The First Hour After Birth: Golden Hour, Cord Clamping and Newborn Shots

Right after the baby is born

• If the baby is breathing well, they're usually dried off and placed on the birthing parent's bare chest, with a warm blanket over their back.
• The Apgar score (color, heart rate, reflexes, tone, breathing) is checked at 1 and 5 minutes and can be done while the baby stays on the chest. A low first score is common and often rises by 5 minutes.
• If the baby needs help breathing, the team will take them to a warmer a few steps away. That's routine, not a sign something is badly wrong.

Delayed cord clamping

• ACOG and the AAP support waiting at least 30-60 seconds before clamping the cord in healthy term and preterm babies. Extra blood flows to the baby, which boosts iron stores for months.
• A partner or support person can often cut the cord; ask ahead.
• If you plan cord blood banking or donation, tell the team early; it can usually fit with delayed clamping.

The golden hour

• Unhurried skin-to-skin for at least the first hour, or until the first feed, keeps babies warm, steadies breathing and blood sugar, and helps feeding start.
• Weighing, measuring and the first bath can wait. WHO suggests holding the bath for at least 24 hours.
• Someone should watch the baby's face the whole time: nose and mouth clear, pink color, head turned to the side. Exhausted parents can drift off, so ask a nurse or support person to stay alert.
• After a C-section, skin-to-skin often happens in the operating room. If the birthing parent can't hold the baby, a partner can do it (see the skin-to-skin guide).

The first feed

• Many babies, left on the chest, will bob, root and crawl toward the breast within the first hour. Help them get close; a nurse or lactation consultant can guide the first latch.
• Colostrum comes in small amounts, a few teaspoons a day, and that's all a newborn needs at first.
• If you're formula feeding, the first bottle can be given skin to skin too, with the baby fairly upright and paced.

Routine newborn care

• Vitamin K shot: one injection that prevents a rare but serious bleeding disorder, including bleeding in the brain. Newborns are born low in vitamin K. The AAP recommends it for every baby; drops by mouth are less effective and not the U.S. standard.
• Eye ointment: an antibiotic ointment that prevents an eye infection from germs picked up during birth. Many states require it. It can usually wait until after the first feed. Some experts are rethinking routine use; ask your hospital what your state requires.
• Hepatitis B vaccine: the AAP recommends a first dose within 24 hours of birth; families can discuss timing with their pediatrician.

When to check in

• Talk through your wishes for this hour at a late-pregnancy visit and write them on your birth plan.
• In the hours after birth, tell your nurse if the baby is grunting with each breath, looks blue or pale, or seems floppy; if this happens after you're home, call 911.