The delivery room is a flurry of activity after a birth, some of it out of sight. Find out what the hospital staff will do in the first minutes and hours of your baby's life. Learn what shots she'll get, why she needs eye drops, and the best time for her first bath (which may surprise you).
What happens to my baby immediately after birth?
The hospital staff will:
Make sure he stays warm. Newborn babies don't have the ability to control their temperature well, so it's very important that they be kept warm and dry.
If you've had a vaginal delivery and you and your baby are in good condition, he should be placed directly onto your abdomen and dried off there. He'll be covered with a warm towel or blanket and be given a cap to keep his head warm.
Skin-to-skin contact will also help keep him warm and let the two of you start bonding as well. (Don't worry if you can't hold him right away due to one of you needing immediate medical care. There'll be plenty of time for bonding later.)
Cut the cord, but not immediately. Your doctor or midwife will clamp the umbilical cord in two places and then cut – or have your partner cut – between the two clamps. Thinking has changed about when to clamp and cut the cord.
Traditionally in the United States, the cord was cut almost immediately after birth. However, recent research shows that delayed cord clamping – which allows extra blood to flow from the placenta to the baby – lowers the risk of iron-deficiency anemia in infancy. The American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology recommend delaying cord clamping for at least 30 to 60 seconds.
Collect blood. If your blood is type O or Rh negative, blood will be collected from the cord to identify your baby's blood type. That's because if your child's blood type is incompatible with yours, it can cause an increased risk of jaundice and hemolytic anemia (a type of anemia caused by red blood cells being destroyed faster than they are created).
If you're banking your newborn's cord blood, that will be collected at this time too.
Suction, if needed. Your doctor may have suctioned your baby's mouth and nose before the delivery of his shoulders. If he still seems to have too much fluid in his mouth or nose, the doctor may repeat the process.
Assess your baby's health. At one and five minutes after birth, an Apgar assessment will be done to evaluate your newborn's heart rate, breathing, muscle tone, reflex response, and color. Your doctor should be able to do these simple assessments while your baby is resting on your belly, so you can stay together.
When can I start breastfeeding?
Babies tend to be very alert right after birth, so that's a good time to begin breastfeeding if you're both willing. In fact, the AAP recommends that healthy, full-term infants "be placed and remain in direct skin-to-skin contact with their mothers immediately after delivery until the first feeding is accomplished."
Most babies will begin to nurse within the first hour or so, given the opportunity. There's no need to panic if your newborn seems to have trouble finding or staying on your nipple right after birth – she may just lick your nipple at first.
Don't be shy about asking for help with breastfeeding while you're still in the birth room (or recovery room, if you had a c-section). Later, when you get to the postpartum unit, there may be a lactation consultant for one-on-one coaching or group breastfeeding support. (It's a good idea to find out ahead of time what resources will be available.) If you're uncertain about anything, ask for help.
What if my baby has problems at birth?
If your baby has any immediate health problems at birth, things will happen quickly. The doctor will cut the cord, and your baby will be dried off and placed on a radiant warmer. The warmer allows him to be left naked without getting cold so that his medical team can do whatever is necessary.
If he needs further care after being stabilized, he may be taken to a neonatal intensive care unit (NICU). But if he's doing well and needs no further care, he'll be swaddled in a warm blanket and brought to you.
What if I have a c-section?
If you have a c-section, your baby will be handed to a nurse or doctor as soon as she's delivered and taken to a radiant warmer. She'll be dried off, her mouth and nasal passages will be suctioned, an Apgar assessment will be done, and she'll get any other attention she needs.
In many hospitals, if you and your newborn are doing well, she'll be swaddled in a warm blanket and placed on your upper chest for a bit — or she can be brought to your partner, who will likely be sitting near your head. Your partner can hold her while you're being stitched up, and you can touch and talk to her while you're still in the operating room.
Afterward, your newborn will go to the well-baby nursery briefly – your partner can go with her – while you head to the recovery room. In the nursery, her vital signs will be taken, and she'll be weighed and measured.
As soon as possible, the two of you will be reunited and you can have skin-to-skin contact. If you plan to breastfeed, this is a good time to start.
What about ID bands and footprints?
A nurse will put matching ID bands on you, your newborn, and your partner minutes after the delivery (and certainly before taking her out of the room for any reason). These bands are checked and matched every time you and your baby are separated or reunited.
The hospital will explain its security procedures to you, including the protocol and form of identification needed for a staff member to take your baby from your room.
Most hospitals routinely make two copies of your newborn's footprints – one for his hospital record and the other as a keepsake for you. If they don't usually do this but it's something you'd like, you can ask for a set.
What else happens soon after birth?
- Eye drops are given. Antibiotic ointment or drops will be placed in your baby's eyes soon after birth. (This may be postponed for up to an hour so that you have a chance to breastfeed.) This is required by law in the U.S. to help prevent eye infections, some of which can cause blindness. These infections are caused by bacteria that he could have been exposed to during birth, such as gonorrhea or chlamydia.
- Weight and other measurements are taken. Your baby will be weighed, and his length and head circumference will be measured.
- Vitamin K shot is given. An injection of vitamin K will help your newborn's blood clot normally and protect him from a rare but dangerous bleeding disorder.
When will my baby get a bath?
Babies have traditionally been given their newborn bath not long after birth. But research is showing there are advantages to waiting at least 12 hours. A delayed bath:
- Promotes breastfeeding. The amniotic fluid that remains on your newborn may provide breastfeeding cues for her. Researchers theorize this may be one reason why delayed bathing in hospitals resulted in increased breastfeeding rates. A study of almost 500 babies published in the Journal of Obstetric, Gynecologic & Neonatal Nursing found that delaying a healthy newborn bath for more than 12 hours after birth resulted in a greater rate of exclusive breastfeeding in the hospital and increased rates of mothers planning to breastfeed (either exclusively or in combination with formula) after leaving the hospital.
- Keeps your baby warm and reduces stress. Longer skin-to-skin contact with you reduces her stress level and keeps her warm. To keep a newborn warm, the World Health Organization (WHO) recommends delaying a baby's first bath for at least six hours and ideally 24 hours after birth. (Because babies have a hard time regulating their temperatures, baths can easily chill and physically stress them.)
- Protects your baby's skin. The waxy, whitish vernix that coats your baby protects and moisturizes her skin. It also helps keep her warm. There's no need to rush to wash it off.
- Cultivates good bacteria. Delayed bathing may help a baby develop her microbiome – her normal bacterial flora, which researchers think may play a part in disease prevention.
Ask what the hospital's usual procedure is for bathing newborns, and request a delay if you prefer that. Baths usually take place in the nursery, where the baby is put under radiant heat for warmth. Parents can usually watch and even participate. Some parents find that the hands-on experience gives them more confidence bathing their baby once they get home, especially if she's their firstborn.
When will my baby get an exam?
Your baby will get a complete pediatric exam within 24 hours and daily exams after that. If your newborn is in your room when the doctor is doing rounds, the doctor will do the exam there and review the findings with you. If your child is in the NICU or nursery, the doctor will do the exam there and then come to your room to talk about the findings.
Will my baby stay in the nursery or be rooming in with me?
It depends on what you want. Different hospitals have different policies, so it's good to ask in advance what your hospital's is. That way, you can be prepared to voice your preference if it's different from what the hospital typically does.
Overall, there's been a shift away from healthy newborns spending stretches of time in the nursery. Instead, your baby can stay in a bassinet by your bedside. This arrangement is called rooming in. That said, the nursery is a resource for you, so don't feel bad if you use it.
Rooming in has benefits for you and your baby:
- If you're breastfeeding, it's easier to learn your baby's feeding cues and begin to establish a feeding routine from the start. In fact, WHO recommends rooming in because research shows it supports successful breastfeeding.
- You can practice caring for your newborn and ask questions about what's normal while you have medical experts available to help you.
- Research shows that both moms and babies sleep better.
- Babies tend to cry less, be more content, and have lower stress hormones.
- You have more opportunities to bond and have skin-to-skin contact with your baby.
Moms sometimes have their baby spend time in the nursery because they:
- Feel better knowing he will be monitored while they sleep
- Had a c-section or other medical complication and need some extra help
- Want to spend some time alone with their other children
- Just need a break
When it comes to rooming in or having your baby spend some time in the nursery, the most important factor is what works for your family.
What tests will my baby have?
- Blood test: All states require newborn screening tests. Your baby's heel will be pricked and a few drops of blood taken to test for metabolic, genetic, and endocrine problems. Because some signs of the conditions don't show up until the second day of life or later, it's best to do this on day two or three, but no later than day seven. If you and your baby leave the hospital within 24 hours of birth, you'll be given instructions about following up to have the tests completed.
- Pulse oximetry (pulse ox): The amount of oxygen in your baby's blood is measured using painless sensors on the hands and feet to check for the possibility of a congenital heart defect.
- Hearing tests: Your newborn's hearing should be checked before you leave the hospital.
- HIV: If your HIV status is unknown, your baby's cord blood may be tested for the virus. (Some states require this.)
If you need further information about newborn testing, your state's newborn screening program can help you out.
Will my baby get a hepatitis B shot?
Yes. Your baby should get his first dose of the hepatitis B vaccine before being discharged from the hospital.
- If you're a hepatitis B carrier or your status is unknown, your baby should be vaccinated within 12 hours of birth.
- Babies of mothers who are known hepatitis B carriers will receive an injection of hepatitis B immune globulin (HBIG) – which provides short-term protection – within 12 hours of birth.
- If your hepatitis B status is unknown, your blood will be drawn for testing, and if you're found to be positive, your child should receive a dose of HBIG as soon as possible.
When can my baby be circumcised?
If you've decided that you want your newborn boy to be circumcised in the hospital, it's usually done a day or two after birth.
When can we go home?
After an uncomplicated vaginal delivery, you're likely to stay in the hospital for 24 to 48 hours. If you have an uncomplicated c-section, you'll probably be in the hospital for two to four days. Find out more about how long you may stay in the hospital after childbirth.
When will we see the doctor again?
Your baby should have a checkup three to five days after birth, or one to two days after going home. The doctor may ask you to bring your newborn in again about two weeks later. If your child has any health problems – such as unexpected weight loss or jaundice – you may see the doctor more often in the first few weeks.
You'll bring your baby in for well-child doctor visits at 1 month and 2 months of age.