OBJECTIVES When you have completed this unit you should be able to: Manage a normal infant at birth. Promote early bonding between mother and infant Diagnose asphyxia at birth. Assess an Apgar score. Prepare for resuscitation. Resuscitate an infant. Prevent meconium aspiration.

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COPYRIGHT All rights reserved. No part of this Perinatal Education Programme may be altered in any way, nor may copies of the complete Programme be made, without the written permission of the editorial board of the Perinatal Education Trust. To facilitate the improvement of perinatal care in Southern Africa, however, parts of the Programme may be reproduced for teaching purposes provided due acknowledgement is given and the material is not sold for financial profit. While the advice and information in the Programme are believed to be accurate, the editorial board cannot accept responsibility or liability for any errors or omissions that may have been made.

MANAGEMENT OF A NORMAL INFANT AT BIRTH

36-1 WHAT CARE SHOULD YOU GIVE A NORMAL INFANT IMMEDIATELY AFTER DELIVERY?

1. Dry the infant, especially the head, with a warm towel. Then wrap the infant in a second warm, dry towel. This will help to prevent the infant from getting cold after delivery.
2. It is not necessary to suction the nose and mouth of a normal infant at birth. If the infant has a lot of secretions, turn the infant onto the side for a few minutes.
3. Clamp the umbilical cord.
4. Assess the Apgar score at 1 minute.
5. A quick physical examination should be done to assess the infant for size, serious congenital abnormalities or other obvious clinical problems.
6. When the above have been completed, give the infant to the mother.

36-2 WHEN IS THE BEST TIME TO CLAMP THE UMBILICAL CORD?

It is best to allow the infant to cry well a few times before clamping the cord. Therefore, dry the infant well first and only then clamp the cord with surgical forceps. Drying the infant usually stimulates crying.

Delaying clamping the cord, until the infant breathes well, allows the infant to receive some extra blood from the placenta. This extra blood may help prevent iron deficiency anaemia later in the first year of life. Before clamping the cord, keep the infant on the bed at the same level as the mother.

The umbilical cord must be clamped or tied about 3 to 4 cm from the infant's abdomen. Once the infant has been dried and assessed, the surgical forceps can be replaced with a sterile, disposable cord clamp or a sterile cord tie.

36-3 WHEN SHOULD YOU GIVE THE INFANT TO THE MOTHER?

It is important for the mother to see and hold her infant as soon as possible after delivery. If the infant appears to be normal and healthy, the infant can be given to the mother after the 1 minute Apgar score has been assessed and the initial examination made. After delivery, both the infant and mother are in an alert state. The infant's eyes are usually open and looking around.

The mother will usually hold the infant so that she can look at its face. She will talk to her infant and touch the face and hands. This initial contact between a mother and her infant is an important stage in BONDING. Bonding is the emotional attachment that develops between mother and child, and is an important step towards good parenting later. Where possible, it is important that the father also be present at the delivery so that he can also be part of this important phase of the bonding process.

36-4 WHEN SHOULD THE NORMAL INFANT BE PUT TO THE BREAST?

If possible the mother should put the infant to her breast within minutes after delivery because:

1. Studies have shown that the sooner the infant is put to the breast, the greater is the chance that the mother will successfully breast feed.
2. Nipple stimulation, by putting the infant to the breast, may speed up the third stage of labour by stimulating the release of maternal oxytocin.
3. It reassures the mother that her infant is healthy and helps to promote bonding.

Some women want to hold and look at their infants but do not want to breast feed soon after delivery. Their wishes should be respected. During a complicated third stage, or during the repair of an episiotomy, some mothers would rather not hold their infants.

36-5 HOW SHOULD THE MOTHER KEEP HER INFANT WARM?

When the infant is given to the mother, she should hold the infant, skin-to-skin, against her chest and cover the infant with the towel. This will keep the infant warm. Skin-to-skin care (kangaroo mother care) is important to promote bonding and breast feeding. The infant must not be left alone in a cot.

36-6 WHEN DO YOU IDENTIFY THE INFANT?

Once the parents have had a chance to meet and inspect their new infant, formal identification by the mother and staff must be done. Labels with the mother's name and folder number, together with the infant's sex, date and time of birth are then attached to the infant's wrist and ankle. Twins must be labelled "A" and "B". Once correctly identified, other routine care can then be given.

36-7 SHOULD ALL INFANTS BE GIVEN VITAMIN K?

Yes. It is important that all infants be given 1 mg of vitamin K1 (0,1 ml of Konakion) by intramuscular injection into the anterolateral aspect of the mid-thigh after delivery. NEVER give the Konakion into the buttock as it may damage nerves or blood vessels that are just under the skin in infants. Konakion will prevent haemorrhagic disease of the newborn. Be very careful NOT to give the infant the mother's oxytocin (Syntocinon) in error. To avoid this mistake, some hospitals give Konakion in the nursery and not in the labour ward. Do not use oral Konakion.

ALL INFANTS MUST BE GIVEN VITAMIN K AFTER DELIVERY

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