First time parents spend the months of pregnancy planning and focusing on the day they meet their new bundle of joy. Now that cute little person is safely in your arms what happens in the first hours and days after?
Every pregnancy and birth experience is unique however in the hours and days afterwards there are a number of experiences for both mum and baby that occur. In this blog Hatch midwife Ryndell Levkovich has broken down the most common to help you prepare for those first few days.
Apgar scores, newborn check and vaccinations
At 1 min and 5 min of age the midwife and/or paediatrician will do an examination of baby looking at 5 main things: Heart rate, Colour, Tone, Respiratory rate and Grimace. These are each scored out of 2 and help assess how well baby is adjusting to being outside of mum. The Apgar’s are most commonly performed while baby is on mum’s chest and with minimal interruption to skin to skin. The initial newborn head to toe check is done within the first few hours of birth by either a paediatrician or midwife. This check looks more in-depth at how baby has adjusted post birth and looks for any anomalies and gathers information that will help guide babies care of the next few days. At this time baby will receive their first vaccinations if mum and dad have consented. The vaccinations offered at birth are Vitamin K and the Hepatitis B you can find more information about them at the link below. If baby is born via caesarean section these checks are commenced prior to baby coming to mum for skin to skin but do not extend the time before baby is back with mum. Prior to discharge the paediatrician will perform a more in-depth newborn examination.
Baby will be placed skin to skin on mum and if breastfeeding is planned will be encouraged to find their way to the breast and start feeding. This can take time and sometimes some positioning assistance but most babies will move towards the breast themselves. This initial feed can be a short feed but often the baby may be off and on for the first hours and it is important to not rush baby but allow them time. Regardless of mode of birth the plan is for early skin to skin for breastfeeding. If planning to formula feed the midwives will help prepare the first feed and support either parent with bottle feeding, while maintaining skin to skin as well. A breastfed baby will ask for a feed anywhere from 6-12 times in a 24 hour period. This is completely normal and encouraged to be led by baby (demand feeding). If baby is formula feeding the midwives will work out a quota of formula needed based on baby’s birth weight and is to be offered every 3-4 hours to ensure adequate nutrition for growth and development. Either way of feeding baby will take time to learn and may need assistance to get their latch and milk transfer working well.
The first stool that baby passes is called meconium and is thick, black and sticky. As baby grows and takes in more food this stool will start to change colour to a dark green and then to a yellow/brown. As a minimum, a healthy baby will do one stool for day 1, two stools for day 2 anything more than this a bonus from your baby. Baby will pass urine a little more frequently and it should be clear to light yellow in colour. Good urine output for babies goes up by days, one wet nappy for day 1, two for day 2, three for day 3 and so on until day 6. After which baby should continue to have greater than 6 wet nappies/day when well hydrated. These good wet nappies help to tell us baby is getting enough colostrum/milk.
The first few hours and days baby will sleep and be fairly settled but will wake regularly for feeds. Often as baby goes from first to second day of life they will wake more and want to be held or snuggled to fall asleep. This is normal behaviour and skin to skin by either parent can help aid in settling them as they have spent 9 months listening to mums heart and being held within her so they feel most comfortable in close contact to mum and dad’s heartbeat. As baby head towards 48 hours old they often change their behaviour and developed a little more personality. During this time baby starts to cluster feed which means to ask for more feeds more frequently, becoming unsettled when not being fed and not wanting to be put down in a cot. This is the time for lots of patience and skin to skin and offering the breast as much as possible. While this change in behaviour is often exhausting as you learn yourself to adapt to broken sleep, it is transient and a biological need for a baby. This behaviour is basically asking your breasts to change the colostrum into milk and is initiated by suckling at the breast. Once this period is over baby usually has a big sleep and then goes back to a more manageable feeding and sleeping pattern. This period can last from a few hours to 12 hours and is dependent on each individual baby.
NNST and Healthy Hearing test
The two health tests that each baby has in the first few days are the Neonatal screen test and the healthy hearing test. The Neonatal screen test (NNST) is performed with parental consent between 48 and 72 hours of age. It is a blood sample that is collected from the baby’s heel. Three circles of blood are collected and the test screens for over 26 rare medical conditions that can impact on a baby normal development (a separate blog will be posted on this in the coming weeks). The Healthy hearing test is performed in the first few days of life and is done to help identify the 1-2 in every 1000 babies that are born with a hearing deficit. The test is done while the baby is asleep and usually takes around 2-10 mins to complete. A pass means baby hears at a level that should ensure speech and language develops as normal however a refer would indicate more testing is needed and appropriate referrals are put into place.
After you birth your baby, either vaginally or through caesarean, baby will be placed skin to skin with you on your chest. During this time you will be left to bond and connect with baby, however the midwives will complete some checks on you to ensure you too are healthy. Your obstetrician will perform an internal check on you with your consent for any vaginal or perineal tearing that may need suturing. This is usually done on the bed with baby on your chest, it can sting a little and if suturing is needed, the doctors will numb the area first. The midwives will also perform observations every 15-30 mins which include your blood pressure, heart rate, temperature, checking your blood loss and checking your fundus (top of your uterus) is firm and central. Over the next few days these observations will be performed every few hours and may include a daily visual check of your stitches to ensure good healing and minimal swelling.
After both vaginal and caesarean births, women can expect vaginal bleeding for a period of time. This bleeding is called Lochia and lasts between 4-6 weeks, starting initially heavier than a period reducing to a heavy period by day 48 hours. It is also common to pass small blood clots, however if the clots are larger than a 50 cent piece size please let your midwife know. It is important to change your pad regularly roughly every 3-4 hours and to shower at least twice a day to maintain hygiene and promote healing.
It is very common initially after birth to feel very overwhelmed with emotions and exhausted. Most mothers want a good sleep and good meal as their first priority after gazing at their babies. Visitors will want to meet the baby, but it is important to also look after yourself and your baby before looking after your visitors. Taking regular naps, eating, keeping hydrated and leaning on your support person all help you and your partner get through the initial days. Hormones are shifting regularly in the first 24 hours resulting in lots of strong emotions and feelings. This is very normal, if after day 5 or 6 the down emotions or days are starting to outweigh the good days it is important to talk to someone. That can be your partner, GP, midwife or child health nurse.
Discomfort and pain
After birth pains or “cramping” are common (mostly for women who have birthed more than one baby before). Thee small contraction like pains are felt as the uterus contracts back down after birth. During breastfeeding or just after is often when the pains are the strongest. Breastfeeding releases hormones that help the uterus contract, which is why after birth pains are strong around feeding time. Heat packs and simple analgesia help the best, rest assured these slowly decrease in the days after birth.
Perineum swelling and pain is normal after a vaginal birth even if you had no stitches. It is often tender, particularly when sitting upright. Ice packs are used to help reduce the swelling and relieve the discomfort in the first few days, the midwives will show your support person where to get them for you. Simple analgesia such as paracetamol and ibuprofen can also help with this pain, each day it should ease slightly, but if it is increasing not decreasing always let your obstetrician or midwife know. This pain can make women nervous to open their bowels after birth, it is important to try to keep your stools soft as this helps relieve pressure and added discomfort.
Caesarean wound pain is something that cannot be avoided but can be managed. It is usually a few hours after birth that the pain increases to a noticeable level. Your medical team will have prescribed medications to help manage this pain and will review your pain regularly. The most painful time will be when you first get in and out of bed and it is important to talk to the midwives caring for you about how the movement impacts on your pain level. Movement helps with recovery after surgery and so finding the right balance of pain relief is important to helping you recover.
Breast Changes and pain
Initially your breasts start to make colostrum just prior to baby being born. Your breast tissue swells, your nipples may darken and sometimes get a little extra hairy. Colostrum is the liquid gold that helps build babies immune system and is sticky and yellow. Initially babies bellies are very small, around the size of a marble, by day 3 it has increased to the size of a ping pong ball. After baby initiates the cluster feeding period your breast may start to feel full, stretched and heavy. They can often feel warm and when laying down feel like they are pushing on your lungs. This occurs as the colostrum is starting the transition into milk, as your baby’s belly grows the milk increases to fill the bigger tummy. Other breast pain can be nipple pain from baby’s latch, often women experience this during the first 15-30 seconds as baby creates the vacuum and pulls the nipple into place. This discomfort educes however, as your nipples desensitize. For some however, the pain does not go away and is intense and sharp throughout the feed. Grazes, bruises and bleeding are common but can usually be relieved by seeking advice from a lactation consultant, and learning new positions to help with bay’s attachment.
After giving birth you will either be in the birth suite or theatre recovery area for a few hours. This is where the initial checks on you are done and once you are showered, have eaten and baby is ready you will move up to your postnatal room. At Mater Mothers Private Hospital the rooms are individual rooms with a day bed for dad or the support person to stay, as well as a private bathroom. This will be your room until you either head home or to the Emporium for the last few days of your stay.