Once the baby is born, the time should be noted and the woman should receive her baby according to her wishes. The priority is to keep the baby warm: as it transfers from body temperature to room temperature it will use up vital energy to keep warm. The parents can be encouraged to dry the baby with a warm towel, which should then be discarded and replaced with another warm, dry towel. Keeping the baby close to the mother is the most effective means of maintaining and restoring a baby’s body temperature (Christensson et al 1998, Walters et al 2007). Babies can lose a lot of heat from their heads, and it should remain covered until it is ascertained that the baby is maintaining a temperature above 36.5°C. In a randomized controlled trial comparing skin-to-skin contact after birth with routine care (drying and wrapping the baby) babies who received skin-to-skin contact had significantly higher temperatures than babies in the control group (Carfoot et al 2005). Skin-to-skin contact has also been found to have additional benefits. In a systematic review of early skin-to-skin contact between the mother and baby (at birth or within 24 hours), reviewers found a positive impact on breastfeeding duration, respiration stability, mother–infant attachement and infant crying (Moore et al 2007).

Prior to separating the baby from the umbilical cord, the midwife should obtain the woman‘s consents. Some women prefer for the cord to have stopped pulsating prior to it being cut as delayed cord clamping has been shown to raise the iron status in the baby for up to 6 months (McDonald & Middleton 2008). This practice has also been associated with an increased risk of jaundice requiring phototherapy and parents should also be given this information.

Following negotiation with the midwife, some partners wish to participate in the birth by cutting the cord, and this involvement should be facilitated where appropriate. First the midwife clamps the cord approximately halfway along its length. She then squeezes a short section of cord after the clamp and applies a second clamp, leaving a blood-free section of cord that can be cut without spraying blood. Once the cord has been cut, a smaller, more secure plastic cord clamp can be attached, approximately 1cm from the umbilicus. The excess cord can be removed, leaving 0.5cm of cord above the clamp.

The Apgar score is a tool developed to assess the physical condition of the baby at birth (Apgar 1953). Five dimensions – heart rate, respiratory effort, muscle tone, response to stimuli and colour – are given a score of zero, one or two. Thus, the maximum score is 10 (see Table 3.1). However, this is not always achieved as many babies have blue hands and feet so soon after birth. This assessment is normally undertaken at 1 minute after the birth, and again at 5 minutes. The Apgar score is repeated if the score is less than seven at 10 minutes.

There have been minor adaptations to the original score, but in essence it has been unchanged and commonly adopted (Michaelides 2004). While the Apgar is a useful tool for assessment of the neonate at birth, it does not differentiate the underlying neonatal condition. A score of five at 1 minute could be given to a baby who was not breathing, had blue extremities, grimaced when a nasal suction catheter was used, had a normal tone and a heart rate of fewer than 100 beats per minute. However, another baby who was pink, with a normal heart rate, gasped at birth yet was limp and did not respond to oral suction could also have a score of five at 1 minute (Roberton 1996). As these babies would require different treatments, any Apgar score would need to be followed with a detailed report of the baby’s clinical condition.

For the majority of babies, the Apgar score can be noted while the baby is in its parents’ arms. With experience, the assessment can be made adeptly without any disturbance to the parents’ interaction with their baby. In a baby that is active, pink and crying, two fingers placed over the sternum should detect a rapid heart rate – and a glance at the baby’s hands and feet will complete the assessment. Reflex irritability refers to the baby’s response to a suction catheter introduced into its nose and mouth. In the baby described above, it can be assumed that it would object to suction – hence, a formal test of this aspect of the Apgar is unnecessary.

The weight of the baby is an essential part of the information expected by relatives and friends. It is likely, therefore, that parents will want this information quite soon after the birth, although the midwife should always seek their permission. The scales should be brought close to the parents and they should be given the opportunity to get the camera ready before the baby is unwrapped. The scales should be set at zero and lined with a clean, soft paper tissue to avoid startling the baby with the cold, hard surface. The naked baby should be gently lowered into the scales, a reading (and photo) taken and then quickly wrapped and returned to the parents. The weight should be documented in grams but converted to pounds and ounces for the parents. The median weight of a full-term baby (40 weeks’ gestation) in England is 3460g (7lb 10oz) (The Information Centre 2007).