In some hospitals, unless you specify otherwise, the baby is cleaned and evaluated immediately after delivery. His nose and throat will be gently suctioned, and he’ll be given an injection of vitamin K, which helps the blood to clot. Antibiotic ointment will be applied to his eyes to prevent infection; your baby can see you through this ointment and it's not irritating. Your baby will be footprinted, and identification bands will be placed on his wrist and leg. You’ll also be fingerprinted – be sure to ask for a copy of these prints.
In lieu of immediate cleaning, many women prefer to hold their babies straight from the womb. "The first hour after birth is when the baby is most awake and alert," says Joyce McKeever, M.S., R.N., I.B.C.L.C., L.C.C.E., clinical program manager for the Baby-Friendly Hospital Initiative and director of clinical services at the Center for Breastfeeding at Jersey Shore University Medical Center in Neptune, N.J. "It's a great time to get acquainted by holding your baby skin-to-skin on your chest and to start breastfeeding, which helps the mom's uterus contract and reduces bleeding immediately after delivery." It's important to keep your newborn warm, as babies lose body heat very quickly.
When writing your birth plan or discussing the delivery with your doctor or midwife, specify how you want that first hour to go, says Meagan Francis, a mother of four and co-author of One Year to an Organized Life with Baby (Da Capo Press). "If the baby is healthy, most everything can be put off a little while to give you one-on-one time," she says. As with all medical care, you have the right to question or refuse any treatment that doesn't sit right with you.
In the meantime, you'll have to deliver the placenta. The placenta may slide out within minutes after the baby, or may take as much as 30 to 60 minutes. The placenta is about one-fifth the size of the baby. It has no bones and is soft, but you may still feel intense cramping.
After the placenta is delivered, you will receive medication call Pitocin (oxytocin). Pitocin can be given as a separate injection or mixed with the IV fluids you are already receiving. Pitocin will help your uterus contract so you won't bleed excessively. To achieve the same effect as Pitocin, your uterus may be externally massaged, or your nipples may be stimulated, or your baby may be put on your breast to suck.
Your midwife or doctor will then inspect your genital area for lacerations. Any lacerations and the episiotomy (if one was performed) will be repaired. A small amount of local anesthesia will be used to numb the area, so during the repair you may feel a little pressure but not pain. You or your partner may be holding your baby, or he may be placed in the warmer. Bonding is a lifelong process; it does not just happen in the moments after birth. Most moms are exhausted and just need to rest during the repair. This a good time for the new dad to be with his baby. Or the nurse may be caring for your baby at this time.
After the inspection and repair are completed, the area will be cleaned with warm water. A sanitary pad will be placed under your perineal area. You'll be helped into a clean gown and then covered with a warm sheet or blanket. Some moms shiver intensely and this warm sheet helps it resolve. Then you'll finally be able to rest. You may be very hungry and it'll be okay to eat and drink.
Both parents should hold, stroke, kiss, and talk to their newborn baby. Talking is important – your baby already knows your voices and will be soothed by the familiar sounds! You might try breastfeeding if you're not too exhausted. Your baby will enjoy sucking, but he won't be hungry yet. Although family and friends may be waiting outside or expecting a phone call, a little quiet time together as a new family is a good idea.
After a couple of hours, you might be transferred to a postpartum room. Other hospitals offer LDRP (labor, delivery, recovery and postpartum) rooms.
What’s more, some facilities embrace "family-centered care," offering private postpartum rooms that include a fold-out bed for your partner. Rooming-in, or having your baby with you at all times, is also increasingly popular, and in some hospitals, it's obligatory. While this practice provides a nice opportunity to bond with your baby, it's also OK to let her spend a few hours in the nursery while you sleep. If you do so, tell the nurses whether they can give your baby formula or you want her returned to you for feedings.
If you'd like to breastfeed but it's not coming easily, ask to see a lactation consultant. (Large hospitals usually have one on staff.) It may also help to adopt a "no visitors" policy while breastfeeding, says Portland, Ore.- based maternal health nurse Jeanne Faulkner, R.N. "Some babies – and moms – need peace and privacy to learn the big job of nursing," she says.
Faulkner, who writes the Ask The Labor Nurse blog, also suggests using your room call button wisely. "Don't hesitate to ask for help from your nurses and hospital staff, but consider asking for several things at once, such as ibuprofen, juice, and breastfeeding help. Clustering requests lets nurses provide more focused, efficient care," she says. And if you decide to shower after you deliver, don't do it alone. Postdelivery fainting is common and it happens most often in the shower because the hot water causes blood pressure to drop, says Faulkner. Use the shower bench and ask your partner, a friend, or a nurse to watch over you.
The hospital staff will also be keeping a close eye on your newborn. Don't be surprised if a wireless tracking device is attached to your baby's ankle. "If your baby is taken too close to an exit, the doors will go into lockdown mode," McKeever explains.
Many insurance plans cover a two-day hospital stay for a vaginal delivery and four days for a C-section. However long you stay, a few things are required before you leave:
A pediatrician will examine your baby and administer a heel-stick blood test, which screens for several metabolic disorders, such as phenylketonuria. Some states perform a hearing screening as well.
The staff will make sure that you're healing properly – i.e., that your uterus is contracting and your bleeding is slowing. You're likely to have heavy bleeding that lessens with each subsequent day, finally letting up in about six weeks.
They'll determine that your baby is able to breastfeed or bottle-feed successfully and that you understand how to perform basic tasks such as bathing, caring for the cord stump and diapering.
You'll need to fill out a birth certificate even if you haven't named your baby yet.
If possible, have someone take home gifts and flowers the day before you leave so that your last day is less hectic, McKeever suggests. Also, make sure your vehicle is equipped with a properly installed car seat that you know how to use – you don't want vexing straps and buckles to delay your happy homecoming.