Keeping baby warm after birth

Normal newborn temperature is 36.5–37.5°C under arm

• Babies lose heat very quickly, eg from a cold room, air touching the baby's skin, lying on a cool surface or evaporation
• Cold will stress baby and may cause respiratory distress (breathing problems) or hypoglycaemia (low BGL). Also makes resuscitation more difficult

Risk factors for low temperatures

If any risk factors present — see Newborn care

• Low birth weight
• Preterm
• Sick, especially breathing problems
• Resuscitated straight after birth
• Mother with diabetes
• Born before arriving at clinic and has become cold

Do not

• Do not use hot water bottle
• Do not overheat baby
• Do not bath baby until temperature normal — most don’t need a bath

What you need

• Warm room for baby to arrive into — turn off air conditioner and put on heating just before birth
• If can't turn off air conditioner and it is warm outside — open doors and windows
• Lots of clean, pre-warmed towels, sheets and blankets — warm by putting in sun, wrapping around hot water bottle or put near heater
• Bubble wrap, cling wrap
• Thick clear plastic bag — if baby thought to be preterm or low birth weight

What you do

• Best way to warm baby is skin against mother’s skin
• Keep baby’s head covered — most heat is lost from the head
• Cover back of baby with bunny rug, sheet or clothing
• As soon as baby born put onto mother’s chest, skin-to-skin and dry thoroughly with warm dry towel — Figure 3.30
• Remove wet towel and put new warm one over baby’s head and body, as baby lies on mother
• If mother not able to hold baby and baby is pink and breathing well
• Ask helper/relative to put naked baby under their clothes, against skin on their chest (chest-to-chest). Add layers of bubble wrap/towels around baby's body and cover head with hat or bunny rug
• OR use clean, warm towel to wrap baby as snugly as possible, making sure head is fully covered to middle of brow — Figure 3.31 THEN wrap body (not head) again in bubble wrap/cling wrap and give to helper to hold and watch over

• After placenta delivered and mother comfortable — take baby’s axillary temp (under arm).
• Make sure skin dry and thermometer is snugly between folds of skin not clothing
• Wait until baby warm and settled with no signs of distress before weighing naked — have all equipment ready before unwrapping baby
• Keep skin-to-skin with mother for as long as possible
• Encourage first breastfeed within first hour — Figure 3.32 —baby will warm up faster after a good feed
• If unable to breastfeed — help mother express some colostrum and syringe/drop into baby's mouth

Babies thought to be preterm or low birth weight

• Do not dry baby
• Place immediately in thick clear plastic bag or plastic wrap
• OR alternatively if mother and baby well enough — place baby on mother's chest between breasts — Figure 3.30 — cover both with plastic wrap then warm blanket
• Keep head out and body completely covered — cover head with small hat
• Continue to closely observe temperature, breathing and heart rate
• Aim for normal temperature — 36.5–37.5°C under arm — avoid overheating