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Welcome to Motherhood: The First Hours

by Dr. Preeti Bhandari | Mom To Be

The first hours after birth are magical, overwhelming, and unlike anything you’ve experienced. Here’s what to expect.

Immediately After Delivery

Skin-to-Skin Contact

Baby placed directly on your bare chest:

  • Immediately after delivery (if all is well)
  • Still wet and covered in vernix
  • Umbilical cord may still be attached
  • Warm blanket placed over both of you

Why skin-to-skin matters:

  • Regulates baby’s body temperature
  • Stabilizes blood sugar and heart rate
  • Promotes bonding
  • Supports successful breastfeeding
  • Reduces stress hormones (yours and baby’s)
  • Baby recognizes your smell and voice

The “golden hour”:

  • First 60-90 minutes after birth
  • Critical bonding time
  • Baby most alert
  • Best time for first feeding
  • Most procedures can wait

Even after C-section, skin-to-skin is possible (often in recovery room).

Delayed Cord Clamping

Waiting before cutting umbilical cord:

  • Typically 1-3 minutes after birth
  • Allows blood transfer from placenta to baby
  • Increases baby’s iron stores
  • Reduces anemia risk
  • Recommended by medical organizations

When cord stops pulsing:

  • Clamped in two places
  • Cut between clamps (by partner or provider)
  • Small stump remains attached to baby

The stump:

  • Will dry up and fall off in 1-3 weeks
  • Keep dry until it falls off
  • No pain (no nerves in cord)

Your Baby’s First Exam

Initial assessment happens while on your chest (usually):

Apgar Score (1 and 5 Minutes)

Quick assessment of baby’s condition:

Five categories scored 0-2:

  • Appearance (skin color)
  • Pulse (heart rate)
  • Grimace (reflexes)
  • Activity (muscle tone)
  • Respiration (breathing)

Score of 7-10: Normal (most babies)

Score of 4-6: May need assistance (oxygen, stimulation)

Score of 0-3: Needs immediate medical help

Done twice:

  • 1 minute (how baby tolerated birth)
  • 5 minutes (how baby is adapting)

Low score doesn’t predict long-term health. It’s a snapshot of that moment.

Quick Visual Check

Healthcare provider observes:

  • Breathing normally
  • Good color (pink, not blue/pale)
  • Active and responsive
  • No obvious abnormalities

If everything looks good, baby stays with you.

First Feeding

Breastfeeding

Baby’s natural instincts:

  • Born with rooting reflex (turns toward touch on cheek)
  • Crawling movements toward breast
  • Can find nipple and latch in first hour

First feeding attempt:

  • May happen immediately or within first hour
  • Baby may latch and suck, or just nuzzle
  • Colostrum (first milk) is ready
  • Small drops are perfect for tiny stomach
  • Practice makes perfect – don’t stress if difficult

Colostrum:

  • Thick, yellowish first milk
  • Packed with antibodies and nutrients
  • Small amounts (teaspoons)
  • All baby needs for first days
  • “Liquid gold”

Nurse will help:

  • Positioning baby
  • Getting good latch
  • Answer questions

Don’t worry if first attempt doesn’t work perfectly. You’ll have many more chances.

Formula Feeding

If you’re not breastfeeding:

  • Formula can be given in first hours
  • Hospital provides formula and bottles
  • Nurse will show you how to prepare and feed
  • Hold baby close (skin contact still beneficial)

Your choice is valid – fed is best.

Full Newborn Examination

More detailed exam, usually within first few hours:

Measurements

Weight:

  • Average: 2.7-4 kg (6-9 lbs)
  • Range: 2.5-4.5 kg is normal

Length:

  • Average: 48-53 cm (19-21 inches)

Head circumference:

  • Average: 33-36 cm
  • May be large from molding during birth
  • Will round out in few days

Head-to-Toe Physical Exam

Pediatrician or nurse checks:

Head:

  • Fontanelles (soft spots) – normal and expected
  • Molding from birth canal (temporary)
  • Possible cephalohematoma (swelling/bruising)

Eyes:

  • Red reflex (rules out cataracts)
  • Clarity
  • Eye ointment applied (prevents infection)

Ears:

  • Shape and position
  • Hearing screen scheduled

Mouth:

  • Palate intact (no cleft)
  • Tongue (can move properly)
  • Sucking reflex

Heart and lungs:

  • Listen with stethoscope
  • Check breathing
  • Heart rhythm and sounds

Abdomen:

  • Soft, not distended
  • Umbilical cord checked

Genitals:

  • Normal development
  • Boys: testicles descended
  • Girls: normal appearance

Hips:

  • Checked for dysplasia (hip problems)
  • Specific tests to ensure proper formation

Spine:

  • No gaps or dimples

Skin:

  • Color
  • Birth marks (often fade)
  • Rashes (common and usually harmless)

Reflexes:

  • Rooting (turns toward touch)
  • Sucking
  • Grasping (holds finger)
  • Startle reflex (Moro)
  • Stepping reflex

Newborn Procedures

Vitamin K Injection:

  • Given in first hour
  • Prevents bleeding problems
  • Babies born with low vitamin K

Eye Ointment:

  • Antibiotic ointment
  • Prevents eye infections
  • May blur vision temporarily

Hearing Screen:

  • Painless test
  • Checks hearing in both ears
  • Done before hospital discharge

Newborn Screening (Heel Prick):

  • Blood test
  • Usually at 24-48 hours old
  • Screens for metabolic disorders
  • Small amount of blood from heel
  • Results sent to you and pediatrician

Your Recovery (Vaginal Birth)

Immediately After Delivery

What’s happening to your body:

  • Uterus contracting (cramps)
  • Bleeding (like heavy period)
  • Delivering placenta (5-30 minutes after baby)
  • Possible tear repair (if needed)

Afterpains (uterine contractions):

  • Especially strong during breastfeeding
  • More intense with second+ babies
  • Necessary to prevent excessive bleeding
  • Cramping is normal and good

Repair (if needed):

  • Local anesthetic (if you didn’t have epidural)
  • Stitches for tears (dissolve on their own)
  • 15-30 minutes
  • You’re likely holding baby during this

First Hours Postpartum

You may feel:

  • Extreme thirst and hunger
  • Shaking or trembling (adrenaline and hormones)
  • Euphoria or emotional
  • Exhausted
  • Sore (vagina, perineum, entire body)

What to expect:

  • Bleeding (heavier than period)
  • Large clots are normal initially
  • Mesh underwear and giant pads
  • Ice pack on perineum (feels amazing!)
  • Cramping

Urination:

  • Need to pee within 4-6 hours
  • May sting (warm water from peri bottle helps)
  • Nurse will check bladder
  • Catheter if unable to urinate

First bowel movement:

  • May not happen for few days
  • Fear of pain is normal
  • Stool softeners help
  • Won’t hurt stitches (but feels like it might)

Your Recovery (Cesarean Birth)

In Recovery Room

After C-section:

  • Moved to recovery area
  • Monitored closely (BP, bleeding)
  • Feeling returning to legs (if spinal)
  • Shaking (very common from anesthesia and hormones)
  • Catheter in bladder
  • IV fluids

Pain management:

  • Medications through IV
  • Oral pain meds as needed
  • Don’t wait until pain severe – stay ahead of it

Skin-to-skin:

  • Can start in recovery room
  • Partner holds baby if you’re too shaky
  • First feeding can happen here

First Hours After C-Section

What to expect:

  • Catheter remains 12-24 hours
  • IV fluids continued
  • Encouraged to move legs
  • Deep breathing exercises (prevent pneumonia)
  • Abdominal incision covered with dressing

Getting up:

  • Nurse helps you stand within 12-24 hours
  • Seems impossible but necessary
  • Moving prevents blood clots
  • Each time gets easier

Incision care:

  • Covered for first 24 hours
  • Check for redness, swelling, drainage
  • Keep clean and dry

Bonding with Your Baby

What Is Bonding?

Emotional connection between parent and baby

For some: Instant, overwhelming love

For others: Gradual, developing over days/weeks

Both are normal!

Bonding isn’t always instantaneous:

  • Especially after difficult birth
  • With emergency C-section
  • If baby needs medical care
  • When you’re exhausted or in pain

Don’t panic if you don’t feel immediate rush of love. Bonding takes time for many parents.

Ways to Bond

Skin-to-skin contact:

  • As much as possible
  • Both parents can do this
  • Releases bonding hormones

Eye contact:

  • Baby can see 8-12 inches (your face when feeding)
  • Focus on you
  • Recognize your voice

Talking and singing:

  • Baby knows your voice
  • Soothing and familiar
  • Doesn’t matter what you say

Responding to cries:

  • Builds trust
  • Baby learns you’ll meet their needs
  • Creates secure attachment

Feeding:

  • Whether breast or bottle
  • Close contact
  • Meeting baby’s needs

Touch:

  • Gentle massage
  • Holding and cuddling
  • Carrying in your arms

Your Emotional State

The Immediate Postpartum Period

Normal emotions:

  • Euphoria and elation
  • Overwhelming love
  • Disbelief (“Is this real?”)
  • Anxiety (responsibility hits)
  • Exhaustion
  • Irritability
  • Weepiness

Or feeling numb/disconnected – also normal after intense experience.

Adrenaline High

May feel wide awake despite:

  • Being up all night
  • Going through labor
  • Major physical trauma

May want to:

  • Text everyone
  • Post photos
  • Talk non-stop
  • Replay birth story

Then you’ll crash – and sleep deeply (between baby wakings).

Your Baby’s Behavior

First Hours

Baby may be:

Very alert (first 1-2 hours):

  • Wide awake
  • Looking around
  • Perfect for first feeding
  • Then falls into deep sleep

Or sleeping deeply:

  • Exhausted from birth
  • May not wake easily
  • Will wake when hungry

Normal Newborn Things

Funny appearance:

  • Cone-shaped head (from birth canal)
  • Swollen or puffy
  • Bruising (especially if forceps/vacuum)
  • Covered in vernix (white coating)
  • Wrinkled skin
  • All temporary!

Sounds:

  • Sneezing (clearing nasal passages)
  • Hiccups (very common)
  • Grunting
  • Snorting
  • Squeaking

They’re not sick – these are normal.

Behaviors:

  • Startle easily
  • Cross eyes occasionally
  • Shaking chin or limbs
  • Peeling skin (especially on hands/feet)

Rooming In vs. Nursery

Baby stays in your room:

  • Learn baby’s cues
  • Feed on demand
  • Bond continuously
  • Easier breastfeeding establishment

Benefits:

  • Immediate response to baby’s needs
  • Practice caring for baby with nurses available
  • Less separation anxiety

Reality:

  • You’re exhausted
  • Baby wakes frequently
  • May seem overwhelming

Nursery Option

Some hospitals offer:

  • Baby to nursery for few hours
  • You get rest/sleep
  • Nurses care for baby
  • Bring baby for feedings

No shame in needing break to recover and rest.

Ask for help when you need it.

Visitors

Consider Limiting

First hours are:

  • Recovery time
  • Learning to feed baby
  • Bonding time
  • Adjustment period

You’ll be:

  • Exhausted
  • Bleeding heavily
  • Wearing mesh underwear
  • Breasts exposed (learning to breastfeed)
  • Emotional

It’s okay to:

  • Delay visitors
  • Limit time
  • Say no to visits
  • Ask people to wait until home (or later)

Your recovery and bonding come first.

If You Do Have Visitors

Set boundaries:

  • Short visits only
  • Must be healthy (no colds/illness)
  • Hand washing required
  • No kissing baby
  • You can ask them to leave when tired

Partner can run interference – protect your rest and privacy.

Questions to Ask Before Leaving Recovery

Don’t hesitate to ask nurses:

✓ How do I know baby is getting enough milk?

✓ What’s normal for baby’s poop and pee?

✓ When should I call the doctor?

✓ How do I care for umbilical cord?

✓ How do I care for circumcision? (if applicable)

✓ When do I follow up with pediatrician?

✓ How do I care for my stitches/incision?

✓ What can I do for pain?

✓ When can I resume normal activities?

Take notes or have partner write things down – you won’t remember everything.

Remember

These first hours are just the beginning. You don’t have to know everything immediately.

You just accomplished something amazing. Your body grew and birthed a human!

It’s okay to feel overwhelmed. It’s okay to cry. It’s okay to need help.

One moment at a time. One hour at a time. One day at a time.

You’re exactly the mother your baby needs.

Welcome to parenthood. You’ve got this.