Bringing your baby home from the hospital is exciting, but it can also be pretty intimidating! I remember when we brought our first baby home I had no idea what to do, plus I was already experiencing “new mom sleep deprivation.” Thankfully, our friends at UAB Women & Infants Services are here today to give moms all the help they’ll need to make an easy transition from hospital to home!
Incidentally, U.S. News & World Report recently ranked UAB Medicine fifth in the nation in Obstetrics & Gynecology on its 2022-2023 Best Hospitals List!
Birmingham Mom Collective especially wants to thank Dr. Sima Baalbaki (obstetrics/gynecology), Barbara Vinson (lactation), and Dr. DeeAnne Jackson (pediatrics) for their help and expertise given to this article.
What to Expect at the Hospital
New moms should expect to spend a few nights in the hospital after delivery. After a vaginal delivery, a mom will generally stay in the hospital two nights (or about 48 hours). Following a Cesarean delivery, a mom can expect to stay in the hospital three or four nights (or approximately 72-96 hours). Some moms are able to go home sooner; others may need to stay longer.
Moms can expect to see an OB or Advanced Practice Provider who works with their OB daily. They can also expect to be evaluated by nurses and Patient Care Technicians. Nurses will be available to bring needed medication to the patient and assist with any needs that arise. The Patient Care Technician will check vital signs regularly and help the nurse.
Will the Baby Be in the Room?
A mom can expect her baby to be in the room with her at all times unless the pediatrician recommends otherwise for medical reasons. It is important for mom and baby to spend time together bonding and learning about each other in the immediate postpartum period. Rooming in facilitates frequent skin to skin time with the baby, which helps regulate heart rate, temperature, breathing pattern, and blood sugar in the first hours of life.
Keeping baby and parents together allows parents to recognize and respond immediately to baby’s cues for hunger and sleep, which allows establishment of healthy feeding and sleep patterns and is essential for the establishment of breast milk supply. Rooming in helps improve parents’ confidence in caring for their baby after discharge and has been shown to lead to better quality of sleep for parents and infant with earlier development of a consistent routine.
The NICU Possibility
Most healthy, full term (37 weeks or more) babies will stay with their mom in the delivery room before going with her to the Mother Baby Unit. Mother and baby will then room-in together until discharge. Many babies born at 35-36 weeks gestation (known as late preterm) may also stay with mom throughout their stay.
Some babies have problems after delivery that require closer monitoring, special testing, or treatment requiring admission to the RNICU (Regional Neonatal Intensive Care Unit). The most common reasons for this are breathing problems or low blood sugar. Both of these are more likely to occur in late preterm infants or if the mother has diabetes. If the issues resolve, the baby may be able to transfer to the Mother Baby Unit to room-in with mom later in the stay.
All babies born before 35 weeks are admitted to the RNICU for special supportive care.
Babies who have congenital problems with their heart or other organs will also require
admission to the RNICU. Many of these conditions can be identified during prenatal care.
Routine Care for Baby After Birth
Healthy newborns are admitted by a nursing team in the delivery room. If there are any risk factors at delivery or if the baby is delivered by Cesarean section, doctors from the RNICU will be at the delivery to assess the baby immediately after birth and provide any needed resuscitation.
As long as the baby is stable, mom will be encouraged to place the baby skin-to-skin immediately after birth. The nurse will assist with the first feeding, which should be offered shortly after delivery.
The baby is then weighed and measured, and vital signs are checked several times in the first few hours. Shortly after birth, the baby will receive a Vitamin K shot to prevent bleeding problems and erythromycin eye ointment to prevent eye infections. He or she will stay in the delivery room with mom until they are both transferred to the Mother Baby Unit where the baby will stay in mom’s room.
Vital signs are checked every four hours for the first day of life and then four times a day after that. The Hepatitis B vaccine is given shortly after arrival to the Mother Baby Unit. If the nurse notices any problems with the baby at any time, a doctor will be called to assess the baby. For stable healthy newborns, a doctor from the Newborn Nursery team will examine the baby and speak with the family no later than 24 hours after delivery.
If the baby’s primary care doctor provides newborn care at UAB, he or she will be
notified after delivery and will see the baby within 24 hours. However, most babies born at UAB are cared for by the Newborn Nursery team. Because UAB is a teaching hospital, residents and medical students on the Newborn Nursery team will also assist in providing care. All babies are seen every day by the attending physician as well. A nurse will continue to check on the baby frequently throughout the stay (and this is usually the same nurse that cares for the mother). In other words, both mom and baby are in great hands during their stay.
A nurse who specializes in breastfeeding support will also see the mother and baby during the first day of life and on subsequent days if needed. At 24 hours of life, the baby will be weighed again, have their first bath, and receive newborn screens. Babies are then weighed each morning until discharge and have a jaundice check by a device
that is placed on the forehead. If the bilirubin level is high or if the baby looks very jaundiced, a heel stick blood test will be given.
Newborn Screens
There are three parts to the state newborn screen.
- Babies are screened for congenital heart disease by checking an oxygen level in their hand and foot shortly after they are 24 hours old, generally at the time of the first bath.
- Hearing screens are done in the mother’s room by a hearing screen team. The family is given the results of these tests immediately. If the baby does not pass the first or second hearing screen, the team will make an appointment for a re-test in the audiology clinic within two weeks.
- A blood spot test is collected from a heel stick when the baby is 24 to 48 hours old. This test is sent to the state lab. The lab is now able to test for more than 40 different conditions with this test. Some of the more common conditions tested include thyroid problems and sickle cell disease. While many of the conditions identified by the screen are very rare, they all have serious consequences that can be prevented if treatment is started before the baby has any symptoms. The hospital puts the name of the baby’s primary care doctor on the blood spot test. If the test is abnormal, the primary care doctor will be notified by the state and will be given instructions for needed follow up testing. This is one of the many reasons it is important to choose a primary care doctor before the baby is born. The results of the blood spot newborn screen are available by the time the baby is 10 days to two weeks old. All doctors in the state can register to get the results electronically. It is important to confirm with the baby’s doctor that the results of the state screen have been reviewed.
When Would a Baby Need to Stay in the Hospital Longer?
Most healthy babies are able to go home from the hospital when their mother is discharged, usually about two days after a vaginal delivery or three to four days after a Cesarean section.
The most common reason a baby would have to stay longer is treatment for jaundice. Jaundice is more likely in babies who are born before 38 weeks gestation, or if there is incompatibility between the mother and baby’s blood.
Treatment for jaundice involves placing the baby under a blue light and can take place in the mother’s room as long as she is still admitted. Babies who need treatment for jaundice usually need only one or two extra days in the hospital.
There are times when unexpected problems can arise. If the baby develops breathing issues, temperature problems, or other symptoms that could be related to infection, special testing and treatment will be needed. The baby will need to stay in the hospital until an infection can be ruled out.
Other more rare conditions can occur, including problems with the digestive tract or signs of a heart condition. If the baby needs continuous monitoring, other significant treatment, or needs to stay in the hospital longer than the mother, the baby’s care will be transferred to the neonatology team in the RNICU.
What to Expect with Breastfeeding
Working with a Lactation Specialist in the hospital is also helpful as breastfeeding is a learning experience for mom and baby. Yes, it is a natural activity, but a new mom can sometimes find that breastfeeding takes practice, which requires time and patience. New moms and their support people often find pre- and post-natal classes, support groups, and lactation consultations to be excellent resources for breastfeeding and other aspects of newborn care.
Colostrum
Moms can expect babies to be sleepy their first two days, but by day three, a newborn will breastfeed 8-12 times that day for 10-30 minutes on each side. Colostrum is the first milk babies receive, and it is full of protein and antibodies. It’s the perfect first food with everything babies need in small amounts—just right for their cherry-sized stomachs! Mom should feel confident and baby should be good at it by the time of hospital discharge.
Setting Moms Up for Success
UAB’s lactation services work with new moms to make sure that both mom and baby are comfortable during feedings and teach mom how to know the baby is getting enough to drink. They can also assist with sore nipples and pumping, as well as giving reminders for self care (such as getting enough sleep)!
Success comes more easily if mom and baby can be together so that she can learn to recognize early hunger cues. Moms will also receive daily support from their nurses as well as lactation consultants. New moms will also be given written information and instructional videos to help once they’re released from the hospital.
Milk typically comes in between the third and fifth day. There will be a greater volume than there was for colostrum. Babies will make lots of wet and dirty diapers and start to gain weight. The mom’s milk volume is determined by how much breastfeeding and pumping she does, so it’s important to start a healthy schedule before leaving the hospital. That way, she can continue the routine once she’s home.
The UAB lactation consultants are available even after moms are released from the hospital. Just reach out to them with any breastfeeding questions that arise!
What to Expect Once You Get Home
It is normal to feel some apprehension about bringing a baby home for the first time, even if this isn’t the first baby. It is also important to remember that a new mom won’t be perfect at everything she does, and that is okay!
Infant Sleep
The American Academy of Pediatrics (AAP) recommends that babies sleep in the same room as parents (but not in the same bed!) for at least the first six months.
Infants should sleep on their backs and in their own space. A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is recommended by the AAP. Sleeping on a couch, in an armchair, in a swing, or in a car seat (unless in the car) is not recommended.
Baby’s sleep space should remain clear of bottles, loose blankets, toys, bumpers, or other soft items to help decrease the risk of choking, suffocation, and sleep-related infant deaths.
There is no formal recommendation for what a baby should wear while sleeping. However, the most important thing to do is ensure there are no choking or suffocation hazards on baby’s clothing. Also, make sure the baby is at a comfortable temperature. Footed pajamas, onesies, socks, and mittens are great options for sleepwear. Swaddling with a thin blanket can be very soothing and comforting for a newborn. A room temperature of 68-72 degrees is generally comfortable for both mom and baby.
If moms have further questions regarding safe sleeping habits, they should consult the baby’s pediatrician.
Caring for Yourself
While making sure a baby is snug, safe, feeding well, and sleeping, it’s vitally important that moms look after themselves, too. The postpartum period is a time of many changes, both physical and emotional. One mom’s experience may not be the same as another’s.
Regarding physical changes, a mom can expect her body to start the process of returning to its pre-pregnancy state following delivery. This process takes many months to occur, and moms may find their post-baby bodies have a new “normal.”
It is common for moms to experience abdominal discomfort and pelvic cramping following delivery, especially when breastfeeding. This is a normal response and means the uterus is trying to return to normal size and prevent heavy bleeding. Ibuprofen and Tylenol can be helpful for managing the cramping, and both are safe to use while breastfeeding. If a mom has a Cesarean delivery, she may be prescribed stronger pain medication to help with the post-surgical pain as well.
While every mom’s postpartum experience is unique, the following signs or symptoms are reasons to seek medical attention:
- fever
- nausea/vomiting with inability to keep food/liquids down
- worsening pain not controlled by medications prescribed by the physician
- heavy vaginal bleeding
- foul smelling vaginal discharge
- drainage/redness/swelling at incision or laceration sites
- thoughts of harming oneself or anyone else
The above list is not comprehensive, and moms know their bodies best. If a new mom feels like something is off, she should reach out to her OB.
Postpartum Bleeding
It is also expected that a mom will have bleeding in the postpartum period. We refer to the vaginal bleeding following delivery as lochia. Lochia can last several weeks, and it changes in color and consistency during that time. It is possible mom will still notice some lochia at the time of the six week postpartum visit. Bleeding will initially be a red or red-brown color that lasts for several days following delivery.
The amount should be similar to or less than a typical period, and there may also be an occasional small clot. If moms experience bleeding requiring pad changes in less than one hour or are passing large clots, it is important to seek medical attention.
Breast Engorgement
Breast engorgement is common three to five days following delivery. This results in breasts feeling firm and full and may be associated with some tenderness and discomfort. This engorgement is related to normal milk production and should resolve with continued breastfeeding over several days.
However, if mom develops fever or chills or notices any areas of redness or worsening tenderness, it is important to seek medical attention to rule out development of a breast
infection.
Postpartum Blues
The postpartum period is a time of many emotions for a new mom. While it is generally a happy and exciting time, it is also a time of change and adjustment.
Changes in sleep, energy level, and appetite are not uncommon as a new mom adjusts to life with her baby. New moms may experience “Postpartum Blues,” which are mild depressive symptoms (feelings of sadness/crying, insomnia, fatigue, difficulty concentrating) that develop in the first two to three days after delivery. They usually resolve within the first two weeks.
However, some women may experience more severe and prolonged depressive symptoms that can include thoughts of self-harm or harm to others. In this case, it is important to seek immediate medical attention.
What To Expect at the First Postpartum Appointment
Following a routine vaginal or Cesarean delivery, a mom can expect to be seen again at
about six weeks postpartum. However, some women need to be seen sooner if there were complications during pregnancy, labor, delivery, or in the postpartum period.
At the routine six week postpartum visit, a mom can expect to meet with her OB to review how things have been going since her baby’s arrival. The provider will check in with her regarding diet, postpartum bleeding, and making sure there is normal bladder and bowel function.
He or she will also assess the new mom’s mood and how she has been handling the many changes of the postpartum period. If it wasn’t addressed during the hospital stay and is something the patient desires, the provider can also offer options for contraception.
The provider will also likely perform a vaginal exam to ensure that any lacerations that occurred during delivery are healed and that the body is recovering as expected following delivery. If there was a Cesarean delivery, the provider will evaluate the incision.
While the provider will have questions for the new mom, this visit is also a great time for her to ask any questions she has regarding delivery, the postpartum period, and care moving forward. It is not uncommon for a mom to have questions prior to the first in-person visit with her OB provider. If that is the case, she should feel free to reach out to him or her before her six-week appointment.
What to Expect at the Pediatrician
A Board Certified pediatrician should be selected before the baby is born, preferably early in the third trimester. A Board Certified pediatrician means the physician has completed at least three years of training in the care of infants, children, and adolescents, and has passed the American Academy of Pediatrics exam and criteria for certification. The American Academy of Pediatrics has a Find-a-Pediatrician tool that lists board certified pediatricians in the area.
Once a new mom identifies a pediatrician, she should confirm that the practice is taking new patients and will accept her insurance. She should be sure to specify that she is looking for a doctor for her newborn.
In the search for a baby’s doctor, consider which factors are most important:
- Is the office location convenient to home, planned daycare, or work?
- Do their office hours include evenings or weekends?
- How many physicians are in the practice? (A larger practice is more likely to be able to offer extended office hours; but a smaller practice may help to guarantee that you see your own physician consistently.)
- Does the practice share call with other practices? Who will be available for questions or sick visits if your doctor is out?
- How will questions about your baby’s health be handled? Is there a patient portal or email system available, or are all questions answered by phone? Are these questions handled by a nurse or by the doctor? How long does it usually take to get an answer to a question about your child’s health?
- How long does it take to get an appointment for a Well-Child Visit?
- How are sick visits scheduled? Can sick children usually be seen the same day? Is an appointment required for sick visits or are there walk-in hours?
When a new mom decides on a pediatrician, she should confirm the process for scheduling the first visit. On the day of the baby’s hospital discharge, the doctor caring for the baby in the hospital will tell the mom when to schedule a follow-up visit based on her baby’s feeding pattern, weight, jaundice level, and any other issues that have come up during the stay.
The First Pediatrician Appointment
Most newborns need their first pediatric doctor visit within one to three days of discharge from the hospital. At this visit, the doctor will check the baby’s weight and overall health. The doctor will ask questions about the baby’s eating pattern, including frequency and length or amount of feeding, as well as urine and stool output. The doctor will also review the hospital discharge summary, so it is important to bring it to the first visit.
The baby will have a head-to-toe physical exam which will include assessing skin and eye color for signs of jaundice or yellowing of the skin. The doctor will also do the following:
- evaluate overall activity level
- check the eyes and mouth for signs of dehydration
- listen to the heart and lungs
- check the abdomen
- look for skin rashes
- if the baby was circumcised, the doctor will check to see how the site is healing
Best Advice for New Moms
Be patient with yourself and your new baby! Don’t be afraid to ask those around you for help! The first few days to weeks at home are a change for everyone. It takes time for you, your baby, and others in your life to adjust to all the new and exciting changes!
