What to expect in the first week home with a newborn

The shape of the week, in one paragraph

You come home tired. The first night is worse than the hospital, because in the hospital somebody else was awake. Day two the house fills with people. Day three your milk arrives, your breasts become hard and uncomfortable, and you cry in the afternoon without knowing why. Day four and five the baby's stools turn yellow, the nappies get heavier, and someone weighs the baby and tells you it is fine. By day six or seven you have stopped counting hours and started recognising which cry means what. That is the week.

Nearly everything alarming in it is ordinary. A small number of things are not, and those are listed at the end — for the baby and for you, because in the first week you are both patients and only one of you is being watched.

Leaving the hospital: the day itself

Discharge takes longer than anyone tells you. There is a bill to settle, an insurance or TPA desk that closes for lunch, a pediatrician's round to wait for, and a set of papers to collect. Plan for it to eat the day, and send someone else to do the queueing.

Do not leave without these

• The discharge summary — yours and the baby's. This is the document every doctor you see for the next year will ask for.
• The immunisation card, with the birth doses actually written in it. Check they are recorded before you walk out; getting it filled in later is a separate trip.
• The birth record or certificate slip the hospital issues. This is what the municipal registration is built on, and it is much harder to obtain a month later.
• Your own follow-up date, and the baby's first check-up date. Ask for both explicitly — they are often assumed rather than written down.
• A phone number that reaches a person after hours, and which number to use at 2am. Save it before you leave the building.
• Any prescriptions filled while you are still somewhere with a pharmacy attached.

For the journey itself: a car seat is the safest way for a newborn to travel and it is worth using from the first trip, whatever the distance and whatever the room says about holding the baby. If you have had a caesarean, sit with a folded towel or a small cushion held against the wound for the drive — every bump and every speed breaker will find it.

The first night at home

This is the one nobody prepares you for. In the hospital the baby was often sleepy and there were nurses. At home, on the first or second night, many babies wake almost hourly, feed for long stretches, settle only while being held, and object to being put down. Parents come out of that night genuinely frightened that something is wrong.

Usually nothing is. A newborn in the first days is doing exactly what a newborn does: feeding in clusters to bring the milk in, and preferring to be against a body because that is the only environment they have known. It eases over the following nights.

Set these up before dark, not at 2am

• A firm, flat, empty sleep surface in your room — cot or bassinet, fitted sheet, nothing else in it.
• A dim light you can switch on without lighting the whole room. Night feeds go better in low light for everyone.
• Nappies, wipes or cotton and warm water, a change of baby clothes and two muslin cloths, within arm's reach of where you will be sitting.
• A large bottle of water and something to eat one-handed, on your side of the bed. Feeding makes you suddenly, urgently thirsty.
• Your pads, and a clean set of your own clothes, in the same reachable place. Getting up to find things is the part that hurts.
• A phone charger that reaches the bed, and the doctor's number already saved.
• An agreement about who is doing which stretch of the night, made while everyone is still calm.

Day by day: what usually happens

Babies do not read schedules, and yours may be a day ahead or a day behind all of this. It is a map of the usual, not a target to hit.

The single most useful thing you can do across these seven days is count wet nappies. Everything else in the week is noisy — the crying, the advice, the visitors — and the nappy count is the one quiet signal that tells you feeding is working.

Feeding in week one: the part that decides the month

Week one is when feeding is established, and it is the week when it is most often quietly derailed — not by a medical problem, but by a room full of people who are worried on your behalf.

Before the milk comes in

For the first two or three days there is colostrum: thick, yellow, and produced in teaspoons rather than millilitres. That is not a shortage. A newborn's stomach on day one holds about a marble's worth, and colostrum is exactly matched to it. Frequent feeding in these days is what signals the body to bring the fuller milk in.

This is also the point at which somebody will suggest a top feed, usually kindly and usually because the baby is crying. Formula started casually in week one, without a medical reason, reduces the stimulation that brings your supply in — and week one is precisely when that supply is being set. If there is a genuine reason to supplement, your pediatrician will say so; that is a decision for them, not for the room.

When the milk arrives

Somewhere around day two to five, usually day three, the volume increases sharply. Breasts become full, firm, heavy and often uncomfortably tight. This settles within a few days as supply matches demand.

• Feed frequently rather than waiting for fullness to build. Long gaps make engorgement worse, not better.
• A warm compress or a short warm shower before a feed helps milk flow; something cool afterwards helps the swelling.
• If the breast is too firm for the baby to latch, hand-expressing a little first softens it enough to get them on.
• Wake the baby for feeds if four hours have passed. A sleepy baby in week one is the thing that quietly becomes a feeding problem.

Feeding should not be painful. Toe-curling pain, cracked or bleeding nipples, or a baby who slips off repeatedly is almost always a latch problem, and it is fixable — most easily in the first fortnight. Ask a lactation consultant or your pediatrician early rather than deciding to endure it. Enduring it is how feeding ends in week three.

Your own body in the first week

You have just been through either major abdominal surgery or a substantial physical injury, and the entire household is looking at the baby. Here is what is ordinary, so that you can tell it apart from what is not.

Bleeding

Bleeding after birth is heaviest for the first three or four days, red and often with small clots, then gradually turns pink, then brown, then a pale discharge over the following weeks. It typically continues in some form for four to six weeks. It usually increases briefly while feeding, because the same hormone that releases milk contracts the uterus.

Use maternity pads rather than tampons or a menstrual cup — nothing goes inside for at least six weeks. Change them often enough to see what is happening, because the pattern is the information.

Afterpains, stitches and the first few days of moving

• Cramping during feeds, sometimes strong, is the uterus contracting back down. It is more noticeable after a second baby than a first, and it fades within a few days.
• Perineal stitches: keep the area clean and dry, rinse with warm water rather than wiping, pat dry front to back, and change pads frequently. Sitting on a soft cushion helps. Ask your doctor before applying anything to it.
• A caesarean wound: keep it clean and dry, wear something loose over it, support it with a hand or a folded cloth when you cough, laugh or get up, and get out of bed by rolling to your side and pushing up rather than sitting straight up.
• The first bowel movement is the thing most women dread and it is genuinely better with water, fibre and, if your doctor agrees, a stool softener. Do not strain, and do not put it off.
• Night sweats and swollen ankles in the first week are the body shedding the extra fluid of pregnancy. Both settle.
• Move gently and early — short walks around the room. Lying completely still for a week raises the risk of clots.

Day three, and the crying nobody warns you about

Somewhere between day three and day five, most new mothers have an afternoon of weeping with no cause they can point to. Everything is fine, the baby is fine, and you cannot stop crying. It comes with irritability, anxiety, feeling overwhelmed, and often a strong sense of failing at something everyone else appears to find natural.

This is extremely common — the majority of mothers experience it — and it is driven by an enormous hormonal shift landing on top of no sleep. It typically peaks in the first week and lifts within a fortnight. It helps to have been told it is coming, to say it out loud to someone, to sleep whenever the opportunity appears, and to have fewer people in the house rather than more.

What it is not is a character flaw, a sign you do not love your baby, or something to be ashamed of in front of the family.

The house: visitors, food, and who does what

In most Indian homes, week one is also the week the house is fullest. Relatives arrive, often from other cities, often for several days, and they arrive to see the baby. This is affectionate and it is also, unmanaged, the single biggest drain on a week where the mother needs to sleep.

• Nominate a gatekeeper who is not the mother. A husband, a sister, a parent — someone whose job is to say "she is sleeping, come back Sunday" so that she does not have to.
• Fix visiting hours and keep visits short. An open house from morning to night means she never gets a two-hour stretch of sleep, and two-hour stretches are what she needs.
• Nobody with a cough, cold, fever or loose motions comes in, however far they have travelled. A newborn has very little defence and an infection at this age escalates fast.
• Hands washed before holding, every time, and no kissing the baby's face or hands. Sanitiser by the door does most of the asking for you.
• Anyone staying should arrive with a job — cooking, the older child, the paperwork, the dishes. A guest who needs tea made is a net loss in week one.

Food matters more than it seems to. Someone should be responsible for putting hot, substantial meals and water in front of the mother several times a day, without her asking. A woman who is feeding around the clock and eating whatever is left over at 4pm will feel far worse than she needs to.

The ceremonies also land in this fortnight — the naming and the first visits, several of them traditionally on the twelfth day. They are worth having. They are also worth someone else planning, at a scale that does not require the mother to be presentable and hosting in the second week of her recovery.

The appointments and paperwork of week one

Two of these are medical and time-sensitive, and one is administrative and easy to forget until it becomes difficult.

The baby's first check

Most pediatricians want to see a newborn somewhere around day three to five, and again in the first fortnight. That visit is checking weight — a loss of up to a tenth of birth weight is expected, with a return to it by day ten to fourteen — along with jaundice, feeding, and the cord stump. Book it before you leave hospital rather than trying to get an appointment on day four.

If your hospital offers newborn screening — the heel-prick blood test for a handful of treatable conditions — it is usually done in the first few days. It is not offered universally in India, so it is worth asking about specifically rather than assuming it has been done.

Your own check

You have a postnatal check of your own, usually at around six weeks — but you do not wait for it if something is wrong. If you had a caesarean or stitches, there may be an earlier wound review; confirm the date at discharge rather than assuming someone will call.

Registering the birth

In India, a birth must be registered within 21 days. Hospitals usually forward the record to the municipal body, but the responsibility for following it through is yours, and the certificate is needed later for school admission, a passport and every official form your child will ever fill in. Doing it after 21 days becomes a slower process involving affidavits and permissions.

• Confirm at discharge whether the hospital files the record, or whether you do.
• Note the reference or acknowledgement number they give you, and keep it with the discharge summary.
• Have the name decided before you register it, or you will be applying for a name inclusion afterwards as a separate procedure.
• Give this job to someone who is not the mother. It is a queue, and it is the easiest task in the week to hand over.

When to call — for the baby, and for you

Two lists, because two people came home from the hospital. The second one is the one that gets missed, and maternal complications in the first week are exactly the sort that escalate quietly while everyone is busy with the baby.

For the baby — call immediately

• Any fever. A temperature of 100.4°F (38°C) or above under one month is an emergency, not something to watch overnight.
• A baby who feels cold and is hard to warm.
• Refusing feeds, or too sleepy to wake for them.
• Fewer than six wet nappies a day after day five, or no urine in twelve hours.
• Fast or laboured breathing, grunting with each breath, the skin pulling in around the ribs, or any pause in breathing.
• Blue or dusky lips, tongue or face.
• Floppy, limp or difficult to rouse.
• Jaundice in the first 24 hours, or yellow reaching the palms and soles.
• A cord stump with spreading redness, pus or a foul smell.
• Persistent vomiting, green vomit, or blood in the stool.
• Any jerking, stiffening or fitting, or a rash that does not fade under pressure.

For you — call immediately

• Soaking a maternity pad in an hour or less, or bleeding that suddenly becomes much heavier again after slowing.
• Passing clots larger than a plum, or repeated large clots.
• A temperature of 100.4°F (38°C) or above, chills, or feeling shivery and unwell.
• Discharge with a foul smell.
• A wound — caesarean or perineal — that is increasingly red, hot, swollen, gaping, or leaking pus or fluid.
• A severe headache that does not lift, blurred or spotted vision, or sudden swelling of the face and hands. These can signal a blood-pressure problem that occurs after delivery as well as before it.
• Pain, redness, heat or swelling in one calf, or one leg swollen noticeably more than the other.
• Chest pain, or breathlessness that comes on suddenly.
• A hot, red, painful area on one breast with fever and body ache.
• Pain that is getting worse rather than better, or that painkillers no longer touch.
• Difficulty passing urine, or no urine for many hours.
• Any thought of harming yourself or the baby, or seeing or hearing things others do not. Same-day help, without waiting.

The things nobody says out loud about week one

That you may not feel a rush of love immediately, and that this is common and says nothing about the mother you will be. For a great many women the feeling builds over weeks rather than arriving in the delivery room.

That you will be given a large amount of confident, contradictory advice by people who love you, and that "we will ask the doctor" is a complete and polite answer to all of it.

That the husband or partner is also not sleeping, is also frightened, and is usually the person who has to hold the door, the paperwork and the family — and that this works far better when it is said in advance than when it is discovered on day four.

And that this week is short. It does not feel short. But feeding regulates, the tears stop, the bleeding lightens, and by the end of the first fortnight most families are doing something that resembles a routine. The first week is the steepest part of the whole thing, and you only do it once per baby.