The first hours after birth

Your baby is here. The first hours after birth are a time of enormous change for both of you: your baby is breathing air and keeping warm for the first time, and your body is beginning to recover. For most families, the best thing in these hours is also the simplest: keep your baby close, skin to skin, and let the checks fit around you.

The golden hour

The first hour after birth is often called the golden hour. If you and your baby are well, your baby is placed straight onto your bare chest, dried with a warm towel, and covered with a dry blanket, with a hat if needed. Routine weighing and measuring can wait until after this first hour. Many checks, including the Apgar score, can be done while your baby lies on you.

Why skin-to-skin matters

Skin-to-skin contact helps a newborn steady their temperature, heart rate, breathing and blood sugar. Babies held this way tend to cry less and are more likely to breastfeed well. It also releases oxytocin in you, which helps your uterus contract and lowers bleeding. Aim for at least an hour without interruption if you can, and keep doing it often in the days after. Your baby should lie tummy down on your chest, head turned to one side, with the nose and mouth visible and the neck straight, not bent forward. If you feel very sleepy or need medicine that makes you drowsy, ask your partner or a nurse to take over or to stay with you. After a caesarean or if you are unwell, your partner can do skin-to-skin too.

The first feed

Breastfeeding

Many babies show a remarkable instinct in the first hour. Left on your chest, a baby will often rest, then begin to wake, lick their hands, bob their head, and crawl and wriggle toward the breast in small pushes of the legs. This is sometimes called the breast crawl. When the cheek or mouth touches the breast, the baby turns toward it and opens wide: the rooting reflex. Many latch on their own within about an hour, some sooner, some later. You can help by leaning back comfortably and supporting your baby's body, rather than pushing the head. A good latch takes in plenty of the darker area around the nipple, not just the tip. The first milk, colostrum, comes in tiny amounts, a few millilitres, and that is exactly what a newborn needs. Ask your midwife or nurse to help with the first feed. If your baby is sleepy or does not latch, keep them skin to skin and try hand expressing a few drops of colostrum onto a spoon.

Bottle feeding

If you are feeding formula, the first bottle is also a moment of closeness. Hold your baby skin to skin or close, semi-upright, and let them take the teat in their own time. Newborns need only small amounts at first, around 5 to 15 ml in the first feeds. Pause often. The daily entries for the first two weeks cover feeding in detail.

The Apgar score

At one minute and five minutes after birth, your midwife or doctor gives your baby an Apgar score, often while your baby is on your chest. It is a quick check of how your baby is adjusting, not a measure of health or intelligence later on.

The five scores are added together for a total out of 10. A score of 7 or more is reassuring. A lower score at one minute is common, especially after a fast or difficult birth, and usually rises by five minutes as the baby breathes and warms up. Few babies score a full 10, because blue hands and feet are so common in the first minutes.

If your baby needs help to breathe, the team will take them to a warmer close by, often in the same room. Most babies who need this respond within a minute or two.

Newborn checks

Weighing and measuring

After the first hour, your baby will be weighed and often measured for length and head circumference. The average birth weight is about 3.3 kg (7 lb 4 oz), and length about 50 cm (19.5 in), but healthy babies vary widely. Your midwife or doctor will also look your baby over from head to toe, checking for anything that needs attention. A more detailed newborn examination, including the heart, hips and eyes, is usually done within the first few days.

Vitamin K

You will be offered a vitamin K injection for your baby, usually in the thigh. Newborns have very low levels of vitamin K, which the blood needs to clot. Without it, a small number of babies develop a rare but serious bleeding problem in the first weeks or months, sometimes in the brain. A single injection prevents this almost completely. Oral vitamin K is available in some places but needs several doses and is less effective. The injection can be given while your baby is on your chest or feeding, which helps comfort them.

Eye ointment

In some places, antibiotic eye ointment is offered or routinely given to prevent certain eye infections that can be passed on during birth. Practices differ between regions. Ask your care team what is offered where you are and why.

How your newborn looks

Newborns rarely look like the babies in advertisements. All of this is normal: Moulding. The head may be long or cone-shaped after squeezing through the pelvis. The skull bones overlap a little and settle into a rounder shape over a few days.

Swelling. A soft, puffy swelling on the head is common, especially after a long labour or a vacuum birth. Eyelids and genitals may also be swollen. Vernix. A white, creamy coating on the skin, especially in creases. It moisturizes and protects. There is no need to wipe it off; it soaks in. Lanugo. Fine, soft hair on the shoulders, back or ears, more common in babies born early. It falls out in the first weeks.

Blue hands and feet. Very common in the first day or two while circulation settles. The body and lips should be pink.

Colour changes. Skin may look red, purple or blotchy, and may flush when crying.

Marks from forceps or a vacuum cup, and small spots or birthmarks. Most fade.

The daily entries for the first two weeks say more about your newborn's appearance.

How your newborn acts

Many babies are wide awake and alert for the first hour or two after birth, with eyes open, gazing at faces and responding to voices they heard in the womb. This is a wonderful time to talk to your baby and feed. Then most babies fall into a long, deep sleep for several hours. That is normal. Keep offering feeds when they stir, and ask for help if your baby is hard to wake for feeds by about six hours after birth or as your team advises. Newborns may make snuffly noises, sneeze, have short pauses in breathing followed by faster breaths, and bring up a little mucus. A nurse can show you how to wipe their mouth or hold them to help.

Keeping your baby warm

Newborns lose heat quickly, especially from the head. Skin-to-skin is the best way to keep them warm. Otherwise, dress your baby in an undershirt, a sleeper and a hat for the first hours, wrap them in a blanket, and keep the room comfortably warm. Feel the back of the neck or the tummy: it should feel warm, not hot or sweaty. Cool hands alone are not a reliable sign. Your body in the first hours

Afterpains

Your uterus keeps contracting after the birth to shrink and to close the blood vessels where the placenta was attached. These cramps, called afterpains, are often stronger while breastfeeding and in people who have given birth before. Pain relief is fine; ask for it.

Bleeding

Bleeding after birth (lochia) is heavy and red at first, like a heavy period, sometimes with small clots. You will wear large maternity pads, and staff will check them regularly. Tell your midwife or nurse if you pass a clot bigger than a plum, or if you need to change a pad more than once an hour.

The first pee

Try to pee within about six hours of the birth. It may sting if you have a tear or graze; pouring warm water over your perineum while you pee helps. Some people cannot feel when the bladder is full after an epidural or a long labour. A full bladder can stop the uterus from contracting properly and increase bleeding, so if you cannot pee, tell staff. A catheter may be used for a short time.

Shaking, hunger and other feelings

Many people shake or shiver hard after birth, even when warm. It is a normal hormone and adrenaline response and passes within an hour or so. A warm blanket helps. Most people are also very hungry and thirsty: eat something. You may feel elated, exhausted, tearful, numb or all of these. If you have a tear or stitches, see "The third stage: the placenta and checking your body".

Rest

Once you have fed and cuddled, rest. Ask visitors to wait. Let your partner hold the baby while you sleep, or place your baby on their back in the bassinet beside you.

What the staff check on you

In the first hours, your midwife or nurse will check your pulse, blood pressure and temperature, feel your uterus through your belly to make sure it is firm and contracting (a soft uterus can mean more bleeding, and gentle rubbing helps it firm up), check your pad and the amount of bleeding, and look at any stitches. These checks are usually every 15 to 30 minutes at first, then less often. After a caesarean, the wound dressing is checked too.

The first night

The first night can be a surprise. After that long first sleep, many babies wake and want to feed very often, sometimes every hour, through the night. This cluster feeding is normal and helps bring in your milk. It does not mean you do not have enough.

Keep your baby close, in a bassinet next to your bed, on their back. If you are breastfeeding in bed and feel sleepy, ask your partner or a nurse to put the baby back in the bassinet. Never fall asleep with your baby on a sofa or armchair. Call for help whenever you need it, for feeding, pain or simply a few minutes' rest. That is what the staff are there for.

When to get help

Get help right away if you soak a pad in an hour or less, pass a clot bigger than a plum, feel dizzy, faint or have a racing heart, or have new severe pain in your belly.

Get help right away if your baby is floppy or unusually hard to wake, is struggling to breathe (grunting, very fast breathing, or the skin pulling in under the ribs), or is blue or grey around the lips, face or tongue. In hospital, press the call button. At home, call your local emergency number. Call your midwife or doctor if your baby has not fed well by about six to eight hours after birth, feels cold or hot to touch, or you have a fever or feel unwell.

In short

If you are both well, keep your baby skin to skin for at least the first hour, and let checks wait.

Many babies crawl to the breast and feed in the first hour; tiny amounts of colostrum are all they need.

The Apgar score is a quick check at one and five minutes, not a prediction for the future.

Vitamin K is offered to prevent a rare but serious bleeding problem. Expect afterpains, heavy bleeding, shaking and hunger; staff will check your uterus, bleeding and blood pressure.

Get help right away for heavy bleeding, or a baby who is floppy, struggling to breathe or blue around the lips.