The Apgar test
Straight after the birth, the midwife will perform some initial checks.
She will be busy observing and scoring your baby using the Apgar test.
“We do a score after a minute and a score after five minutes,” explains Kim Housham, clinical lead midwife at London’s University College Hospital (UCH).
“We look at the baby’s colour, muscle tone, respiratory effort, heart rate and how each one responds to a stimulus, giving the baby a maximum score of two for each thing and an overall score of 10,” she says.
Full newborn examination
You will then be offered a more detailed top-to-toe examination of your baby within 72 hours of birth.
“Although most newborn babies are checked within 24 hours,” says Kim.
Baby’s first head check
A midwife, neo-natal doctor or GP will look at your baby, starting at the head and working down. Kim says, “We check the baby has two soft spots – a big one at the top of the head and a smaller one at the back.
“And, because babies’ skulls are not fused, we feel the suture lines to check where the bones of the head meet.”
Checking mouth and skin
Baby’s first mouth check
The midwife will ask permission to pop a gloved finger in your little one’s mouth to check the palate and gums.
Baby’s first skin check
Your baby’s skin will be checked for birthmarks, such as raised red strawberry marks and stork marks (the reddish V-shaped marks on the back of the neck).
The colour of the skin is also checked to make sure there’s no bruising or trauma from birth.
Eye test and ear check
Baby’s first eye test
The midwife will look at the shape of your baby’s eye for any sign of Down’s syndrome.
“Then we shine a light into the eye,” says Kim.
“We’re looking for something called a red reflex, like when you get red eye when you take a photo with the flash on.
“This tells us that the baby doesn’t have congenital cataracts, which are treatable.”
Baby’s first ear check
Ear folds and skin tags are checked at this stage. Some babies are born with little skin tags and that could indicate problems with their hearing.
Your baby won’t have a hearing test during the initial newborn examination.
However, some hospitals will check your baby’s hearing before you go home. Other hospitals will treat your baby as an outpatient, giving you an appointment within four weeks.
Heart and lungs check
Checking for heart murmurs
The midwife will listen to your baby’s heart with a stethoscope to check for heart murmurs (extra heart sounds).
Murmurs can be quite common in the first few days. This is because your baby’s circulation worked differently when she was inside you.
However, murmurs often disappear once the baby adapts to life outside your womb.
Checking baby’s lungs
“The midwife will first look at the chest to see that it’s rising equally and both lungs are filling and emptying at the same time,” says Kim.
The midwife will then listen to your baby’s lungs with a stethoscope.
“We’re listening for breath sounds to make sure they’re clear. Sometimes babies can swallow a lot of fluid during birth, so the lungs might not sound clear, but it doesn’t mean that there’s anything wrong,” she explains.
Checking hands and feet
The hand and foot test
The midwife will count your baby’s fingers and toes.
She’ll also look for any webbing between them and check for two palmar creases on his palm.
“One palmar crease may be indicative of Down’s syndrome, but there are usually other physical signs as well,” says Kim.
“We also check for talipes, which is where the foot is turned inwards or outwards.
“Most talipes are positional, so it’s just where the baby’s been snuggled up inside mum. If the midwife can move the foot to the right position, then it’s not usually a problem,” explains Kim.
Checking hips and spine
Your baby will be checked for ‘clicky hips’ and to make sure they can’t be dislocated.
“We test the hip by supporting one side of the pelvis and then bending the knee up to the baby’s chest, turning the leg out and then turning the leg in,” says Kim.
“The baby may be offered a scan if he was born breech, because generally the legs are up near the ears, so that could impact on the possibility of having dislocated hips.”
The spine is checked for straightness by running a finger down its length.
It will also be checked to make sure the sacral dimple (a little dimple at the base of the spine) is present.
The midwife will ask if your baby has done a wee and passed dark poo (meconium) in the first 24 hours.
Boys will be checked to make sure the hole where the wee comes out is in the right place, and the testicles have dropped.
If the testicles haven’t dropped, don’t panic as he’ll get another check at six weeks where this will be checked.
Sometimes there may be blood in a girl’s nappy as they can actually have a pseudo period and bleed a little.
This is perfectly normal and to do with the transfer of hormones from mum to baby.
The midwife will check your baby’s reflexes.
She’ll check the plantar reflex by rubbing her thumbs on the bottom of your baby’s foot.
“The normal response is for him to clench his toes, while the grasping reflex is tested by him clasping our finger,” says Kim.
The midwife may test the Moro, or startle reflex, by letting your baby’s head safely fall a short distance. Your baby will respond by flinging out his arms, and perhaps letting out a whimper.
The heel prick test
The heel-prick test is usually done by a community midwife between days five and seven, but this will vary depending on the hospital trust.
The midwife will take four drops of blood from the side of the baby’s heel. This is because there are fewer nerve endings there, so it’s less painful.
The blood will be screened for various genetic conditions including cystic fibrosis, sickle-cell blood disorders, underactive thyroid, phenylketonuria, and MCADD, a disorder where the baby can’t break down fats properly.