The Golden Hour After Birth

By Lauren Lisle

Medical Experts: Susan Lipinski, MD, OB-GYN; Jill Purdie, MD, OB-GYN; Rebekah Mustaleski, CPM

During pregnancy, soon-to-be parents spend endless hours envisioning meeting their baby for the first time; finally getting to see, touch, and hold your newborn is truly an unforgettable moment.

In the past, these tender moments have been sandwiched between assessments, procedures, and visitation with eager family members. But over the past 30 years, birth facilities have slowly moved toward a less-interrupted scene following delivery to allow a mother and child to connect before letting in the outside world, also known as the “golden hour.”

What Is the Golden Hour?

The golden hour refers to the first hour after birth when a new mother has uninterrupted skin-to-skin contact with her new baby to facilitate bonding, initiate breastfeeding, and slowly transition the little one from the womb to the world. As long as both mom and baby are well, immediate skin-to-skin contact is recommended.

During this time (sometimes also called the “magic hour”), non-urgent tasks that involve separation, such as newborn bathing, are delayed for at least 60 minutes. There’s so much evidence on the benefits of the golden hour that some hospital-based labor and delivery units have started implementing protocols to help protect mom and baby’s first hour of life together as long as there are no complications following birth.

“Direct skin-to-skin contact after birth prompts the release of the [love] hormone oxytocin,” says Jill Purdie, MD, OB-GYN and medical director at Northside Women’s Specialists, part of the Pediatrix Medical Group in Atlanta. “This hormone has been shown to improve the connection between mom and baby. Additionally, skin-to-skin improves breastfeeding rates and helps stabilize the infant’s body temperature and breathing rates.”

Following the excitement and stress of birth, this time of bonding can bring comfort to a new baby, who up until very recently enjoyed the controlled environment of the uterus with plenty of food, warmth, and protection. Skin-to-skin not only acts as an avenue for bonding immediately after birth, but also as a way of establishing lasting benefits between a new mother and child.

“Having the opportunity to establish breastfeeding in the early minutes improves the chance of successful breastfeeding in the long-term,” explains Susan Lipinski, MD, OB-GYN at Obstetrix of Colorado. “Breastfed babies have lower rates of many childhood illnesses, including asthma, diabetes, ear infections, and even Sudden Infant Death Syndrome (SIDS).”

The golden hour offers a host of other benefits for mom and baby as well, including supporting optimal infant brain development, decreasing crying, and improving a baby’s state of alertness after birth. For mom, this bonding session increases oxytocin—which helps decrease postpartum bleeding, minimizes the risk of postpartum hemorrhage, and helps with quicker delivery of the placenta), decreases maternal anxiety, and boosts maternal satisfaction with the overall delivery service.

What Does (and Doesn’t) Happen During the Golden Hour

To get the most out of the golden hour, there are certain things to allow, and certain things to avoid, following the birth of your baby.

What to allow

Skin-to-skin contact with your newborn

Think of this as your first of many cuddling sessions together to promote connection. After your baby is dried off, they will be placed belly-down on your bare chest and a blanket will be placed over both of you. Your infant may or may not wear a hat, depending on your preference (and as long as baby’s body temperature isn’t too low).

Spend this time gazing, smelling, and simply marveling at your newborn baby. Remember that they know you and are comforted by your voice and the rhythm of your heartbeat. And if your little one is alert, they’ll be taking in your soon-to-be familiar (albeit a bit blurry) face as well.

Early breastfeeding

Once your baby is situated on your chest, breastfeeding can be initiated, but you don’t have to force it. Oftentimes, newborns will initiate breastfeeding on their own through what’s called the “breast crawl.”

This phenomenon was first described in 1987 in Sweden and refers to when a newborn placed on their birth parent’s chest is given time to find the nipple and begin feeding on their own. Researchers believe this happens, in part, due to odors secreted by the birth parent’s breasts that attract the newborn through their sense of smell.

“The birthing parent’s skin (particularly the breast and areola) will smell familiar to baby, which provides them emotional comfort and a feeling of being safe,” explains Rebekah Mustaleski, a certified professional midwife with Roots & Wings Midwifery in Knoxville, Tennessee. “When the baby feels safe, it allows the newborn instincts and reflexes to kick in and can start the series of movements that have become known as the breast crawl. But even if your baby doesn’t crawl up to the breast on their own, giving them this time to root around and start looking for the breast will help them have a smoother transition to life outside of the womb.”

Giving adequate time for an infant to attempt the breast crawl and feed for as long as necessary has a significant positive impact on the onset of lactation and quality of attachment. (You can see the breast crawl in action here.)

Delayed cord clamping

Delaying the cutting of the umbilical cord means the cord remains unclamped and attached to the newborn anywhere from 30 seconds up to 10 minutes after delivery, depending on the situation and parental preferences. This allows more blood to transfer from the placenta to the baby, sometimes increasing the infant’s blood volume by up to a third.

According to the American College of Obstetricians and Gynecologists (ACOG), delayed cord clamping (DCC) increases hemoglobin levels at birth for term infants and improves iron stores in the first several months of life. For stable, preterm infants, DCC is associated with “significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of intraventricular hemorrhage.”

Additionally, the World Health Organization (WHO) recommends late cord clamping (at least one to three minutes or longer) for all births, including situations where the mother tests positive for HIV or Hepatitis B. In these cases, WHO guidelines insist that proven benefits of cord clamping outweigh theoretical risks of transmission to the newborn.

Routine procedures (that do not interfere with skin-to-skin)

Medical staff can conduct the first physical assessment of the baby (also known as the APGAR test to assess your baby’s health) while they’re on your chest. Of course, this will not apply if your child is showing any signs of distress, or if they’re having difficulty breathing on their own.

For mom, anything that can be done in the same position without causing separation (such as taking your blood pressure or getting a temperature reading) is permitted. This same rule applies to delivering the placenta and getting stitches for a vaginal tear, as long as the mother is able to safely hold her newborn without assistance. While not enjoyable, these time-sensitive factors can be accomplished without interrupting skin-to-skin contact, which is the priority during the golden hour.

What to avoid

Visitation with family and friends

While everyone is excited and eager to meet your new baby, holding off on allowing visitors is a good idea, according to the experts.

“Generally, allowing mom, partner, and baby to bond for two or three hours before introducing other family is beneficial,” says Dr. Lipinski, adding, “If delivery occurs at night, families may need more time to rest and recover before bringing extended family members in to [visit]. When mom and baby become overly tired, then bonding can be compromised, as can establishing breastfeeding.”

When it comes to drawing boundaries and communicating your desires to family and friends, know that more and more families are choosing to delay visitation to promote better bonding, according to Dr. Purdie. And if you need additional reinforcements, you can call on the help of medical staff.

“New parents should discuss their wishes for post-birth visitors with their care team in the hospital/birth center, so the nursing staff can help to maintain their privacy,” notes Dr. Lipinski.

Separation from your newborn

Procedures such as weighing, measuring, bathing, injections, or blood tests should wait until after the first feeding.

Be aware that separation can also come in the form of distraction or stress, so be mindful of anything that may take away from your ability to bond, such as incoming texts asking for updates or concerns over older children at home. Express your feelings and any needs for help to your partner or someone on your birth team, so they can help ensure you stay focused on baby.

The Golden Hour After a C-Section

Immediate skin-to-skin contact is generally not possible after a surgical birth, but you can still reap benefits early on in your baby’s life.

According to Evidence Based Birth, there are three different types of skin-to-skin care for healthy term infants:

• Birth or immediate skin-to-skin care beginning the first minute after birth
• Very early skin-to-skin care beginning 30-40 minutes post-birth
• Early skin-to-skin care that takes place anytime during the first 24 hours after baby is born

This means that any skin-to-skin contact (even after separation) is beneficial to mom and baby and still helps facilitate connection, and for standard cesarean sections, mothers and newborns can be reunited shortly after birth.

“During most C-sections, the baby will be assessed by nursery staff immediately after birth to ensure the breathing, color, and tone of the baby is normal,” explains Dr. Purdie. “The baby can then be brought over to the mother and placed next to her or across her chest if feasible. Once the surgery is completed and the mother and infant are in recovery, the infant can then be placed skin-to-skin and breastfeeding can be initiated, usually within the first hour of life.”

Another option is to have your partner do skin-to-skin contact while you receive necessary care nearby, then transition baby to your chest once it’s safe. Keeping mom and baby together through recovery, also known as “couplet care” allows for continual close physical and psychological proximity and a greater opportunity for post-birth bonding.

“While technically you and baby are two separate people, in the postpartum the two of you should be thought of as a dyad—you are two parts of one, explains Mustaleski. “You need each other to make a smooth transition to postpartum: You need baby to help your hormones shift from pregnancy hormones to postpartum hormones. Your baby needs you to help show them how to regulate their temperature, heart rate, and respiration. So, as long as you are both medically stable, the best place for both you and baby is together.”

However, the Centers for Disease Control and Prevention (CDC) reports that only 52% of newborns remain in uninterrupted skin-to-skin contact for at least one hour or until breastfed, as opposed to 71% of babies born vaginally, so it’s important to advocate for yourself when necessary. Similarly to dealing with visitation expectations ahead of time, it’s best to include a C-section plan in your birth plan and to communicate with your birth team to help facilitate your wishes through recovery and early postpartum.

What Parents of Preemies Need To Know

For parents of premature infants, the timeline of skin-to-skin contact is dependent on your baby’s particular needs and your doctor’s recommendations. However, it’s important to reiterate that skin-to-skin (at any time) offers a host of short- and long-term benefits, including:

• Better response to stress
• Improved function of the nervous system
• Stabilization of sleep patterns
• Improved cognitive control

Preterm babies who receive skin-to-skin are also less likely to develop hypothermia, hypoglycemia, and sepsis.

“As soon as [skin-to-skin] can be facilitated, you should spend time every day with your baby directly on your chest with no clothes in between you,” says Mustaleski. “This ‘kangaroo care’ improves outcomes for babies born prematurely and also gives you and baby lots of quality bonding time.”

If touch is restricted, parents of preemies can utilize other forms of contact, such as gently massaging baby while in the incubator or holding your baby’s hands to offer calming comfort.

While any time in the NICU is hard on the whole family, it’s important to try to not blame yourself for an unexpected separation after birth.

“No new mom should feel guilty because this time is interrupted. While very rare, there can be emergencies that occur and take precedence,” says Dr. Lipinski. “Mom and baby will have a lifetime [together] and while this first hour is magical and important, it should not risk the life or health of either.”

How To Find Out if Your Hospital Implements the Golden Hour

The term “Baby-Friendly” is now used to describe facilities that uphold the protocols of the golden hour during post-birth care. Accredited Baby-Friendly facilities follow certain criteria outlined in the Baby-Friendly Hospital Initiative (BFHI), a program organized by the WHO and UNICEF in 1991 that encourages hospitals and birthing centers to promote breastfeeding through tactics included in the golden hour (skin-to-skin, adequate feeding time, delayed assessments and procedures, etc.).

Approximately 1 in 6 hospitals or birthing centers in the U.S. are Baby-Friendly designated; approximately 24% of babies born in the U.S. are born in a Baby-Friendly facility. (You can find out if your facility is designated here.)

“Most hospitals attempt to give mom and baby skin-to-skin as soon as possible, but not all hospitals strictly observe a ‘golden hour,’” explains Dr. Lipinski. Even if your hospital isn’t considered Baby-Friendly, you can still specify your preferences in a birth plan and be ready to communicate those expectations throughout the process. This will allow you to work with the medical team to best achieve the post-birth experience you desire.

“Talk with your provider about [your preferences] before you go into labor. Ask them what the hospital policy is about skin-to-skin, the golden hour, breastfeeding or supplementation, etc. so you can know what to expect,” says Mutaleski. “Let the hospital staff know these things are important to you, but also be willing to speak up if you need to. Especially if the hospital is not baby-friendly, you may need to remind them of your wishes in the moment because they may end up doing things how they’re used to handling them at birth. Hiring a doula can be another way to help achieve the care you desire, as they can help you prepare before the birth and also help remind you of things you said you wanted during the big day.”

While the golden hour can be a wonderful experience for new mothers and families, it’s important to acknowledge that birth and breastfeeding are not one-size-fits-all experiences. Whatever way you deliver, and however you spend the first few hours following birth, remember that the health and well-being of mom and baby are the priority and that forging a forever bond with your baby is something that (thankfully) takes a lifetime.