What to Expect When Your Baby is Born

Every baby’s welcome to the world is important and unique. Some newborns come earlier than expected, some with a twin, some by vaginal delivery and others by cesarean birth. We are here to help you and your new baby get off to the best start possible.

It is not unusual for many newborns to need a little extra help adjusting to life outside of your womb. He or she might need to spend a short time on the warming examination table in the delivery room or in the Newborn Intensive Care Unit (NICU). If that happens, your nurses and doctors will keep you informed about your baby’s condition and how he or she is doing.

Three female doctors with a newborn

Skin to Skin Care

Your baby will be ready for skin-to-skin care with you soon after birth. Being close to mom will help your newborn adjust to being born and make him or her feel safe and secure. If you have chosen to breastfeed, it is important for you and your baby to get started as soon as possible after birth. Being skin-to-skin with you gives your baby the best chance to help that happen.

Read more about skin-to-skin, or “kangaroo care.” 

What to Expect When Your Baby is Born

Immediately After Birth

Baby’s Vital Signs

Your baby’s heart rate and breathing will be measured and his or her temperature will be taken, and this can be done while your baby is skin-to-skin. In addition, your baby will be weighed and measured prior to transfer to your post-partum room.

Apgar Score

The Apgar score is a measure of your baby’s condition at one and five minutes after birth. This score will be determined after your baby is born.

Learn more about the Apgar Score.

Medications

Shortly after birth, your baby will have an antibiotic ointment, erythromycin, applied to his or her eyes to prevent eye infections. The baby will also be given a shot of Vitamin K in the thigh because some babies have low Vitamin K at birth and this supplement helps prevent life-threatening internal bleeding. The shot of Vitamin K completely protects your baby from this problem.

Postpartum Care

After your labor and delivery care is completed, you will be moved to the postpartum floors (Floor 9 or 10 in the Center for Women and Newborns). Your postpartum nurses will be your coaches as you learn to care for your new baby. They will help you learn about feeding your baby and will ask you to keep track of the baby’s feedings and “pees and poops.” After your baby has adjusted to being born, he or she will have his or her first bath. 

Your baby will be examined by a pediatrician within the first day of life and throughout your baby’s stay. During the first visit, the pediatrician will review your obstetric care and discuss your health history and your family’s health history. Your baby will then have a complete physical exam and his or her hospital care will be discussed with you.

Hepatitis B Vaccine

The hepatitis B vaccine protects your baby against the hepatitis B virus which can cause severe liver disease. The vaccine is given as a series of three doses: at birth, one month and six months of age.

Learn more about the hepatitis B vaccine.

Newborn Screening Tests

Massachusetts Mandatory Testing

All Massachusetts babies are provided with newborn screening services. This public health program helps prevent serious health problems that can develop in some newborns.  This testing is mandatory. Massachusetts also offers optional newborn screening services using the same blood sample. Between 24-48 hours of life, a few drops of blood will be taken from your baby’s heel. This blood specimen will be sent to the New England Newborn Screening Program for testing. Any concerning results will be reported to your pediatrician for further testing.

Learn more about newborn screening services.

Hearing Screen

All newborns also undergo a hearing screen prior to discharge. Learn more about newborn screening services.

Critical Congenital Heart Defect Screening

Your baby’s blood oxygen level will be checked by using a soft probe placed on the skin to screen for a serious heart condition.

Caring for your newborn’s heart.

Screening for critical congenital heart defects.

Concern for Infection

If you developed a fever or other signs of possible infection during delivery, your baby might need to be checked for signs of infection. During this evaluation he or she will be cared for in the NICU on the sixth floor of the Center for Women and Newborns. A blood culture will be performed to monitor for any signs of bacteria growth over 48 hours. Your baby may also have an intravenous (IV) line inserted and be started on two antibiotics--usually ampicillin or gentamicin. The baby will be returned to you as soon as this evaluation is completed.

Your pediatrician will continue to monitor your baby for signs of infection and will determine when antibiotics may be discontinued. Most babies evaluated for infection are ready to go home with their mothers.

Jaundice

Your baby will be carefully evaluated daily for jaundice (yellow skin color). It is normal for newborns to become jaundiced in the first few days after birth. Jaundice is caused by a substance called bilirubin, which is a breakdown product of hemoglobin, the substance found in red blood cells. Most newborns will have mild jaundice which is not a health problem. Some babies, however, are at risk to develop serious jaundice that, rarely, can cause brain damage or hearing loss.

Your baby will be screened for jaundice with a skin test. In some cases a blood test may also be done. When treatment for jaundice is required, your baby will be placed under “phototherapy” lights. These are blue lights that help the baby’s body decrease the jaundice levels quickly. The baby will be under this blue light therapy at all times except when feeding. This treatment will be continued until the jaundice level is safe for your baby.

Breastfeeding

If you have decided to breastfeed, we want to help you to get the best start possible. We will encourage you to spend as much time as possible with your baby “rooming-in.” Your baby will feel more secure, feed better and more often, sleep better and cry less if rooming-in with you.

Being skin-to-skin with you is the best possible place for your baby, especially during the first few days when he or she is learning to breastfeed. There is a Breastfeeding Chat each day. This is a time for breastfeeding mothers and their newborns to meet with our certified lactation consultants for information about breastfeeding and hands on practice. Times may vary so please check with your nurse for the correct times and location.

Breastfeeding Chats:

  • 9th floor Conference Room 939 (near service elevators)
  • 10th floor nursery

Our lactation consultant will get to know you and your baby during the chats and make plans for individual counseling, if needed. Your care team will make sure that you and your baby both know how to breastfeed before you return home.

Late Preterm Infants

If your baby has arrived earlier than 37 weeks gestation or is smaller than expected, he or she will require extra special attention. The baby may have more trouble staying warm, needing to stay close to you, or in an incubator while you are asleep. He or she also may have a harder time breast or bottle feeding. Your care team is very experienced at helping you learn to care for your early arrival and prepare for his care at home. It is also important to remember that if your baby is under five pounds, you will need a car seat that fits the baby properly.

Breastfeeding Tips for You and Your Baby

Learn more about the care of preterm infants.

Read about car seat safety.

Circumcision

Circumcision is a surgical procedure that removes the foreskin that covers the glans of the penis. Whether or not to circumcise your baby boy is largely a personal choice.

Reasons for Circumcision

  • It is easier to keep the area clean.
  • There is less chance of the foreskin becoming infected.
  • It provides protection against sexually transmitted diseases.
  • This is how you want your child to look.

Reasons against Circumcision

  • There is a slight chance of injury to the penis.
  • There is a chance of infection or bleeding at the circumcision site.
  • The baby will feel pain.

If you choose to circumcise, lidocaine injections and acetaminophen will be used to reduce pain your baby may experience. Your obstetrician or pediatrician will explain the details of the procedure and perform the circumcision. Your nurse will teach you how to care for the area as it heals. Learn more about circumcision:

BWH Circumcision Information

BWH Circumcision Consent Form

Preparing for Discharge

Your care team will help you prepare to bring your newborn home. To make sure your needs are met, we encourage you to ask questions. Our goal is for you to feel comfortable feeding, bathing, diapering and caring for your baby before going home. You will need to have an approved car seat of an appropriate size for taking your baby home. If your baby is under five pounds, you will need a car seat that fits the baby properly.

You also will need to choose a primary care pediatrician and make an appointment for the day your hospital pediatrician recommends, usually two to four days after discharge. Your baby’s hospital record will be sent by fax to your primary care pediatrician and you will be provided another copy to bring with you to your appointment. Our social work staff is always available if you have any special concerns.

Learn more about caring for your baby once you get home: A Guide for New Parents.

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