Kelly was the first of her friends to have a baby. When she found out she was pregnant, her first emotion was pure elation. Every time she thought about being a mom, she became more and more excited.
As the big day drew nearer, though, a different kind of feeling took hold: trepidation. What would it be like to birth a baby? Would it be as painful and arduous as the media portrays it? Should she think through her birth plan beforehand?
As she researched on her own and heard from acquaintances about their birth processes, she wondered if there were hidden tricks to making her experience easier, ones they didn’t teach you in prenatal classes. Social media certainly suggested there were. It seemed as if every mom who came before her had a tale to tell or an infographic to share on the internet. She scoured Pinterest for as much secret intel as she could find only to realize afterward that most of the guidance wasn’t accurate or appropriate for her individual birth situation.
I’m not sure when Pinterest became the go-to information source for moms-to-be. It has simplified checklists for all things in the pregnancy and birth preparation realm, that’s for sure. There are sample checklists for what to bring to the hospital, for how to pack for postpartum needs, and for what to include in your birth plan (the most successful moms I meet have a very simple birth plan of “keeping mom and baby healthy and safe,” by the way).
I think the cultural obsession we have with planning and controlling the birth and postpartum period is rooted in fear. We’re scared it will all go wrong. And we’re a little bit right; sometimes it goes wrong. But usually, it goes just fine, and the superficial checklist items we make sure we address before baby comes are definitely not the deciding factors in our success. It will all be OK no matter what labor playlist you curate or which bathrobe you pack. It will work out no matter which newborn outfit you buy for the car ride home.
There are, though, factors that play a role in helping you and your baby get off on the right foot. The first is having a basic understanding of how the hospital system works and who the main players are in your care. Knowing this information can help you self-advocate effectively. The second is an understanding of the normal hospital postpartum timeline, so that you can prepare yourself for what will happen to most new babies in the first hours to days.
In the hospital, nurses are the main people who take care of babies. They’ll do all the initial weighing, measuring, and monitoring. If you are in a traditional hospital setting, a pediatric specialist, either your pediatrician (or someone from your pediatrician’s group) or a pediatrician who provides coverage for the hospital, will also check on your baby to make sure everything is OK.
The nurses are your main source of help with breastfeeding while you’re there. Take advantage of their expertise and time to make sure you feel as confident as possible with the way your baby is latching during breastfeeding. Because your nurse will be coming into your room to check on you and your baby at regular intervals throughout your stay, you’ll have multiple opportunities to ask your nurse to verify baby’s positioning at your breast and to assist as you start off on your breastfeeding journey.
It may feel as if the doctor is never around. In fact, the nurses have 24-7 private line access to a pediatric expert. They will call right away if they are concerned about your baby’s feeding or health.
Following are common things to expect when your baby is in the hospital.
Vitamin K is a substance in the blood that helps the clotting process (coagulation). Clots are little clumps of platelets that help keep your body from bleeding when it is not supposed to. For example, when you scrape your knee, your body forms a clot. Some people’s bodies don’t have enough of vitamin K and cannot form these important little clumps. It wouldn’t be that big of a deal if we were just talking about scraped knees, but clots are important in preventing bleedings in the brain, in the gut, and everywhere in the body. It’s very difficult to know at birth who has and does not have enough vitamin K, so all babies are given this as an injection in the hospital.
When babies come through the birth canal, they are exposed to bacteria in the vaginal canal. Some of these are helpful ones that populate your baby’s skin and his gastrointestinal tract, but some could be harmful. Although you may be 100% confident in your sexually transmitted infection (STI) status and, if you had prenatal care, could have had STI testing in pregnancy, erythromycin ointment is given. This is an ointment that we put into babies’ eyes to make sure that, in the very off chance an infection was missed, the infection does not spread to the baby’s eyes and cause permanent damage.
Jaundice is the yellow color of skin that results from a product called bilirubin in the blood. Bilirubin has healthy antioxidant properties and is useful in small amounts to us, but when there is too much, it can cross what is called the blood-brain barrier and cause problems in the brain.
Jaundice can be caused by a variety of things, but in the early days, one of the main reasons a baby gets jaundice is because he is not feeding well enough.
Twenty-four hours after birth, all babies in the hospital have a bilirubin test. This helps doctors see whether they need to do anything to intervene if the level is really high. A specific intervention called phototherapy (light therapy) can be used if the level of bilirubin is too high, and your nurse and provider can work together to figure out the cause of the jaundice. Typically, babies requiring phototherapy in the hospital are placed into an incubator with special lights attached along with a light-therapy blanket. During the treatment, your baby will wear a protective covering over his eyes.
Hepatitis B is a serious disease that can affect the liver and lead to permanent damage or cancer. Although many people think of hepatitis B virus as affecting only users of IV (intravenous) drugs or those with high-risk sexual behaviors, it is highly contagious for a baby when she comes through the birth canal as well. Newborns especially are considered susceptible to hepatitis B virus and are more likely to have severe consequences. Some have acquired hepatitis B virus without known significant contact, so it is best to protect all babies from this virus and the serious disease it can cause.
The younger you are, the more likely you are to contract hepatitis B virus if you are exposed to it and the more likely you are to have permanent, serious problems from it. In my practice, we recommend the hepatitis B vaccine before discharge from the hospital, and then your baby will receive boosters later on in infancy.
Newborn screening is a public health effort to catch treatable diseases early on in babies that could otherwise be devastating, such as cystic fibrosis, thyroid disease, and metabolic disorders (of which babies can die suddenly because they can’t process sugars or proteins correctly). All 50 states have a newborn screening program.
Getting your baby tested involves a tiny heel prick. The blood is then sent to the state and the screening program contacts you and your baby’s doctor right away if there is an issue. No news is good news for the newborn screening program. Generally, this test is done in the first few days after birth. If your baby is born at a birthing center or leaves the hospital early, a second test by 2 weeks of age may be recommended.
All babies have a hearing screening before they leave the hospital. Some babies have a little bit of fluid in their ears when they are first born and will “fail” the screening for that reason. The hospital will set up a repeat screening or will give you instructions on how to arrange the repeat screening before you leave the hospital. It’s really important to follow up if there was any initial concern, because hearing deficits can impede language development significantly, and if we catch them early, we can intervene as soon as possible.
Several rare issues with a new baby’s heart can manifest in the first few hours, days, or weeks after birth. Most hospitals have instituted a screening protocol to catch most of these issues. It can’t catch everything, but it can catch a lot. A tiny, painless sensor, called an oxygen saturation monitor, will be put onto your baby. This will read how much oxygen is in your baby’s blood, giving experts a great indicator of how her heart is doing.
For a baby born via vaginal delivery, most moms stay in the hospital for 2 nights. For cesarean deliveries, the general rule is 3 to 4 nights (federal legislation allows 48 hours for vaginal delivery and 96 hours for cesarean delivery).
Imagine you are in my hospital. In my hospital, a doctor performs an initial baby checkup within the first 24 hours after a baby is born, usually the morning after the baby has been delivered. On that first visit, we’ll review what happened during the delivery, talk with the nurses about any concerns they have, come into the hospital room to talk with you about any concerns you have, examine your baby (the nurses will have already done this, but we do our own look), and make a plan for the day.
The plan is not that complicated: it’s generally rest, eat, get as much help as you can from your nurses, and focus on learning how to feed your baby. Your early breast milk, called colostrum, has a ton of amazing benefits for your baby, such as antibodies and antioxidants, but there are small amounts of it, so you will need to feed frequently. In a few days, when your baby needs more milk, your supply will have increased.
Unless there are problems, such as your baby needs extra attention for feeding problems or the doctor has concerns about infection, we’ll come back to see your baby on the day she is ready to be discharged from the hospital. On that day, we’ll go over how to feed your baby and signs of infection to look for.
It’s also important to set up an appointment with your baby’s pediatrician. This appointment date depends on how things are progressing with your baby. For second-time parents and for parents of babies for which everything seems to be hunky-dory, we’ll generally see you 2 to 3 days later. If we are concerned, we’ll see you the next day in clinic.
My number 1 tip?
Stay in the hospital for the full amount of time your insurance allows if possible. A lot of parents ask me whether they can leave at the 24-hour mark. If things are OK with baby, that is a possibility, but I encourage them not to. Besides the actual delivery, the second 24 hours after birth are when babies tend to have issues.
Michelle and her partner could hardly wait to go home after their first little girl was born. They thought they would be more comfortable learning how to breastfeed in their own space instead of a hospital room. Besides, they lived only a few minutes from their pediatrician’s office and it would be easy to take the baby in for visits as needed. Michelle delivered her baby at 8:00 am on a Tuesday and was home by noon on a Wednesday.
The first night after delivery, the baby was sleepy and latched well. The second night, however, was more stressful. Michelle and her partner struggled to help their baby latch well and worried when she spit up a few times.
“We wished we stayed a little longer at the hospital,” she said to me in the office a few days later.” Yes, our bed was more comfortable and familiar, but we were not comfortable or familiar with taking care of our new baby yet, so it didn’t really matter. In the end, we could have used the extra support and attention we received from the hospital’s nursing staff for a little longer.”
When parents leave the hospital, I find that there is a range of worrying, sometimes a little, sometimes a lot. It’s a Goldilocks situation that is very hard to understand. Even the experienced freak out a bit. I freaked out with my first child, and I had been giving parents advice for years about how to raise a new baby. That’s typical. You have fluctuating hormones and you have never been responsible for another human being before.
One important rule about newborns that many new parents soon learn: they change rapidly, and their needs are not always consistent nor intuitive. What is true for their fluid needs right at birth is extremely different from their needs at 2 days, 3 days, and 4 days. Things ramp up really quickly (or at least should), and things that seem like no big deal (a small fever) can be a really big deal.
In all honesty, there really is no worrying too much when it comes to a newborn. What can happen, though, is the balance tips and you don’t get the sleep you need because of anxiety, and your baby starts to pick up on the fact that you are uncomfortable.
The way to prevent this? Set yourself up with help from a lactation specialist or a doula so that you have a touch point along the way to reassure yourself and to guide you on the many little things that can go wrong. Ask for the doctor’s appointment to be sooner once you are discharged. Stop searching the internet. Instead, look at or access reputable sources of information: doctors, nurses, lactation specialists, or quality books about newborns.
At our office, we also have a 24-hour nurse line. I encourage new parents to call this as often as they need to. “You are not bothering us when you call us,” I say to parents. “You are the people we hope will call us when you are concerned.”
The day you go home with your baby can be really awesome and a little terrifying. If you find yourself terrified, take a deep breath and consult the resources you have around you. I advise new parents to make a short emergency contact list for their phones or refrigerators before they head out the door and back into the “real world.” Include the hospital, pediatrician advice line, close friends, and family.