The Golden Hour: What Happens in the First Hour After Birth

That first hour after birth is called the 'golden hour' for good reason. Midwife, educator, and mum Grace Strange shares how to soak up the magic while ticking off the essentials.

The first hour after birth is dedicated to uninterrupted skin-to-skin contact, the first breastfeed and initiating bonding between mum and baby. The idea is to leave the baby on mum’s chest for a minimum of one hour, uninterrupted. This means not doing any non-urgent newborn assessments and keeping them warm and together. This has shown to improve breastfeeding success, emotional wellbeing and reduced stress for both mum and baby, more stable vitals for baby and a reduction in postpartum bleeding for mum, magic!

FIRST FEW MINUTES

If your baby born via a vaginal birth, they will be placed naked, usually on their tummy or side, directly onto mum’s bare tummy or chest with their face positioned sideways to keep their airway open. The baby will be covered in amniotic fluid and maybe a bit of blood from the birth so the midwives will rub your baby with a towel to dry and to stimulate it to start breathing. Your baby should take its first breaths in those first couple of minutes after birth. You will both then be covered with a warm blanket and stay cuddled up like this for at least an hour. If you had your baby in a birthing pool, then your baby will be lifted onto your chest and stay submerged in the lovely warm water.

If you have a c-section then your baby will be delivered by the surgeons, and they will hold the baby up for you to see. You can ask for the drape over your chest to be lowered so you can see more (you can ask for it to be lowered earlier for you to watch the baby come out if you like!) In most cases the surgeon will then hold the baby or place it between your legs while they do one minute of delayed cord clamping. The baby will then be given to the midwife, and how the next few minutes go will depend on the condition of the baby and your midwife’s preferred way of doing things (along with any specific requests from you). If mum and baby are healthy and mum wants to, then you can have immediate skin-to-skin in theatre. The baby will be placed naked on your bare chest, like in a vaginal birth. Your midwife will dry the baby down with a towel and cover you both with warm towels or a blanket and put a hat on your baby’s head. You will stay like this as long as possible until the surgery is ended and you are transferred to your postnatal bed or if the midwife needs to do some quick checks on the baby – in both cases the baby will be removed from your chest temporarily and then replaced asap.

Other options following a c-section delivery is that the midwife might take the baby immediately and do some quick checks, dry the baby, put a hat on them, give them a vitamin K injection and get your partner to trim the cord. This might take two to five minutes, then they will bring the baby to you and pop the baby on your chest as explained above. Or the midwife might do a full top to toe baby check, weigh it, then wrap it up in blankets and give it to your partner or leave it in the cot beside you. As you will read below, there are so many amazing benefits of doing skin-to-skin, so I would encourage you to do it as soon as possible if you’re able to. 

After any type of birth, if your baby is unwell and needs special baby care then the pediatrician team will be available to look after your baby. In most cases baby care will be performed in the same room as you initially, so you will remain close with the baby. If they decide the baby needs to be transferred to the special baby unit, then likely this will take longer and your support person can go with the baby if you want them to.

SKIN-TO-SKIN

Provided your baby is healthy and well, skin-to-skin with mum is encouraged as soon as possible after birth. The benefits between you and your baby are incredible. Skin-to-skin helps baby regulate their heart rate, breathing, temperature, blood sugars and reduces their overall stress. It helps them to feel calm, safe and comforted and research shows they cry less. Your baby is exposed to bacteria on your skin which promotes gut health, which helps them with their immunity. For mum, the love hormone oxytocin is produced when your baby is skin-to-skin. Not only is this hormone important in helping with lactation and breastfeeding as you will read below but oxytocin also aids in the expulsion of the placenta from the uterus, reducing your chances of hemorrhaging.

If mum is unwell or unable to do skin-to-skin for any reason, then she can nominate her partner to do it in the meantime. Many of the benefits are transferrable to the baby with either parent. Skin- to-skin is beneficial and good for babies at any time so even if you didn’t manage to get it in the first hour then the earliest chance you get is the best time – it’s never too late to start! You can’t have too much either so soak up those lovely newborn snuggles!

FIRST BREASTFEED

The first breastfeed is likely to be initiated by the baby within ‘the golden hour’. A baby that is skin-to-skin in that first hour will often instinctively move towards your breast using their sense of smell to navigate before latching on. This process is referred to as the ‘breast crawl’. The World Health Organisation recommends that all newborns breastfeed within that first hour post birth as they are often naturally alert and have that instinct to feed. It’s important because it stimulates the release of lactation hormones, especially that all-important oxytocin, which increases lactation and colostrum let-down and helps to build up mum’s milk supply. The first milk baby gets is colostrum, which is rich in everything they need for those first few days of life. It’s especially important for their immunity and helps protect them from infection as well as encouraging them to clear meconium (their first poos) from the gut.

LOOKING AFTER MUM

The placenta will be delivered within the first hour after birth also, usually within the first five minutes as most women will be given an oxytocin medication at delivery of the baby to speed up the process of the delivery of the placenta. If you have low risk factors and mum and baby are healthy you might be able to have a physiological delivery of the placenta, which means no medications are given and the cord is left attached to the baby and the placenta inside you, until it decides to come away on its own which is usually within an hour post birth.

If you need any stitches these will also be done within the first hour after giving birth. Around 80% of mums will need stitches with most perineal tears being able to be repaired by your midwife in the same room as you birthed in. If the tear is more significant then you will need to go to theatre to get the surgeons to repair it.

No matter how you have given birth you will be observed closely by midwives to make sure that mum is physiologically recovering and baby is transitioning into the outside world as we would expect. Any concerns about the baby will be reviewed by a pediatrician who will specifically be monitoring the baby’s colour, heart rate, respiratory rate, temperature and airway integrity and overall condition is well and that the baby has good tone and activity and is alert and able to feed.

Any concerns with the mother will be reviewed by an obstetrician as well. She is observed for overall wellbeing and mobility (especially as her epidural wears off if she had one). Her uterus is contracting well and her uterine blood loss is normal. Any bleeding from her c-section or vaginal wounds are monitored, as well as temperature, pulse, respiratory rate and blood pressure.

The first hour post birth is so precious. Slow down, advocate for yourself and your baby to have that magic time together. The birth of a newborn is a miraculous event so protect it. Make sure that your partner and midwife are on the same page and know your wishes before you go into labour, so they can do all they can to make this first hour as special as possible for you and your baby.

Grace Strange is a midwife and creator of Antenatal Co. – independent antenatal classes that were born out of a desire to ensure parents have access to the very best antenatal education and head into labour, birth and beyond fully prepared. Find out more at antenatal.co.nz or on Instagram @antenatalco.