But oh, no—it starts waaaay sooner than that.) The Apgar test (named after anesthesiologist Virginia Apgar, who first started using the test in the early 1950s) measures your baby’s Appearance (skin color), Pulse, Grimace (reflexes), Activity, and Respiration. The nurse or midwife will chart your baby’s Apgar score at one minute and five minutes after birth. The score sheet looks something like the following chart. Keep in mind that the scores are used by the medical staff to help them determine how much intervention (if any) the baby needs. Although the scores have absolutely nothing to do with IQ or future earning power, and college admissions committees never ask for them, they do give new parents a handy (but completely useless) way of comparing their children.
The theoretical maximum score is 10, but anything between 7 and 10 at one minute is a sign of good health. Almost no baby gets a 10 (unless she’s the child of someone on the medical team) because most of them are born with slightly blue toes and fingers. This means that the baby needs only routine care. A baby who scores 4–6 may require some medical intervention such as oxygen or suction to remove mucus from the throat or lungs. A score of less than 4 may indicate the need for resuscitation. However, a low score could be the result of pain medication given to the mother or of the baby being born prematurely. The test will be done again at five minutes after birth to assess the effectiveness of the interventions. If the score is still low, the test will be repeated at five-minute intervals.
At the same time as the tests are going on, your baby will be weighed, measured, given ID and security bracelets, bathed, diapered, footprinted, have some antibiotic ointment applied to her eyes, get a quick injection of Vitamin K (to prevent bleeding and help her blood clot properly), and be wrapped in a blanket. She may even get her first picture taken. If your baby was delivered by C-section, or if there were any other complications, she’ll have her little lungs suctioned before returning for the rest of the cleanup routine.
| APGAR TEST | 2 POINTS | 1 POINT | 0 POINTS |
| A-Appearance | The entire body is pink from head to toe | Body is pink but arms and/or legs may be bluish | Body is entirely blue, pale, or gray |
| P-Pulse and heart rate | Above 100 beats per minute | Fewer than 100 beats per minute | Not detectible |
| G-Grimace (reflexes) | Loud cry when reflexes are stimulated | Moderate crying or whimpering when reflexes are stimulated | No response |
| A-Activity | Lots of movement of the arms or legs | Some movement of the arms and legs | No movement at all |
| R-Respiration | Big breaths and lots of crying mean those little lungs are working well | Slow, weak, or irregular breaths | No breathing |
Quality Time Starts Now
Most hospitals now encourage “rooming in”—keeping the baby in the same room as the new mom and dad. Some don’t have nurseries at all, except the ones for babies with serious health problems. Others still have nurseries but offer unlimited access for the parents.
If your hospital does have a nursery, you may want to take advantage of it. You may be tempted to have the baby room with your partner, but depending on how the birth went, she might really need to rest. Ask the nursing staff to bring the baby to your partner at feeding times. You, on the other hand, can spend as much time as you want with the baby. Of course, if your partner would prefer to have the baby nearby—plenty of new moms want exactly that—don’t bother arguing with her.
And while we’re on the subject of rest, you may have to get tough with the staff to make sure your partner gets enough. The nurses will tell her that she needs to sleep as much as possible, but if you don’t ask them to give her a break, they’ll be in every hour or two to check her vital signs.
The Placenta
For some reason, before my first child was born I’d never really thought very much about the placenta, which had been my daughter’s life-support system for a lot of the pregnancy. But whether you think about it or not, it’s still there—and it has to come out.
After the baby is born, your partner will continue to have mild contractions for anywhere from five minutes to about an hour until the placenta is delivered. The strange thing about this stage of the delivery is that neither you nor your partner will probably even know it’s happening—you’ll be much too involved with your new baby and with each other.
Once the placenta is out, however, you need to decide what to do with it. In this country most people never even see it, and those who do just leave it at the hospital (where it will either be destroyed or, more likely, sold to a cosmetics company—honest). But in many other cultures, the placenta is considered to have a permanent, almost magical bond with the child it nourished in the womb, and disposal is handled with a great deal more reverence. Some have special rituals and believe that if the placenta isn’t properly buried, the child—or the parents, or even the entire village—will suffer some terrible consequences.
In rural Peru, for example, the father is required to go to a far-off location and bury the placenta deep enough so that no animals or people will accidentally discover it. Otherwise, it might become “jealous” of the attention paid to the baby and take revenge by causing an epidemic.
In some South American Indian cultures, they believe that a child’s life can be influenced by objects that are buried with its placenta. Boys’ placentas are frequently buried with a shovel or a pick, and girls’ are buried with a loom or a hoe. In the Philippines, some bury the placenta with books as a way of ensuring intelligence.
But placentas are not always buried. In ancient Egypt, pharaohs’ placentas were wrapped in special containers to keep them from harm. Traditional Vietnamese medicine uses placentas to combat sterility and senility, and in India, touching a placenta is supposed to help a childless woman conceive a healthy baby of her own. And in China, some believe that breastfeeding mothers can improve the quality of their milk by drinking a broth made of boiled placenta.
This sort of placenta usage isn’t limited to non-Western cultures. Even today, in France and other countries, placentas are found in a variety of products, including cosmetics and medicines. And some people even believe that eating some of the placenta (called placentophagy) may help a new mom increase her milk supply and reduce her pain and the risk of developing postpartum depression. There’s no solid scientific proof behind any of that. But one thing is for sure, if your partner chooses to do this, she should stick to her own. Yumm.
Whatever you and your partner decide to do, it’s probably best to keep it a secret—at least from the hospital staff. Some states try to regulate what you can do with a placenta and may even prohibit you from taking it home (although if you really want to, you can probably find a sympathetic nurse who will pack it in a Tupperware container for you). My oldest’s placenta stayed at the hospital, but we stored the younger ones’ in the freezer for a year before burying them and planting trees on top.
Newborn Screenings
If you thought the testing was over with the Apgar test, think again. Even the healthiest-looking babies sometimes have invisible disorders that, if undetected, could stunt their physical and intellectual growth, lead to permanent brain or organ damage, and even cause death. Caught early, most of these disorders can be controlled or even cured. For that reason, your baby will be tested for a number of conditions before you’re allowed to take her home.
There are three types of tests: blood, hearing, and heart.
BLOOD TESTS
In the U.S., about 19,000 babies have a treatable condition that could be picked up by a screening test. Several organizations have pushed for a Recommended Universal Screening Panel (RUSP) that would require routine testing for more than fifty conditions. But for now, each state sets its own standards and depending on where you live, the actual number of required tests ranges from four to more than forty. (
