Your complete guide to your newborn baby

You’ve faithfully attended each antenatal class, you’ve read every book on baby care and even practiced breastfeeding with a plastic doll at a workshop. But can anything prepare you for the first few days of parenthood, when that baby is no longer a quiet and undemanding bump in your tummy but a living, breathing, fragile and furious force?

The short answer is no. ‘The reality is often much better or much worse than you expected – and usually both at once,’ says Lucy Atkins, author of First-Time Parent (£17.99, Collins). ‘No one will have experienced the sleep deprivation and hormone fluctuations those first few weeks can bring. It’s a unique and mind-blowing combination.’

You may look around and think other mothers are taking to it easily, but don’t be fooled. ‘They’re probably putting on a good show,’ says Lucy. ‘Most of us, at some point, will look down at our precious newborns and think, “Oh no! What now?” Becoming a mother can be very scary, overwhelming, even. The good news is that this feeling is usually temporary.

‘It’s amazing how fast you can learn to trust your own instincts,’ says Lucy. ‘Looking after a baby isn’t rocket science. And I always tell women that they may feel like a novice – but their baby certainly isn’t going to notice.’
Even so, you might appreciate some help in those early minutes, hours and days. So here’s a start…

What will your baby look like?

Newborns come in all shapes, sizes and shades. For nine months your placenta has been providing your baby with oxygen, so in the first moments after birth, while he’s breathing for himself for the first time and his circulation gets going, he may be a bit purple, red or bluish-grey.

He’ll certainly be slippery and wet as he has been living in amniotic fluid for the past 40 weeks. Many babies are born with light-coloured eyes, which darken as melanin levels rise throughout their first year.

And don’t be alarmed if your baby resembles a prize fighter. ‘Your newborn may look squashed and swollen after being squeezed through the birth canal. And if the delivery involved forceps or a ventouse the appearance can be worse,’ says Rebecca Byrne of the National Childbirth Trust (NCT). ‘Babies have soft heads; ¬ their sculls are made up of plates that move to allow them to fit through the birth canal, and delivery can push their heads out of shape often it’ll look like a cone. This is called “molding” and should return to normal within a couple of days.’ C-section babies generally look prettier, having avoided the big squeeze!

Once your baby is born, he will still be attached to you via the umbilical cord and placenta. The midwife will clamp and cut the cord after delivery, so when you finally get to hold your newborn he may have an unsightly jellied, bloodied ‘stump’ where his belly button should be. The stump will dry and fall off at some point over the next week.

What happens after birth?

Your baby

While the labour itself is pretty unpredictable, there are set procedures post-birth, although each midwife may perform them in a different order. ‘The baby is usually dried off by the midwife so he doesn’t get cold, and wrapped in a towel,’ says midwife Sue Macdonald. ‘She will weigh, measure and examine your baby from top to toe, counting fingers and toes, looking at the eyes, ears, mouth, the soft palate, making sure he looks normal and is moving and breathing properly.’ This initial examination is called the APGAR test (see box).

Parents will also be asked if they’d like their baby to receive vitamin K, administered by mouth or injection. Due to the low levels of vitamin K in a newborn’s blood, there is a five in 100,000 chance of him developing bleeding on the brain, which the vitamin helps to prevent by aiding blood clotting.

After these quick tests you’ll be given your baby to hold. If you’ve had a caesarean you may still be able to hold your baby, but you may find it’s too uncomfortable so he can be given to your birth partner and held close to you until the surgery is complete.

His initial needs

Newborns are usually very wide-eyed and alert. ‘He’ll be looking for you,’ says Sue, ‘and although his vision is very fuzzy, he will recognise your voice and smell.’ Skin-to-skin contact  – ideally laying the baby on your chest – is recommended, especially if you’re planning to breastfeed. ‘Some babies will be rooting, almost wriggling up to the breast,’ says Sue. ‘But if it’s been a stressful birth he may not feel like eating. Some babies need time to get used to being in the world.’

After about an hour, babies tend to have a long, deep sleep and your newborn may sleep for much of the next 24 hours, although you could find yourself feeding every three hours. Most newborns will also pass one stool, called meconium, around 12 hours after birth. It’s essentially a tar-like, odour-free poo and your baby will continue to pass this from time to time for the first few days.

What happens after birth?

You

After hours of labour, the sudden arrival of your child into the world can be a shock and the emotions you expect to feel will often take second place to the sense of exhaustion and relief. ‘Although you could feel absolutely elated by the arrival of your child, don’t be surprised if you feel totally numb,’ says Rebecca Byrne.
‘Some mothers fall in love at first sight – but this isn’t always the case. Your baby is still effectively a stranger and, as in any relationship, bonding might happen gradually.’

If you had a vaginal delivery, you’ll be checked for tears and, if stitches are required, they’ll be given as soon as possible using a local anaesthetic.

Your placenta

Once your baby is out, you’ll need to deliver the placenta. You’ll be asked if you want an injection of Syntocinon or Syntometrine to make your uterus contract and speed things along (most women have it). If you have the jab, your placenta will be expelled within five to 10 minutes of the birth. If not, it can take up to an hour to come out.

Passing the placenta does not hurt. In fact, it’s likely you’ll be so distracted by your new baby that you’ll barely realise what’s happened until you see your placenta: a huge, purpley mass of veins.

If you’ve had a caesarean you’ll be given Syntocinon or Syntometrine via the drip and the placenta will be lifted out. Doctors will then begin stitching you up. Either way, the placenta is checked by your midwife to make sure it’s all been expelled.

Once the delivery is over

‘In the first hour, the midwife usually catches up on paperwork while the mother, father and baby get to know each other, says Sue Macdonald. You may be sent for a shower (newborns are not bathed), which will give you a chance to check out your post-baby tummy. ‘It’s likely you’ll still look quite pregnant, although your stomach will have lost its firmness until the skin can recede back to normal,’ says midwife Gail Johnson. ‘How long that takes depends on how stretched your skin was and how active you’ve been – at the very least it takes a few days.’

You may be and thirsty so pack a snack and plenty of water. After about an hour, usually when the baby has gone to sleep, mother and baby will be transferred to the postnatal unit. ‘Some mothers want to walk there, others are often tired and sore and go in a wheelchair,’ says Sue. ‘Caesarean mothers will be wheeled on a bed.’
Your blood pressure will be monitored and you’ll be kept as comfortable as possible. As your uterus continues to clear you’ll pass a bloody vaginal discharge, called lochia,. This can continue for a few weeks.

Before you’re discharged

Before you can leave hospital your newborn will be thoroughly checked over by a paediatrician to make sure he’s feeding well and does not have any abnormalities. Eyes, mouth and palate, back and spine, heart, hips, skin tone and the contents of your baby’s nappy will all be examined for signs of illness. The paediatrician will also check your baby’s reflexes:

- Sucking and rooting. These are automatic responses to help him feed. If you touch his cheek he will automatically turn to that side to suckle.

- The Moro reflex (startle). A newborn throws his arms and legs out if startled by a sudden noise, movement or flash of light. 

- Grasp. When you place anything against the palm a newborn’s hand he will grip it tightly. This is a survival reflex, so a child can hang on if in danger.

- Plantar and palmar reflexes. This is when his toes and fingers curl in when you touch the sole of his feet or palm of his hand.

- Walking. If you hold a newborn upright with his feet on a surface, he will lift his legs up and down as if walking.

- Diving. Babies can hold their breath if submerged in water.
You will also have your stitches checked, if you had any. All the results of these tests will be collated in the discharge notes you’ll be given before you leave hospital to pass on to your GP or midwife. You may start to notice that, having been the centre of attention throughout the pregnancy, you’re starting to fade in to the background. From now on, all eyes are on your baby. Welcome to parenthood.

The APGAR score

The APGAR score was designed to quickly assess a newborn’s physical condition and determine whether any extra medical care is needed. It is given one minute after birth and again five minutes later and looks at five areas. Each has a top score of two and most newborns can expect a score of eight or nine (few babies make a perfect 10). Any babies scoring less than seven may need some immediate care, like suctioning of the airways. The APGAR is not an indicator of long-term health, intellect or development, it just helps identify which babies need more help adjusting to life outside the womb.

APGAR SCORE

ACTIVITY and muscle tone:
Active movement [scores 2] Little movement, arms and legs flexed [scores 1] Floppy, no movement [scores 0]

PULSE
Normal, above 100 beats a minute [scores 2] Below 100 [scores 1] No pulse [scores 0]

GRIMACE (responsiveness)
Coughs, sneezes, pulls away when stimulated [2] Grimace/ feeble cry when stimulated only [scores 1] Absent, no response to stimulation [scores 0]

APPEARANCE (skin colour)
NORMAL all over, hands and feet are pink [scores 2] Normal colour but hands and feet are blue [scores 1] Bluish grey or pale all over [scores 0]

RESPIRATION
Normal breathing rate and good cry [scores 2] Irregular breathing, weak cry [scores 1] Absent (no breathing) [scores 0]