Birth: The first 24 hours

Birth: The first 24 hours

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 nanny and postnatal advisor Katie Thomas.

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.

Instinctive reflexes 

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 flat 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 may still be an option when the time is right. 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 confident to do it alone.

Umbilical cord stump 

The umbilical cord stump will dry up and fall off anywhere between seven days and six 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 aggravating it will help the healing and falling off process.

First poos 

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!