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“To awake my senses; rouse me from the darkenss of the womb and begin to shape the essence that is me.”
Audrey Willis

In making the first journey of its life, through the birth canal, a baby goes through a major physiological change. The womb was secure, warm and dark - shielded from the impact of the world outside. But on emergence from it, he or she is suddenly exposed to space, light, gravity, noise, cool air and tactile stimuli. And against this frightening onslaught, he or she needs the reassurance that only immediate mother-baby contact can provide.

As the baby adapts to this strange new environment, he or she exhibits some characteristic responses. Babies who have had a physiological birth are usually alert, being intensely receptive to their surroundings and particularly to their mother. But interventions during labour can affect how the baby behaves after birth, particularly pharmacological interventions (where the drug crosse the placenta), diminishing this alertness.

A baby is born with a complex communication system, which springs into action immediately. They are already social beings, with their own individuality, able to influence those around them as well as be influenced by them. And you can effectively communicate with a newborn using the senses of sight, hearing and touch, to ascertain that she or he is making a successful adaptation to life outside the womb.

Current evidence suggests that the birth process for both mother and baby can be enhanced if you establish a safe, quiet, warm palace for labour and birth. This will make it easier for the woman to follow her instinctive maternal responses during labour and in the first couple of hours after birth.

Assessing normal behaviour of the baby

Babies are not the ‘empty slate’ they were once imagined to be. Right from the beginning a baby has the ability to absorb information and learn about her or his family and environment.

The state of the baby at birth is commonly assesed by APGAR score. However this is really only a basic physiological assessment of vital system functions. As the awareness of wider behavioral cues that denote a baby’s well-being are understood, new assessment practices are being introduced which support a more comprehensive assessment. Instead of restricting assessment to only to the APGAR method, observing the baby’s behaviour and responses provide a much more accurate measure of its state and well-being.

The Neonatal Behavioral Assessment Scale (NBAS) introduced by T. Berry Brazelton assesses the alertness (and other behaviours) of newborns and can be used at birth. This assessment produces an individual emotional and behavioral ‘portrait’ of the infant which describes its strengths, adaptive responses and possible vulnerabilities. It can be used to develop appropriate care-giving strategies aimed at enhancing the earliest relationship between babies and parents and support the positive outcomes of normal birth.

The Scale is based on the realisation that babies, even vulnerable ones, already have many capabilities when they are born. They also ‘communicate’ through the way they behave in what is quite a rational way. They don’t just respond to stimuli in their environments, as was previously thought, but actively try to control these environments.

In order to respond appropriately to an individual baby, we as care givers must first understand the her or his capabilities and behavioral cues. It is necessary to observe the baby’s ability to organise himself or herself and recognise how this state changes and reacts to environmental stimuli.

Tips and tricks

• Talk with her about welcoming her new baby - explaining how the baby may respond to the shock of entering the world and what he or she will need in the way of contact and reassurance

• Prepare the birth environment appropriately - so that it is not just comfortable and cosy for the woman, but is gentle and welcoming for the newborn baby. Although you may think that you need a brightly lit environment to assess the newborn, in reality you need all your senses to get a full picture of the newborn baby. And this assessment can be organised sensitively and discreetly, without subjecting the baby to a further shock. Try also putting your resuscitation area in the background – so that you can access it if necessary, but it is not intrusive.

• Learn about the six states of consciousness - learn to evaluate the baby’s ability to control his state from one state to another and maintain alertness.

Further reading

Brazelton TB, Nugent JK (1995) The Neonatal Behavioral Assessment Scale. Mac Keith Press, Cambridge

Royal College of Midwives (2003) Brown Study Series Number 4. Midwifery Clinical Practice: the fetus in labour - the baby at birth. Royal College of Midwives Trust, London

Odent M (1976) Entering the World Maron Boyars

Leboyer F (1975) Birth Without Violence Wildwood House

Michaelides S Physiology, Assessment and Care (Neonate). In: Henderson C, Macdonald SE (eds) (2004) Mayes’ Midwifery: A Textbook for Midwives (13th Edition)Bailliere Tindall, London