Newborn baby checks

At birth, your midwife will perform a brief check of your newborn baby. This is called the Apgar score and is so quick that you might not even notice them do it. Your midwife will also want to weigh your baby, measure her head and check her temperature.

If you are in agreement, your baby will be given an injection of vitamin K, to help with blood clotting. This is because around one in 10,000 babies have problems that mean their blood is unable to clot to prevent serious bleeding.

Within the first 72 hours your baby will have a more detailed check. A baby doctor or a specially trained midwife will perform this before you leave hospital. If you have your baby at home, this check will take place at a GP surgery or community clinic. This is a top-to-toe check to ensure that your baby is healthy.

Additionally, your baby will be offered a hearing test. This may be in hospital, at home or sometimes in a clinic. It only takes a few minutes and is not upsetting to your baby. Hearing loss affects 1 to 2 in every 1000 babies, and this test aims to identify these issues early. If your baby has been in a special or intensive care unit, a further test will be added on as these babies are at a higher risk of hearing problems.

In the first week of life, your newborn baby will be offered a blood spot screening test. A midwife will use a small needle to prick your baby’s heel and collect a few drops of blood. The blood is collected on a card that is sent away for testing to identify 7 rare but serious conditions. You will receive the results of the test 6 to 8 weeks later. These results are usually normal. If they are not, your baby will be referred to a specialist.

Your midwife will give you a red book (the personal child health record). This book provides a record of your child’s health and development. It also provides information on screening tests, immunisations, child development on advice on how to take care of your child. Keep this book safe and take it to all of your appointments.

Leaving the hospital

After your labour, your midwife will continue to look after you. If you are on a ward with obstetric doctors, they may also be involved in your care after the birth. If you have had a caesarean section, you may require more intensive nursing care. Trained nurses will provide this in a recovery unit.

If you have given birth in a midwife-led birth centre, you are likely to leave hospital around 6 hours after giving birth, or in the morning, if your baby is born overnight. If you have had a caesarean section you are likely to stay in hospital for a little longer, 24-48 hours.

Before you leave the hospital, your midwife will give you the details and contact numbers of the community midwives.

If you are leaving the hospital by car, you will need to have your baby’s car seat ready. Remember that it is a legal requirement to use a properly fitted car seat.

Feeding your newborn baby

Skin-to-skin contact after birth will encourage your newborn baby to breastfeed instinctively. Breastfeeding is natural but it is also a skill that can take time to learn. To help this process, you will be encouraged to breastfeed in the first hour after birth. Your midwife and breastfeeding support workers will ensure that your baby is feeding well before leaving hospital. If you need more help then get in touch with your midwife or a breastfeeding support worker.

Your newborn baby should feed at least 8 times per day (after the first 48 hours), for 5-30 minutes per feed. If you have any concerns about your baby’s feeding, contact your midwife or GP.

Your baby’s urine and stool will give you an indication that she is feeding well. Over the first 48 hours your newborn baby will have 2 or 3 wet nappies. These will then become more frequent, and by day 5 baby will have a wet nappy at least 6 times a day. Initially, your baby will pass meconium (a black, tarry poo). By day 3 this should be lighter, runnier and greener. From day 4 your baby should pass at least 2 yellow stools per day. Breastfed babies often have loose stools. If you are concerned that your baby is not passing normal urine or stool please contact your GP or midwife.

You may need to express milk if your breasts are uncomfortably full or your baby isn’t sucking well. It is easier to express by hand in the first few days. If your baby needs extra support and has to stay in hospital, it is important to start expressing straight away. Expressed milk should be stored in the fridge (for 5 days) or freezer (for 2 weeks).

If you are unable to breast feed or want to bottle feed your baby, you will need to learn how to sterilise and make up a bottle. You should give your newborn baby first infant formula. You can use formula based on cows’ milk or goats’ milk. It comes in 2 forms: liquid or powder. To safely make up powder formula milk at home, follow the manufacturer’s instructions on the packet. To sterilise bottles, follow the manufacturers’ instructions for the sterilising equipment you are using. Just as with breastfeeding, you should feed your baby on demand and not encourage overfeeding just to finish a bottle. Useful information is available from the First Steps Nutrition Trust.

You can mix bottle and breastfeeding, doing each as often as you want. However, giving bottle feeds will reduce your breast milk supply.

Sleep

Every newborn baby will have their own sleep pattern. It is normal for newborn babies to be asleep more than they are awake (up to 18 hours a day). They will need to wake during the night to feed.

Your baby should sleep in a cot in the same room as you. The guidance on putting your baby down to sleep aims to prevent cot death. Your baby should be on her back on a firm, flat mattress. She should not be overdressed or covered and the bedding must not be able to cover her head. The room should be around 16-20C and smoke free. Further information is available from the Infant Sleep Information Source and The Lullaby Trust.

Most breastfeeding mothers sometimes share a bed with their baby. If you are sharing a bed with your baby, ensure that the baby is away from any pillows and that the bedclothes can’t cover her face or head. Make sure the baby can’t fall out of the bed or get trapped between the mattress and the wall. Do not share a bed if with your baby if she is preterm or very small, if you smoke, or if you have been drinking alcohol or using drugs that may cause drowsiness. Avoid dozing off with your baby on a sofa or chair.

Soothing a crying baby

All babies cry and some babies cry a lot. This is your baby’s way of communicating with you. It is not always easy to work out why your baby may cry, so try to work through the different reasons systematically. You will soon become more confident at working out why your baby is crying. The most common reasons for crying are:

• Hunger
• Tiredness
• A wet or dirty nappy
• Wind/pain
• Wanting a cuddle
• Too hot or too cold
• Boredom/ overstimulation

Once you have checked whether your baby is hungry or has a dirty nappy, you can try soothing your baby by holding her close to you and gently rocking her. Other ways to soothe a baby include rocking your newborn baby in a pram, singing or playing music or trying a warm bath.

If you are concerned by your baby’s crying, contact your midwife or GP.

Washing and dressing your newborn baby

Your baby will need her nappy changed whenever it is soiled or wet. Use cotton wool and warm water or sensitive baby wipes to clean the nappy area. Your baby needs her face, neck, hands and bottom washed every day. Use cotton wool and warm water for this. Your baby needs a bath 2 or 3 times a week. The water temperature should be 36-37C. This should be checked with a thermometer.

The stump of the umbilical cord needs to be washed and dried carefully. Ensure that the nappy is not rubbing it. The stump should drop off after a week or two. Slight bleeding is normal as it separates. If it bleeds heavily, oozes or becomes red or smelly, please contact your midwife or GP.

As a basic rule, your newborn baby should wear the same amount of clothes as you, plus an extra layer or two, during the day. At night, your newborn baby should wear a vest, a babygro, plus the same number of layers as you. Outdoors, your newborn baby should wear a hat. In summer this prevents sunburn and in winter this keeps them warm.

Taking care of mum

After birth it is important to take care of your physical and emotional health.

While this is a happy time, it is also nerve-wracking and can be stressful. Your body will go through physical and emotional changes. The baby blues are common, frequently occurring around 3 days after giving birth. However, some people can become severely ill so it is important to take care of yourself, and know what to look out for and when to seek help.

Singing lullabies is an ancient practise with health benefits for mum and baby. It is soothing and can help to reduce stress. If lullabies are not for you, it is vital to find a way to relax and control your stress as this plays a big part in helping to manage tiredness. Sleep may be in short supply in the first few days after birth. Tactics to help with this include sleeping when your baby sleeps, sharing responsibility with a partner, and safely sharing a bed with your baby.

It is important to recognise that mental health problems can occur after childbirth. If you are worried that you are suffering from postnatal depression then ask yourself the following questions:

• Are you feeling down, depressed or hopeless?
• Are you finding that you have little interest or pleasure in doing things?
• Are you suffering with poor sleep, poor concentration, poor appetite or low self-confidence?

If the answer to these questions is “yes”, then speak to your midwife or your GP. It may help to discuss these feelings with a partner or a friend. You need urgent help if you are feeling that you cannot cope or you have thoughts of harming yourself or committing suicide. If you are having new and unusual or disturbing thoughts or feelings, you should seek urgent help as this is an indicator of postpartum psychosis – a severe form of mental illness which occurs in 1 out of 1000 women after childbirth.

Your physical health

In terms of your physical health, you will need to rest initially to recover from the physical effort of giving birth. Lying on your side may be more comfortable if you have stitches in your perineum or if you have piles. Placing a pillow between your legs may also help.

If you are in pain, then you can take painkillers to help with this. Paracetamol and ibuprofen are both safe when breastfeeding. You may also be given stronger painkillers when discharged from hospital. Take these as instructed by your doctor or midwife. If you feel you need more pain relief, speak to a pharmacist or GP.

Your posture is very important. Try to change your baby at waist height so that you are not bending over and straining your back. If your feet are swollen, try to sit with them up and avoid crossing your legs.

You should start pelvic floor exercises as soon as possible after vaginal delivery. These help with bladder and bowel control, prevent prolapse, stabilise your pelvis and lower back and increase sexual satisfaction for both partners. Initially, you may be more comfortable doing these lying on your side. Aim to do these at least 3 times per day.

If you have had a tear or an episiotomy, you should clean the area with fresh, warm water and then pat it dry. Change your pad regularly in order to keep the area clean and dry. If you had any stitches, these should dissolve in the first 10 days. If you notice any signs of infection (increasing pain, offensive, smelly discharge, fever), then please consult your midwife or GP.

You will experience some vaginal bleeding after giving birth. This normally continues for 2 weeks and can continue for up to 6 weeks. If you are worried that you are bleeding heavily, speak to your midwife or GP. Similarly, you should seek medical advice if there is any smelly discharge as this may indicate an infection.

Passing urine may sting. Pouring warm water over your perineum can help relieve this. Try not to get into the habit of going to the toilet “just in case”.

It is important not to rush or strain when opening your bowels. Try to avoid becoming constipated by drinking plenty of water (at least 2 litres per day), eating fruit and vegetables and taking laxatives if required (especially if you are using dihydrocodeine for pain as this is constipating). Haemorrhoids (piles) are common after giving birth. If you have developed these, then it is even more important to avoid becoming constipated. You can apply Anusol cream (available from pharmacies) to help with the discomfort of haemorrhoids. You should see your GP if you have any concerns.

If you have had a caesarean section, the physical challenges will be slightly different and you will require more pain relief. This will be supplied when you leave the hospital and should be taken as instructed. Your wound will be covered by a dressing that is usually removed at 24-48 hours. The community midwives will remove the stitches for you 5-7 days after the birth. Try to keep the wound site clean and dry. If you are worried that your wound is infected, please see your GP. Signs that your wound is infected include developing a fever; redness, warmth and pain around the wound; and wound breakdown. You must avoid lifting anything heavier than your baby for the first 6 weeks.

You may have been given other medicines to take at home. Common medications include iron tablets to boost your blood levels and injections, which prevent blood clots. If you need these medicines, you will be told how and when to take them before you leave hospital. If you have any questions about these medicines, speak to your GP.

Who can help?

Once you have been discharged from hospital, you will be under the care of the community midwives. They are available in working hours and can offer advice over the phone or arrange emergency home visits. They will visit as required to perform any outstanding baby checks, such as the heel prick test, that were not done at the hospital. They will also monitor you for any complications that have arisen during the pregnancy or birth. For example, if you had high blood pressure in pregnancy, they will monitor this at home.

Your midwife should give you the details of a breastfeeding support team. The NCT (National Childbirth Trust) will continue to support you at this time.

As always, your GP can be contacted for medical help or additional support. For medical care out of hours you can call the 111 service and for urgent medical attention, dial 999.

For more information on your baby’s development during their first week of life, visit our Early Years section.

Main points

• Your midwife will perform a brief check of your new born baby – the Apgar score.
• With your consent, your midwife will also give your baby an injection of vitamin K to help with blood clotting.
• Your baby will receive a more detailed check within the first 72 hours of life.
• Your baby will also be offered a hearing test and blood spot screening test.
• Your midwife will continue to look after you after you’ve given birth.
• You’re likely to be able to leave the hospital 6 hours after giving birth. If you’ve had a C-section, you may be required to stay in the hospital for 24-48 hours.
• Before you leave the hospital, your midwife and breastfeeding support workers will ensure your baby is feeding well.
• After the first 48 hours, your baby should feed at least 8 times per day for 5-30 minutes per feed. Urination will also become far more frequent, and they will usually wet their nappy at least six times a day by day 5.
• After your baby’s first poo – meconium, which is black and tarry – bowel movements should become lighter and runnier.
• If you want to bottle-feed your baby, you will need to be able to sterilise and make up a bottle (remember that bottle feeding will reduce your breast milk supply).
• Newborn babies tend to be asleep more than they are awake, sleeping for up to 18 hours a day.
• Your baby’s cot should be placed in your room. You can help prevent cot death by following the correct guidance.
• Do not share a bed with your baby if they were born prematurely or are very small. You should also not share a bed with your baby if you smoke or have been drinking.
• If your baby is crying, try systematically working through the most common reasons to work out the cause.
• Consult your midwife or GP if you become concerned about your baby’s crying.
• Your baby needs to have their face, neck, hands, and bottom washed every day as well as a 2 or 3 times a week.
• The stump of the umbilical cord also needs to be washed (it should drop off after a week or two). If the stump shows any sign of infection, contact your midwife of GP.
• As your body is going through many changes at this time, it’s important to ensure you take care of your physical and emotional health.
• You should talk to your doctor or midwife if you think you’re suffering from postnatal depression.
• To help with the pain, you can take painkillers as instructed by your doctor or midwife.
• To help with bladder and bowel control, you should start your pelvic floor exercises as soon as possible after vaginal delivery. Aim to do three sets or pelvic floor exercises per day.
• It’s normal to experience vaginal bleeding for up to six weeks after giving birth. Seek medical help if the bleeding is heavy or you notice smelly discharge.
• As haemorrhoids are common after childbirth, it is important to avoid constipation and apply proper treatment.
• You will require more pain relief if you’ve had a caesarean section. This will be given to you when you leave the hospital.
• If you think your wound may have become infected, speak to your GP.
• Once discharged from hospital, you’ll be under the care of the community midwives.