What should happen in the first hour after birth (the golden hour)

In the first hour after birth, three simple things matter most. Wait at least a minute before the cord is clamped. Put your baby on the mother's bare chest. Let the first breastfeed happen while the baby is alert. Weighing, bathing and photographs can wait.

What is the golden hour after birth?

The golden hour is the first 60 minutes after birth. In this hour your baby moves from life in the womb to breathing, feeding and keeping warm on their own.

Before birth, the placenta did all of this work. Now the lungs, gut and skin must take over within minutes. Small, gentle steps in this hour make that change easier. None of them need costly equipment.

Dr Dutta uses the phrase with parents because it is easy to remember. The idea is simple: keep mother and baby together, keep the baby warm, and protect the first feed, unless the baby needs medical help.

How long should the doctor wait before clamping the cord?

For a baby who is breathing well, WHO advises waiting at least 1 minute before the cord is clamped.¹ WHO describes late clamping as roughly 1 to 3 minutes after birth.¹

At birth, a good amount of your baby's blood is still in the cord and placenta. If we wait, much of it flows into the baby. In a Cochrane review of term babies, waiting led to higher haemoglobin (the oxygen-carrying part of blood) in the first two days and better iron stores for months afterwards.² Babies were also about 100 grams heavier at birth, simply from that extra blood.²

Iron deficiency is very common in Indian infants, so Dr Dutta considers these few seconds well worth it.

Does delayed cord clamping help premature babies?

Yes, and the benefit is even larger. In a review of 18 trials of preterm babies, waiting before clamping reduced deaths in hospital by about a third.³

The same review found fewer blood transfusions in the babies whose cords were clamped late.³ Most of these babies had a delay of 60 seconds or more.³ This is why most neonatal teams now try to delay clamping even in small babies, as long as they are stable.

Is cord milking safe instead of waiting?

Cord milking (squeezing blood from the cord towards the baby) is not advised for babies born before 28 weeks. In a large trial, babies born at 23 to 27 weeks who had milking had more severe bleeding in the brain (22 percent versus 6 percent).⁴

That trial was stopped early, so the findings need care.⁴ But the signal was strong enough that most units avoid milking in very early babies. For term and late preterm babies the picture is less clear, and your team will follow its own protocol.

Does delayed cord clamping cause jaundice?

It can slightly raise the chance of needing light treatment for jaundice. In term babies, a few more babies needed phototherapy (blue light treatment) after late clamping.²

More red cells means more bilirubin (the yellow pigment made when old red cells break down) to clear. In Dr Dutta's view this is a fair trade for better iron stores. We check every baby for jaundice before discharge anyway, so the small extra risk is easy to manage.

Why is skin-to-skin contact important after birth?

Skin-to-skin contact helps babies stay warm, keeps blood sugar steadier and makes breastfeeding more likely to succeed. WHO advises early, uninterrupted skin-to-skin contact as soon as possible after birth.⁵

The latest Cochrane review found that babies who had skin-to-skin contact were more likely to be exclusively breastfed at discharge and up to six months later.⁶ Their blood glucose was higher too.⁶

How to do it:

• Dry the baby with a warm towel.
• Place the baby on the mother's bare chest, tummy down.
• Cover the back with a dry cloth and put a cap on the head.
• Leave the baby there for at least the first hour, without breaks for weighing.

Even in a Kolkata summer, an air-conditioned labour room can chill a wet baby fast.

Can I do skin-to-skin after a caesarean section?

Yes, in most cases. The Cochrane review supports skin-to-skin contact after all types of birth, including caesarean section.⁶

With help from the theatre staff, the baby can lie on your chest while the operation is finished. If that is not possible, it can start in the recovery room.

If the mother is under general anaesthesia or unwell, the father or another close relative can hold the baby skin-to-skin on their own chest. It is not quite the same, but it still keeps the baby warm and calm. Ask about this before your delivery date so the team is ready.

Is skin-to-skin safe for my baby?

Yes, when someone is watching. Rare cases of sudden collapse in healthy newborns have been reported during unobserved skin-to-skin care in the first hours.⁷

So a few simple rules apply:

• Keep the baby's face visible, with the nose and mouth uncovered.
• Turn the head to one side, with the neck straight, not bent forward.
• A nurse or a companion should stay with you and look at the baby often.
• If you feel very drowsy, hand the baby to someone or place the baby in the cot.

These rules let you enjoy skin-to-skin safely.

Does kangaroo care help small or premature babies?

Yes. Kangaroo mother care means long hours of skin-to-skin contact on a parent's chest. Started straight after birth, it saved lives in a large WHO trial that included Indian hospitals.⁸

That trial studied babies weighing 1.0 to 1.8 kg. Deaths in the first 28 days fell from 15.7 percent to 12.0 percent when kangaroo care started immediately, instead of after the baby was stable.⁸ Many Indian NICUs now practise this, and parents can do it for many hours a day.

When should the first breastfeed happen?

The first breastfeed should start within the first hour after birth.⁵ A healthy baby left on the mother's chest will often find the breast without much help.

In a pooled analysis, babies who started breastfeeding 2 to 23 hours after birth had a higher risk of dying in the newborn period than those who started within 1 hour.⁹ Babies who started after 24 hours had about twice the risk.⁹

The first milk, colostrum, is thick and yellow. The amount is small, but it is rich in antibodies. Babies are often very alert in the first hour and then sleep deeply for some time, so this early window is precious.

What is the Apgar score?

The Apgar score is a quick check of your baby at 1 and 5 minutes after birth. It looks at colour, heart rate, breathing, muscle tone and response, each scored 0 to 2.

It is a useful way to record how a baby is doing just after birth.¹⁰ But a low score on its own does not predict how an individual child will do later.¹⁰ If your baby's score was low at 1 minute and normal at 5 minutes, that is very common and usually reassuring.

What does the doctor check in the first newborn examination?

A short check happens at birth, and a full head-to-toe check follows within the first day. This full examination looks at the heart, breathing, hips, spine, mouth and palate, eyes, genitals and limbs.

WHO advises that every newborn should also be screened for eye problems and for hearing.¹¹ Your baby will also be weighed and measured, but this can wait until after the first feed. Most of the first check can even be done while the baby lies on you.

When should my baby get vitamin K and the birth vaccines?

Vitamin K is given as one injection soon after birth, to prevent serious bleeding.¹² The birth vaccines (BCG, oral polio and hepatitis B) are usually given before discharge as per the national schedule.

There is no need to take the baby away from you for these. Babies held skin-to-skin during an injection cry for less time.¹³ You can ask the nurse to give the injection while the baby is on your chest or at the breast.

When should a newborn have the first bath?

The first bath should wait at least 24 hours after birth.¹¹ WHO found no good reason for an early bath, even if the baby was born with meconium (the first stool) on the skin.¹¹

Bathing early can make a baby cold. The white, creamy coating on the skin is called vernix. It moisturises and protects the skin, so please do not let anyone scrub it off. When you do bathe, keep it short and warm and dry the baby well. WHO's general advice is 1 or 2 more layers of clothing than an adult is wearing.¹¹ In hot, humid weather, use the lower end: one light cotton layer more than the adults in the room.

What can wait until after the first hour?

Almost everything routine can wait, as long as your baby is well. This includes:

• Weighing and measuring
• The first bath, which should wait at least a day
• Dressing in new clothes for photographs
• Passing the baby around the family

Grandparents are often eager to hold the baby straight away. Dr Dutta understands that. But the baby's place in the first hour is on the mother's chest. Visitors will have plenty of time later.

What if my baby needed help at birth and we missed the golden hour?

Bonding and breastfeeding are not ruined if the first hour does not go to plan. Skin-to-skin and the first feed can start as soon as things settle, even hours later.

Sometimes a baby needs the warmer straight away, or the mother is bleeding and the team is busy. In those moments, breathing support comes first, and that is the right priority. Once the baby is stable, ask for skin-to-skin. If the baby is in the NICU, ask the nurses to help you express colostrum within the first hours so it can be given to the baby.

What should I ask my doctor before delivery?

A short talk in the last months of pregnancy is enough. You might ask:

• Will you wait at least 1 minute before clamping the cord if the baby is well?
• Can my baby go straight onto my chest and stay there for the first hour?
• If I have a caesarean, can we do skin-to-skin in theatre or in recovery?
• Can routine checks and injections happen while the baby is on me?
• Who will stay with me to watch the baby during skin-to-skin?

These are fair requests. Dr Dutta has never met a paediatrician who objects to them for a well baby.

When should I call a nurse or doctor in the first hour?

Call for help at once if your baby:

• Looks blue or very pale around the lips and face
• Breathes very fast (60 or more breaths a minute), grunts, or pulls in the chest with each breath¹⁴
• Is floppy, limp, or does not respond to touch
• Feels cold even when covered
• Has the face pressed into the breast or bedding, with the nose and mouth blocked⁷

Do not wait to see if it passes. In the first hour, a nurse should always be close by.