18: The Golden Hour
Introduction
Today we are going to dive into what is known as “The Golden Hour” which begins immediately after the birth of your baby. We’ll talk about what it is, what happens during the Golden Hour, how it relates to the initiation of breastfeeding, and how to get the most out of that time even if it's not perfect.
What is the Golden Hour?
So, I am a shoot-for-ideal kind of gal. I think knowing what the best case scenario is and what you want is important, because then we can: visualize it, ask for it, and make decisions that point in that direction. When it comes to breastfeeding, The Golden Hour is a window of opportunity to support skin to skin and the chance for your baby to self attach which supports physiological stability, bonding, and creates a ripple effect for later feeding skills.
The Golden Hour is the hour immediately after birth, and within that hour there are normal series of behaviors that a newborn will demonstrate to regulate and prepare for feeding- if given the ideal conditions. It’s mostly discussed and encouraged for moms who want to breastfeed since self attachment to the breast is part of it, however we can apply a similar support strategy to bottle fed babies. (Sometimes people forget that bottle fed babies are still normal babies with all the same needs and behaviors.)
During the Golden Hour there are 9 stages which were identified by Widstrom et al., all the way back in 2011- but still we have not really caught on to it consistently across birthing practices yet.
In an ideal scenario, every baby and mother would experience these stages in an uninterrupted nurturing environment. Today I’m going to review each stage or infant behavior that occurs during the perfect Golden Hour and then we’ll touch on some important threads within it.
The Nine Stages
Birth cry (This helps the lungs transition to breathing air.)
Ideally, immediately after birth (even before the umbilical cord is cut) your baby will put on you skin to skin to recover and adjust from the experience- without a bunch of unnecessary handling, poking, measuring, jostling, gloved hands, etc. And you can totally have a blanket to cover the both of you and get super cozy in like a little safe cocoon. A primary factor to the Golden Hour is the chance for your baby to be well regulated with skin to skin and feeding-wise to self attach to the nipple. Here they will continue through the rest of the steps.
Relaxation (When a baby takes a rest post birth.)
Awakening (Starts when your baby begins to move a little, they are awakening from their rest.)
Activity (Involved stronger bigger movements of limbs and head, pushing and trying to shift their body. They may also show some rooting behavior.)
Rest (You may notice another rest, or a rest at any time since being born and all this activity can be quite exhausting.)
“Crawling” (Is not the same crawling your baby will learn to do several months from now, but body movements that get them closer to the areola and nipple.)
Familiarization (With the nipple which may include licking or even brushing their face or mouth on it.)
Suckling (Is when your baby takes the nipple into their mouth and sucks or suckles.)
Sleeping (This one is pretty straight forward and understandable they will need a nap after all of this)
Remember that they may take a rest at any time during this sequence as needed.
In this scenario, you are allowed to help your baby along instinctively when they are showing you they want to nurse or are trying to get closer to the nipple- but a hospital employee plucking your baby up and sort of just shoving them on your breast is not the same experience.
Also, more medicalized births (and this includes what we sometimes now consider routine birth like receiving an epidural for example) can extend the time that these stages take for your baby to do, because they are also physically processing the drugs. No shame, just a fact you should know.
What to Do
First, I recommend stating that you want the uninterrupted Golden Hour, if you do I also recommend having high standards for your care. But if for any reason the perfect Golden Hour doesn’t happen, there’s no reason to feel all is lost. You can easily hop back on your path, by establishing skin- to-skin and supportive but infant led feeding as soon as you are able.
Let’s address some common worry questions next.
What if I have a c-section? Yep you can still put your baby skin to skin and achieve some if not all of these stages.
What if I plan to bottle feed? Well you too can reap the benefits that come with immediate skin to skin and you will simply guide your baby to the bottle instead of the breast when they are getting close and looking ready to get familiar and suckle.
Now I want to pull over for a moment and touch base regarding premature or emergency situations in which you are not able to immediately have your baby skin to skin. First, this is not likely going to happen-but it needs to be addressed if you are like me you have already considered worst case scenarios regardless of whether there are any indications you are actually at risk. If you have a premature baby, you can still do skin-to-skin and there is a solid amount of research showing this is physiologically beneficial to both you and especially premature babies. If for any reason, there is an emergency which leaves you or baby unable to be together then Dad (or your partner) can fill in until you are able. If that is not an option, then step one is allow your team to help everyone get stable- then you jump back in, to skin to skin. You can always return here.
Second, I need you to know that if for any reason you or your baby are not able to have that immediate ideal Golden Hour- please know you will still bond with your baby. You can still support following their lead with cue based feeding when the time comes, even if it’s quite delayed. Bonding and following infant cues isn’t something that only happens in the first hour after birth- it happens throughout your child’s life. So if you find yourself on a path you never expected or planned for, you can and will pick back up once things feel stable.
Okay whew, let’s get back to the more likely scenario where things go pretty normally and talk about some of the benefits.
Benefits of Skin to Skin in the Golden Hour
As far as breastfeeding and lactation goes, skin-to-skin and the ideal Golden Hour supports suckling within the first 1-2 hours and this has been shown to have better lactation outcomes regarding milk supply.
Skin-to-skin and allowing these stages to unfold is shown to support early optimal self regulation skills for your baby.
Brindyr et al. published a paper from 2020 in the journal of Maternal and Child Nutrition which reported several other benefits including: earlier placenta expulsion, reduced postpartum bleeding, less stress for you and your baby. And, improved temperature regulation, and more optimal suckling.
Also, it’s thought that allowing self attachment to the nipple promotes interest and a desire to feed rather than a defensive relationship to feeding. And I think this starts at the first feed and continues on. Just think- if someone is regularly shoving something in your mouth verses in your are leaning in to accept a bite, your experience, posture, and stress level with meals would be totally different.
Conclusion
Whew, well that’s a lot. But don’t worry you don’t have to memorize all of this. All you gotta do if you want to capture some if not all of these benefits is communicate clearly that you expect your baby to be put skin-to-skin on you, you expect your team to delay all non-emergency procedures, and support but don’t rush the first feed. Remember, you got this. This is your birth into motherhood. And you are strong as a mother.
If you are looking for a robust course on newborn feeding with visual supports, guides that were created based on infant behavior rather than pretty on paper schedules, troubleshooting downloads, and much much more I am so excited to announce the release of my newborn feeding course which I partnered with women of Baby Boldly to create. It will be released next month and we are offering it for free to a limited group to get feedback and do our due diligence to make sure it’s exactly what you want and need. If you want me to let you know when it’s available, send me an email at Barbara@FeedingByJanuary.com.
You can also email me if you have specific questions, I do offer 1:1 support.
Thank you so much for listening, and I’ll be here next week!
Articles mentioned and utilized in this episode:
Widström AM, Lilja G, Aaltomaa-Michalias P, Dahllöf A, Lintula M, Nissen E. Newborn behaviour to locate the breast when skin-to-skin: a possible method for enabling early self-regulation. Acta Paediatr. 2011 Jan;100(1):79-85. doi: 10.1111/j.1651-2227.2010.01983.x. Epub 2010 Sep 14. PMID: 20712833.
Widström, A.-M., Brimdyr, K., Svensson, K., Cadwell, K. and Nissen, E. (2019), Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr, 108: 1192-1204. https://doi.org/10.1111/apa.14754
Brimdyr K, Cadwell K, Svensson K, Takahashi Y, Nissen E, Widström AM. The nine stages of skin-to-skin: practical guidelines and insights from four countries. Matern Child Nutr. 2020 Oct;16(4):e13042. doi: 10.1111/mcn.13042. Epub 2020 Jun 16. PMID: 32542966; PMCID: PMC7507317.