The First 48 Hours for Baby
We have just welcomed baby #4, Mr. Ollie Jack, to the world. He came in like a freight train (Read more about his birth HERE) and our lives feel as though they are moving faster than ever, but at the same time in slow motion as we take every aspect of Ollie in. Our 4th natural, unmedicated birth, and 3rd homebirth (but 1st unassisted birth!), we had a plan – a plan that was thrown out the window as he arrived. Everything from his birth and golden hour, to my “Lying-In” time hasn’t been what I pictured, but here we are: loving a newborn and figuring it all out. As I sit in bed, nursing this tiny 6lb baby, my heart skips a beat. He may be our last baby so I am trying to soak it all in. Instead of just letting the moments pass by, I’m really trying to pay attention to it all. In doing so, I have kept notes throughout the first 48 hours postpartum. I figure that some of you may be interested in learning about this timeframe with a newborn! Each baby is so different, and each time I am in my postpartum period it seems different. I forget about all I should be looking for with the baby, and I forget just how precious the time is. I’ve compiled a list of everything you need to know about your newborn over the first 48 hours after birth. I have included warning signs, newborn care, my favorite must-haves, and everything I have needed during this time frame. Whether at home, a birthing center, or a hospital, the way you spend your hours after birth is up to you. You have the right to request or refuse whatever you would like. (This includes the vitamin K, eye ‘drops,’ and anything you do not agree with.) I’m approaching this topic through my own experiences as being at home with the baby and having the responsibility of watching baby on my own.
The First 48 Hours With BabySkip the Baby Bath: Rub in the vernix! You know, that cheesy, creamy stuff that baby comes into the world covered in – yes that – RUB IT IN! It is the best thing for baby’s skin. Remember that the skin is the biggest organ and absorbs what is put on it. That vernix serves a greater purpose than any bath ever will. We hold off on real baths until at least 10-14 days after birth, and even then we skip the soap. (Our kids may qualify as dirty hippie kids most days of the week, whatever – don’t judge.) Skip the Hat: New research shows it is much better for baby to skip the newborn hat. A hospital likes to use them to hide any imperfections, but in reality they are not needed and can actually make it harder for baby to regulate his temperature. Skip the Mittens: Mittens may keep baby from scratching his face, but they also prevent his little fingers from feeling things. The senses at the finger tips are very important for a newborn. Skin to Skin: You can read more HERE about skin to skin. You regulate baby’s body temperature, allow him to hear your heart beating, and keep him as close to the womb as possible. This should be practiced throughout infancy, not just during the first two days. Body Temperature: I am very strict about feeling the baby constantly over the first week. I deny all testing during pregnancy, including GBS – I’ll write about that soon. Basically, you can test positive one day and negative the next, so the point of testing is pretty absurd. I watch for any signs after baby is born (as do my midwives). I also do not take a temperature rectally, as it has been warned you can puncture the rectum. Anything over 99.5* needs to be seen by a doctor. Cord Care: NOTHING. I repeat, do nothing. A little sunshine and dry air is enough to heal the cord. Do NOT use alcohol or any other harmful substance. If you really can’t stand it, squirt some breastmilk on it. #BreastmilkHealsEverything Urinating: The rule of thumb is one wet diaper per day alive. This has never been true for my children though. They pee as often as they breastfeed. But the concern would be if they are not having wet diapers. Meconium: The sticky (GROSS) black, tar-like poop will last the first 2 days or so. This is the meconium and will transition to a mustard-like poop throughout the first few days. Hiccups: Baby is learning the whole ‘breathing air’ thing and will have the hiccups frequently. If he does not, there’s nothing to worry about, but if he has them constantly, follow up with the doctor or midwife. Coughing: Again, coughing is normal – like hiccups – as baby adjusts to the world. Your baby may sound a bit congested, but he isn’t sick. Don’t stress out. However, if your gut is screaming at you, then go have him checked out. Weight Loss: Babies will lose up to 10% of their birth weight over the first few days, less if you have an unmedicated birth. They should gain it back between 2-3 weeks old.
First 2-hours after birthQuiet-alert: The perfect opportunity to establish breastfeeding. Evidence shows that babies “imprint” on their first oral experience, and will remember this later. Breastfeeding at this point can also help stop postpartum bleeding. Consider the first feedings as “practice” for both mom and baby. Even if baby only licks or nuzzles, it is helping to orient baby toward the breast and stimulates milk-producing hormones in the mother.
Next 12 hoursDeep sleep: This is the time for both mother and baby to rest and recover from the birth. The breast should be offered every 2-3 hours during the day and every 4-5 hours a night, altering with waking techniques, such as unbundling and bringing baby into an upright position (doll-eyes effect). Most babies do fine with very little to eat during this period. (Protocol: Blood sugar with no feeding for 5-6 hours.)
Next 12-36 hoursHungry: Baby may seem insatiable with frequent feeding cues, i.e. licking lips, hand to mouth motion, rooting, and crying. This is a normal stage and is meant to stimulate the mother’s milk supply. It does not indicate that the mother does not have enough milk. The colostrum is there! It has been there since the middle of the pregnancy. Colostrum is like concentrated milk. It is high in fat and protein with special immunities to protect the baby after the birth. It also has a laxative effect to clear the meconium after the birth, which helps prevent jaundice. A few teaspoons of colostrum, are equal to an ounce of formula. If baby will not latch, a few drops of colostrum hand expressed into baby’s’ mouth is often enough to maintain blood sugar. Input-Output: We know how much a breastfeeding baby is getting by output. The guideline is one wet diaper for each day of life the first week: 1 wet on day one, 2 wet on day two, etc. Expect 2-3 stools a day, with the stool transitioning from black meconium to green, and finally yellow by Day 4.
Things I Love:Chiropractic Care: Yes, we take our 2 day old to the chiropractor. You'll believe in this too if you saw what a difference it makes. Newborn Cloth Diapers: We are modern hippies. My babies wear cloth from birth and we’ve never owned disposable diapers since my first baby was 2-3 months old. There is nothing cuter than a fluffy butt; not to mention knowing that your baby has zero chemicals on him (especially the genitals!). Ring Sling (My favorite is the Maya Wrap Ring Sling!): Even my bigger kids wear the baby in a sling! Kimono style tops: Until the cord has fallen off, kimono shirts are the easiest clothing to get on and off baby. Tiny baby socks Aden and Anais organic blankets Digital thermometer Printable Chart/Log to record the first few days: Use a chart to record the time and duration of nursing sessions (Every baby is different, but you want at least 8 sessions a day, if not more – my kids are always MORE – like 12+). You can keep track of wet diapers and frequency of meconium passing. You can note baby’s temperature and temperament too. All of this will help you feel more confident in your transition period, and it will give insight to something that could be wrong. Download a newborn log HERE.
Warning Signs for BABYCall your doctor immediately if your baby has any of the following:
- Temperature over 99.5° or under 97.5°F axillary, or over 100.4° or under 98.4°F rectal
- Respiratory difficulty (noisy “grunting” on the exhale, flaring nostrils with each breath, ribs stick out when inhaling) or becomes blue or grey in the torso and head
- Becomes yellow or orange in the skin or eyes in the first 24 hours
- Lethargy or seizures: If lethargic (can't wake up even with stimulation, is very tired, won't eat) or has seizures (possible signs - eyes rolling upward or fluttering; stiffening of the body; movements of the tongue, lip smacking or excessive sucking; uncontrolled jerking movements or body twitching; staring spells or periods of unresponsiveness)
- Develops high-pitched cry
- Baby will not feed
- Skin bruising or unusual bleeding, especially ANY bleeding from a circumcision as babies are very sensitive to blood loss