The First 48 With Your New Baby

Childbirth, Featured Article, Pregnancy

For a new mom, nothing caps off nine months of eager anticipation like the moment when she is introduced to her baby for the first time. And while there may be some lingering pain or other physical side effects from the delivery, she is likely overwhelmed with emotion—grateful for the new life she holds in her arms. Baby, too, is glad to finally meet the woman who’s provided his food and shelter for almost a year, but he also has other concerns as he begins to slowly transition to life outside of his mother’s womb.

“When baby takes his first breath, he generates a very high pressure that changes the dynamic of blood flow in the heart and lungs, allowing the lungs to oxygenate the blood,” says Theresa Kledzik, RN and Infant Developmental Nurse Specialist. “This is a major change from the placenta oxygenating the fetus’ blood.”

While baby is taking his first solo breaths, nurses will be bustling about, cutting the umbilical cord (that is, if Dad doesn’t do it, or if baby was born via c-section—in which case dad is not allowed to cut the cord) and testing the baby’s vitals. The Apgar test is given twice—at 1 minute and 5 minutes post-birth—to test baby’s responsiveness and to determine how well he survived the birthing process and how well he is coping outside of the womb, respectively. “A nurse will listen to respiratory and circulatory systems; then the baby is weighed, measured and checked for signs of illness,” says Dr. Meena Chintapalli of A thru Z Pediatrics in San Antonio, Texas. “After that, the baby is given a shot of vitamin K to help with blood clotting, then the baby is diapered and handed to the mother for breastfeeding and/or bonding.”

In addition to breathing without mom, baby must also assume control of his other vital functions. But despite the coming days when he will have to be taught how to walk and talk, at this earliest stage of his life, he has an incredible ability to assume control on his own.

“The biggest of baby’s new duties are cardiovascular, respiratory, glucose stability and nutrition,” says Kledzik. “The ability to suck, swallow and breathe in coordination to take in milk is reflexive at this age and one of the most sophisticated tasks a newborn must master.” Internally, she adds, baby’s intestinal track is also being prepared to begin digesting food, as the first bits of colostrum are ingested. “As the feedings continue, the lining of the GI tract changes so it can absorb the nutrients.”

“After 30 minutes the baby will be put in an isolette and taken so that its vitals will be checked,” Chintapalli says. “A nurse will check temperature, heart and lungs and look for abnormalities. If anything troubling is noted, a pediatrician will be brought in immediately.” If baby is progressing as normal, pediatrician check-ups will slow to once every 24 hours. During the first day, the Hepatitis B vaccine will be administered, if parents approve, and a hearing test will also be administered. For boys, circumcisions are usually performed on the second day, once baby has had a chance to rest.

It is estimated that a newborn baby can generate more than 2,000 dirty diapers in his first year alone, and that starts with his first in the hospital. Within the first 24 hours of birth, baby will pass the meconium stool, a thick, dark, odorless stool that looks almost like tar. Meconium can be messy, but as baby begins to feed, his stool will change colors and begin to thin. “You should consult a physician if the meconium stool does not pass within the first 24 hours or if the stool is a clay or red color,” says Chintapalli. “Clay colored meconium stool can be an indicator of liver disease. Sometimes red stool can be caused by the mom’s nipples bleeding during feeding, but it is always better to be safe.”

Baby will be extremely tired from the delivery, and he will likely sleep quite a bit the first 48 hours. It is important for Mom, then, to wake him to feed at least every three hours. Particularly for breastfeeding moms, this feeding time is important because it helps Baby to get used to the nursing process and perfect his latch. Then, around the 48-hour mark, baby will be awake more and will probably be more interested in eating. “Many babies will start to cluster feed around 48-72 hours,” says Dr. Carol Wilkinson, Medical Director at Kinsights and pediatrician at the University of California, San Francisco. “It will seem like they want to feed ALL the time—even every 30 minutes or every hour. Nursing moms: Remember to take care of your breasts and to get help from nurses about proper positioning.”

It will seem like a lot of work, and Mom will still be exhausted herself from delivering her bundle of joy, but those precious moments are vital to the bond that will develop between Mom and Baby. “Just like their parents, every baby is born with their own personality and their own unique delivery experience that will shape their first 48 hours,” adds Wilkinson. “Remember that your baby is experiencing the world for the first time, so there is lots of learning to be done for both your baby and you.”

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