Your first hours as a mum

The hard graft of labour is over, but what happens next? We’ve got the lowdown on what will happen in your first hours as a mum

Throughout the last weeks of pregnancy, one thing is etched on your mind – the birth. Every waking moment (and most of your sleeping ones, too), you’re speculating about how it might turn out, and doing everything you can to prepare.

But what happens once your baby is out in the big wide world? Most of us have never thought beyond our first, long-awaited cuddle, but the hours after delivery can be surprisingly busy. Here’s what to expect in that life-changing post-birth period.

Apgar scores

The Apgar test is a basic check on your baby’s condition within a minute of birth, repeated after five and 10 minutes. ‘It looks at his heart rate, breathing, muscle tone, colour and response to stimulation,’ says Dr David Elliman, consultant in community child health at Great Ormond Street Hospital.

Your baby will be given a score out of 10. Lots of newborns don’t manage full marks straight away, but most have picked up by the 10-minute check. If your baby scores between five and seven, he might need a bit of help to start breathing – a vigorous rub-down, or a puff of oxygen. If he scores below five, a paediatrician will be called.

The good news is that Apgar scores needn’t interfere with your first moments with your baby. ‘If he’s a healthy colour, moving and crying, then you can assume that he’s alright, without taking him away from the mother,’ Dr Elliman explains.

Squeaky clean?

Newborns are sometimes covered in vernix, a creamy substance that protects his skin from the amniotic fluid, and helps him down the birth canal by making him more slippery.

If your baby is early, he’s likely to have more vernix than a full-term newborn. Vernix is a natural moisturiser, so some mums prefer it to be left on their baby, so it’s gradually absorbed into the skin. But others prefer their baby to be wiped clean. The choice is yours.

Weighing in

You’ve probably been speculating for months about your baby’s weight, and now you get to find out. Your newborn will be weighed soon after the birth, although not before you’ve had a cuddle. The average birth weight is 3.4kg (7lb 7oz). Your baby may also have his length and head circumference measured; these figures will help to monitor his growth in the coming weeks.

Delivering the placenta

Once your baby is out, your placenta will soon follow. The good news is that after the sheer effort of labour, this bit is usually a breeze. Most women opt for a managed third stage, and are given a drug called syntometrine. This is injected into your thigh as your baby is born, and helps your uterus contract and push the placenta out.

Syntometrine speeds up the delivery of the placenta, and reduces the amount of bleeding. But it makes some women feel sick and dizzy. It also means the umbilical cord has to be clamped immediately, so your baby misses out on the last bit of oxygen-rich blood from the placenta.

Because of this, some women opt for a natural third stage, without drugs. It usually takes longer, and you’ll probably have to push, rather than the placenta just plopping out. You may also lose more blood, but if your bleeding is a cause for concern, you can be given syntometrine at any time.

Your baby’s first feed

If your baby is well, you’ll be encouraged to breastfeed as soon as possible, as his sucking reflex is strongest soon after birth. But don’t expect to get the hang of it straight away. ‘It’s common for newborns just to snuffle around,’ explains midwife Melanie Every of the Royal College of Midwives.

‘What’s important is the skin-to-skin contact.’ It helps your newborn regulate his breathing and body temperature, and makes your body release hormones to stimulate your milk.

Your milk won’t come in for three to five days; until then, your breasts produce colostrums, a precursor to breastmilk. It’s full of fats, protein and antibodies, which help your baby resist infection and kick-start his immune system. Over the first week or so, the colostrum will gradually be replaced with milk.

Most hospitals have breastfeeding advisors to help you through the first feeds. ‘If you need help, don’t be afraid to ask,’ says Melanie. ‘Postnatal wards are busy places, and if you look like you’re coping, you’ll probably be left to it.’

Vitamin K

The last thing any mum wants is someone sticking a needle into her new baby, but all newborns are given vitamin K, usually by injection, soon after delivery. That’s because a very small number of babies are born with a vitamin K deficiency, which can cause severe bleeding – with no warning signs.

Vitamin K can either be given orally or by injection. The oral treatment requires repeat doses at seven days and 28 days old. ‘The injection is more effective, but one study in the 1990s linked it to childhood cancer,’ explains Dr Elliman. ‘Although lots of subsequent studies have disproved that, your baby can be given vitamin K orally if you’re worried, but it’s very important that he has the follow-up doses.’

Newborn check

Within 72 hours of being born, your newborn will have a top-to-toe examination by a specialist midwife, paediatrician or neonatal nurse. This is usually done before you leave hospital, but if you have a quick discharge or a home birth, you may need to go back a day or so later, or the check may be done by a GP or midwife at home.

The newborn check is intended to pick up any physical problems, such as heart murmurs, hip defects and talipes (club foot). It also takes into account any family health issues or complications in pregnancy or labour which might have affected your baby.

If any defects are detected, your baby may need immediate hospital treatment. ‘If, however, it’s a minor problem, you’ll be able to go home and see a specialist at a later date,’ says Dr Elliman.

All newborns are also screened for hearing defects, again usually before leaving hospital. A tiny earpiece is placed in your baby’s ear to see how it responds to sounds.

‘There’s evidence that the sooner you detect any irregularities, the better the outcome for the baby – even tiny babies can be fitted with hearing aids,’ says Dr Elliman.

Going home

Postnatal wards tend not to be particularly restful places, so chances are you’ll want to go home as soon as possible. Generally, if you’ve had an uncomplicated vaginal delivery, you’ll be discharged between six and 24 hours after giving birth. However, if you had any complications, or need help with breastfeeding, you’ll be advised to stay in a little longer. After a caesarean, the average stay is three to five days.

Taking your newborn home can be nerve-wracking, but you’re not alone. ‘The hospital will arrange for a midwife to visit you the next day,’ says Melanie. ‘You’ll also be given a telephone number for emergencies.’ And, scary though it may seem, nothing beats crossing the threshold of your own home as a family.