Editing Childbirth (section)

== Vaginal birth ==
{{Further|Vaginal delivery}}
[[File:2920 Stages of Childbirth-en.svg|thumb|upright=1.6|Sequence of images showing the stages of ordinary childbirth]]

Station refers to the relationship of the [[Presentation (obstetrics)|fetal presenting]] part to the level of the [[ischial spine]]s. When the presenting part is at the ischial spines the station is 0 (synonymous with engagement). If the presenting fetal part is above the spines, the distance is measured and described as minus stations, which range from −1 to −4&nbsp;[[centimetre|cm]]. If the presenting part is below the ischial spines, the distance is stated as plus stations ( +1 to +4&nbsp;cm). At +3 and +4 the presenting part is at the perineum and can be seen.<ref name="Pillitteri2010">{{cite book| vauthors = Pillitteri A |title=Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family|chapter-url=https://books.google.com/books?id=apeLf0mPx1QC&pg=PA350|access-date=18 August 2013|year=2010|publisher=Lippincott Williams & Wilkins|location=Hagerstown, Maryland|isbn=978-1-58255-999-5|page=350|chapter=Chapter 15: Nursing Care of a Family During Labor and Birth|url-status=live|archive-url=https://web.archive.org/web/20140628043145/http://books.google.com/books?id=apeLf0mPx1QC&pg=PA350|archive-date=28 June 2014}}</ref>

The baby's head may temporarily change shape (becoming more elongated or cone shaped) as it moves through the birth canal. This change in the shape of the fetal head is called ''molding'' and is much more prominent in women having their first vaginal delivery.<ref>{{cite web |title=Baby's head shape: Cause for concern? |url=https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/healthy-baby/art-20045964 |publisher=Mayo Clinic |access-date=9 July 2023 |date=10 March 2022}}</ref>

[[Cervical effacement|Cervical ripening]] is the physical and chemical changes in the cervix to prepare it for the stretching that will take place as the fetus moves out of the uterus and into the birth canal. A scoring system called a [[Bishop score]] can be used to judge the degree of cervical ripening to predict the timing of labour and delivery of the infant or for women at risk for [[Preterm birth|preterm labour]].  It is also used to judge when a woman will respond to [[induction of labour]] for a [[postterm pregnancy]] or other medical reasons. There are several methods of inducing cervical ripening which will allow the uterine contractions to effectively dilate the cervix.<ref>{{cite journal|first=Aaron E|last=Goldberg|name-list-style=vanc|title=Cervical Ripening|url=https://emedicine.medscape.com/article/263311-overview|website=Medscape|access-date=10 May 2018|date=2 March 2018|archive-date=7 August 2020|archive-url=https://web.archive.org/web/20200807104204/https://emedicine.medscape.com/article/263311-overview|url-status=live}}</ref>

Vaginal delivery involves four stages of labour: the [[cervical effacement|shortening]] and [[Cervical dilation|opening of the cervix]] during the first stage, descent and birth of the baby during the second, the delivery of the [[placenta]] during the third, and the fourth stage of recovery which lasts until two hours after the delivery. The first stage is characterised by abdominal cramping or back pain that typically lasts around half a minute and occurs every 10 to 30 minutes.<ref name="Col2016" /> The contractions (and pain) gradually becomes stronger and closer together.<ref name="NIH2010" /> The second stage ends when the infant is fully expelled. In the third stage, the delivery of the placenta.<ref name=":9" /> The fourth stage of labour involves recovery, the uterus beginning to contract to pre-pregnancy state, [[delayed cord clamping|delayed clamping of the umbilical cord]], and monitoring of the neonatal tone and vitals.<ref name=":10" /> All major health organisations advise that immediately following a [[Live birth (human)|live birth]], regardless of the delivery method, that the infant be placed on the mother's chest, termed [[skin-to-skin contact]], and delaying routine procedures for at least one to two hours or until the baby has had its first [[breastfeeding]].<ref name=":12" /><ref name="Medscape" /><ref name="Intrapartum Care" /><ref name=":13" />

===Onset of labour===
[[File:2919 Hormones Initiating Labor-02.jpg|thumb|upright=1.3|The hormones initiating labour]]
Definitions of the onset of labour include:
* Regular uterine contractions at least every six minutes with evidence of change in [[cervical dilation]] or [[cervical effacement]] between consecutive digital examinations.<ref>{{cite journal | vauthors = Kupferminc M, Lessing JB, Yaron Y, Peyser MR | title = Nifedipine versus ritodrine for suppression of preterm labour | journal = British Journal of Obstetrics and Gynaecology | volume = 100 | issue = 12 | pages = 1090–94 | date = December 1993 | pmid = 8297841 | doi = 10.1111/j.1471-0528.1993.tb15171.x | s2cid = 24521943 }}</ref>
* Regular contractions occurring less than 10 minutes apart and progressive cervical dilation or cervical effacement.<ref>{{cite journal | vauthors = Jokic M, Guillois B, Cauquelin B, Giroux JD, Bessis JL, Morello R, Levy G, Ballet JJ | title = Fetal distress increases interleukin-6 and interleukin-8 and decreases tumour necrosis factor-alpha cord blood levels in noninfected full-term neonates | journal = BJOG | volume = 107 | issue = 3 | pages = 420–25 | date = March 2000 | pmid = 10740342 | doi = 10.1111/j.1471-0528.2000.tb13241.x | doi-access = free }}</ref>
* At least three painful regular uterine contractions during a 10-minute period, each lasting more than 45 seconds.<ref>{{cite journal | vauthors = Lyrenäs S, Clason I, Ulmsten U | title = In vivo controlled release of PGE2 from a vaginal insert (0.8 mm, 10 mg) during induction of labour | journal = BJOG | volume = 108 | issue = 2 | pages = 169–78 | date = February 2001 | pmid = 11236117 | doi = 10.1111/j.1471-0528.2001.00039.x | s2cid = 45247771 }}</ref>

Common signs that labour is about to begin may include what is known as ''lightening'', which is the process of the baby moving down from the rib cage with the head of the baby engaging deep in the pelvis. The pregnant woman may then find breathing easier, since her lungs have more room for expansion, but pressure on her bladder may cause more frequent need to urinate. Lightening may occur a few weeks or a few hours before labour begins, or even not until labour has begun.<ref name="mayoclinic.org">{{cite web|title=Labor and delivery, postpartum care|url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/signs-of-labor/art-20046184|website=Mayo Clinic|access-date=7 May 2018|archive-date=7 May 2018|archive-url=https://web.archive.org/web/20180507222539/https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/signs-of-labor/art-20046184|url-status=live}}</ref> Some women also experience an increase in vaginal discharge several days before labour begins when the "[[Cervical mucus plug|mucus plug]]", a thick plug of [[mucus]] that blocks the opening to the uterus, is pushed out into the vagina.  The mucus plug may become dislodged days before labour begins or not until the start of labour.<ref name="mayoclinic.org"/>

While inside the uterus the baby is enclosed in a fluid-filled membrane called the [[amniotic sac]].  Shortly before, at the beginning of, or during labour the [[rupture of membranes|sac ruptures]], commonly known as the "water breaking". Once the sac ruptures the baby is at risk for infection and the mother's medical team will assess the need to [[Labor induction|induce labour]] if it has not started within the time they believe to be safe for the infant.<ref name="mayoclinic.org"/>

===Stages of labour===
====First stage====
The first stage of labour is divided into latent and active phases, where the latent phase is sometimes included in the definition of labour,<ref>{{cite journal | vauthors = Giacalone PL, Vignal J, Daures JP, Boulot P, Hedon B, Laffargue F | title = A randomised evaluation of two techniques of management of the third stage of labour in women at low risk of postpartum haemorrhage | journal = BJOG | volume = 107 | issue = 3 | pages = 396–400 | date = March 2000 | pmid = 10740337 | doi = 10.1111/j.1471-0528.2000.tb13236.x | doi-access = free }}</ref> and sometimes not.<ref>{{cite journal | vauthors = Hantoushzadeh S, Alhusseini N, Lebaschi AH | title = The effects of acupuncture during labour on nulliparous women: a randomised controlled trial | journal = The Australian & New Zealand Journal of Obstetrics & Gynaecology | volume = 47 | issue = 1 | pages = 26–30 | date = February 2007 | pmid = 17261096 | doi = 10.1111/j.1479-828X.2006.00674.x | s2cid = 23495692 }}</ref>

The latent phase is generally defined as beginning at the point at which the woman perceives regular [[uterine contraction]]s.<ref>{{cite web |title= Latent phase of labor |url= http://www.uptodate.com/contents/latent-phase-of-labor | vauthors = Satin AJ |work= [[UpToDate]] |publisher= Wolters Kluwer |date= 1 July 2013 |url-status= live |archive-url= https://web.archive.org/web/20160303224621/http://www.uptodate.com/contents/latent-phase-of-labor |archive-date= 3 March 2016 }}{{subscription required}}</ref> In contrast, [[Braxton Hicks contractions]], which are contractions that may start around 26 weeks gestation and are sometimes called "false labour", are infrequent, irregular, and involve only mild cramping.<ref name=Hen2005>{{cite book | vauthors = Murray LJ, Hennen L, Scott J |title=The BabyCenter Essential Guide to Pregnancy and Birth: Expert Advice and Real-World Wisdom from the Top Pregnancy and Parenting Resource|publisher=Rodale Books|location=Emmaus, Pennsylvania|year=2005|isbn=978-1-59486-211-3|url=https://archive.org/details/babycenteressentmurr| url-access = registration |pages= [https://archive.org/details/babycenteressentmurr/page/294 294]–295 |access-date=18 August 2013}}</ref> Braxton Hicks contractions are the uterine muscles preparing to deliver the infant.

[[Cervical effacement]], which is the thinning and stretching of the [[cervix]], and [[cervical dilation]] occur during the closing weeks of [[pregnancy]].  Effacement is usually complete or near-complete and dilation is about 5&nbsp;cm by the end of the latent phase.<ref name="Cervical effacement and dilation">{{cite web | url=http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/cervical-effacement-and-dilation/img-20006991 | title=Cervical effacement and dilation | publisher=Mayo Clinic | access-date=31 January 2017 | author=Mayo clinic staff | url-status=live | archive-url=https://web.archive.org/web/20161204112729/http://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/cervical-effacement-and-dilation/img-20006991 | archive-date=4 December 2016 }}</ref> The degree of cervical effacement and dilation may be felt during a vaginal examination.

[[File:Bumm 158 lg.jpg|thumb|Engagement of the fetal head]]
The active phase of labour has geographically differing definitions.  The [[World Health Organization]] describes the active first stage as "a period of time characterised by regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilatation from 5 cm until full dilatation for first and subsequent labours”.<ref>{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (Recommendation 5)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=6 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}}</ref> In the US, the definition of active labour was changed from 3 to 4&nbsp;cm, to 5&nbsp;cm of [[cervical dilation]] for mothers who had given birth previously, and at 6&nbsp;cm for those who had not given birth before.<ref>[http://www.acog.org/About_ACOG/ACOG_Departments/Patient_Safety_and_Quality_Improvement/~/media/Departments/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-Labor.pdf Obstetric Data Definitions Issues and Rationale for Change] {{webarchive|url=https://web.archive.org/web/20131106064308/http://www.acog.org/About_ACOG/ACOG_Departments/Patient_Safety_and_Quality_Improvement/~/media/Departments/Patient%20Safety%20and%20Quality%20Improvement/201213IssuesandRationale-Labor.pdf |date=6 November 2013 }}, 2012 by [[American Congress of Obstetricians and Gynecologists|ACOG]].</ref> This was done in an effort to increase the rates of vaginal delivery.<ref>{{cite journal | vauthors = Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK | title = Primary cesarean delivery in the United States | journal = Obstetrics and Gynecology | volume = 122 | issue = 1 | pages = 33–40 | date = July 2013 | pmid = 23743454 | pmc = 3713634 | doi = 10.1097/AOG.0b013e3182952242 }}</ref>

Health care providers may assess the mother's progress in labour by performing a cervical exam to evaluate the cervical dilation, effacement, and station. These factors form the [[Bishop score]]. The Bishop score can also be used as a means to predict the success of an [[induction of labour]].

During effacement, the cervix becomes incorporated into the lower segment of the uterus. During a contraction, uterine muscles contract causing shortening of the upper segment and drawing upwards of the lower segment, in a gradual expulsive motion.<ref>{{Cite web|title=Birth (Parturition) {{!}} Boundless Anatomy and Physiology|url=https://courses.lumenlearning.com/boundless-ap/chapter/birth-parturition/|access-date=26 February 2021|website=courses.lumenlearning.com|archive-date=11 August 2021|archive-url=https://web.archive.org/web/20210811012109/https://courses.lumenlearning.com/boundless-ap/chapter/birth-parturition/|url-status=live}}</ref> The presenting fetal part then is permitted to descend. Full dilation is reached when the cervix has widened enough to allow passage of the baby's head, around 10&nbsp;cm dilation for a term baby.

A standard duration of the latent first stage has not been established and can vary widely from one woman to another. However, the duration of active first stage (from 5&nbsp;cm until full cervical dilatation) usually does not extend beyond 12 hours in the labour of first-time mothers, and usually does not extend beyond 10 hours in subsequent pregnancies.<ref>{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (item #3.2.2.)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=6 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}}</ref>

==== Second stage ====

The second stage begins when the cervix is fully dilated, and ends when the baby is born. As pressure on the cervix increases, a sensation of pelvic pressure is experienced, and, with it, an urge to begin pushing. At the beginning of the normal second stage, the head is fully engaged in the pelvis; the widest diameter of the head has passed below the level of the [[pelvic inlet]]. The fetal head then continues descent into the pelvis, below the [[pubic arch]] and out through the [[Human vagina#Vaginal opening and hymen|vaginal opening]]. This is assisted by the additional maternal efforts of pushing, or bearing down, similar to [[defecation]]. The appearance of the fetal head at the vaginal opening is termed crowning. At this point, the mother will feel an intense burning or stinging sensation.

When the [[amniotic sac]] has not [[Rupture of the membranes|ruptured]] during labour or pushing, the infant can be born with the membranes intact. This is referred to as "delivery en [[caul]]".

Complete expulsion of the baby signals the successful completion of the second stage of labour.  Some babies, especially preterm infants, are born covered with a waxy or cheese-like white substance called [[vernix]].  It is thought to have some protective roles during fetal development and for a few hours after birth.

The second stage varies from one woman to another. In first labours, birth is usually completed within three hours whereas in subsequent
labours, birth is usually completed within two hours.<ref>{{cite web|title=WHO recommendations Intrapartum care for a positive childbirth experience (item #33)|url=http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|website=World Health Organization|access-date=6 May 2018|archive-date=29 March 2018|archive-url=https://web.archive.org/web/20180329081924/http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf?sequence=1|url-status=live}}</ref> Second-stage labours longer than three hours are associated with declining rates of spontaneous vaginal delivery and increasing rates of infection, [[perineal tear]]s, and obstetric haemorrhage, as well as the need for intensive care of the neonate.<ref>{{cite journal | vauthors = Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, Caritis SN, Peaceman AM, Sorokin Y, Sciscione A, Carpenter MW, Mercer BM, Thorp JM, Malone FD, Harper M, Iams JD, Anderson GD | title = Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes | journal = American Journal of Obstetrics and Gynecology | volume = 201 | issue = 4 | pages = 357.e1–7 | date = October 2009 | pmid = 19788967 | pmc = 2768280 | doi = 10.1016/j.ajog.2009.08.003 | author18 = Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network | display-authors= 4 }}</ref>

==== Third stage ====
{{Further|Umbilical cord|Placental expulsion}}
The period from just after the fetus is expelled until just after the [[placenta]] is expelled is called the ''third stage of labour'' or the ''involution stage''. [[Placental expulsion]] begins as a physiological separation from the wall of the uterus. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10–12 minutes dependent on whether active or expectant management is employed.<ref>{{cite journal | vauthors = Jangsten E, Mattsson LÅ, Lyckestam I, Hellström AL, Berg M | title = A comparison of active management and expectant management of the third stage of labour: a Swedish randomised controlled trial | journal = BJOG | volume = 118 | issue = 3 | pages = 362–69 | date = February 2011 | pmid = 21134105 | doi = 10.1111/j.1471-0528.2010.02800.x | display-authors= 4 | doi-access = free }}</ref> In as many as 3% of all vaginal deliveries, the duration of the third stage is longer than 30 minutes and raises concern for [[retained placenta]].<ref>{{cite journal | vauthors = Weeks AD | title = The retained placenta | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 22 | issue = 6 | pages = 1103–17 | date = December 2008 | pmid = 18793876 | doi = 10.1016/j.bpobgyn.2008.07.005 }}</ref>

Placental expulsion can be managed actively or it can be managed expectantly, allowing the placenta to be expelled without medical assistance. Active management is the administration of a [[uterotonic|uterotonic drug]] within one minute of fetal delivery, controlled traction of the [[umbilical cord]] and [[fundal massage]] after delivery of the placenta, followed by performance of uterine massage every 15 minutes for two hours.<ref>{{cite journal | vauthors = Ball H |title= Active management of the third state of labour is rare in some developing countries |url= http://www.guttmacher.org/pubs/journals/3510509.html |journal= International Perspectives on Sexual and Reproductive Health |volume= 35 |issue= 2 |date= June 2009 |url-status= live |archive-url= https://web.archive.org/web/20160304053957/http://www.guttmacher.org/pubs/journals/3510509.html |archive-date= 4 March 2016 }}</ref> Active management of the third stage of labour in vaginal deliveries helps to prevent [[Postpartum bleeding|postpartum haemorrhage]].<ref>{{cite journal | vauthors = Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, Portillo JA, Jarquin D, Marin F, Mfinanga S, Vallecillo J, Johnson H, Sintasath D | title = Use of active management of the third stage of labour in seven developing countries | journal = Bulletin of the World Health Organization | volume = 87 | issue = 3 | pages = 207–15 | date = March 2009 | pmid = 19377717 | pmc = 2654655 | doi = 10.2471/BLT.08.052597 | display-authors= 4 }}</ref><ref>{{cite journal | title = Joint statement: management of the third stage of labour to prevent post-partum haemorrhage | journal = Journal of Midwifery & Women's Health | volume = 49 | issue = 1 | pages = 76–77 | year = 2004 | pmid = 14710151 | doi = 10.1016/j.jmwh.2003.11.005 | author-link1 = International Confederation of Midwives | author-link2 = International Federation of Gynaecology and Obstetrics | author1 = International Confederation of Midwives | author2 = International Federation of Gynaecologists Obstetricians }}</ref><ref>{{Cite report|title= WHO recommendations for the prevention of postpartum haemorrhage |year= 2007 |url= http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf |archive-url= https://web.archive.org/web/20090705031910/http://whqlibdoc.who.int/hq/2007/WHO_MPS_07.06_eng.pdf |archive-date= 5 July 2009 | vauthors = Mathai M, Gülmezoglu AM, Hill S |publisher= [[World Health Organization]], Department of Making Pregnancy Safer |location= Geneva}}<!-- updated version available at http://www.who.int/maternal_child_adolescent/documents/postpartum_haemorrge/en/index.html --></ref>

Delaying the clamping of the [[umbilical cord]] for at least one minute or until it ceases to pulsate, which may take several minutes, improves outcomes as long as there is the ability to treat [[jaundice]] if it occurs. For many years it was believed that late cord cutting led to a mother's risk of experiencing significant bleeding after giving birth, called [[postpartum bleeding]]. However, delaying cord cutting in healthy full-term infants results in early [[haemoglobin]] concentration and higher birthweight and increased iron reserves up to six months after birth with no change in the rate of postpartum bleeding.<ref>{{cite journal | vauthors = McDonald SJ, Middleton P, Dowswell T, Morris PS | title = Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD004074 | date = July 2013 | pmid = 23843134 | doi = 10.1002/14651858.CD004074.pub3 | editor1-last = McDonald | editor1-first = Susan J | pmc = 6544813 }}</ref><ref>{{Cite news |last1=Campbell |first1=Denis |name-list-style=vanc |title=Hospitals warned to delay cutting umbilical cords after birth |url=https://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting |newspaper=The Guardian |access-date=11 June 2018 |date=10 July 2013 |archive-date=12 June 2018 |archive-url=https://web.archive.org/web/20180612145023/https://www.theguardian.com/society/2013/jul/11/hospitals-nhs-umbilical-cords-babies-delay-cutting |url-status=live }}</ref>

==== Postpartum period ====
{{Further|Postpartum period|3=Postpartum physiological changes|4=Parental leave}}
[[File:Geburt 01.jpg|thumb|Newborn rests as caregiver checks breath sounds.]]
[[Postpartum period|Postpartum]], sometimes termed the fourth stage of labour, is the period beginning immediately after childbirth, and extends for about six weeks. The terms ''postpartum'' and ''postnatal'' are often used for this period.<ref name="pmid2001778">{{cite journal | vauthors = Gjerdingen DK, Froberg DG | title = The fourth stage of labor: the health of birth mothers and adoptive mothers at six-weeks postpartum | journal = Family Medicine | volume = 23 | issue = 1 | pages = 29–35 | date = January 1991 | pmid = 2001778 }}</ref> The woman's body, including hormone levels and uterus size, return to a non-pregnant state and the newborn adjusts to life outside the mother's body.  The [[World Health Organization]] (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period.<ref name="WHO postnatal care">{{cite web | url=https://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | title=WHO recommendations on postnatal care of the mother and newborn | publisher=World Health Organization | date=2013 | access-date=22 December 2014 | author=WHO | url-status=dead | archive-url=https://web.archive.org/web/20141222172315/http://www.who.int/maternal_child_adolescent/documents/postnatal-care-recommendations/en/ | archive-date=22 December 2014 }}</ref>

Following the birth, if the mother had an [[episiotomy]] or a tearing of the [[perineum]], it is stitched. This is also an optimal time for uptake of [[long-acting reversible contraception]] (LARC), such as the [[contraceptive implant]] or [[intrauterine device]] (IUD), both of which can be inserted immediately after delivery while the woman is still in the delivery room.<ref>{{Cite journal|last1=Whitaker|first1=Amy K.|last2=Chen|first2=Beatrice A.|publication-date=January 2018|title=Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices|journal=Contraception|volume=97|issue=1|pages=2–13|doi=10.1016/j.contraception.2017.09.014|issn=0010-7824|date=5 October 2017|pmid=28987293|doi-access=free}}</ref><ref>{{Cite web|url=https://www.acog.org/en/Clinical/Clinical%20Guidance/Committee%20Opinion/Articles/2016/08/Immediate%20Postpartum%20Long-Acting%20Reversible%20Contraception|title=Immediate Postpartum Long-Acting Reversible Contraception|website=www.acog.org|language=en|access-date=20 April 2020|archive-date=22 July 2020|archive-url=https://web.archive.org/web/20200722134522/https://www.acog.org/en/Clinical/Clinical%20Guidance/Committee%20Opinion/Articles/2016/08/Immediate%20Postpartum%20Long-Acting%20Reversible%20Contraception|url-status=live}}</ref> The mother has regular assessments for uterine contraction and [[fundal height]],<ref name="Maternal-Newborn Care">{{cite web | url=http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | title=Postpartum Assessment | publisher=ATI Nursing Education | access-date=24 December 2014 | url-status=dead | archive-url=https://web.archive.org/web/20141224072821/http://www.atitesting.com/ati_next_gen/skillsmodules/content/maternal-newborn/equipment/postpart_assessment.html | archive-date=24 December 2014 | df=dmy-all }}</ref> vaginal bleeding, heart rate and blood pressure, and temperature, for the first 24 hours after birth. Some women may experience an uncontrolled episode of shivering or [[postpartum chills]] following the birth. The first passing of urine should be documented within six hours.<ref name="WHO postnatal care"/> Afterpains (pains similar to menstrual cramps), contractions of the uterus to prevent excessive blood flow, continue for several days. Vaginal discharge, termed "[[lochia]]", can be expected to continue for several weeks; initially bright red, it gradually becomes pink, changing to brown, and finally to yellow or white.<ref name="Labor and Delivery: Postpartum Care">{{cite web | url=http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | title=Postpartum care: What to expect after a vaginal delivery | publisher=Mayo Clinic | access-date=23 December 2014 | author=Mayo clinic staff | url-status=live | archive-url=https://web.archive.org/web/20141221202550/http://www.mayoclinic.org/healthy-living/labor-and-delivery/in-depth/postpartum-care/art-20047233 | archive-date=21 December 2014 }}</ref>

At one time babies born in hospitals were removed from their mothers shortly after birth and brought to the mother only at feeding times.<ref>{{cite web |title=Rooming-in: An Essential Evolution in American Maternity Care |url=https://www.nichq.org/insight/rooming-essential-evolution-american-maternity-care |website=NICHO |date=28 April 2016 |access-date=7 June 2022 |archive-date=28 May 2022 |archive-url=https://web.archive.org/web/20220528034609/https://nichq.org/insight/rooming-essential-evolution-american-maternity-care |url-status=live }}</ref> Mothers were told that their newborns would be safer in the nursery and that the separation would offer the mothers more time to rest.  As attitudes began to change, some hospitals offered a "rooming in" option wherein after a period of routine hospital procedures and observation, the infant could be allowed to share the mother's room. As of 2020, [[rooming-in]] has increasingly become standard practice in maternity wards.<ref>"Rooming-in: An Essential Evolution in American Maternity Care", By Jennifer Usianov. ''National Institute for Children's Health Quality''. {{cite web|url=https://www.nichq.org/insight/rooming-essential-evolution-american-maternity-care |archive-url=https://web.archive.org/web/20210417183052/https://www.nichq.org/insight/rooming-essential-evolution-american-maternity-care |url-status=dead |archive-date=17 April 2021 |title=Rooming-in: An Essential Evolution in American Maternity Care |date=28 April 2016 }} Retrieved 1 November 2021.</ref>

===Early skin-to-skin contact===
[[File:La méthode kangourou Bébé Prématuré Laquinitinie Douala.jpg|thumb|[[Kangaroo care]] by father in [[Cameroon]]]]

[[Skin-to-skin contact]] (SSC), sometimes also called [[kangaroo care]], is a technique of newborn care where babies are kept chest-to-chest and skin-to-skin with a parent, typically their mother or possibly the father. This means without the shirt or undergarments on the chest of both the baby and parent. Early skin-to-skin contact results in a decrease in infant crying, improves cardio-respiratory stability and blood glucose levels, and improves breastfeeding duration and effectiveness.<ref name="WHO skin-to-skin 2008">{{cite web | url=http://apps.who.int/rhl/archives/hscom2/en/index.html | title=Early skin-to-skin contact for mothers and their healthy newborn infants | work=The WHO Reproductive Health Library | publisher=WHO | date=4 January 2008 | access-date=23 December 2014 | vauthors = Saloojee H | url-status=dead | archive-url= https://web.archive.org/web/20141221025957/http://apps.who.int/rhl/archives/hscom2/en/index.html | archive-date=21 December 2014 }}</ref><ref name="The Journal of Perinatal Education">{{cite journal | vauthors = Crenshaw J | title = Care practice #6: no separation of mother and baby, with unlimited opportunities for breastfeeding | journal = The Journal of Perinatal Education | volume = 16 | issue = 3 | pages = 39–43 | date = 2007 | pmid = 18566647 | pmc = 1948089 | doi = 10.1624/105812407X217147 }}</ref><ref>{{cite journal | vauthors = Moore ER, Bergman N, Anderson GC, Medley N | title = Early skin-to-skin contact for mothers and their healthy newborn infants | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | pages = CD003519 | date = November 2016 | issue = 11 | pmid = 27885658 | pmc = 3979156 | doi = 10.1002/14651858.CD003519.pub4 }}</ref>

Early postpartum SSC is endorsed by all major organisations that are responsible for the well-being of infants.<ref name="Medscape"/> The [[World Health Organization]] (WHO) states that "the process of
childbirth is not finished until the baby has safely transferred from placental to mammary nutrition."  It is advised that the newborn be placed skin-to-skin with the mother following vaginal birth, or as soon as the mother is alert and responsive after a Caesarean section, postponing any routine procedures for at least one to two hours or until the baby has had its first breastfeeding.  The baby's father or other support person may also choose to hold the baby SSC until the mother recovers from the anaesthetic.<ref name=fathers>{{cite web|title=Fathers and skin-to-skin contact|url=http://www.kangaroomothercare.com/fathers-skin-to-skin.aspx|publisher=Kangaroo Mother Care|access-date=30 April 2013|archive-date=26 April 2013|archive-url=https://web.archive.org/web/20130426093714/http://www.kangaroomothercare.com/fathers-skin-to-skin.aspx|url-status=dead}}</ref>

The WHO suggests that any initial observations of the infant can be done while the infant remains close to the mother, saying that even a brief separation before the baby has had its first feed can disturb the bonding process.  They further advise frequent skin-to-skin contact as much as possible during the first days after delivery, especially if it were interrupted for some reason after the delivery.<ref name="World Health Organization">{{cite web |title=Essential Antenatal, Perinatal and Postpartum Care |url=http://www.euro.who.int/__data/assets/pdf_file/0013/131521/E79235.pdf |url-status=live |archive-url=https://web.archive.org/web/20150924034812/http://www.euro.who.int/__data/assets/pdf_file/0013/131521/E79235.pdf |archive-date=24 September 2015 |access-date=21 December 2014 |work=Promoting Effective Perinatal Care |publisher=WHO}}</ref><ref name="Intrapartum Care"/>

[[La Leche League]] advises women to have a delivery team which includes a support person who will advocate to assure that:
:* The mother and her baby are not separated unnecessarily
:*The baby will receive only her milk
:*The baby will receive no supplementation without a medical reason
:* All testing, bathing or other procedures are done in the parent's room<ref>{{cite web |title=Birth and Breastfeeding |url=https://www.llli.org/breastfeeding-info/birth-and-breastfeeding/ |website=La Leche League |access-date=27 April 2022 |archive-date=17 May 2022 |archive-url=https://web.archive.org/web/20220517052016/https://www.llli.org/breastfeeding-info/birth-and-breastfeeding/ |url-status=live }}</ref>

It has long been known that a mother's level of the hormone [[oxytocin]] elevates when she interacts with her infant. The oxytocin level in fathers that engage in SSC is increased as well and SSC reduces stress and anxiety in parents after interaction."<ref name="Oxytocin and early parent-infant in">{{cite journal |title=Oxytocin and early parent-infant interactions: A systematic review |year=2019 |pmc=6838998 |last1=Scatliffe |first1=N. |last2=Casavant |first2=S. |last3=Vittner |first3=D. |last4=Cong |first4=X. |journal=International Journal of Nursing Sciences |volume=6 |issue=4 |pages=445–453 |doi=10.1016/j.ijnss.2019.09.009 |pmid=31728399 }}</ref>

===Discharge===
{{See also|Early postnatal hospital discharge}}
For births that occur in hospitals the WHO recommends a hospital stay of at least 24 hours following an uncomplicated vaginal delivery and 96 hours for a Cesarean section.  Looking at length of stay (in 2016) for an uncomplicated delivery around the world shows an average of less than 1 day in Egypt to 6 days in (pre-war) Ukraine.  Averages for Australia are 2.8 days and 1.5 days in the UK.<ref name="businessinsider.com">{{cite web |last1=Harrington |first1=Rebecca |title=American women giving birth leave the hospital as quickly as women in Haiti and Kenya |url=https://www.businessinsider.com/length-hospital-time-after-giving-birth-2016-3 |website=Insider |access-date=20 March 2022 |archive-date=21 May 2022 |archive-url=https://web.archive.org/web/20220521024824/https://www.businessinsider.com/length-hospital-time-after-giving-birth-2016-3 |url-status=live }}</ref> While this number is low, two-thirds of women in the UK have midwife-assisted births and in some cases the mother may choose a hospital setting for birth to be closer to the wide range of assistance available for an emergency situation.  However, women with midwife care may leave the hospital shortly after birth and her midwife will continue her care at her home.<ref>{{cite web |title=Where to give birth: the options |url=https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/ |website=NHS |date=December 2020 |access-date=20 May 2022 |archive-date=14 February 2022 |archive-url=https://web.archive.org/web/20220214201435/https://www.nhs.uk/pregnancy/labour-and-birth/preparing-for-the-birth/where-to-give-birth-the-options/ |url-status=live }}</ref>
In the U.S. the average length of stay has gradually dropped from 4.1 days in 1970 to a current stay of 2 days.  The CDC attributed the drop to the rise in health care costs, saying people could not afford to stay in the hospital any longer. To keep it from dropping any lower, in 1996 Congress passed the [[Newborns' and Mothers' Health Protection Act]] that requires insurers to cover at least 48 hours for uncomplicated delivery.<ref name="businessinsider.com"/>