The Golden Hour


The Golden Hour

You have probably heard the expression: “First impressions last”?

Have you heard the saying by SUITS character Harvey Specter: “You start behind the eight ball, you will never get in front”? – I don’t play pool but apparently it is when your cue ball is behind the 8 ball you are unlikely to make any shot – can only pocket the 8 ball once all the other balls have been cleared from the table…. which basically means when placed in a difficult situation from the start one is unlikely to escape it.

During the first hour after birth we have an opportunity to make a good first impression and help our child start life at an advantage - not behind the 8 ball. So how do we do that?

You have probably heard of the term the “Golden Hour”.

Sunset West Coast South Africa Dec 2018

In photography, the Golden Hour (figuratively) is the period of daytime shortly after sunrise or before sunset, during which light is properly diffused and warm, transforming photos from ordinary to extraordinary.

The Golden Hour of neonatal life is defined as the first hour of life requiring rapid adaptation of multiple newborn organ systems and includes respiratory, vascular, metabolic, and hemodynamic changes. Important elements of the Golden Hour (among which are mother–baby skin-to-skin contact (SSC) for at least an hour, delayed cord clamping, the early initiation of breastfeeding) contributes to neonatal thermoregulation, decreased stress levels in a mother and her newborn, improved mother–newborn bonding and neonatal adaptation. Implementation of these elements is also associated with increased rates and duration of breastfeeding.

Dr Nils Bergman (a specialist in perinatal neuroscience and well know promoter of skin-to-skin contact) says the first hours of life – while we may not remember our own – are absolutely critical for the development of a baby's brain and long-term social behaviour. He goes on to say earliest experiences matter most, because those are the ones that are building the foundation and early bonding in the first day leads to secure attachment in the first 1 000 days, giving a child "a safe base from which to explore the world".

SO the first hour is a sensitive period in which the newborn infant begins to orient to what life outside the womb is about. This sensitive period is defined as a vulnerable period of time whereby specific developmental behaviours can be exhibited. These periods contribute to the acquirement of specific competences and are vulnerable to outside influences that can disrupt the process. A new skill acquired during the sensitive period is much more readily acquired than if it is missed. When this sensitized period has passed, considerable attention and effort is required to then master the skill.

Mother–Baby Skin-To-Skin Contact

As mentioned above, one of the elements of the Golden Hour is skin-to-skin contact (SSC). SSC is the placing of the dried, unclothed newborn directly on his/her mother’s chest and abdomen just after birth, before cutting the umbilical cord. Benefits of continuous and prolonged SSC between mother and child, observed from numerous researches include: improved maintenance of the infant’s temperature, heart rate and other vital signs; lower pain measurements reducing stress levels resulting in further optimization of growth; promotion of exclusive breastfeeding; reduced risk of sepsis, hypothermia, hypoglycaemia and readmission to hospital. The benefits have shown to improve overall outcomes in all infants but it is especially advantageous to preterm infants.

Due to these well documented benefits, all major organizations responsible for the well-being of newborns and mothers, such as the WHO, American Academy of Paediatrics, Academy of Breastfeeding Medicine and the Neonatal Resuscitation Program, advocate SSC immediately after birth and for up to 24 hours thereafter.

Apart from the above-mentioned advantageous, something amazing happens when a baby is in skin-to-skin contact after birth: there are nine observable newborn stages, happening in a specific order, that are innate and instinctive for the baby. Within each of these stages, there are a variety of actions the baby may demonstrate.

Stage 1: The Birth Cry

The first stage is the birth cry. This distinctive cry occurs immediately after birth as the baby’s lungs expand for the 1st time. (Though babies do not always cry.) It is the most glorious sound imaginable as it confirms your baby is alive and well! He is making his presence felt and letting his mom and dad know that he has arrived.

Stage 2: Relaxation

The second stage is the relaxation stage. The baby is placed skin to skin with the mother covered with a warm, dry towel or blanket. During the relaxation stage, the newborn exhibits no mouth movements and the hands are relaxed. This stage usually begins when the birth cry has stopped.

Stage 3: Awakening

The third stage is the awakening stage. This stage usually begins about 3 minutes after birth. The newborn in the awakening stage may exhibit head movements, open his eyes, show some mouth activity and might move his shoulders. S/He is feeling the wide spaces around him, no longer tightly confined in the uterus but free to stretch.

Stage 4: Activity

The fourth stage is the activity stage. During this stage, the newborn begins to make increased mouthing and sucking movements - the rooting reflex becomes more obvious. This stage usually begins about 8 minutes after birth.

Stage 5: Rest

At any point, the baby may rest. The baby may have periods of resting between periods of activity (using sliding, pushing, leaping and crawling movements) throughout the first hour or so after birth. Just let him be and he will continue in his own time. Don’t rush him. Enjoy this time together.

Stage 6: Crawling

The sixth stage is the crawling stage. The baby approaches the breast during this stage with short periods of action that result in reaching the breast and nipple. This stage usually begins about 35 minutes after birth.

Stage 7: Familiarization

The seventh stage is called familiarization. During this stage, the newborn becomes acquainted with the food source by licking the nipple and touching and massaging the breast. This stage usually begins around 45 minutes after birth and could last for 20 minutes or more.

Stage 8: Suckling

The eighth stage is suckling. During this stage, the newborn takes the nipple, self-attaches and suckles. This early experience of learning to breastfeed usually begins about an hour after birth. If the mother had pain medication during labor, it may take more time for the baby to complete the stages and begin suckling.

Stage 9: Sleep

The final stage is sleep. The baby and sometimes the mother fall into a restful sleep. Babies usually fall asleep about 1½ to 2 hours after birth.

Delayed Cord Clamping

Another element of the Golden Hour is delayed cord clamping. It allows for the flow of blood from the placenta to the newborn, which improved red blood cell volume, increased birth weight, and greater iron stores in infants at 6 months of age.

Exact amount of time given before cutting the cord vary between individual providers and institutions, the WHO recommends clamping the cord 1 to 3 minutes after birth, the amount of time that is generally required for the cord to cease pulsating. Guidelines also show that the additional 1 to 3 minutes of placental blood flow due to delayed cord clamping have not been shown to increase the risk of HIV transmission from mother to newborn and thus encourage delayed cord clamping as a best practice for mothers and newborns, except for those babies in need of immediate resuscitation. Discuss delayed cord clamping with your Health Care Provider.

Early Initiation of Breastfeeding

The last element of the Golden Hour that we will look at here is the early initiation of Breastfeeding.

Breastfeeding is the “latching and suckling of maternal milk of a newborn on its mother’s breast”. Breastfeeding in newborns is an instinctive response, however this is found to be true only when the newborn is left undisturbed after birth to find their way to the maternal breast. Thus if missed during the first hour baby may need more effort and attention to master the skill.

Positional stability, nipple protection and optimal milk transfer are achieved when we let baby go through the natural stages that occurs during the Golden Hour.

Breastfeeding and bonding are closely linked as they both occur on the mother’s skin and chest.

It is known that the most sensitive period for initiation of breastfeeding and bonding occurs strongest in the first hour and day following childbirth.

While first impressions last, our children do not have to start behind the eight ball! We can help our child start life at an extraordinary advantage.

Every single newborn baby is born with the full potential of the universe – and that potential is about the quality of early experience. Our earliest connection sets the stage for the connections we are to make throughout the rest of our lives. We can help lay the foundation for our child’s secure attachment, bonding and successful breastfeeding through a few simple acts like prolonged and continuous skin-to-skin contact and the early initiation of breastfeeding.

References

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#breastfeeding #skintoskin #mother #newborn #9stages

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