxygen while he establishes his own breathing. The cord will be clamped and cut. (Because there are no nerves in the cord, the baby feels no pain during this procedure.) The clamp will remain in place for 24 to 48 hours, or until the cord is dry and no longer bleeds. The stump that remains after the clamp is removed will fall off sometime between 10 days and three weeks after birth. Once you've had a few moments to get acquainted with your baby, he will be dried to keep him from getting too cold, and a doctor or nurse will examine him briefly to make sure there are no obvious problems or abnormalities. One minute after birth, and again at five minutes, he will be given Apgar scores, which measures his overall responsiveness. Then he will be wrapped in a blanket and given back to you. Depending on the hospital's routine, your baby may be weighed, measured and receive medication before leaving the delivery room. All newborns are slightly low in vitamin K, which is necessary for normal blood-clotting, so they are given an injection of this vitamin to prevent excessive bleeding. Because bacteria in the birth canal can infect a baby's eyes, your baby will be given antibiotic ointment, either immediately after delivery or later, in the nursery, to prevent any infection. There's at least one other important procedure to be done before either you or your newborn leaves the delivery room: Both of you will receive matching labels bearing your name and other identifying details. After you verify the accuracy of these labels, one will be attached to your wrist and the other to your baby's. Each time the child is taken from or returned to you while in the hospital, the nurse will check the bracelets to make sure they match. Many hospitals also footprint newborns as an added precaution. Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999