The Sacred Hour: Why the First Hour After Birth Matters More Than You May Think
Prepared for Parenthood: Season One: Episode Two: Part One
Meet Neonatologist, Dr. Raylene Phillips
Dr. Stephanie Dueger: Welcome back to Prepared for Parenthood. I’m so excited today to have Dr. Raylene Phillips with us. She is joining us from California, and I will let her share a little bit about her work with expectant and new parents and their little, itty-bitty ones. Welcome Raylene, I’m so happy to have you here.
Dr. Raylene Phillips, MD: Thank you, Stephanie. I’m really happy to see you again and also to be here to be a part of the work you’re doing, which is really, really important. I’m a neonatologist who works with sick and premature babies in the Neonatal Intensive Care Unit or NICU. But I also have the honor and privilege to take care of well babies in a community hospital that has both a small level two NICU and then also well babies that are in couplet care with their mothers. So, I trained to take care of the sickest of the sick preterm babies down to 23 weeks gestation, and I can do that, and that’s what most neonatologists do is work only with sick and premature babies. But at this hospital, I also get to take care of the well babies, which I love doing. So, it’s kind of the best of both worlds here.
What is The Scared Hour?
Dr. Stephanie Dueger: That’s wonderful. So, you wrote an article about the Sacred Hour, and I’m wondering if you could just share what that is for people and why it’s so important.
Dr. Raylene Phillips, MD: Well, I’ll give a little background. When I was doing my neonatology fellowship at Loma Linda University Children’s Hospital, which is our 84-bed level 4 NICU, I would go to deliveries when the neonatal team was called. And if all was well, I would be sure myself to put the babies on mom’s chest, skin-to-skin, and then I’d go back to the NICU. And what I found out from one of my OB friends, one of the OB-GYNs was that as soon as I left the room, the baby was taken off of mom’s chest and put back on the warmer so the nurses could finish their checklist of: weigh the baby, do the footprints, the handprints, give the vitamin K, erythromycin or whatever else they were going to do in their first assessment. And then sometime during the first hour, the baby would be put back on mom’s chest. But it was often interrupted. And there was no thought given to what was the purpose of that first hour? What all was going on during that first hour after birth? So, what I realized is that there was a misunderstanding about what was really important in that first hour.
Why the First Hour After Birth Matters: Physiological Changes
Dr. Raylene Phillips, MD: So, we created a task force at our hospital with our OB-GYN colleagues, both physicians and nurses, and also our neonatology colleagues. It took about a year, but we realized we had to change the protocol of our postpartum care. And the things that were not absolutely necessary to do for well babies could be delayed until after the baby’s first breastfeeding. Because after birth, the newborn’s physiology is completely changing from what it was in utero. The blood flow is different; now, instead of avoiding the lungs, it’s actually going to the lungs because the placenta is no longer present to provide oxygenation. And then the baby, of course, was in a warm, wet environment, and now they’re in a cooler environment of the delivery room and they’ve got to stay warm. And ideally, they get their warmth from their mom’s chest.
Also, they’re meeting their mother for the first time outside the womb. And mother’s meeting her baby, who she has imagined and hopefully spoke to and sang to, but for the first time outside the womb. So, very beginnings of afterbirth bonding are taking place. And these are really important, but they aren’t really highly valued or really even thought about by many in the medical world because they’re not really prioritized. They’re not talked about. So, it’s not that people don’t care, it’s just they don’t really know, and they aren’t really aware.
Why the First Hour After Birth is Sacred
Dr. Raylene Phillips, MD: So, our goal was to educate the labor and delivery nurses who were there at the time of birth and the doctors, that this was a very special time. In fact, it’s a once in a lifetime experience to be born. And so we want them to treat it with respect and protect that special time. And our group decided to call it The Sacred Hour. The first hour after birth for a trauma victim is called The Golden Hour. And so very preterm babies, we call it The Golden Hour, where a lot needs to be done to stabilize them for admission to the NICU. And that first hour is really, really critical. You have to get off to a good start with these babies, keep them warm, keep them ventilated, and that sort of thing.
So, this is a special time too, this first hour after birth. And so, we set it aside as a sacred time, something that is highly important, that is deserving of respect and protection. We compared it to a wedding, for example. Now, even if a wedding was a civil service with no religious connotation at all, we still recognize it as a very important event that’s sacred for that couple, right? When they’re pledging their life to each other. So, we wouldn’t interrupt it for just routine business. Only if something was wrong, say the bride or groom fainted, would we interrupt that wedding. So, if something’s wrong with the mother or the baby, of course we interrupt The Sacred Hour. But if not, we put them skin-to-skin immediately after birth and we don’t interrupt them until after the first breastfeeding is complete. And then we do our routine cares.
Skin-to-Skin Contact: More Than A Trend
Dr. Raylene Phillips, MD: And one other thing we made everyone aware of is that all newborn babies, if they’re skin-to-skin with their mothers, they know how to find the breast and latch on by themselves, just like every other mammal. In the animal world, there are no lactation consultants, and the mother doesn’t initiate breastfeeding, the baby does. The baby finds the teat, the baby finds the nipple and latches on. And in the human world, the baby will do the same thing. You’ve probably heard of the breast crawl, but there are actually nine stages that babies go through, which are really fun to watch and identify if they’re left uninterrupted. And so, we instituted that practice in about 2011. I wrote the article in 2013. And we’ve continued to practice it through all those years now, over 10 years now. And it’s wonderful. Parents, mothers love it. We even do it with C-section babies. In fact, we introduced it at Loma Linda with C-section babies. And at Murietta, it’s always been that way. That’s our community hospital – Murietta Hospital.
And I met a mother in the cafeteria one day and she said, “You were at my baby’s birth.”
I said, “Really? Was it a C-section birth or was it a vaginal birth?”
She said, “It was a C-section birth.”
Then I said, “Did you get to have your baby skin-to-skin right after your birth?”
And she said, “Oh yes.” She said, “I didn’t get the vaginal birth I wanted, but at least I got my baby immediately after birth, skin-to-skin. So, it was a wonderful birth.” So very, very happy about that.
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The Nine Stages of The Breast Crawl
Dr. Stephanie Dueger: Very sweet. And you spoke about the physiological importance and the importance for the building of attachment right off the bat. And also, of course, we hope that that’s happening in the womb as well, the attachment process. But what are those nine stages of the baby finding the breast after birth?
Dr. Raylene Phillips, MD: Well, they’re kind of artificially defined, but it’s still fun to look at it.
- So, the first one is called the birth cry, and that’s when the baby takes a breath. And usually, at least in the hospital setting, they often cry. Now I’ve seen many, many videos of home births, especially water births, where the babies don’t cry at all. They just take a breath and start breathing. And I imagine it probably has to do a little bit with the stress, or quite a lot, probably with however the labor was and the stress of the mother. But nevertheless, it’s the first breath we could call it.
- And then there’s where the babies lay on mother’s chest it’s called a quiet time. They lay, when you put them skin-to-skin, they become very quiet, very still. It’s kind of like, when you think of the baby’s perspective, think about being all curled up in a tight little ball, very constrained, but very secure in mother’s womb. And it’s relatively quiet, and you only hear mother talking from a distance, and you hear the heartbeat, and the bowel sounds and everything. And then, all of a sudden, you’ve gone through this tremendously tight little tunnel. And then you burst into this room where there’s light and sound, and your arms and legs are flailing for the first time since you were very tiny. And so, it’s a huge adjustment for babies. And if you’re with your mother, at least you feel something familiar. You hear the heartbeat and that sort of thing.
- So, after this quiet time, then there’s kind of an awakening where the baby opens its eyes because it’s bright, you know. So, their eyes are usually shut tight and then they open their eyes and they begin to look around, but they aren’t really moving much yet just because they’re kind of resting.
- And then they begin to move their upper body. So, there’s a little bit of activity here in the arms and moving.
- And then they begin the crawling. So, they push with their feet and that’s their lower body and then push up towards the breast.
- And then there’s sometimes a rest in between. So that’s one of the stages.
- Then they find the nipple and they start familiarizing themselves. It’s called the familiarization stage where they’re kind of bouncing their mouth back and forth around the nipple, licking the nipple, tasting it, seeing how their tongue works in air and gravity, something they’ve never done before. This stage can take about 20 minutes and that’s when we usually try to get involved and say, “Oh, let me help you. Let me help you.” But they can do it themselves if we just give them a chance.
- And then, all of a sudden, they just latch onto that nipple and go to suckling and we call that suckling, of course.
- Then afterwards there’s a sleep where mom and baby, if they’re allowed to, can have a nice deep sleep.
So, there are nine of them, and they’ve kind of been divided into their stages of activity.
The Sacred Hour After a Cesarean Birth
Dr. Stephanie Dueger
And when you see that, for example, after a C-section birth, does it look different for those babies than it does for the vaginally-born baby?
Dr. Raylene Phillips, MD
No, not at all. In the lecture that I give, I have pictures of twins actually that were 37-week twins and they were placed skin-to-skin. Usually, single babies we put across this way to begin with. And then when they get to the recovery room, we put them more vertical. But we put these babies both vertical and they both went through exactly the same stages. Every baby does, it’s really fun to see. And they will go through those stages again for every time they’re skin-to-skin, even after birth. If mothers didn’t get that right at birth, they can sometimes get into a bathtub where the water’s kind of shallow or even just on a couch or a bed and lay a little bit on an angle or supine and put the baby skin-to-skin. Watch. They’ll go through those same stages, and they’ll do it until about three months of age when the neocortex is mature enough to override the brain stem reflexes, because these are instinctive breastfeeding behaviors that are activated when babies are skin-to-skin.
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What Happens When Mother and Baby Are Separated?
Interrupted Bonding, Attachment, and Emotional Repair
Dr. Stephanie Dueger
That’s so sweet. And what is the danger, Raylene, if that gets interrupted? Sometimes it needs to get interrupted, as you said, if there’s an emergent issue. And sometimes just out of lack of awareness, it gets interrupted. But what are the downsides of interrupting that time if it’s not necessary, or even if it is necessary? And what do we do about that to help repair it?
Dr. Raylene Phillips, MD
So, something is missed if that’s not allowed. And I really believe that when mother and baby are separated after birth, there is an emotional wound that’s created because the mother and the baby are so primed to be together, to develop that post-birth or out of the womb bonding that hopefully began in the womb. And that emotional wound, like any wound, can be healed. It’s not that it can’t be. It’s just that we need to be aware that there is a wound in order for us to repair it. It’s like if you have a gash on your leg and you don’t even see it, it never heals. Or at least it doesn’t heal correctly. You know, it may heal, but not heal in a way that is optimal.
So, I know this from my own birth experience of my children. My firstborn was born, now that I have some medical background I understand he was born three weeks early, so he was right on the borderline of being a late preterm baby. And they just kept him in the nursery for 24 hours. They told me they just needed to observe him, and he was my first baby, so I didn’t question it. And they said he was okay, wasn’t in danger.
And they brought him back to me 24 hours later. And at that time, it was like I’d already distanced myself from this baby that was in my womb. And he had been alone for 24 hours without his mother. And so, he breastfed beautifully, which is very lucky because that doesn’t always happen. But I didn’t feel a connection to him. But I didn’t realize that it was lacking until my second and third babies were born. And then I recognized that there was something missing, some emotional connection missing. It was not that I loved him any less because I loved him just as much, but there was a connection missing and I really agonized over it for quite a few years.
And then I found APPPAH [The Association for Prenatal and Perinatal Psychology and Health], and I understood once I learned about how conscious and aware babies are and what a difference it makes if you are separated at birth. So, then we were actually able to do some repair. I was able to attend a workshop that taught me how to repair that missing first connection.
And then I was able to also speak to my son about it. He was an adult. So, I don’t believe it’s ever too late. Bonding and attachment can happen at any time of life. It’s just easier the earlier it begins. The baby’s brain is primed for learning trust. It’s packed in the psychological world. That’s the most important task of the first year, the most important psychological task is to learn trust.
In the second year, the primary task is to begin to learn independence, which of course you don’t have to teach. If you’ve ever been around toddlers, you know that. But you do have to teach trust. It isn’t automatic. But the right hemisphere of our brains is dominant in the first year. And that’s our social brains, our relationship brains, its facial recognition, its sensing safety or security. And if we can use that time for optimal bonding, then it comes easy. It’s just meant to be that way. It can be developed later. It’s just more difficult.
Supporting Mothers through NICU & Medical Separation
Dr. Stephanie Dueger
I love that you were able to repair that early emotional wound with your son, even as he was an adult. And I think so many of my clients come to me as adults and they’re working on their very early own experience of being born or having separation from a parent when they were little. And I love just the whole premise that even if we miss it, most things can be repaired, right, at least to some degree.
Dr. Raylene Phillips, MD
They can. And I also really firmly believe that the sooner we can explain things to the baby, the more we can minimize any trauma of separation. So, in the NICU, when mothers and babies sometimes need to be separated or often need to be separated, if the mother or father can explain to the baby why they have to go or why they were separated, for some reason that we don’t understand, babies get it. Probably not the words or the language, but the intent. They’re very, almost psychically in tuned. They get the intent of what we’re saying, the emotion of what we’re saying.
And later on in life, when they get language, they can often put words to that intent. And we know that adults under hypnosis have memories of their birth and they can put words to them. They can tell you who was there and what was said and what almost happened or what did happen.
Whenever I am at the birth of a baby who is needing some resuscitation, I always talk to them and tell them what we’re doing. Tell them, I’m so sorry, they’re not with their mother right now, but someone’s taking care of their mother and we’re here to help them. And then as soon as we can, we’ll get them together. And always I bring the father over or the partner, say, here’s your daddy, he’s here with you. And when the baby hears their dad’s voice, which they’ve heard before, you can just see them relax. And many times, that’s all they need to begin to breathe normally if they’re having trouble with their transition. So, I always have the dads at the bedside with me when I’m working on a baby that needs some respiratory support or anything else.
Staying in Connection with Baby During Birth and Postpartum Challenges
Dr. Stephanie Dueger
And are you teaching the other doctors and the OBs and the nurses and everyone in your hospitals how to have these conversations with the baby? So, even going into, say a planned C-section? Where speaking to that baby and letting them know, “Hey, this is really important that we get you out right now.” I think you can do so much to create that repair before the trauma has even happened, right?
Dr. Raylene Phillips, MD
Exactly, exactly. Whenever I’m doing an antepartum consultation, I encourage the mother to talk to the baby and let the baby know what’s happening. I remember hearing about a father who during labor was talking to his baby and saying, “Okay, another power hug is coming,” which is the way they were referring to contractions. But no, when I go to the birth of a baby, the first thing I say is, “Happy birthday, Little One. Welcome to our world. We are here to help you.”
And then more, if explanation is needed. And my nurses hear that and they talk to the babies too. And they also know if they bring a baby from the operating room to the NICU where I’m waiting for them, they bring the dad with them because they know that the dad is really, really important. The dad is therapeutic if mom can’t be there. Otherwise, mom’s therapeutic. They also know that if a baby is having just a slight bit of respiratory distress, maybe some fast breathing or a little bit of effort that they put the baby skin-to-skin with mom. And they let me know if baby’s doing a little bit of fast breathing, working a little hard, “But is it okay if we put the baby skin-to-skin with mom and just watch and see if that improves?” And I always say, “Yes!” And of course, I’ll come to evaluate too. But often by the time I get there, the baby’s doing great.
Stay tuned for part 2 of this conversation about The Sacred Hour with neonatologist, Dr. Raylene Phillips…
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Frequently Asked Questions: The Sacred Hour, Skin-to-Skin, and Early Bonding
What is “The Sacred Hour” after birth?
The Sacred Hour refers to the first uninterrupted hour after a baby is born, when a newborn is placed skin-to-skin with their parent immediately after birth whenever medically possible. This time supports early bonding, breastfeeding initiation, regulation of body systems, and attachment.
Why is the first hour after birth so important?
The first hour after birth is a major transition for babies. They are adapting to breathing air, regulating body temperature, changing circulation patterns, and adjusting to life outside the womb. At the same time, parents and babies are beginning an important attachment process. Skin-to-skin contact helps support both physiological regulation and emotional connection.
What is skin-to-skin contact?
Skin-to-skin contact means placing a baby directly on a parent’s bare chest immediately after birth and during the postpartum period. Babies often become calmer, regulate temperature and breathing more effectively, and begin instinctive feeding behaviors during this time.
What are the benefits of skin-to-skin after birth?
Research suggests skin-to-skin contact may help:
- Support body temperature regulation
- Promote more stable breathing and heart rate
- Encourage breastfeeding initiation
- Reduce stress hormones
- Support parent–baby bonding
- Increase oxytocin release
- Help babies transition to life outside the womb
What is the “breast crawl”?
The breast crawl is a newborn’s instinctive ability to move toward the breast and initiate feeding when placed skin-to-skin after birth. Babies are born with built-in reflexes that help them seek, locate, and latch onto the breast.
Can babies really find the breast on their own?
Often, yes. When babies are given uninterrupted time skin-to-skin, many naturally move through instinctive stages that lead toward locating and latching onto the breast. Some babies need more support, especially following a medicated birth, and feeding experiences vary.
What are the nine stages of the breast crawl?
Dr. Raylene Phillips describes nine stages often observed during uninterrupted skin-to-skin:
- Birth cry or first breath
- Relaxation/quiet phase
- Awakening
- Increased activity
- Crawling movements
- Rest periods
- Familiarization with the nipple
- Suckling and feeding
- Sleep and recovery
Every baby’s timing can look a little different.
Does The Sacred Hour work after a C-section?
Yes. Many hospitals now support skin-to-skin care after Cesarean births when parent and baby are medically stable. The Sacred Hour can happen after C-sections, and many babies still demonstrate the same instinctive feeding and attachment behaviors.
What if my baby needed NICU care or we were separated after birth?
Medical situations sometimes require separation, and many families experience this unexpectedly. Separation can feel emotionally significant, but connection and attachment continue to grow over time. Bonding and attachment are not limited to a single moment.
Can bonding and attachment be repaired if we missed early skin-to-skin contact?
Yes. Bonding and attachment develop through repeated experiences of safety, responsiveness, and connection. While early moments matter, relationships remain flexible and repair is possible throughout childhood—and beyond.
How can parents support attachment after a difficult birth?
Helpful practices can include:
- Skin-to-skin contact later in the postpartum period
- Responsive feeding and caregiving
- Talking and singing to your baby
- Eye contact and touch
- Babywearing
- Repair-focused support if birth trauma occurred
Connection is built through many small moments over time.
What if my birth didn’t go according to plan?
Many parents carry grief about unexpected birth experiences. It’s possible to hold both disappointment and love at the same time. Attachment is a relationship, not a single event. There are many pathways toward connection.
Prepared for Parenthood takeaway: You do not need a “perfect” birth to build a meaningful bond or healthy attachment with your baby. Connection begins prenatally, can increase in the first hour—and continues growing every day after that with your child. And remember that birth trauma can be repaired.
For more information on Parent Coaching for Parents of Babies and Young Children click here.