Fourth Stage of Labor — Bonding & Recovery
During the fourth stage of labor, your caregiver will repair the episiotomy, if one was done, as well as any vaginal or perineal lacerations. If the repair work becomes uncomfortable, ask for another injection of local anesthetic.
If you were given medication to help contract the uterus, or if you have already started breastfeeding, you may notice uterine contractions. In addition, you may feel exhilarated and very excited about the baby. If your labor was long or difficult, you may feel relieved or exhausted. ¥our legs and/or your body may tremble involuntarily.
Bonding refers to the development of the attachment that a mother and father feel for their child. This process actually begins before birth, when the parents-to-be feel their baby’s movements and anticipate his arrival. The feeling is heightened at the first sight of the newborn. For centuries, mothers have felt the desire to hold and cuddle their new babies as soon as possible after birth. Studies confirm that this is best for the babies, too.
The current emphasis on bonding is the result of research first done in connection with battered, abused, and “failure to thrive” children. “Failure to thrive” babies do not grow, gain weight, or develop behaviorally at a normal rate, even though they have no sign of an organic disease. A profound number of the infants studied had been separated from their mothers at birth for a period of time. A significant correlation was found between this early separation and the subsequent development of these disastrous conditions. In addition, researchers have documented that in the animal kingdom, when a mother and baby are separated, the mother abandons or rejects the baby. As a result, neonatal intensive care nurseries now encourage families to visit, touch, cuddle, and even assist in the care of their premature or sick newborns during hospitalization.
Numerous studies by Marshall Klaus and John Kennell have confirmed these original findings. Parents who spent time with their newborns immediately after birth and for an extended period while in the hospital were found to be more responsive to their babies’ needs in the following weeks, months, and even years. This, in turn, had a positive effect on the learning abilities and the social and emotional development of these children. The children were found to be better adjusted, have more self-esteem, and develop their own sense of identity and independence sooner.
Because of these findings, Drs. Klaus and Kennell suggest that a father, mother, and infant be allowed to spend at least 1 hour together in privacy soon after birth, and that the mother and baby be allowed to stay together as much as the mother desires while in the hospital. During the first 45 minutes of life, the baby is in a quiet alert state. In this state, the baby is awake and responsive to his environment. He looks intently at his mother’s face and gazes into her eyes. It is now known that babies can see at birth and that they focus best on objects 8 to 10 inches away—the distance between an infant’s face and his mother’s face when he is being breastfed. It is suggested that a newborn’s eyes not be treated with antibiotic ointment or silver nitrate drops until after this initial bonding period to avoid interference with vision.
Ideally, breastfeeding should also be initiated soon after birth. Many studies have shown that if the baby nurses within this first hour, the mother and baby will be more successful at breastfeeding. In addition, the colostrum that the baby ingests during fee first nursing period provides him with protection against infection and acts as a laxative, cleansing his system of mucus and meconium. The mother also benefits from early nursing. The baby’s sucking releases the hormone prolactin, which enhances maternal feelings. Oxytocin, which is also released, causes the uterus to contract and reduces blood loss following birth.
Most hospitals no longer separate mothers and infants right after birth. Parents begin bonding with their newborns in the same room where the woman labored and gave birth. In complete privacy, the new parents can explore and marvel at their creation. The mother can hold her naked infant close to her bare breast, provide skin-to-skin contact, and begin the nursing relationship. By covering mother and baby with a blanket, a drop in the baby’s temperature can be prevented, even without a heat lamp. Both parents can hold, talk to, and caress the baby. Do not be surprised if you find yourselves talking to your newborn in high-pitched voices. This is almost instinctive, and babies respond very positively to these sounds.
When you hold your baby in your arms, you will notice that he is especially attracted to your eyes and facial features. He will respond by gazing, listening, imitating, possibly crying (he can be soothed), and following you with his eyes. He is so new, yet so alert!
A positive childbirth experience usually fosters the bonding process. Similarly, a negative childbirth experience may adversely affect a mother’s feelings toward her child for a while and thus cause a delay in maternal attachment. Some parents simply take a little longer to develop loving emotions toward their newborns. In these cases, bonding takes place in the weeks following birth, rather than during the first few minutes. The newborn stage is not the only time in a baby’s life when a strong parent-baby bond can be established. The initial bonding period can be compared to a honeymoon: If a couple become ardent, completely satisfied lovers, then so much the better. But a less-than-perfect honeymoon does not doom a marriage. Nor does a less-than-perfect birth-bonding experience doom the parent-child relationship.
Any medications used during labor and delivery may also adversely affect the bonding experience. If a mother is heavily sedated, she will not be able to interact with her baby immediately. In this case, she should bond with her baby as soon as she is able. In addition, the father can arrange to bond with the baby right after delivery.
A baby who received medication via the placenta may be sleepy and less responsive right after birth. The medication may remain in his system for as long as 30 days and may affect his responses and sucking ability. Bonding is more difficult in this situation.
Active participation in the birth of their child enhances the parents’ strong feelings of attachment toward the baby. In addition, when a woman and man work together to bring about the birth of their baby, they feel a closeness toward one another that is not easily forgotten. The bonding between mother and father can be tremendous. They should work to maintain this close feeling, especially during those difficult first 6 weeks after birth.
Make the most of your opportunity for bonding. Find out about your hospital’s policies on bonding and about 24-hour rooming-in. Some hospitals do not separate the mother from her infant at all, moving them directly from the birthing room to a postpartum room. All the care and examinations are done in the mother’s room. Other hospitals take the baby to the nursery after delivery for the initial bath and for routine examinations by the nurse or pediatrician. You should discuss your desires for bonding and extended contact with both your caregiver and your baby’s pediatrician. Bonding is very important in family-centered maternity care, enabling parents to love and cuddle their new baby as they welcome him into their lives.
- Take photos of the mother and baby.
- Cut the cord when it has stopped pulsating.
- Hold and talk to the newborn.
- Tell your partner that she was wonderful!
Call your caregiver if you are in labor.
While you are bonding with your new baby, you will be closely observed for about 1 to 2 hours. This is the time it usually takes for the vital signs—blood pressure, pulse, and respiration—to stabilize.
The nursing staff will check your uterus for firmness and for position in the abdomen. A nurse will massage your fundus, or instruct you to do so, to keep the uterus in a contracted state. The amount and consistency of the lochia will be closely watched. Lochia is the normal discharge of blood, excess tissue, and fluids from the uterus after birth. You will be asked to urinate before you are allowed to leave the birthing room because a distended bladder can force the uterus up and out of position and cause it to relax. However, you may not feel the need to urinate, since other sensations after birth can mask awareness of a full bladder. If necessary, the nurse will insert a catheter into your bladder to empty it.
A blanket will help stop your legs from trembling, an experience that is common postpartum. An ice bag will be placed on your perineum to reduce swelling and relieve discomfort. If you have afterbirth contractions caused by your uterus continuing to contract and grow smaller, use slow paced breathing. These afterbirth pains are more noticeable alter second and subsequent births.
During recovery, you should try to do Kegel exercises. Contracting the pelvic floor muscles increases blood flow to the area, which reduces swelling and speeds healing of the episiotomy site. If you did not have an episiotomy, you should still do Kegels to help restore the muscle tone of your pelvic floor.
You may be hungry and thirsty after the work of labor and birth. The nursing staff should give you some well-deserved nourishment. If a meal or snack is not offered, ask for one.
Both you and your partner will experience an emotional high, feeling proud of your accomplishment. Together, you will probably relive the details of the birth over and over again.