Baby's First Hours
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Your first day with your baby will be exciting (and emotional), as doctors and nurses examine him to ensure that he's healthy -- and teach you the essentials of caring for him. Knowing what to expect will make this special time feel more joyful and less overwhelming. While procedures vary by hospital, our time line will give you a sense of how the hours typically unfold, starting with the minute he's born.
First 5 Minutes
As soon as your child arrives, the doctor will suction her mouth and nose to clear away mucus and amniotic fluid, and she should begin to breathe on her own. The doctor will then clamp and cut (or let your partner cut) the umbilical cord before determining your baby's Apgar score, which is based on heart rate, color, reflex response, activity and muscle tone, and breathing at one minute and five minutes post-delivery. Scores can range from zero to ten, but anything above seven is generally considered healthy. Most babies score eight or nine, but if your baby tests lower, the cause will be addressed (say, she's having trouble breathing) and testing will continue at five-minute intervals until the issue is resolved. Not to worry: Most infants who receive a low mark at birth go on to be healthy, happy babies, says Michael A. Posencheg, M.D., medical director of the newborn nursery at the Hospital of the University of Pennsylvania, in Philadelphia. While you're delivering the placenta, your newborn will be weighed and measured. Typically a nurse will wipe her clean and place her in a baby warmer until she's able to maintain her own body temperature -- a process that can take from a few minutes to a couple of hours. You may be able to watch all of this happen, but you also may be getting stitches, if necessary.
When you're still in the delivery room, your baby will get antibiotic eye ointment to prevent eye infections that can result from passing through the birth canal. He'll also receive a vitamin K shot in the thigh to prevent clotting problems. If you plan to breastfeed, you'll be encouraged to try it. Even if you've had a C-section you can begin nursing as soon as you leave the operating room, provided that you're comfortable, alert, and aren't experiencing complications, says Parents advisor Ari Brown, M.D., coauthor of Baby 411. If the doctor sends your baby to the neonatal intensive-care unit (NICU) because he was born prematurely or there's a risk of infection, this bonding session will be postponed.
Hours 2 to 3
Now that your child's initial tests have been completed, the two of you will spend time together in your hospital room or the recovery room, as long as both of you are well. At some point the nurse will examine your baby to determine how well she's adjusting to newborn life. She'll also check her pulse, feel her abdomen, make sure her genitals have formed properly, and verify that she has all ten fingers and toes. She'll also record the Ballard score, in which your child's head circumference, chest circumference, and length are measured to confirm her gestational age.
If your baby is premature, she'll most likely remain in the nursery, where her temperature, heart rate, and respiratory rate can be closely monitored, and you'll be able to visit. Her vitals will be checked every 30 minutes for the first two hours and then every four to six hours if all is on track. If her vitals aren?t stable after two hours, the NICU staff will perform more tests.
The Rest of the Day
Hours 4 through 22
You'll spend this time learning how to care for your newborn. You'll probably help a nurse give him his first bath and change his diaper once he passes his first bowel movement, called meconium. You'll also learn how to swaddle and hold your baby, as well as how to handle his umbilical-cord stump and his circumcision site (if he's been circumcised). If you choose to breastfeed your baby, you'll be nursing him every two to three hours. Most hospitals have a lactation consultant who will check in to see how you're doing, even if you've breastfed before, says M. Terese Verklan, Ph.D., a nursing consultant in Houston. If you don't get a visit, ask for one.
Hours 23 and 24
By now your baby will have been formally evaluated by a pediatrician -- unless a problem was discovered at birth, in which case this exam will have been done then. The doctor will assess risk factors for infection, check for malformations, and ensure that your child is feeding and breathing well. She'll be checked for jaundice, which causes yellowish skin because bilirubin isn't being broken down in the liver. Babies with the condition may be exposed to a special kind of light that helps break down bilirubin, and you'll be encouraged to nurse your little one often to help eliminate the substance through her stool. In rare cases, if left untreated, jaundice can lead to brain damage. Additionally, your baby's heel will be pricked to screen for up to 50 different metabolic diseases, depending on your state's requirements, including sickle cell anemia and phenylketonuria (PKU). Performing this test any earlier is useless; blood levels in a baby don't rise until 24 hours after she has begun to drink breast milk or formula, so there can be a higher incidence of a false negative if the test is performed too soon. This evaluation is extremely important -- if your baby has one of these diseases, detecting and treating it early can substantially improve her prognosis.
Just Before Hospital Discharge
You'll stay at the hospital 24 to 48 hours after having a routine vaginal delivery. If you've had a C-section, you'll generally be there for three to four days. Right before you leave, your baby will receive a hearing test, in which he'll wear a pair of headphones and an audiologist will monitor his brain waves in response to sound. He'll also be weighed, and you'll probably notice that his weight has dropped since birth. Don't be alarmed. Fluid is moving from his extravascular system to his blood vessels, increasing his blood pressure and promoting the flow of oxygen to his organs. He's urinating out the excess fluid, which causes a 5 to 7 percent dip in his birth weight, but he'll gain back the weight after a few days of eating, Dr. Verklan explains.
After you've been discharged but before you can drive off, the hospital staff will confirm that you have a car seat, which is required in all 50 states. Once you get the go-ahead and realize that you're on your own, you may feel overwhelmed. "Don't panic," Dr. Brown says. "No one goes home really feeling prepared." Try to relax. Before you know it you'll be parenting like a pro.
Originally published in the July 2012 issue of Parents
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