birth center, First Baby, Home Birth, hospital birth, Midwife, Midwife's Assistant, Newborn, Newobrn exam, Nurse, Pediatrician, Postpartum

Testing Tuesdays: The Newborn Exam

Photo by Hana Souther

When baby is born, the first question is often, “How much does baby weigh?!”  We don’t know yet, because we don’t weigh the baby until we weigh the baby!  When baby is transitioning well, there’s no reason to take them away for an immediate exam. Skin-to-skin in the first hour is vital for bonding, nursing, and stabilizing vitals. Baby-on-chest also reduces uterine bleeding and encourages the placenta to detach. 

In an hour or two, we’ll check the baby out more closely. Here’s a little of what we’re looking for: 

  • General appearance:  Is baby symmetrical, with good tone and color? Does anything unusual stand out? Are there any obvious signs of distress, such as nasal flaring or grunting? 
  • Skin: Cracking, peeling, and blotchiness are normal. Are there birthmarks? Some babies have bruising from the birth. We note it and keep an eye on it. 
  • Head and face: Ear placement in relation to eyes. Are the fontanelles a normal size? Are ears and nose open and palate closed? Eye tracking and gaze.
  • Torso: Full heart and lung auscultation and palpation of abdomen. Bowel sounds. 
  • Genitalia and anus: Do all orifices appear open and functional? Has baby pee’d or poo’ed yet? 
  • Hands and feet: Fingers, toes, palm and sole creases. 
  • Reflexes: Reflexes look at baby’s neurological well-being and can assess for birth injury. Just a couple are Moro (startle) and step reflex. We assess suck organization with a gloved finger.
  • Spine: Is it straight? Are there any dimples? Does baby resist turning their head to a different side? 
  • Gestational age assessment. This is one of those “nerd” things. As long as your baby is term, doing a gestational age assessment doesn’t matter too much. Baby’s born and that’s that; we can’t gestate your baby for any more or less time. However, if dates were uncertain or the baby is preterm, a gestation age assessment can help solve some mysteries. A commonly used gestational age tool is the Ballard Score.
  • Weighing and measuring:  I like to do this last – it’s the most fun and everyone gets out their cameras.  It’s fun to do a poll of everyone’s guess for weight and see who got the closest.

There are plenty of times when a small feature is not “textbook”. As long as vitals are stable and baby is nursing, we will ask the parents to call this feature to the pediatrician’s attention at a later time. Some abnormal findings may be concerning enough that a pediatrician is consulted in the moment. All aspects of the newborn exam exist on a spectrum.

Babies are not tiny adults; they are physically and neurologically very different from us, and a normal baby feature or behavior can be alarming to a new parent. If you feel concerned about something looking not quite right, ask! You may get lots of reassurance.

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