The birth of a new baby is extraordinary, but can be a completely overwhelming time in your life. Particularly for first-time parents, there are going to be surprises and unexpected hurdles along the way, explains maternity nurse and postnatal advisor Katie Thomas.
The First 24 Hours
Depending on the length of pregnancy and type of birth, your newborn baby will enter this world generally a shade of blue, quickly turning to pink, with a swollen face and eyes, possibly jaundice (a yellowish skin colour due to an excess of bilirubin in the blood), and covered in a little or a lot of vernix – a greasy, white, cream-cheese-like substance. A soft, fine layer of hair called lanugo may cover your baby to help hold the vernix on their skin, which together form a protection against the long immersion in amniotic fluid during pregnancy.
Lumps and bumps, mild skin rashes, birthmarks, hormone spots, swollen genitals, and a pulsating, soft fontanelle on the top and back of your newborn’s head are all completely normal, but somewhat disconcerting for new parents. Your LMC will be there to reassure you of what is normal, and to look out for any abnormalities. If your baby is born vaginally, their skull may have formed a strange-looking cone shape, as the bones moulded together to allow passing through the birth canal; this will slowly adjust in the following few days as the bones gradually move. Babies born via Caesarean (C-section) usually have perfectly round heads.
The First Few Minutes
All going well during and after the birth, your baby will be placed on your chest while the placenta is delivered and the umbilical cord cut. An Apgar score is taken one minute and five minutes after birth, checking and recording your baby’s Appearance, Pulse, Grimace (reflexes), Activity and Respiration.
Your baby will let out a few cries and settle with your reassuring touch while gazing up into your eyes. Your new baby can see around 20-30cm, and is fascinated by faces and contrasting colours. Having crossed or bloodshot eyes can be alarming for parents, but this is normal and will generally go away within a few days. Newborns can usually hear loud and clear by the time they are born, being easily startled by loud noises, even their own cries!
If you have had pain relief during labour, you may be drowsy, sedated, dizzy, itchy, nauseous, or have distorted vision. If the medication has crossed the placenta, the effects on the baby can be drowsiness, slow initial breastfeeding, inability to regulate body temperature and, in some cases, the baby’s breathing can be affected (known as respiratory depression). These situations will be closely monitored by your LMC.
Instinctively, your baby has reflexes present from birth; they work as survival skills due to your newborn’s lack of control over their body. These include the root reflex (turning to find food when anything brushes their cheek), sucking reflex (sucking on whatever is in their mouth), moro reflex (startling at loud noise or the sensation of falling), babinski reflex (flaring of toes when sole of foot is stroked), stepping reflex (walking movement when baby is held upright on at surface), tonic reflex (baby turns head and same side arm reaches out when lying down), and grasping reflex (hand grasps finger or object when placed in palm).
The First Latch
Within the first hour or two following birth, your baby will find your breast and gradually start sucking. Not all situations will allow this immediate breastfeeding to occur, and if bottle intervention or syringe feeding is needed, remember that breastfeeding will most likely still be an option when your baby is ready. Stay as calm and positive as possible. The sooner they are able to latch on and suck, the sooner the hormones will be produced to begin the milk let-down process and the uterine contractions.
These contractions, known as “after pains”, are completely normal and are due to the involution of the uterus (contraction back to non-pregnant state). They should ease after two to three days, though it can take up to six weeks for your uterus to return to its normal size. The cramp-like pains are often worse while breastfeeding, as your baby’s sucking triggers the release of the hormones that cause the contractions.
The first milk your breasts produce is called colostrum; also known as “liquid gold”, as it is a thick, yellowy liquid full of nutrients and antibodies. After two to four days of colostrum, you will gradually start producing normal milk. Signs of this are breast fullness, leakage, warmth, swelling, heaviness, and tingling.
Your baby will probably be very sleepy following birth, as adjusting to the outside world requires plenty of sleep within the first few days and weeks. Your newborn will be waking every two to three hours to feed, meaning multiple feeds throughout the day and night, so rest when you can.
Baby’s First Bath
Bathing your newborn baby can be a daunting exercise. Most babies love the water from the beginning, and it is a beautiful, calming activity for all, but some babies take a while to warm to bathing. Depending on where and how you birthed, your baby may be given a bath before you head home. Your midwife or nurse will be there to help and guide you if necessary, until you feel content to do it alone.
Umbilical Cord Stump
The umbilical cord stump will dry up and fall off anywhere between six days and four weeks after birth. So long as there is no sign of infection (thick, red skin around the base or yellowish pus), there is no reason for concern. Keeping it clean and dry, washing gently with fresh water, drying thoroughly, allowing time to air it out, and folding down the front of the nappy to avoid aggravation will help the healing and falling off process.
Meconium is a greenish- black, thick, sticky, tar-like poo that your baby will be passing for the first few days. The colostrum will help baby pass the meconium, which has built up in their gut throughout pregnancy. Following this, the stools will gradually become a lighter greeny-yellow and be a lot easier to clean up! Putting a little natural oil on baby’s bum after the first nappy change, will make the meconium a lot easier to clean.
The First Two Weeks
Following birth, there is a huge shift in a new mother’s hormone levels. Some levels increase with the production of milk, but many levels drop after the birth of the placenta, which was a factory for hormones during pregnancy. This can cause extreme emotions for an already tired and overwhelmed new mother. It is completely normal, and between 70-80% of mothers experience a drop in mood around three to six days after the birth of their baby. It is known as the “baby blues” and should pass within two weeks with adequate rest and support from loved ones. If you still feel you are irritable, depressed, anxious, and tired but unable to sleep at around three to four weeks following the birth, you could have postnatal depression, and should seek help from your midwife or health care provider.
Swaddling your baby in a wrap or muslin for sleep times can be extremely useful to help settle and ensure long, deep sleeps. The moro reflex is strong in most newborns and doesn’t disappear for three to four months. Swaddling nice and snug around their arms means any startling caused by a noise, sensation, or change in sleep cycle will hopefully not wake your baby, as their arms can’t instinctively fling outward. A newborn baby’s ability to regulate their temperature is not developed at this stage, meaning you need to be aware and careful about appropriate clothing and their environment. A general rule is that your baby should be dressed in one more layer of clothing than you are.
Don’t overdo it
Over this first week at home with your baby, you will find that friends and family start requesting visits and making offers to help. Be aware of your own feelings and needs and only accept help as you need it. Having close family or a friend over to mind the baby while you get some rest, or to clean, cook, or care for older siblings are all practical ways of welcoming help. Be clear with family and friends about timing and the nature of visits, as it is important to ensure you don’t overdo it and miss out on vital rest time.
Getting the hang of it
By week two with your baby, your hormones are hopefully now regulating and you are getting the hang of newborn care. There is still a lot to figure out, but hopefully you’ve found a little rhythm with your baby.
Your healing body
Lochia is the vaginal discharge you will experience following the birth. Containing blood, mucous, and uterine tissue, it will be bloody for the first few days, and then will gradually change to brownish or pink, then to yellowish. It should gradually ease and be gone in four to seven weeks.
Engorgement is when you are producing greater quantities of milk to keep up with your baby’s growth, meaning that your breasts can feel full, hard, hot, swollen, and painful. Feeding frequently and applying a warm compress or having a warm shower before feeding can help ease discomfort.
Incontinence when sneezing or coughing, leaking breast milk (particularly when you hear your baby cry), and having pain when passing urine are all common (running warm water over your vulva or sitting backwards on the toilet seat can help).
Your baby’s cries
All babies cry. It can be hugely upsetting to new parents when the cries are indecipherable and seem inconsolable.
Crying is your baby’s main method of communicating with you when they are in need. Whether your baby is hungry, has wind, is tired or overtired, is hot, cold, scared, or uncomfortable, they will most probably cry to let you know. Some people seem to easily tune in to these cries, while others use a process of elimination to figure out what their baby is attempting to communicate.
As your baby gets older and you get more and more in sync with each other, you will find it easier to decipher these cries. If you are finding there is a period in the day of uncontrollable crying, and you believe colic or reflux may be an issue, talk to your midwife or health care provider.
The First Month
By one month, the sleep deprivation has really kicked in, and you probably feel like the night wakings are never going to end. It will get easier as your baby establishes a feeding and sleeping pattern. If you want to create a routine, now is a good time to encourage feeding at particular times, and setting a nighttime routine to help differentiate day and night can be really useful. Ensure you limit your baby’s awake time, as a baby of this age can generally only cope with one to one-and-a-half hours awake. Getting out and about for walks is highly beneficial for you and baby. It’s amazing what a change of scenery and fresh air can do.
Other people’s opinions
Everyone has an opinion when it comes to babies, and this can be one of the biggest challenges for new parents. Books, google, social media, hospital staff, family, and friends may overwhelm you with their conflicting advice and opinions. Well-meaning but misdirected or irrelevant advice can make new parents feel inadequate, try to trust your gut and follow your instincts. If you can, find one or two trusted people you can turn to for guidance and filter out the rest.
Remember, this too shall pass – try to keep these weeks as simple and calm as possible. Stay mindful and try to focus on the small, wonderful moments. It is such a precious time that you can never get back, and as difficult and demanding as it may feel when you’re in it, you will miss it. Contact Katie for support and guidance.