After the birth
When your little one’s born, your midwife will be busy observing and scoring him using the Apgar test. “Most new mums aren’t even aware this is going on,” says Kim Housham, clinical lead midwife at London’s University College Hospital (UCH). “We do a score after a minute and a score after five minutes. 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.” Most newborns score between seven and 10, but if your baby scores lower, she may need a little help, such as oxygen to help her breathe.
“The first newborn examination is usually carried out within 72 hours of birth, although most babies are checked within 24 hours,” says Kim. A midwife, neo-natal doctor or GP will look at your baby, starting at the head and working down. “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,” explains Kim.
Ear folds and skin tags are checked at this stage. “Some babies are born with little skin tags and that can be a sign that there might be problems with their hearing,” says Kim. Your baby’s hearing won’t be tested during this examination, you will be given a separate appointment. Some hospitals will check it before you go home and others will treat your baby as an outpatient giving you an appointment within four weeks.
“The midwife will look at the shape of the eye for any sign of Down’s syndrome and then we shine a light into the eye. We’re looking for something called a red reflex, which is the same as 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,” says Kim.
The midwife will ask permission to pop a gloved finger in your little one’s mouth to check the palate and gums. “We’re checking to see that the palate’s intact,” explains Kim. “Lots of cleft palates are now diagnosed during your scans, but sometimes it’s just a tiny one that can interfere with breastfeeding.” It might sound odd, but your midwife will also be checking for teeth. These are natal, rather than milk teeth, and very rare.
The midwife will listen to your baby’s heart with a stethoscope to check for heart murmurs. “The midwife will check that she can hear the heart sounds clearly,” says Kim. “Murmurs can be quite common in the first few days, as your baby’s circulation when she’s inside mum is different to when she’s outside. There’s a valve that has to close and sometimes it takes a while, so you hear a murmur.” Murmurs often disappear once the baby adapts to life outside mum’s uterus.
Hands and feet
As well as counting your baby’s fingers and toes, the midwife will 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,” 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.”
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Your baby will be checked for clicky hips and to make sure his hips 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 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,” explains Kim.
The midwife will ask if your baby has done a wee and passed dark poo (meconium) in the first 24 hours. “For boys, we check to make sure the hole where the wee comes out is in the right place and the testicles have dropped,” says Kim. “It’s not necessarily a problem if they haven’t, as the baby gets another check at six weeks and, by then, we would have expected both testicles to have dropped.” First-time mums can often be worried by blood in a girl’s nappy. “They can actually have a pseudo period and bleed a little, which is to do with the transfer of hormones from mum to baby and is perfectly normal,” says Kim.
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). “We look for skin tags, birthmarks and also the colour of the skin to make sure there’s no bruising or trauma from birth,” says Kim.
“We check the spine is straight by running our finger down its length,” says Kim. “We also check that we can see the sacral dimple, which is the little dimple at the base of the spine.”
“We check the plantar reflex by rubbing our thumbs on the bottom of the baby’s foot and he’ll 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, to which he will respond by
flinging out his arms and perhaps letting out a whimper.
“The heel-prick test is usually done by the community midwife between days five and seven, but this will vary depending on the hospital trust. The midwife takes four drops of blood from the side of the baby’s heel, as there are fewer nerve endings here, so it’s less painful,” explains midwife Kim. The blood is 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.
“Rosie was born by emergency c-section and I had a general anaesthetic, so I wasn’t awake when they did the Apgar test. But I read in her notes that she was resuscitated and kept in the neo-natal unit for four days. She was monitored for a year to check she’d reached key milestones.”
Fleur McCrone, 35, from Kent, mum to Rosie, 5, Olivia, 3, and Archie, 5 months
“I was a bit sleep-deprived when Poppy had the heel-prick test. I was surprised by the amount of blood, as it looked a lot, but she was asleep throughout and didn’t even flinch.”
Claire White, 37, from Manchester, mum to Poppy, 5 months