Right after delivery, and then again five minutes later, the doctor or midwife will test your baby against the Apgar score (Activity, Pulse, Grimace, Appearance, Respiration), a series of short tests to determine his general physical well-being. They are designed to detect whether your baby requires immediate special care. The doctor will then examine your baby to assess his general condition.
A doctor will give your baby a thorough examination shortly after birth and again 24 hours later, to make sure that nothing was missed and that no new problems have developed. Once the initial tests and examination have been carried out, your baby will be wrapped up snugly and put in his bassinet to keep warm. The checks done include the following:
1. Making sure that your baby’s facial features and body proportions are normal.
2. Turning your baby over to see that his back is normal and there is no spina bifida.
3. Examining his anus, legs, fingers, and toes.
4. Recording the number of blood vessels in the umbilical cord – normally there are two arteries and one vein.
5. Weighing your baby.
6. Measuring your baby’s head and body length.
7. Checking your baby’s temperature and warming him if he needs it.
If you are in the hospital, you should ask to be notified when the second examination is to take place, so that you can be there. You will have the opportunity to ask the doctor questions and to raise any concerns you may have.
For both examinations, your baby is placed on a flat surface in a good light and at a convenient height for the doctor, who may be seated. You can have the examination at your bedside if you are immobile, but should you be absent, never fail to get the results of the examination. Generally the doctor will start examining at the top of the head and work down to the toes.
The doctor will look at the skull bones and the fontanels, and check for any misshaping that occurred when the head passed through the birth canal during delivery. He will look at the eyes, ears, and nose, and inspect the mouth for any abnormality, such as cleft palate, and for any teeth. Although it is rare, some newborn babies do have teeth. If they are loose or growing at an unusual angle they will be removed so that there is no risk of their falling out and being swallowed. The doctor will also check your baby’s neck for cysts or swellings.
The heart and lungs are checked with a stethoscope. The lungs should be expanded and working normally. The work load of a baby’s heart increases substantially when he becomes responsible for his own circulation, sometimes causing what sounds like a heart murmur, but the vast majority of murmurs disappear spontaneously and rapidly. Your child will be examined during the postnatal checkup to see if a heart murmur is still present.
The doctor will check each arm for a pulse, and for normal movement and strength. He will also check your baby’s fingers and palm creases. Nearly all babies have two major creases across each palm; if there is only a single crease, the doctor will look for other physical abnormalities.
The doctor will press his hands gently into your baby’s abdomen to check the size and shape of the liver and spleen. Both may be slightly enlarged in a newborn baby. The testes will be checked to ensure that they are properly descended if your baby is a boy; if you have a girl, a check will be made to see that the labia are not joined and the clitoris is a normal size. The doctor will also check the lower spine and anus for congenital abnormalities.
The doctor will hold both thighs firmly and move each leg to see whether the head of the thigh bone is unstable or lies outside the hip joint, suggesting congenital dislocation of the hip. Testing the hips is not painful, but your baby may cry at the movement. The doctor will examine the legs and feet to make sure they are of equal size and length and that no skeletal abnormalities are present.
The doctor will also put your baby’s arms and legs through a range of movements to ensure that they are not too stiff or floppy. This will tell about the health of your baby’s nerves and muscles. The doctor will make sure that the normal newborn reflexes, such as the grasp, stepping, and Moro reflexes are present, and check your baby’s head control.