Newborn and Maternal Checks After a Home Water Birth

After the first quiet hour, your midwife works through a series of checks on your baby and on you. None of this is rushed. Most of it happens while you’re still holding your baby, still resting, still in that early post-birth calm.

The Apgar score

The Apgar score is the first assessment — a quick snapshot of your baby’s condition at 1 minute and 5 minutes after birth. It measures five things: skin colour, heart rate, reflex response, muscle tone, and breathing. Each is scored 0 to 2, for a maximum of 10.

A score of 7 to 10 at 1 minute means the baby is doing well. A score of 4 to 6 means the baby needs some help — stimulation, airway clearance, possibly brief ventilation. Below 4 means active resuscitation is needed. The 5-minute score matters more for predicting outcomes. A baby who scores 5 at 1 minute but 8 at 5 minutes has responded well.

The Apgar is a clinical tool, not a grade. Your midwife uses it to decide what the baby needs right now. It doesn’t predict the child’s future health.

Newborn checks

Once skin-to-skin and the first feed are established — usually within the first one to two hours — your midwife does a more thorough examination. She checks weight, head circumference, and temperature. She listens to the heart and lungs with a stethoscope. She checks the eyes, palate, hips, spine, genitalia, and cord stump. Fingers and toes are counted, skin is examined for birthmarks or rashes.

This is a systematic check to confirm that everything is as it should be. A more comprehensive newborn examination happens within 72 hours, either by your midwife or a paediatrician.

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Vitamin K

Vitamin K is offered to all newborns to prevent vitamin K deficiency bleeding — a rare but potentially serious condition where the baby bleeds internally because their blood can’t clot properly.

There are two options. An intramuscular injection — a single dose, the most effective method, providing complete protection. Or oral doses — three doses spread over the first weeks, less reliable because it depends on the baby receiving all three and absorption can vary.

The injection is given in the baby’s thigh during skin-to-skin. It’s quick. The baby typically cries briefly and settles. Some parents prefer the oral route; some decline vitamin K entirely after informed discussion. Your midwife will explain both options and document your decision.

Maternal checks

While the baby is being assessed, your midwife is also monitoring you.

Bleeding is the primary concern. Some bleeding after birth is normal — the placental site is an open wound inside the uterus. Your midwife checks the amount of blood loss and palpates your uterus to confirm it’s contracted and firm. A soft, spongy uterus is a warning sign for haemorrhage.

The perineum is examined for tears. First- and second-degree tears are common and usually heal well. Your midwife can suture first- and second-degree tears at home — she carries suturing equipment and local anaesthetic. Third- and fourth-degree tears, which are much less common (approximately 3% of vaginal births), require hospital assessment and repair.

Vitals — blood pressure, pulse, and temperature — are checked within the first hour and again before the midwife leaves.

The bladder — your midwife will encourage you to pass urine within a few hours. A full bladder can prevent the uterus from contracting properly, increasing the risk of bleeding.

The placenta is examined to confirm it’s complete. Both sides are checked, and the membranes and cord insertion are inspected. A complete placenta means nothing has been retained. The midwife notes the weight and any observations in the birth records.

Your midwife stays for a minimum of one to two hours after birth — longer if there are any concerns — before leaving you as a family. She returns for a postnatal visit within 24 hours.