All About
Baby!
You have waited months to meet your child and she is finally here!
Phew!
The hard part is over! Sort of … now what?
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The first few days of a newborn’s life are remarkable. The baby will often be wide-awake staring at you and many are ready to feed right away. They undergo tremendous change in the next few days as they get used to the outside world. It can be stressful as well as you learn to care for this new baby. We love working with new families to help you understand what to expect and how to care for our newborn. Read to learn about the first few hours of life, the first few days, and what routine screening procedures to expect.
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There is a lot to learn so let’s get started!
First Few Hours
During the first few hours after delivery, your baby will usually have a wonderful quiet alert period. Enjoy this magical time getting to know your new child.
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You can expect several things to occur in the first hours after delivery:
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Skin-to-skin contact
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First breastfeeding
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Antibiotic eye ointment application
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Vitamin K shot administered
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Baby’s measurements are taken
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Blood sugar levels tested (if needed)
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Skin-to-Skin Contact:
After delivery, if you and your baby are doing well, we encourage you and your baby to have “skin to skin” time. This means placing your baby directly on your chest – no blankets or clothes between you and your baby. Medical science shows that early skin to skin contact improves the baby’s transition to the outside world and encourages breast-feeding. Skin to skin is effective with either parent.
The benefits of skin-to-skin contact include:
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Stabilizing newborn’s temperature and circulation.
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Improves infants ability to latch at the breast
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Less crying
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More normal blood sugars
First Breastfeeding
If you plan to breastfeed your baby, try to have the baby breast feed as soon as possible after delivery. Science shows that breast feeding is more successful when babies have a chance to latch and feed soon after delivery. This is not always possible if the baby or mom is having medical problems.
Some important reasons to breastfeed your baby:
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Fewer ear infections
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Fewer respiratory & gastrointestinal infections
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Potential protection against SIDS or crib death
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Less risk that your child will be overweight
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Less risk of Type 2 Diabetes for your child and mom
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Less risk of breast cancer for mom
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At birth, a newborn has about 20/200 vision.
She can see your face and the optimal distance is about x inches, no coincidence that this is about the distance from the breast to mom’s face.
Antibiotic Eye Ointment
Antibiotic eye ointment will be placed on your baby’s eyes to prevent possible infection of the baby’s eyes. This can make her eyes look wet or goopy.
Vitamin K Injection
The American Academy of Pediatrics recommends all infants receive a Vitamin K injection as soon as possible after birth to prevent hemorrhagic disease of the newborn. Vitamin K plays an essential role in the blood’s ability to clot. This Vitamin K boost helps the newborn quickly achieve normal vitamin K levels and reduces the chance of internal bleeding in the first months of life. Oral vitamin K is not as effective at preventing late bleeding from Vitamin K deficiency which can lead to bleeding in the brain.
Birth Measurements
Birth measurements (weight, length, head circumference) will be taken usually after you have had time to be skin-to-skin with your baby. Everyone wants to know how big the baby is!
Blood sugar levels may be checked on the baby if mom had diabetes during the pregnancy or if the baby’s size is large or small for his gestational age* or if the baby is premature**.
First Few Days
Over the first few days of your baby's life, you are learning about each other. Be sure you take time to eat, drink lots of fluids, and sleep when you can. Be patient with yourself while you are learning to care for a new life. It can be exhausting.
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Your baby’s behaviors during the first day of life are often like one of the seven dwarfs (sleepy, sneezy, hiccupy, spitty, gaggy, poopie and fussy). Babies are sleepy the first day of life after an initial quiet alert period. You will usually need to wake your baby for feeding. As your baby gets closer to the second day of life, she may become fussier, more alert, and demand to eat more (see cluster feeding below). This is expected, newborn behavior in healthy, term babies.
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Hiccups during the first month of life are normal. Hiccups bother us as parents more than they bother the baby. Hiccups are not harmful and will go away on their own. Skin to skin and rubbing their back seems to help. Sneezing is very common in the first few days. This is how the baby clears her nose and is not a sign of a cold or illness.
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Things you might notice in the first few days:
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“My baby is gagging and spitting up!”
Most babies have swallowed amniotic fluid, and will gag as they spit it up. If this happens, sit them up and pat their back to encourage a burp. You can use your suction bulb to help clear any extra fluid. The baby may turn red or purplish, which can be very scary, but usually resolves in a few seconds. Call your nurse to help if the baby looks blue or purple. Gagginess usually goes away after 24-48 hours and good burping does help this resolve.
Most babies also have some spit-up, which is normal for newborns. When they spit up, it may be clear, yellow or bloody. If it is yellow, it is your colostrum. If it is bloody, also scary to see, most often it is swallowed blood from delivery, but have your nurse take a look to confirm. Clear fluid is mostly amniotic fluid. Let you nurse or doctor know if spit-up is green – that can be worrisome.
“This meconium is very sticky and hard to get it all off.”
Meconium is super sticky, black and really hard to wipe off the skin. Over the first two days, the stool should become more thin and easier to wipe off. By the way, crying during all diaper changes is normal. Babies prefer to be wrapped up and cozy. You will get faster with experience!
“My baby hasn’t pooped yet.”
Most babies poop within the first 24 hours, but some can take up to 48 hours to poop. Continue to breastfeed at least every 2-3 hours to encourage stooling. Let your doctor know if the baby still has not stooled after 24 hours.
“My baby hasn’t urinated yet.”
We expect at least one urination during the first day of life – which is not much. Sometimes the urine can be mixed with meconium and hard to see. Check the front of the diaper –the yellow line will change to blue once it comes into contact with urine (girls are usually towards the bottom). Continue to breastfeed at least every 2-3 hours to encourage fluid intake. Your nurse will notify the doctor if there is concern about lack of urine.
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“I have the perfect sleeper!”
Most babies tend to be sleepy for the first 12-24 hours of life and then begin to wake up and demand to feed more (cluster feeding – see the second-third day of life). In this first 24 hours, you will likely need to wake up your baby for breastfeeding. You should not let him/her go longer than 3 hours, with the goal of a minimum of 8 breastfeeds in 24 hours.
“My family and friends all want to hold my new baby.”
It is wonderful to have lots of social support! Everybody loves to cuddle a new baby. However, these first few days are crucial to bonding and breastfeeding, and visitors should not interrupt your baby’s feeding schedule. Do not hesitate to ask guests to step out so you can feed.
Day 2-3
As your baby moves into the second day of life, he will have more awake periods and will become more demanding. He will want to feed more and be close to a parent – he may not settle down in the crib anymore. These changes can worry parents who were enjoying a quiet sleepy baby. This is very normal behavior for a healthy term baby. Preterm babies will be sleepier.
During the 2nd and 3rd day of life, babies will want to eat lots especially at night then settle down for a nap around 5 am. You will finish a feed then she is ready to eat again 30 minutes later! This is exhausting but don’t worry! This is not permanent but a natural phase called cluster feeding. By feeding at the breast often, the baby is stimulating the milk supply to increase. Allow the baby to feed as often as he desires – you cannot overfeed a breast fed baby!
“Is it okay to give my baby a pacifier?”
If your baby wants to suck, we encourage you to put her to the breast to nurse. She will get small amounts of colostrum every time and stimulate your body to make milk. Using a pacifier will teach her that sucking is not linked to eating and she may lose some interest in feeding.
If you plan to use a pacifier, wait until breastfeeding is well established and your milk is in. You may see pacifiers used for simple procedures, which does not interfere with feeding.
“How to do I soothe my crying baby?”
This is one of the hardest parts of being a new parent! It can be very challenging to figure out what your baby needs and we worry that we are not doing a good job. In the first few days of life, crying is often due to a desire to feed. If the baby just finished feeding, try burping to see if that is the reason for crying. You can also check the diaper for stool or urine. Sometime the baby just wants to be swaddled and held. Swaddling is very comforting to most new babies since it limits the startle reflex.
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MYTH: You will spoil the baby by holding him too much.
This is not true for a newborn. They want to feel secure and need to be held. Listen to your instincts and cuddle your baby!
“Breastfeeding hurts.”
This is a very common concern, and please do not grin and bear it. Often when a baby first latches it can be painful for 5-10 seconds. If it remains painful, he does not have a good latch – you need to try again. Take the baby off the breast by placing a finger between her jaws to break the suction so you can remove your nipple. Your nipple should not be visually damaged.
Painful latch can usually be resolved through improved technique, but some babies can have a “tongue tie.” All of us have a small frenulum or piece of tissue connecting the bottom of the tongue with the floor of the mouth. In some babies, this tissue or “tongue tie” can prevent normal tongue movement. This can lead to painful breastfeeding and latching difficulties. It often runs in families! Your doctor will check for this if you are having trouble breast feeding.
“My nipples have blisters and are sore.”
Damage usually means that your baby has had a poor latch during feedings. Your baby’s doctor or your lactation consultant will help improve the latch and give you advice on what ointment would be most helpful. Sometimes you will need to take a break from breastfeeding and use the breast pump to let the blisters heal. If the baby is not feeding from the breast, it is important to use the breast pump to ensure your body is stimulated to produce milk.
“My baby is yellow”
Many babies will have some jaundice or yellow color that develops on their eyes and skin. It takes a few days for the baby’s body to figure out how to break down bilirubin – the chemical that causes jaundice. The more the baby feeds, the more she stools, which helps her get rid of bilirubin. In some babies, they make bilirubin quickly for other reasons like a blood type mismatch (Mom is O+ and the baby is A+ or B+) or bruising from delivery. Your doctor will discuss with you if treatment is needed based on your baby’s bilirubin blood level.
“I am pumping but no milk is coming out!”
When using the breast pump in the first few days of life, usually only drops to 1-2 ml may come out every time you pump. This can be very frustrating since it is so much work to pump! The goal of pumping at this time is to stimulate your body to make milk – it is not as effective at removing early milk or colostrum. Healthy term babies and hand expression are much more effective to remove colostrum. Don’t stop pumping just because you don’t see milk – it will come!
“There is blood in the diaper!”
There are two common reasons that a baby may have something that looks like blood in the diaper. First, after the first few days of life, the baby has lost the extra fluid from delivery and the urine becomes concentrated with urate crystals. It looks like a salmon colored paste in the diaper. As the baby’s milk intake increases, this will go away. In little girls, they can have clear or bloody mucus from the vagina. As the maternal hormones decrease in the baby, this will go away in a few weeks.
Does your baby get really red when crying?
The baby has a very high red blood cell count in the beginning of life so he looks bright red when upset.
What to Look For
Day 4-5
You may have already gone home from the hospital and will be seeing your baby’s doctor in the next day or two. If the baby was delivered by cesarean, you are usually still in the hospital for the 4th and 5th days of life. Hopefully by now you and your baby have gotten to know each other a bit and you are having more success with feedings. This is not always the case, which can be disappointing. Sometimes milk production is delayed, and the baby is ready for more before your body can provide it. Do not worry! This is not uncommon, and it does not mean that breastfeeding will not be successful. We just need a temporary plan until the milk is coming.
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Reasons to need milk supplementation:
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Prematurity
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Twins
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Small size (under 6 pounds)
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Unable to latch at the breast
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Over 10% weight loss
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(all babies lose some weight – that is normal!)
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Breast surgery
Reasons why milk production may be decreased or delayed: Some moms are likely to make less overall breast milk or to have a delayed onset of production. First time moms, cesarean delivery or maternal health complications can have delayed milk production. Decreased overall production can occur if you have a history of PCOS, infertility, obesity, or breast surgery. Talk to your doctor about how to maximize your milk production from the first day of life.
“I am crying a lot and don’t feel like myself”
Many mothers experience mood changes after having a baby. About 75 percent of new mothers experience the baby blues (especially with the first baby). This can last two to three weeks before resolving spontaneously. While formal intervention is not needed, close support from family and friends can certainly help. Baby blues cause the mother to feel sad, moody or irritable. Sleep and appetite may be affected. Some women call this time an emotional roller coaster.
If the blues persist or intensify, it is important for you to meet with your OB or primary care doctor for advice, as up to20 percent of mothers can experience postpartum depression (PPD). PPD can occur at any time in the first year but is most common four to eight weeks after delivery.
You should seek medical care if experiencing the following, beyond the period of baby blues:
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Feelings of anger or irritability.
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Lack of interest in the baby.
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Appetite and sleep disturbance.
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Crying and sadness.
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Feelings of guilt, shame or hopelessness.
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Loss of interest, joy or pleasure in things you used to enjoy.
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Thoughts of harming the baby or yourself.
