You and your baby: the first hours and days after

‘I remember looking out of the hospital window thinking how strange it was that the rest of the world carried on as normal while I was in there going through a life-changing experience,’ says Estelle, mum to Isabel, 8 months.

Your baby after birth

Birth is a shock to the system, and not just for you! For your baby, the birth has been exhausting, and he’s now in an unfamiliar world. The sense of space around him and the feeling of air on his skin are new and strange. While he was inside your womb, your baby’s oxygen supply came through the placenta directly into his bloodstream.

The moment he emerges into the air, the change in temperature gives his lungs the signal to start working, and he’ll take his first gasp of air – usually accompanied by his first cry. As soon as your baby starts to breathe, the placenta stops working.

‘I had an emergency caesarean for the birth of my daughter and as I lay there I heard someone say, “Here’s baby”. But then silence. It seemed like minutes, with no-one saying a word and me not being able to see anything that was going on. Suddenly, this little cry went up and the whole room seemed to breathe a collective sigh of relief. I looked at my husband and tears were streaming down his face. What a moment!’ says Lindy, mum to Kirsten, 6 months.

The umbilical cord, which links your baby to the placenta, needs to be cut so your newborn can begin life as a separate being from you. But it has already stopped functioning by this stage, so your baby won’t notice that it has been cut. The cord has no nerves, so neither of you will be able to feel the snip.

The Apgar test

Immediately after the birth, the midwife or doctor will do the Apgar test. This is a quick and painless way of assessing your baby’s wellbeing. It looks at five things:
*heart rate
*respiration (breathing)
*muscle tone
*skin colour
*reflex response

The test is done a minute after birth and again at five minutes. Each of the five areas is given a mark between one and two, and the scores are then added together to give an overall total.

The maximum mark is 10, and babies who score between 8 and 10 are fine, while those with a result of between 5 and 7 may need a little help, such as a good rub to warm them up or a few puffs of oxygen to help their breathing. Newborns who score below 5 are more poorly and may need to be taken to the special care baby unit for extra help (for more info, see our Special care babies section of this article).

You’ll also be asked if you’re happy for your baby to be given a dose of vitamin K. In very rare cases, newborns don’t have enough of this vitamin, which means their blood doesn’t clot properly. So all babies are offered an injection (or, occasionally, a dose given by mouth) at birth.

Bonding with your baby by touch

The best way to bond with your baby and make him feel loved, secure and contented, is to spend lots of time touching and cuddling him. Never be afraid that cuddling your baby too much will ‘spoil’ him. All creatures, particularly mammals, use physical contact to help their young get used to life outside the womb, and a young animal wouldn’t thrive if it were separated from its mother in the first days of life.

Babies crave touch, and you’ll notice immediately that picking baby up calms him if he’s crying or unsettled. Sometimes he’ll be unhappy for no other reason than he wants to be held. He can’t talk, so being physically close is the only way he can express his sociable nature.

‘The birth was hard, and feeding didn’t go well to begin with, which was stressful,’ says Jane, mum to Nathan, 18 months. ‘Then early on our second morning in hospital, while everyone else was asleep, I lifted my baby boy, took off his sleepsuit and let him curl up on my chest. As I looked down at his tiny head and felt him breathe, I knew I loved him more than I could have ever imagined, and that everything was going to be okay.’

If your baby has to be taken to a special care unit, you may not be able to enjoy as much skin-to-skin contact. But rest assured, this shouldn’t affect long-term bonding, and there are other things you can do (see Special care babies section).

Your newborn’s body after birth

Midwife Yvonne Faulkner on how your baby’s body changes after the birth:
*Your baby’s head may be misshapen, because the bones of his skull are soft and move across each other to protect his brain as he moves through the birth canal. He’ll also have a soft spot on the top of his head (the fontanelle), where the skull bones haven’t yet fused.
*Your baby’s eyes may look puffy due to the pressure they’ve been under during contractions. Your baby’s eyes will be dark blue – his true eye colour will develop over the next months.
*Your baby’s skin may be covered in vernix – a white coating that protected him in the womb.
*Your baby’s hands and feet will be curled up and his legs tightly flexed, but he’ll straighten out over the next few days.

Special care babies

If your baby has to be taken to the special care baby unit (SCBU or neonatal unit), it can be upsetting and confusing.

Within the special care baby unit there will be an intensive care section for very sick babies, and a high-dependency part for newborns needing intravenous feeding or help with their breathing. The rest of the unit will be devoted to babies whose needs are less serious.

Bonding with your special care baby

If your baby is in the special care baby unit, you may miss out on having skin-to-skin contact with him. Don’t be worried that this will affect bonding with your baby – even tiny, premature little ones are now encouraged to have close physical contact with their parents.

Robin Bishop, spokesperson for BLISS, the premature baby charity, has this advice for parents with children in special care baby units:
*Talk. Your baby will know your voice and find it reassuring.
*Touch. This has been shown to benefit premature/sick babies. If your newborn is very tiny or ill, you may only be able to do ‘containment holding’ – putting your hand gently on your baby’s body for a few seconds. If he’s stronger, many special care baby units encourage ‘kangaroo care’, where newborns are snuggled against their parents’ skin.
*Feed. Breastmilk is easily digested and has antibodies to help your baby fight infection. He may be too weak to suckle, but expressed milk can be given via a feeding tube.
*Get support.Ring the BLISS Parent Support Helpline on 0500 618 140.

Feeding your newborn baby

In the first hours of your baby’s life, if not immediately after the birth, you’ll be encouraged to offer your baby a feed. Your midwife will ask you if you want to breast or bottlefeed. If breastfeeding, you’ll be offered help to get your baby latched on. If you’ve chosen to bottlefeed, the hospital may provide bottles of formula.

Don’t worry if your baby doesn’t seem interested in feeding to begin with: he’ll be tired from the birth and may just want to sleep. You’ll have plenty of opportunity to keep trying over the next day or so. While some babies take to breastfeeding immediately, others need a bit of time and practice.

Even if you’ve successfully breastfed a baby before, it can be tricky getting a floppy, tiny newborn positioned correctly, and a bit of help from a midwife or your partner can make all the difference, so don’t be afraid to ask.

Midwives see breasts every day, and help thousands of women feed their babies, so they don’t think twice about giving your nipple a squeeze to get some milk out or pushing and pulling your breast to get it into your baby’s mouth.

This can be a bit disconcerting, but unfortunately when you feed a baby your breasts are no longer the private, hidden parts of your body they once were. They become much more functional and public, so you may as well get used to it early on!

You may be encouraged to try a bottle if your baby doesn’t take to breastfeeding in the first couple of days. Remember, however, that hospitals have breastpumps and you can ask to be shown how to use one to express your own milk for your baby, so you can persevere with breastfeeding until you both get the hang of it.

‘My experiences of breastfeeding in the first hours were different with each baby,’ says Penny, mum to Cameron, 2, and Alfie, 3 months. ‘My firstborn had swallowed meconium and mucus during the delivery and didn’t seem to be hungry or to know how to suck. It made the first day and night very hard, as I kept trying – and failing – to feed him and was becoming anxious. It wasn’t until I was relaxed at home that it came together, and I breastfed him for nearly a year. My second little boy knew what to do straight away, and had a small feed within minutes of birth. I was so relieved, and it made the initial day a happier experience than the first time round.’

Tests and health checks for your newborn baby

Within the first day or so, your baby will have a 24–hour check. If you leave hospital quickly, your GP will come to your home to do this. The test is a thorough top-to-toe check, and looks at the following:
*Weight, length and head circumference. These measurements will give you a starting point for plotting your baby’s growth over the next months and years.
*Eyes, ears and mouth. The doctor will check for any obvious hearing or sight problems, and for things like cleft palate or tongue-tie (where the tissue joining the tongue to the floor of the mouth restricts movement of the tongue).
*Heart and lungs. The doctor will listen to your baby’s heartbeat to check for irregularity or murmurs, and to his breathing.
*Spine. Your baby’s spine will be checked for straightness, and his legs given a wiggle to rule out clicky hips (where the hip joint is too loose and the thigh bone dislocates itself).
*Hands and feet. These will be looked over to check for webbing and talipes (club foot).
*Genitals. Baby boys will be examined to see if both testicles have descended and that the hole where wee comes out is at the end, not round the side. The doctor will also check your baby’s bottom and ask if he’s done a poo yet.

Your newborn may also have a separate hearing check, using a small machine that tests how an echo is bounced off the inside of the ear.

Within the first week, your midwife will give your baby a heel prick test, which involves taking a small amount of blood from his heel using a tiny needle. The blood will then be tested for enzyme or thyroid deficiencies and, in some areas, for cystic fibrosis.

Your midwife will visit you at home for the first 10 days after the birth, so this is the time to raise any concerns you may have about either your health or your baby’s.

Your body after birth

Midwife Yvonne Faulkner on your body after the birth:
*If you’ve had a vaginal delivery, you may feel bruised, and if you’ve had stitches there may be swelling, too. This will go down over the following few days, and your midwife will advise you on how to avoid infection. Any stitches you’ve had will dissolve.
*In the first 36 hours after the birth, you may experience ‘after-pains’ as your uterus contracts. In particular, you’ll feel them when you feed your baby, as breastfeeding triggers oxytocin, a hormone that stimulates contractions.
*After-birth bleeding, called ‘lochia’, is like a heavy period for the first couple of weeks, but will continue more lightly for anything up to 8 weeks. You’ll need plenty of maternity pads, but you can’t use tampons as they could cause an infection.
*If you’ve had a caesarean, you’ll be in pain from your scar, for which you’ll be given painkillers. You’ll find it hard to get up and about for the first few days, but it will get easier. You should avoid strenuous activity for at least six weeks.
*Your breasts will be soft initially. You only produce colostrum, a thick, yellow early milk, for the first few days, but your milk will come in on day three or four, when your breasts swell and may feel hot and tender.

For more on labour, birth and your newborn, don’t miss Practical Parenting magazine each month.