The First 48 Hours Postpartum

Here’s a question that you probably don’t know the answer to: What is going to happen in the immediate hours after giving birth? This isn’t a minor question. But it’s one that many people don’t fully know the answer to. And they should. You’ve prepared for birth, but have you prepared for what the first 48 hours following birth will look like? It’s time you did, so let’s dive in.

Your Body After Delivery

You did it! Hooray! You gave birth to your baby. Now what?

If you delivered vaginally, labor isn’t quite over. Yep. Now it’s time to deliver the placenta. This stage of labor can take anywhere from 5 minutes up to 30 minutes, and thank goodness pushing out a placenta is nowhere near as challenging as pushing out a baby. A physiological delivery means that time will be given for the cord to stop pulsing, no medications will be given, and the placenta will be pushed out without assistance. A managed delivery of the placenta will involve administering synthetic oxytocin and there could be some cord traction (pulling) in conjunction with fundal massage to encourage a quicker delivery. As you think about your birth plan, be sure to consider which method of delivery you would like for the placenta.

If there was any tearing at the perineum, this will also be the time for repair. Depending on the degree of tearing, your doctor will likely repair it with stitches. Normally an anesthetic will be administered to help with any discomfort during this repair.

If you had an unmedicated vaginal birth, you should be able to walk soon after this, although you will still be transferred to your postpartum recovery room in a wheelchair. If you had an epidural, it can take a bit of time - 1-2 hours generally - for the anesthetic to fully wear off, so don’t expect to get up and walk around right away. And of course following a cesarean birth, it will also take time but your postpartum nurses will encourage you to get up and start moving as soon as you are able.

Regardless of whether you delivered vaginally or via cesarean, you will experience postpartum bleeding, called lochia. This is a totally normal part of the postpartum recovery period and the blood flow for those first 48 hours can be rather heavy. It is also not uncommon to pass blood clots as well. You just want to make sure that those clots are not larger than a golf ball or that you are not soaking through a fresh pad within one hour. If those things happen, you will want to alert your nurse immediately (or call your provider if you’re already home).

Toileting can be a little challenging in these first 48 hours. There can be stinging while urinating if you have stitches, which is why the peri bottle the hospital will give you will be essential when going to the bathroom. Spray this area liberally with warm water from your peri bottle to help take the pain out of urinating and to help keep this area clean.

Your Baby After Delivery

A lot of these changes happening to your body might go unnoticed since your mind will probably be on meeting your baby for the first time! So what happens to your baby immediately after birth?

For many area hospitals, it is now standard practice to offer immediate skin-to-skin time with your baby after they are born. If you and your baby are healthy, your provider or nurse will place the baby directly on your chest or stomach. Your baby may still be attached to the placenta via the umbilical cord and the first newborn assessments will be done will your baby is on your chest. If you are hoping to achieve the Golden Hour, this skin-to-skin time will be uninterrupted for the first hour post birth.

In most areas of the country, your baby will also be offered several medications within the first hour of life. Erythromycin is normally administered as an ointment to the baby’s eyes to prevent ocular infection. Vitamin K is also normally given as a shot to help with blood clotting. You may also choose to give your baby the first round of the Hepatitis B vaccine in the hospital, though other families wait for this to be administered at the first pediatrician appointment.

Following skin-to-skin time, your baby will then be fully assessed - they will be weighed and measured, their vital signs will be checked, and they will be examined just for overall health. These vital measurements will continue - temperature and pulse checks - along with checks to bilirubin levels prior to being discharged from the hospital. A hearing screening, which will normally require a nurse to remove the baby from your room and take them to the screening area, is also standard practice in the hospital.

One thing that is no longer standard practice is bathing the baby at the hospital. This is normally left to the parents’ discretion and you can choose how long you would like to delay your baby’s first bath. Some parents will prefer to have their nurse give the first bath in the hospital, while others will wait until they are home and give the first bath there.

Baby Sleep and Nutrition Needs

Two other things to prepare for during these first 48 hours are what your baby’s sleep and feeding needs will look like. During that first hour after birth, most hospitals will want to see the baby’s first feeding take place. If you are choosing to have an interrupted Golden Hour, this first feeding could look like the breast crawl, whereby the baby is placed on the mother’s chest and is allowed plenty of time to let their inherent feeding instincts kick in so that they squirm and root towards the breast, find the nipple, and latch entirely on their own without any assistance. This is done in a laid-back or “natural” feeding position.

But other parents may choose a more upright feeding position - like the cross-cradle or football hold - and will help guide and latch the baby to the breast. And yet other parents will choose to bottle feed rather than breastfeed, so a small bottle of either donor breast milk or formula will be given.

Regardless of how you are choosing to feed your baby, if everyone is healthy it is standard practice to give your baby their first feed within an hour after being born.

Following this first feeding, expect your baby to sleep - HARD. Being born is no small feat and you’re probably not the only one that is exhausted. Your baby will probably sleep for several hours straight and my best advice to you during this time is: YOU SHOULD SLEEP TOO! I know, it might be hard if you’re feeling elated after giving birth, but you won’t regret any chance to get some sleep in these early newborn days. Because after this first big sleep, it’s pretty normal for you baby to be up quite frequently.

In these first 48 hours, you will start to get into a feeding routine of every 2-3 hours with your new baby. Around the clock. It’s important to note that this 2-3 hour feeding clock is the maximum amount of time you will let your newborn go without eating. It’s pretty normal that your new baby might want to eat more frequently than this. It’s very common to experience cluster feeding - your baby wanting to eat in very frequent intervals for hours at a time - during these first 48 hours. And it’s exhausting, but it’s also normal. So feed your baby when they are showing you signs they are hungry.

The other thing to keep in mind as you get adjusted to this new feeding routine, is the amount of food that your baby will need. A brand new baby’s stomach is about the size of a marble. Yes, really. And that marble-sized stomach holds about half a tablespoon food; that’s not a lot. So if you are breastfeeding, recognize that the small amounts of colostrum your body is producing is totally adequate for your baby’s needs. As their stomach begins to get larger, your body will begin producing mature breastmilk at higher volumes. It’s normally around day 3-5 postpartum that you will experience your milk “coming in.” And if your are formula feeding, just remember the size of your baby’s stomach during these early days - it is very small and they don’t need a lot to feel full.

And remember, the size of that tiny tummy also controls how often your baby will sleep. You can expect your newborn to be awake frequently, throughout the day and night, because they will be hungry frequently and need to be fed. This is totally normal. “Sleep like a baby” means something totally different for parents in the newborn trenches.