Birth Plan Creation - Choices for Baby After Delivery - Golden Hour, Delayed Cord Clamping, Baths & More

By: Aunt Doula (01/11/2024)

When creating a birth plan document, you can elect multiple choices for your baby in addition to the choices you have made for your delivery. Below are the most common choices for interventions immediately after delivery and during your stay to ensure you have the experiences you wish followed as much as possible.

Golden Hour

The moment your baby enters the world, they are entering with a immature and essentially ‘blank’ immune system. They have no established antibodies except a small set passed from the placenta of the birthing person during the third trimester which only last a short while. A newborn has no map of good bacteria and no trained immune cells to fight infection of their own. The first hour after birth is when your baby will imprint upon many things, and not just emotionally.

Parental flora are the first introduction to immunity with good bacteria which is present on your skin from your home and clothes. This directly keys into golden hour along with a colostrum kick for building the immune system if you have collected or are doing any chest feeding - the first skin to skin your baby gets ideally will be with the gestational parent because they have been the baby’s entire world for nine months – they have the strongest knowledge of that heartbeat and voice. Unless there is an emergency, that golden hour is the best foundation you can give your baby and yourself.

In the first hours after birth, an overwhelming number of hormones, pheromones, and imprinting is occurring which reduce postpartum bleeding, promote connection, improve chest feeding, provide significant soothing, and more. When brand new to this world, newborns are not perfect at regulating their needs for warmth, heart rate, breathing and emotional calm, so when the first impression they can receive is one of a warm chest, the familiarity the heartbeat they’ve heard all their life, and the sound of breathing, they are that much calmer overall and adjust to this ‘outside world’ a little easier.

While the golden hour is becoming more and more a part of hospital policies and procedures, nurses still get in a hurry or have their set routines - you don't have to be held to their schedule though. This is your baby and your birth – ask for what you want and insist upon it. What's best for baby is to stay on the birthing persons chest for at least the first hour of life, again, switching to a partner only if an emergency presents itself or after the first hour. Performing the 1 & 5 minute APGAR score can be done on the chest of the birthing person. Wiping baby off more than to dry them, getting their weight, length, putting antibiotic gel in their eyes and the vitamin k & hep b shots can all be delayed until after the golden hour. Unless baby is in serious distress that requires intervention, staff can and they will work around you! Even in a c-section birth, the golden hour can be facilitated and it can be even more important for baby and birthing person.

In an ideal, healthy birth, baby will not need to be taken to the warmer. Baby will have to leave parents arms for weight and length, however this can wait until after the golden hour. There is no general need for anyone to take a healthy baby away from the birthing person or partner unless there is an emergency or the choice of the parents. The warmer can also be brought to the birth beside and baby can remain in hand contact or visual range of the birthing person in most circumstances, so if there needs to be a compromise, you may be able to start there so you can be as close as possible and involved in decisions. For anyone who has anxiety about being separated or out of visual range of their newborn that must be taken to the warmer, asking where the warmer can be closest is best facilitated as soon as you are in the room for delivery.

Delayed Cord Clamping

In recent years there has been a shift in practice of when to clamp and cut the umbilical cord after a baby has been born. There was a small study decades ago which set in motion the practice to immediately clamp the umbilical cord as soon as baby was born Recent studies have shown the benefits of delayed cord clamping which has brought it forward into more western medicine practices. While it has not completely supplanted immediate and short clamping times, it is now standard for people to request delayed cord clamping and it is regularly honored as a request. You can request that the cord be delayed by 1-5 minutes (discuss with your provider the length) or request that the cord not be clamped until after it stops pulsating.

By delaying cord clamping to 3 minutes or more, most notably it increases the blood volume of baby. This is important to their body catching up fastest in adjusting to the outside world and decreases risks of newborn blood transfusions. Delayed cord clamping also increases the hormone and endorphin exchange between the birthing person and baby necessary for the strongest bonding – the two (or more) bodies are in their last communications before separation. Delayed cord clamping has many other benefits especially if baby requires any interventions. Biologically if baby is connected to their placenta, they are getting an extra 3-5 minutes of oxygenated blood transferring to them if the cord is in healthy condition with pulse. It is the number one job of your partner, doula, advocate – whomever you decide - to remind the provider to not separate baby from their cord for your decided minutes, or until it stops pulsating.

It is always an option to ask your provider about how they manage resuscitation if needed, specifically if they practice keeping baby connected to their cord during efforts. You may want to ask if they bring the baby warmer over to the delivery beside or if they perform any efforts at/on the birthing bed, or if they always clamp the cord immediately and take baby to the warmer. It is an option mentioned here especially for those who are anxious about what may happen and want to know about options. It is not a requirement that you place this on your birth plan or discuss it with your provider – many parents choose to leave the decisions of this nature to their labor team and that is absolutely okay!

Other Choices for Baby After Delivery

Eye Ointment – This is often not something that can be declined, nor is it recommended to decline. However, you may request that it be delayed for the period of the golden hour.

Vitamin K Injection – This is often not something that can be declined, nor is it recommended to decline. However, you may request that it be delayed for the period of the golden hour and be administered while being held by a parent for soothing.

Hepatitis B Injection – This is an optional first vaccination opportunity in some places, however it is not recommended to decline. You may request that it be delayed for the period of the golden hour and be administered while being held by a parent for soothing.

First Bath – You may decline that your baby be bathed at all in the hospital, and there are some indications that baby not being bathed for at least the first 24 hours of life increases the bonding between birthing person and baby, increases chest feeding efforts, and is beneficial to the immune system, skin health and more. Hospitals may have a policy to bathe babies who are born in meconium, but you have the option to be present for the bath and bring a fragrance free soap in the case a bath is deemed medically indicated.

Bottles/Pacifiers/Formula – You may elect if you do or do not want baby given formula, fed by bottles, or given a pacifier at any time after birth. Your hospital may have a milk donor program where if your baby requires supplemental feeds they can be given screened breast milk that has been donated instead of formula. If you have collected colostrum, ensure staff knows your wishes to use that. If you do not want bottles introduced to your baby, you can request syringe feeding for the interim time until chest feeding can be started. You may also request an ‘SNS’ – Supplemental Nursing System - be provided so that you can still feed your baby at your chest with donor milk or formula.

As noted above, you may also request that all weights, measures and other ‘check boxes’ be done after the golden hour.

It is also of note that many hospitals still have parents fill out paperwork, watch ‘informational education videos’ and speak to multiple services in the first hours after birth – you can request that this all be delayed! Staff convenience does not override your well deserved bonding time. Simply requesting that all non-medically-necessary visits be delayed until 12-24 hours post delivery can get the majority pushed back.