Essential Care for Newborns Born by Spontaneous Vaginal Delivery (SVD) Who Are Breastfeeding
Skin-to-skin contact (SSC) should be initiated immediately after birth and continued for at least one hour to promote successful breastfeeding and optimal newborn transition. 1
Immediate Post-Birth Care
Skin-to-Skin Contact
- Place the dried, naked baby prone on the mother's bare chest immediately after birth
- Cover the baby's head (optional) and body with prewarmed blankets
- Ensure proper positioning:
- Baby's face must be visible
- Head in "sniffing" position
- Nose and mouth uncovered
- Neck straight, not bent
- Shoulders and chest facing mother
- Legs flexed 1
Initial Assessment
- Perform initial assessment while the baby remains on mother's chest
- Delay routine procedures (weighing, vitamin K administration, eye prophylaxis) until after the first breastfeeding 2
- Monitor vital signs during SSC:
- Breathing
- Activity
- Color
- Tone
- Position 1
Breastfeeding Support
First Feeding
- Allow the infant to root and latch on spontaneously within the first hour of life 2
- For infants with oral pain or blistering, use a soft silicone or cleft-palate-style teat 1
- Assess breastfeeding effectiveness using standardized tools (e.g., IBFAT score) 3
Ongoing Breastfeeding Support
- Provide education and support for breastfeeding by healthcare professionals 4
- Implement cue-based feeding (responding to infant's hunger cues) 1
- Use gentle patting, tapping, or rubbing for burping after feeds 1
- Monitor for signs of successful breastfeeding:
- Adequate latch
- Audible swallowing
- Appropriate number of wet/soiled diapers
- Weight gain pattern
Rooming-In
Rooming-in (mother and infant remaining together 24 hours per day) should be implemented for all healthy newborns regardless of feeding or delivery method 1.
Benefits of Rooming-In
- Increases frequency of breastfeeding in first few days
- Decreases hyperbilirubinemia
- Increases likelihood of continued breastfeeding up to 6 months 1
- Higher rates of exclusive breastfeeding at hospital discharge 4
Safety Considerations
- Continuous monitoring by staff in delivery environment
- Regular monitoring on postpartum unit
- When mother wants to sleep, infant should be placed in bassinet or with another support person who is awake and alert 1
- Monitor for signs of sudden unexpected postnatal collapse (SUPC), especially in first 2 hours (73% of events occur during this time) 5
Potential Complications and Management
Breastfeeding Challenges
- For breast engorgement: breast massage, continuing breastfeeding, and pain relief 4
- For maternal pain: NSAIDs and acetaminophen for uterine cramping and perineal trauma 4
- For infants with oral blistering: provide non-sedating pain relief 20 minutes prior to feeding 1
Monitoring for Complications
- Assess Apgar scores at 1,5, and 10 minutes after delivery 5
- Maintain newborn temperature between 36.5°C and 37.5°C 5
- Monitor for signs of respiratory distress or poor transition
- For Category III tracings (absent baseline variability with recurrent late/variable decelerations or bradycardia), immediate intervention is required 5
Special Considerations
Delayed Cord Clamping
- Delay cord clamping for at least 1 minute in term infants 5
- This allows for physiologic circulatory transition 1
Bathing
- Delay the first bath to prevent hypothermia and promote SSC
- When bathing, wrap the infant in a thin cloth and place in a padded bath 1
- After bath, wrap in towels and allow to dry while holding; do not rub dry 1
Clothing and Diapering
- Keep the newborn dressed and wrapped to reduce trauma from movement and friction 1
- Use well-fitted standard diapers with soft cloth liners coated with emollient 1
- Trim off inner elastic of disposable diapers to reduce friction 1
By implementing these evidence-based practices, healthcare providers can optimize outcomes for newborns born by spontaneous vaginal delivery who are breastfeeding, promoting successful breastfeeding initiation and supporting the mother-infant dyad during this critical transition period.