Preparing for Baby
Preparing for Immediate Postpartum

Early Postpartum

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Early Postpartum

The Days Immediately Following Birth

25 MINUTE READ

Published October 2024

AUTHOR

Elisabeth Mulligan
Registered Nurse, MSN, RN

Congratulations! You are a new proud parent! No matter how long your labor lasted or how your baby came into the world, you should feel extremely proud of yourself. Now, your journey as a parent begins! We know you are tired, and figuring out what you need to know next can be overwhelming. We are here to help! Your hospital stay will be busy, with your and your baby’s healthcare providers checking in, performing assessments, and helping you find your footing as a parent. This guide aims to prepare you for the first few days after welcoming your baby, while you are in the hospital.

Knowledge is power

The more you know, the more confident you will feel. A 2018 study by researchers at the University of Louisville found that women leaving the hospital did not know about the risk factors for maternal mortality and problems, including mental illness¹. At the same time, maternal mortality rate is highest in the postpartum period, with 52% of pregnancy-related deaths occurring postpartum². It is easy and understandable that your focus immediately shifts to your baby - after all, you did wait 9 long months to meet him or her! Try to remember that you need to be healthy in order to care for your baby. Remind your partner that you require care. Spend the first few days in the hospital using the resources around you to help care for yourself and your baby. Your priorities should be resting, healing, and learning your baby’s cues -  building your confidence for when you take your baby home.

Breaking it down

The first few days for mom

Pain management

You will experience some soreness for the weeks following your delivery. Use ice, heat, and relaxation techniques to help. Your uterus will begin shrinking to its pre-pregnancy size after giving birth. This is called involution³. You may also experience afterpains, or weak contractions, that can feel stronger when you are breastfeeding, since this stimulates the release of oxytocin. You can ease afterpains by:

  • Using your labor-breathing techniques

  • Emptying your bladder before breastfeeding

  • Placing a heating pad on your belly

  • Taking pain medication recommended by your healthcare provider

You may also experience constipation and/or hemorrhoids after giving birth. To prevent or relieve constipation:

  • Drink plenty of water

  • Eat fiber-rich foods such as fruits, vegetables and whole grains

  • Do not resist the urge to have a bowel movement 

  • Take short walks frequently, as you are able

  • Consider taking an over-the-counter stool softener

Perineal care

If you delivered vaginally or labored and had an unplanned c-section, your perineum was stretched and will need some extra care for the first few weeks. If you needed stitches due to a perineal tear, they should dissolve on their own after a few weeks. 

  • In the first 12-24 hours, apply a covered ice pack to reduce swelling 

  • To reduce the risk of infection, wash your hands before using the bathroom and wipe yourself from front to back

  • Take a sitz bath. You can buy a plastic sitz tub that fits on your toilet, or fill a clean bathtub with shallow water. Use warm water to soothe soreness or cold water to help reduce swelling. 

  • Squirt warm water from a bottle onto your vaginal area while you urinate. This prevents stinging and helps keep the area clean

  • Apply witch hazel compresses. Witch hazel can help provide relief for common postpartum perineal concerns such as swelling, pain, bleeding, itching and tearing⁴. Frida Mom and Tucks are two widely-available brands to look for. 

  • Avoid lifting anything heavier than your baby and limit stair climbing

  • Rest!

Lochia

One thing you will notice after birth is lochia⁵, or blood and tissue being shed by your uterus as it shrinks. Characteristics of lochia include:

  • Heavy bleeding at first that decreases over time

  • Color that gradually changes from red to brown to white

  • It can last up to 6 weeks postpartum

  • Bleeding can increase after breastfeeding

  • Passing clots is normal. They should become smaller and less frequent, and not be accompanied by intense cramping or heavy bleeding

Normal lochia

    • Bright/dark red color

    • Heavy flow

    • Small/medium clots (smaller than a golf ball)

    • Brown/pink color

    • Less blood; more discharge

    • Fewer clots

    • White/yellow color

    • More discharge;  little to no blood

    • No clots

There is a risk of infection to the uterus and vaginal area after childbirth. Reduce the risk of infection by avoiding pools and hot tubs until lochia has ended, and using sanitary pads, not menstrual cups or tampons.

C-section birth recovery

If you gave birth via c-section, it is very important to rest whenever possible and follow your healthcare provider’s instructions. It takes at least 6 weeks to fully recover from your surgery⁶. Healing tips include: 

    • Take any medication as directed by your provider

    • After your surgery, walk as soon as possible. This helps prevent blood clots in your legs, relieve constipation, and decrease gas pains

  • Do not lift anything heavier than your baby

  • Abide by restrictions set by your provider, such as driving or lifting a car seat

  • If you are breastfeeding, try the football or laid-back positions to avoid pressure on your incision.

  • Check your incision regularly to see how it's healing. Warning signs of infections include:

    • Bleeding, fluid or drainage

    • Separation around the edges

    • Increased swelling, redness or tenderness

    • A temperature of 100.4 or higher

    • A sudden pain or pain that gradually gets stronger in your incision area

    • A red, tender area on  your leg or arm - this could be a blood clot

    • Chest pain or shortness of breath - this could be a sign of a blood clot in your lung

Emergencies

There are two common emergency conditions that can occur in the immediate postpartum period, regardless of if you delivered via c-section or vaginally; postpartum hemorrhage and postpartum preeclampsia. If you suspect either of these emergencies while you are in the hospital, call your nurse immediately. If you notice any of the warning signs when you are at home, go to your nearest ER.

Postpartum hemorrhage

It is normal to bleed after giving birth, but very heavy bleeding could be a sign of a postpartum hemorrhage. About 3% of all hospital births are complicated by postpartum hemorrhage in the US⁷. It is a rare complication and usually happens within 1 day after birth but it can occur up to 12 weeks postpartum. Warning signs include:

  • Heavy bleeding that does not slow or stop

  • Soaking through 1 or more pads within an hour

  • Passing blood clots larger than an egg

  • Drops in blood pressure or signs of shock (blurry vision, chills, clammy skin, fast heartbeat, confusion, dizziness, weakness, feeling faint)

  • Nausea or vomiting

  • Pale skin

  • Severe swelling and pain around the vagina or perineum 

Postpartum preeclampsia

Similarly, postpartum preeclampsia usually develops within the first 48-72 hours after delivery. However, it can happen up to 4-6 weeks postpartum. Hypertensive disorders of pregnancy complicate between 10-20% of pregnancies in the US (8). While most cases are diagnosed during pregnancy, new-onset postpartum preeclampsia is increasingly being recognized as an important factor in maternal morbidity in the postpartum period. If you experience any of the following warning signs, call your nurse if you are in the hospital or if you are already home, go to the ER immediately:

  • Sudden swelling of the face or limbs

  • High blood pressure

  • Nausea or vomiting

  • A strong headache that is not relieved by taking Tylenol

  • Pain under the ribs on the right side of the abdomen 

  • Very little urine output

  • Sudden shortness of breath

  • Rapid weight gain

Postpartum mental health

Baby blues

Approximately 50%-80% of postpartum women experience mood swings or weepiness during the first 2 or 3 weeks after giving birth⁹. These emotions are a result of hormones, lack of sleep, changes in routine and a general shift in your lifestyle. Talk through your feelings with your support system and get as much rest as possible. If your mood swings or sadness do not get better after three weeks, or if you start to experience concerning, obsessive or anxious thoughts, contact your provider immediately. 

If you had an unexpected c-section, experienced an emergency during delivery, your baby is in the NICU, or any other type of delivery complication, you may feel grateful, relieved, confused, disappointed, and/or sad. All feelings are normal, and all feelings are valid. It is important to talk about them with your partner and your healthcare provider.

Perinatal mood and anxiety disorder

Perinatal mood and anxiety disorders, including postpartum depression, can happen to anyone. You may  be asked to fill out the Edinburgh Postnatal Depression Scale at your postpartum appointment, however it is important to recognize that symptoms of a mood disorder can appear at any time. These conditions are not your fault and do not reflect on your ability to be a good parent. See Triplemoon’s guide on The Many Faces of Postpartum Emotions for more information support and always reach out to your support system and provider if you feel like you need help.

Warning signs:

  • Excessive worrying and anxiety

  • Intrusive thoughts

  • Persistent crying or sadness

  • Irritability

  • Inability to sleep, even though you are exhausted

  • Difficulty concentrating

  • Not finding pleasure in things you used to enjoy

  • Changes in appetite

  • Thoughts of suicide

  • Inability to take care of yourself or your baby

  • Extreme changes in behavior 

Call 911 or go to the emergency room immediately if:

  • You have hallucinations 

  • You fear you are going to harm yourself or your baby

Baby’s first few days

Feeding baby

Whether you choose to breast or bottle feed your baby is a personal choice. This section will guide you through feeding your newborn in the first few days after birth. Please see Triplemoon’s “Got Milk” guide for complete breastfeeding support.

Newborns need to eat often, about 8-12 times in 24 hours, including night feedings¹⁰. Let your baby breastfeed for as long as they want, or offer about 5 milliliters per feed if you are bottle feeding. A newborn’s stomach is very small at first, and can only handle a few ounces of milk or formula per feeding¹¹. Below is a guide to your baby’s stomach size in the first week of life:

  • Day 1 - 5-7ml (the size of a grape)

  • Day 3 - 22-27ml (the size of a cherry tomato)

  • Day 7 - 45-60 ml (the size of a strawberry)

The first few days, you can expect some clustered feedings. This is when your baby eats frequently for a few feedings then takes a longer break before feeding again. If you are breastfeeding, offer your baby both breasts. Removing milk regularly from both breasts supports healthy milk production and helps prevent breast engorgement.

You may be curious if your baby is getting enough milk. It can be tricky to know at first, but you will soon learn your baby’s cues that tell you if they are hungry or full. Here are some signs that your baby is getting enough milk:

  • During feedings, you can hear and see your baby suck and swallow¹³

  • Your baby has 4 or more loose yellow stools and 6 or more clear or pale-yellow wet diapers by day 5

  • Your baby has periods of being awake and alert during the day

  • Your baby regains their birth weight within 10-14 days

Some babies are very sleepy in the first few days of life. It is important that you wake your baby to eat at least 8 times per 24 hours - here are some ways to do so:

  • Look for restlessness and wake them during a light sleep

  • Change their clothing or remove clothing

  • Change their diaper

  • Touch or stroke their feet

  • Gently compress your breast to express milk into your baby’s mouth

  • Switch breast or position while feeding

Baby’s appearance

Nothing is more beautiful than your sweet new baby! However, do not be surprised if your baby’s appearance right after birth is a little bit different than you imagined. Common newborn characteristics include:

  • A cone-shaped head, formed during birth¹⁴

  • Fontanelles - the soft spots on the head where the bones will eventually join together

  • Birthmarks - red splotches that may get brighter during crying on fair-skinned babies, or blue-green or blue-gray marks typically found on the lower back or buttocks of darker-skinned babies¹⁵

  • Lanugo - fine, downy hair, noticed especially on the back and shoulders

  • Milia - tiny white bumps on the face that go away with time

  • Stork bites - patches of deep-pink skin on the face and neck

  • Skin tone that may be paler than yours if you have dark skin (skin maturation continues into a baby’s second year¹⁶)

  • Swelling in the genital area

  • Vaginal discharge or blood spotting for girls

Some newborns develop jaundice, a yellowish color in their skin and eyes. You may notice a yellow-ish hue to your baby’s skin, or if your baby has darker skin, in the whites of their eyes. It is caused by a buildup of bilirubin, a pigment in the blood¹⁷. Bilirubin is passed in the baby’s stool and urine, so frequent breastfeeding helps treat jaundice. Most cases of jaundice clear up in days to the end of the first week. Your baby will be screened for jaundice in the hospital and at their first pediatrician appointment.

Newborn screenings

Your newborn will also be screened for rare conditions and disease using a heel stick (18). This screening is a public health program that detects treatable disorders in newborns, allowing treatment to begin often before symptoms or permanent problems occur. Within the first 24 to 48 hours after birth, babies undergo a simple heel stick and a few drops of blood are collected on a special paper card. Providers test those dried blood spots for a variety of different congenital disorders, or conditions that are present when the baby is born. Each state decides specifically which conditions newborns are screened for, but a government committee of experts recommends screening for more than 30 core and 26 secondary conditions. 

Your newborn will also have a hearing test performed, which may identify hearing loss, as well as a heart screening, which identifies critical congenital heart disease. Speak with your baby’s pediatrician if you have any questions about the screening tests performed in the hospital.

Newborn vaccines

In the hospital your newborn will be offered two medications immediately after birth - erythromycin eye ointment and a Vitamin K injection. Erythromycin ointment is an antibiotic given to prophylactically treat an infection that can cause corneal scarring, ocular perforation, and blindness¹⁹. Babies are born with very little Vitamin K in their bodies, so in order to prevent Vitamin K Deficiency Bleeding (VKDB), they are given an injection in their thigh right after birth²⁰. Your baby will also be offered the Hepatitis B vaccine during your hospital stay. Hepatitis B causes an infection in the liver. Hepatitis B vaccination is a three-part vaccine given to infants at 12-24 hours of life, 1-2 months, and 6-18 months²¹.  If you have questions about your newborns vaccines, speak to your nurse or your baby’s pediatrician.

Breathing

Your newborn may pause for a few seconds between breaths, especially when sneezing or sleeping. In the first 24 hours after birth, you may hear your newborn gagging and choking. This is your baby clearing out the amniotic fluid and mucus that is still in their lungs. Sometimes, a bulb syringe is helpful to clear out fluids from your baby's nose and mouth. Ask your postpartum nurse or healthcare provider to teach you how to use the bulb syringe. Remember, as long as your baby is calm and their lips, tongue, and mouth are a normal pink color, there is no reason to be worried. If you feel your baby is having trouble breathing or if their lips, tongue, or mouth are blue, call your nurse immediately. 

Sleep cycles

Newborns sleep as much as 14-17 hours per day²². Sometimes your baby will sleep for short spurts, while other times they will sleep in 1 to 3 hour periods. Do not worry about being absolutely quiet when your baby is sleeping. They need to get used to the sounds of everyday life. You can expect your baby to wake 2 or 3 times per night. This allows them to feed at night, which is important for newborn growth. When your baby wakes up at night, keep feedings quick and boring, the room quiet and lights dim to help them go back to sleep.

Your baby will go through cycles of light and deep sleep about every 30 minutes. If you have a very sleepy baby that has gone more than 4 hours without eating, wake them up so that they can feed. Try to do this during their light sleep when you recognize that they are more restless, rather than deep sleep. Take note of your baby’s overnight sleep schedule and share it with their pediatrician at their well-child visits. If your baby is gaining weight steadily and there are no contraindications, most pediatricians will advise that you can stop waking your baby to eat overnight after a few weeks, and instead let your baby sleep for as long as they choose between overnight feedings.

Hospitals will provide a bassinet for your baby to sleep in your postpartum room. Some hospitals will offer to take your baby to the nursery overnight, if you wish. If your hospital offers this, you may ask to have them bring you your baby to eat every 3 or 4 hours. You may also wish to “room-in”, or have your baby in your postpartum room with you. This is a personal choice. 

It is important to have a safe space for your baby to sleep at home. The American Academy of Pediatrics (AAP) recommends placing your baby on their back, on a flat, non inclined sleep surface, in the parents’ room, ideally for at least 6 months²³.

Umbilical cord stump

Keep the area around the baby’s umbilical cord stump clean and dry. Be sure to fold diapers down so that they do not rub against the cord stump and dress your baby in loose clothing so that air can get around the stump. Do not pick at the stump! It will fall off on its own within a few weeks. You may notice some blood - that is OK. If you notice the skin around the stump is red, pus, drainage, or a foul smell, that is a sign of infection and you should contact your baby’s pediatrician²⁴.

Bowel and bladder functions

Your baby’s stools will change in texture and color in the first few days of life as the intestinal tract begins to work. A good rule of thumb for urination is that your baby should have at least as many wet diapers as number of days old they are²⁵. Below is a chart outlining the healthy number of diapers per day for the first week of your baby’s life. If you ever notice red, white or gray stool, contact your baby’s pediatrician immediately. 

  • Wet diapers per day - 1+

    Dirty diapers per day - 1-2

    Type of stool - Meconium: black, tarry, thick

  • Wet diapers per day - 2+

    Dirty diapers per day - 1-2

    Type of stool - Meconium: black, tarry, thick

  • Wet diapers per day - 3+

    Dirty diapers per day - 2+

    Type of stool - Greenish and looser

  • Wet diapers per day - 5+

    Dirty diapers per day - 2+

    Type of stool - Greenish and looser

  • Wet diapers per day - 6+

    Dirty diapers per day - 3-4+

    Type of stool - Yellow, seedy, loose

Weight loss

A healthy newborn is expected to lose up to 7-10% of their birth weight, but should regain that weight in the first 2 weeks of life²⁶. Weight loss typically reaches its lowest point by 2 to 3 days after birth. Your baby will be weighed frequently during your hospital stay. If their weight loss reaches 10% or more of their birth weight, you may be counseled to breastfeed your baby more frequently or consider supplementing with formula, if you are comfortable with that option. Engage in shared decision-making with your baby’s pediatrician, if necessary.

Transitioning home

When it is time to take your baby home, you may feel excited, anxious, and nervous! The busyness you experienced in the hospital will continue for the first week or two after getting home, filled with finding your routine, doctors appointments for you and baby, and of course the inevitable visitors wanting to come meet the baby! Consider what type of support you will need at home, whether it is a night nurse to help with overnight feedings, someone to help maintain the house during the day, a mix of both, or something else. Talk to your partner about how they can support you as you recover. See Triplemoon’s guide for finding the right childcare for more details. 

Depending on what type of delivery you had, you may be asked to go to your OBGYN/Midwife’s office for a check-up in the first week or two following birth. You will also need to take your baby to their pediatrician for their first well-child appointment. You can expect to visit the pediatrician at 1 to 3 days after leaving the hospital, 1 to 2 weeks after birth, 1 month, 2 months, 4 months, 6 months, 9 months, and 12 months. When choosing your baby’s pediatrician, one consideration is convenience, as you will be going in often in their first year of life (don’t forget about the sick visits too!).

At your baby’s well-child appointments, you can expect the nurse or doctor to take your baby’s measurements (weight, height, head circumference), examine your baby head-to-toe, discuss developmental milestones, and answer any questions you have. Your pediatrician can be a great source of information for you as a new parent! Keep a running list of questions so that you are prepared to make the most of the appointment and not wracking your sleep-deprived memory!

Sponge bathing

Sponge bathe your baby until the umbilical cord stump falls off as it is important to keep that area dry. A sponge bath 2-3 times per week is all that is needed until your baby is ready for a tub bath. Gather all of your materials for the sponge bath and ensure you keep your baby wrapped in a warm towel - babies do not like to be cold! Start at the top and work your way down your baby’s body, unwrapping areas you are washing as you go, then wrapping them back up. Pay special attention to the folds and creases, especially the neck and diaper area.

Warning signs

If you are ever worried about your baby, call your pediatrician's office or go to the ER. Some common warning signs that need to be addressed immediately include:

  • A rectal temperature of 100.4 or higher

  • Bloody or green vomit

  • Difficulty breathing

  • Lack of energy/suddenly very sleepy or hard to wake up

  • Yellow eyes or skin

  • Very pale, blueish or grayish skin. If your baby has darker skin, look at the lips, inside of the mouth, gums, or tongue²⁷

  • The skin around the umbilical cord stump is red, has pus, drainage or a foul smell

What the research says

The postpartum period is a time of significant challenge and need as women adapt to hormonal and physical changes, recover from delivery, experience shifting family responsibilities, and endure sleep deprivation, all while caring for and nourishing their newborn²⁸. It is also a period of significant maternal health risk. Triplemoon’s goal is to address the traditional care gaps and provide you with the care you need during this critical period.

About the author

Elisabeth Mulligan

Registered Nurse, MSN

Elisabeth started her nursing career in labor and delivery at one of the busiest birthing hospitals in the U.S., assisting with hundreds of deliveries from routine to complex. Now specializing in women's reproductive health across the lifespan . . .

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Resources our Experts Love

  • March of Dimes: Postpartum: Learn how to best take care of yourself as your body changes ↗

  • CDC: Information About Infants & Toddlers (Ages 0-3) ↗

  • National Library of Medicine MedLinePlus: Infant and Newborn Care ↗

  • Nemours KidsHealth ↗

Nutritionists

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Adult mental health

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Couples mental health

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Infant & child mental health

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Sleep coaching

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Nutritionists • Adult mental health • Couples mental health • Infant & child mental health • Sleep coaching •

When to get
expert support

  • If you feel that anything is not right with your recovery, or if you experience any of the warning signs of postpartum hemorrhage or postpartum preeclampsia, call your provider or go to the nearest ER

  • If you experience any warning signs of a perinatal mood & anxiety disorder, call your provider or go to the nearest ER

  • If you think that your baby might be ill, contact your baby’s pediatrician or go to the nearest ER

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