The manner in which a new baby is welcomed into the world during the first hours after birth can have short and long term effects. There is good evidence that normal, term newborns that are placed skin to skin with their mothers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature and glucose stability. They experience significantly less crying indicating decreased stress. Mothers who hold their newborns skin to skin after birth demonstrate increased maternal behaviors, show more confidence in caring for their newborns, and breastfeed for longer durations. Being skin to skin with mother protects the newborn from the well-documented negative effects of separation, supports optimal brain development and facilitates attachment, which promotes the infant's self-regulation over time. Most babies are born with instinctive skill and motivation to breastfeed, are able to find the breast, and self-attach without assistance when skin to skin. When the newborn is placed skin to skin with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Here at Delta County Memorial Hospital Stork's Landing, the first hour of life outside the womb is a special time when a baby meets his or her parents for the first time and a family is formed. A "sacred" time that should be honored, cherished and protected. This "once-in-a-lifetime" experience should not be interrupted unless the baby or mother is unstable and require medical attention.

What might the first moments after birth be like for a newborn infant? A fetus fortunate enough to spend his/her fully allotted 40 weeks in the womb since has had the luxury of having all his/her emerging developmental needs met. The uterus and the placenta have provided warmth, protection, nutrition and oxygen, as well as close and continual proximity to the mother's heartbeat and voice. Being in the womb is the "natural habitat" for the unborn fetus. After birth, the mother's body and breasts take over the function of the uterus and placenta providing warmth, protection, nutrition, and support for optimal oxygenation. It is comforting to continue close proximity to the mother's heart and voice. Being skin to skin with the mother is the newborn infant's "natural habitat"…the one place where all his/her needs are met.

In "The First Hour" after birth, nine instinctive stages seen with skin to skin newborn contact include: 1) the birth cry 2) relaxation 3) awakening 4) activity 5) rest 6) crawling/sliding 7) familiarization 8) suckling 9) sleeping. The birth cry (1st stage) occurs immediately after birth as the baby's lungs expand, but usually ends abruptly when the baby is placed onto mother's chest. Relaxation (2nd stage) begins when the birth cry stops and usually lasts 2-3 minutes during which the baby is very quiet and still. Awakening (3rd stage) begins with small head movements, as the infant opens his/her eyes and shows some mouth activity (approximately 3 minutes after birth). During activity (4th stage) the baby has more stable eye opening, increased mouthing and suckling movements and often some rooting (approximately 4-12 minutes after birth). Resting (5th stage) can occur at any time between the other stages. Many may assume, a resting baby has given up trying to find the breast, seeming to clearly need assistance to breastfeed successfully. With knowledge of the nine instinctive stages, we know this is

simply a normal stage and babies will move on when they are ready. Undoubtedly, rushing a newborn to the breast during a resting stage can prove counterproductive. During the crawling/sliding (6th stage) the baby makes short pushing movements with the feet and/or slides the body towards one of the mother's breast (approximately 35 minutes after birth). The baby may lift the upper torso and bob his/her head in a clear effort to get near the breasts. After reaching the breast, familiarization (7th stage) begins and may last up to 20 minutes while the baby becomes acquainted with the nipple by licking, touching and massaging, if left to instincts. During all of these stages, the baby moves in a purposeful manner, without frustration or hurry. The challenge for those observing this is to relax, leave the baby and the mother alone and marvel at the amazing act of nature unfolding as the baby finds the breast, latches and suckles without assistance or interference. After adequate familiarization with the new environment and mother's nipple, the newborn opens his/her mouth wide, cupping the tongue which is now low in the bottom of the mouth, grasps the nipple in a correct latch and begins to suckle (8th stage). This usually occurs an hour after birth. Sleeping (9th stage) follows usually between 1 ½-2 hours after birth.

Being skin to skin with the mother is the best way for a stable baby to adjust to life outside the womb. It is, not only safer for both babies and mothers, but provides multiple short and long term beneficial effects. Early postpartum skin to skin contact increases physiologic stability, promotes optimal psycho-emotional well being and supports structural and functional infant brain development.

However, being skin to skin with the mother immediately after birth is much more than simply a nice way to be welcomed in to the world. "The First Hour" after birth is a "once-in-a-lifetime" occasion for both baby and parents. This is the "sacred hour" during which a family is formed. Here at Stork's Landing we take pride in doing everything in our power to honor, cherish and protect this special time for our new families.

Gail Houseweart, RN, LDRP
Stork's Landing