Problems In The Delivery Room: Why Can’t I Hold My Baby Right Away?

Every mother anticipates the moment after delivery when she first sees her newborn baby. Most of the time, somewhere around 90% of full-term deliveries are uncomplicated. In this case, the baby will be put directly on the mother’s abdomen, gently dried, and evaluated right there.

Sometimes, however, something goes wrong. This might be expected, as would be the case if an ultrasound showed that the fetus had a serious problem. It can be unexpected, when there is a congenital abnormality that was not detected beforehand. It can also be unexpected when there is some stress to the baby during the mother’s labor and its journey through the birth canal. Stress at that point can mean the baby will need some assistance after birth.

Normal Term Infants Can Have Stress During Birth
The transition from fetus to newborn baby is amazing. The baby has to breathe in air for the first time. The umbilical cord is clamped, so there is no more blood or oxygen getting to the baby from his or her mother. The events of delivery, including the first breath and cord clamping cause a whole series of changes in the baby’s circulation. If things go correctly, the baby successfully breathes room air, and all the fluid goes out of the lungs. The circulation in the heart and lungs then changes so that the baby’s oxygenated blood goes out as it should to the rest of the body.

In the approximate 10% of cases in which this transition is not seamless, the baby may need help to breathe. This is often something as little as stimulating the baby as he is warmed under a lamp, giving him more oxygen, or suctioning fluid out of his mouth. Ninety percent of that 10% only need simple interventions that will quickly get them breathing normally. If a baby is not put right on top of the mother’s abdomen and the nurses and/or doctors are helping him, it does not mean there is a serious problem. The mother will probably get to hold the baby very soon. If not, the doctor will explain as soon as possible what is wrong and what they need to do.

When a baby needs help to make the transition from fetus to newborn, the procedures are usually performed away from the mother. The baby may be cared for under a warming light in the room; this is usually what happens when a baby just needs a little help.

Meconium
Fetuses can pass meconium before they are born. Meconium is a dark green to black sticky substance in fetal intestines that is there before they have ever ingested anything outside the mother’s body. Meconium that is visible in the fluid around the baby (amniotic fluid) usually means that the baby was stressed in some way during labor. This may happen in anywhere from 7% to 20% of deliveries. 2% to 9% of babies who are delivered with meconium-stained fluid may develop meconium aspiration syndrome, which is a problem with the lungs.

If a baby born through meconium-stained fluid is otherwise vigorous and healthy, it is not necessary to try and remove all the meconium. If a baby with meconium is not vigorous or breathing well, suction must be performed to get as much of the meconium as possible out of her mouth and trachea. Trained personnel must do this away from the mother.

Neonatal Resuscitation Teams and the NICU
As mentioned above, 90% of infants who need help after labor will become pink and active after stimulation, and will not need anything else specific.

Babies who do not respond to the above measures may need to have a tube put into their airway (trachea) and have breath delivered to them. They may need heart compressions if their heart is not beating fast or well enough. There are a variety of drugs that may be administered. In most hospitals, a neonatal resuscitation team should give this care. Only 0.2% to 0.3% of delivered infants may go on to have some amount of brain damage from lack of oxygen to the brain.

If there is any reason to expect a difficult delivery, it should take place in a hospital with this kind of team, and the team should be there at delivery. A baby who is not responding normally will go to the NICU, the Neonatal Intensive Care Unit. You might want to visit the hospital you are planning to use early in your pregnancy to make sure it has an NICU, as well as a neonatal resuscitation team. This is extremely important if you have been told your pregnancy is high-risk, or you know of any significant problem with your baby.

Actual Birth Injury
Large babies who are born to small mothers can have actual trauma during delivery. An example of this is shoulder dystocia, in which the baby’s shoulders get stuck after the head has already come through the birth canal. The baby must be delivered, but it is possible to have the collarbones of the baby break, as well as injury to the collection of nerves in the baby’s armpits.

There can also be injury to the head in a difficult birth. Babies born breech can have limb or head injuries, which is why they are usually delivered by C-section.

High-Risk Situations
Babies that are born prematurely are more likely to have trouble making the transition, and more likely to need medical intervention. The more premature, the more possible problems the baby may have.

Twins or other multiple births are also often premature and are at risk not just because of prematurity, but also because of other problems unique to twin births. Multiple births also increase the chance of congenital abnormalities.

Babies born by C-section may also need assistance. These are factors that are known when labor begins or a C-section is started, and there should be a neonatal resuscitation team available.

Significant congenital abnormalities can mean an infant needs more than just resuscitation but also definitive surgical or other care. Many severe birth defects are detected by ultrasound or other tests beforehand, and preparations can be made. Sometimes surgery is even done while the baby is in the uterus.

However, a baby can be born to someone who did not receive prenatal care or who did not want prenatal testing. Some conditions may not be detected. If the baby is known to have a specific birth defect, there may need to be a medical or surgical team ready at delivery. Serious malformations that will need immediate evaluation and special care include:

  • Spina bifida with all its variations. The spinal cord can be exposed.
  • Anencephaly, which is essentially always incompatible with life because most of the brain is absent.
  • Gastroschisis and omphalocele – conditions where defects in the abdominal wall mean that the intestines are outside of the body.
  • Diaphragmatic hernia – some of the abdominal contents are in the chest cavity.
  • Chromosomal abnormalities – rare ones that cause multiple defects that are usually incompatible with life, such as three copies of chromosome 13 or 18.
  • Hydrops fetalis – an abnormal accumulation of fluid in the fetus’ chest and/or abdomen, which can be caused by blood type incompatibility between mother and baby.
  • Twin problems in which one twin grows at the expense of the other. Both may need urgent care.

Examples of less severe problems that should be evaluated but will not need any urgent treatment can include other chromosomal abnormalities such as Downs’ syndrome, and congenital conditions such as cleft lip, cleft palate, or club foot. Some congenital heart problems may not be apparent immediately, but are very serious.

If there is any reason for the medical personnel at your delivery to be concerned about your baby, they need to take the time to evaluate and treat problems. By itself, this does not need to be a cause of great concern. Serious problems are rare, especially if you have had good prenatal care and your baby is not born prematurely. Most of the time, a short amount of time is all that is needed to help the baby make the transition to breathing outside of the womb, and most babies can be safely given to their mothers.

What do you think?

Problems In The Delivery Room: Why Can’t I Hold My Baby Right Away?

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17 comments

  1. Profile photo of elizabeth elizabeth says:

    Ermm you dont know anything about clubfoot. Clubfoot DOES need urgent treatment because it can relapse. And everything I’ve read about this foot defect says it may become serious. My baby son Noah has SB. Spina bifida is a birth defect of the spine that can cause hydrocephalus and other problems. He has bilateral clubfoot that was caused by spina bifida.

    And orthopedic surgeons recommend we begin at once. Starting early makes a huge difference. Noah has had a tenotomy done that helped as well. Please edit this article.

  2. Profile photo of mommy nhoj mommy nhoj says:

    Good thing I got hold of my little one right after c-sec. Few minutes agter she was taken out, I’d managed to hold her and latch her. The feeling was amazing! She stayed overnight at NICU but I got to feed her that night. The following day she was roomed in 🙂

  3. Profile photo of LIZ says:

    my daughters friend was born with meconium but tnx to the doctors fast action with the c section baby was alright

  4. Profile photo of joyce joyce says:

    My daughter was born with Meconium in her lungs they suctioned the stuff out of her nose and mouth and she was fine. Luckily she did not swallow a lot so she did not have to go to nicu. I was the one that ended up in icu due to bleeding and low blood pressure.

  5. Profile photo of Jessica Jessica says:

    During my clinical rotation on the OB unit I had the opportunity to observe the birth of a baby that was ‘stunned’ at birth, my supervising RN quickly took the baby from the doc, placed him under a light, and pounded and rubbed his back and sides until he coughed and started breathing. Doctors and nurses are so well trained these days on OB units that I don’t feel that there is anything to fear when it comes to the well-being of my baby.

  6. Profile photo of Daniela Daniela says:

    I hope everything goes well when the time comes for my delivery

  7. Profile photo of MadXanSi MadXanSi says:

    I had to wait 10 days to hold my 3rd child!!!

  8. Profile photo of Kimberly Kimberly says:

    My daughter was born super small she was a month early, and she was placed on my chest for a few seconds then taken away so they could make sure (because of her size) she was going to be able to function correctly on her own. I was super glad for that since she was so tiny.

  9. I had to have my baby via c-section and I was very scared and I hated that I could not keep my baby with me and that he had to leave the room without me.

  10. Profile photo of Christina Christina says:

    My 4th baby was full term. She was placed on me first then taken away and was tube fed as she had fluid.

  11. Profile photo of Elfie Elfie says:

    My full term vaginal delivery son was placed on my chest first then taken away because of his breathing but he quickly recovered.

  12. Profile photo of MamaCat MamaCat says:

    Aimee – I think it depends on the issue. My daughter had Meconium aspiration so I couldn’t hold her most of the first day. We were in sepearate hospitals a lot of that time which was incredibly frustrating and by the time I could I was scared I would hurt her. She came out of the whole mess just fine and at 3 1/2 you would never know she had any issues at all.

  13. Profile photo of sathyaa sathyaa says:

    Hope this does not happen for me..All these months i have been waiting only to hold my baby moment he is born!!!!!

  14. Profile photo of Aimee Aimee says:

    What is the average time that a newborn is kept from their mother if these events happen?

  15. Profile photo of verochka31 verochka31 says:

    you could go in with the best birthing plan ever, but you never know what awaits once your process starts. don’t get mad or upset, just focus on your baby’s health as well as your own. everything else will work itself out in time……………..

  16. This is a lot to think and worry about. As far as I know, everything is okay. I hope it stays that way.

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