What Baby's First Day Home Is Really Like
The first few days at the hospital with a newborn are actually like a minivacation, except you don’t realize it at the time: Nurses take care of your every need, someone brings you food, you can sleep as much as you like and a lactation consultant is a call button away. Two to four days later, assuming it was an uncomplicated birth, homecoming is a mash-up of emotions, sleep exhaustion and, possibly, minor chaos. Here’s what’s in store on Day 1 for you and your newly expanded family.
Just a few days old, baby is trying to adjust to life outside your womb—which is a big job! Expect him to be doing a lot of eating, pooping, peeing, sleeping and crying on that first day home.
Newborns, whose stomachs are about the size of a Ping-Pong ball, feed every two to four hours for a total of eight to 12 sessions a day. Don’t feel as if you have to stick to a schedule right away; instead, plan to breastfeed on demand. “Breastfeeding meets so many needs—warmth, the need to suck, skin-to-skin contact, the desire to be held,” says Leigh Anne O’Connor, an international board certified lactation consultant and La Leche League leader in New York City. “All those things are satisfied at the breast.”
If you need a break but baby seems KrazyGlued to your nipple, try this trick: Offer baby your pinkie facing up, and tickle his palate gently. “A baby has been sucking nonstop in the womb, and now all of a sudden there’s nothing to suck,” Cathryn Tobin, MD, a baby sleep expert at the New Baby Sleep School explains. Using your finger in place of a soother is a good idea until baby is gaining weight and feedings are established.
Don’t be worried if baby spits up. Spit-up is typically dictated by how much extra air baby takes in during a feeding. She probably won’t spit up every time, and when she does it’s usually just a dribble. “The amount is typically less than a tablespoon,” says Tobin.
Pooping and peeing
By now, meconium, the tarlike goop that appears in the first day or two of life, should be replaced by greenish transitional poop that will eventually turn yellowish, possibly speckled with little “seeds.” Look for a minimum of three to six wet diapers a day.
“When a baby comes home, he’s incredibly tired,” says Helen Moon, a certified lactation educator based in Windsor, England, and author of Cherish the First 6 Weeks. “The trip will be strenuous. It may be the first time the baby is exposed to fresh air, the cold, the heat of the sun, the outside world. So a simple drive will give you a very sleepy baby.” Count on baby conking out shortly after walking through the door. “Grace slept in my arms for hours the afternoon we got home,” says Sarah S., mom to a 7-month-old girl. “She has never liked the car seat, starting with her ride home from the hospital. She (and I) cried the whole 10 minutes. By the time we arrived, her face was red as a tomato and she was exhausted.”
Expect baby to sleep between two and four hours in one stretch. If she sleeps longer, you need to wake her up so she can eat. “Their tummies are so little that they can’t drink very much milk at one time,” Moon says. “If they’re left to sleep longer than four hours, they might become too lethargic and then will be unable to eat enough.”
Encourage awake time during the day—about an hour between naps—to shift baby’s schedule. Otherwise, he’ll be awake during the night, since he had been used to the sleep-inducing rocking of your uterus during the day and tended to be more alert in the evening, Moon says.
Crying (and other noises)
That’s how babies communicate their needs, whether it’s hunger, discomfort, crankiness or the desire to suck. Once the need is satisfied, your little one should calm down. When holding and rocking baby doesn’t seem to work, Tobin suggests cupping baby’s head in your hands, lifting her head slightly and talking to her quietly. “Most babies will stop crying, as they are trying to hear you. They’ll also open their eyes and look at you.” If baby is wailing no matter what you do, call your pediatrician.
Other than crying, baby might be making grunting sounds. “I remember being worried about my baby snorting,” says Jill S., mom to 5- and 7-year-old girls. “It was like I had a piglet in the bassinet next to our bed!” As long as he doesn’t turn bluish or have to stop nursing to get air, his nasal passages are probably fine. “Babies are generally nose breathers when they sleep,” says Tobin. “They have tiny passages, so most babies sound snorty.”
When to call the doctor
• Continuous blue skin coloring. This means not just blue hands and feet that return to normal pink when warmed up but also the entire body, especially when she’s feeding. The symptoms could be related to poor heart and lung function. Seek medical attention immediately.
• Yellowing of the skin and whites of the eyes. These are typically signs of jaundice.
• Repeated vomiting. This is more forceful and has more volume than spit-up. It could mean baby is sensitive to something in your breast milk or formula, or she may have gastroesophageal reflux disease (GERD) or an infection such as rotavirus.
• Redness, puffiness, pus around the umbilical cord stub. It could be infected.
• Extreme lethargy. If you’re continuously waking baby around the four-hour mark, your doctor may want to check for infection and to ensure he’s gaining weight and getting enough liquid.
• Rectal temperature reading of 100.4 F or greater. High temperature in a newborn is a sign of a serious infection and needs immediate evaluation.
• Coughing. Anything beyond minor sputters when feeding (which is a result of milk coming in too quickly) might be a sign of respiratory or allergy issues.
• Less than three wet diapers in 24 hours. Baby is showing signs of dehydration and inadequate feedings. Dark yellow urine is a symptom of dehydration.
• Any dramatic changes in baby’s looks and behavior. For instance, a weak cry, endless wailing or poor sucking reflexes are signs for concern.
Your body has just had its limits tested, and now that the adrenaline and medications have worn off, you’re really starting to feel the aftermath. Besides the obvious vaginal and (if you had a c-section) belly pain, you’ll likely experience profuse bleeding. Every time you stand up, a small gush of blood will plop into your pad—and while it’s far from fun, it’s totally normal. Whether or not you’ve had an episiotomy, you’ll want to stock up on those ginormous ice pack pads and disposable grannypanties they offer at the hospital; they’ll not only make you more comfortable but also save you from doing extra laundry. Having a doughnut-shaped seat cushion can be helpful too.
You may also be surprised to find soreness all over the body. “Pushing is athletic,” says Margaret Buxton, CNM, a Nashville-based regional clinical director at Baby+Co birth centers and clinical faculty at Vanderbilt University School of Nursing. “It stimulates muscles you’re not used to activating all at once—your legs, upper body, neck, arms and chest.”
Your breasts will also dramatically increase in size and heaviness, whether or not you plan to breastfeed. At this point, breast milk (white and thin, like 1 percent cow’s milk) will start to replace colostrum (the golden yellow thick liquid); this can leave your breasts tender, especially if you had a medicated birth. “When a woman gets an epidural or other drugs during birth, she has to have two bags of IV fluid,” O’Connor says. “Breasts are designed to allow for expansion and contraction, and this fluid competes for space in the breast as milk is beginning to increase. This is one reason so many women get that uncomfortable engorgement.” Hand-expressing milk from firm breasts will give you relief and also make it easier for baby to properly latch on. Some women swear by frozen cabbage leaves as an alternative to cold gel packs to find additional relief.
Nursing can be challenging, as it was for Mackenzie C., mom to an 8-month-old girl who came two weeks early and had difficulty with the sucking reflex. “Breastfeeding was the most amazing experience of my life, although you wouldn’t know it at first,” she says. “Even with the nipple shield, it was a toe-curling, teeth-clenching, hunched-shoulders experience. I have never counted to 100 back and forth so many times in my life than I did those first few days. Now, I find breastfeeding relaxing and a wonderful time with my baby. After going through this experience, I am all the more appreciative that my sweet girl and I still have this bond.”
Another side effect is constipation. “Labor diverts the blood flow from the digestive system, and it could take a couple of days to get into a normal rhythm,” Buxton says. Add hemorrhoids, post-episiotomy discomfort and certain postpartum narcotics —and things can come to a halt, literally. “I had no idea that the Percocet given after my c-section caused constipation,” says Abby L., mom to 1-year-old boy and 3-year-old-girl. “I was so backed up when I got home from the hospital that I sent my father-in-law to the store to get stool softener and prunes. We do not have that kind of a relationship! And then I broke the toilet, so he and my husband had to fix it. I was so embarrassed.” Besides prunes and laxatives, natural laxatives, such as Traditional Medicinals Smooth Move tea (which contains intestine-stimulating senna), can help. To prevent future problems, consume at least six eight-ounce glasses of water and 5 grams of fiber each day. This could mean having some bran cereal for breakfast, incorporating beans or whole-wheat pasta in lunch or dinner, and snacking on raspberries. For hemorrhoid relief, try witch hazel wipes, a 1 percent hydrocortisone cream and warm sitz bath.
When to call the doctor
• Golfball-size blood clots. If you see them on your pad, it could be a symptom of a retained placenta.
• Fever over 100 F. It can be a sign of infection.
• Belly tenderness getting worse, not better. This could be related to problematic uterus contractions.
• Foul-smelling odor from vaginal discharge. This is often another sign of infection.
• Sudden onset of acute headache and/or chest pain. While a regular headache or breast soreness is normal, intense pain could be a sign of a more serious problem, such as a blood clot.
• Burning pain when you urinate. If it doesn’t stop hurting by the time you’re done urinating, it could be a sign of a urinary tract infection.
The first 24 hours will likely be an emotional roller coaster. “The only thing I can remember clearly is that on my first night home we ordered sushi and I had pumpkin ale,” says Noelle E., mom to a 10-month-old girl. “The two things I had abstained from for so long. I was so excited. The rest was, honestly, a blur. I just remember being so incredibly happy. I couldn’t believe she was here, but I was so exhausted, like I was in survival mode.”
Once baby is born, your body tries to balance out the hormonal and chemical soup that can lead to mood swings—weepiness, excitement, irritability—and that’s only enhanced by the severe physical exertion and lack of sleep. Not surprisingly, the onset of the baby blues can start around the same time, about a week postpartum.
Fatigue will likely mess with your head, especially considering you probably haven’t slept much since early labor. Then when everyone finally goes to bed, you’re probably wide awake listening for the baby to make sure she’s okay. Sometimes, the best remedy is a sense of humor. Take Meghan E., mom to 4-year-old Oliver, who (along with her husband) experienced a bit of sleepwalking. “I was nursing for 40 minutes every two hours, so I basically got no more than 30 to 45 minutes of sleep at any given time,” she remembers. “There were several instances when I was in bed and confused the cat for Oliver and insisted she be put back in the bassinet.” Apparently, her husband was delirious too. “He would wake up and take all the pillowcases off, claiming he was ‘looking for the baby,’” she says.
When to call the doctor
• You’re having disturbing ideas or intrusive thoughts. If you can’t get them out of your mind, it’s possible that you have postpartum obsessive compulsive disorder. Call your OB immediately.
• Your baby blues leave you feeling hopeless or keep you from taking care of baby. You may have postpartum depression. Again, don’t wait until the six-week OB appointment; get help immediately.
You may have given birth, but it’s not as if your partner was on vacation. The thing to remember is that everyone is high on emotions and short on sleep and, therefore, deserves a break. Ideally, a few weeks before your due date, you and your partner should have a discussion about household roles and expectations for those first few days postpartum. Drawing up a plan in advance can curb the resentful “you should have known to do that” argument.
The goal is to enter a divide-and-conquer mentality, like Melissa G., mom to a 10-month-old boy. “The first 24 hours at home were super overwhelming,” she says. “It was just the three of us. My kiddo was crying and eating so much, we had to divide and conquer—I breastfed and my husband changed the diapers and swaddled.”
To help you optimize a peaceful transition into parenthood, talk about what each of you values and what type of support you might need. “We both worked at keeping each other fed,” Melissa G. adds. “We are forever grateful for our friends and family who brought us food—and wine!). We also took turns napping and taking care of the baby. That was huge. We were so tired, but had some relief and could function. We both even got to shower!”
Published September 2017