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The end of your journey has come after 40 weeks. The fruit of your labour (literally) will soon be in your hands.

There are a few things you might want to know about your new arrival. Typically, a newborn baby has the following characteristic appearance:

  • Weight: Average 2.8 kg for Indian babies (range 2.5 – 3.2 kg). Babies below 2.5 kg at birth are considered to be low birth weight and need special evaluation.

  • Length:  Approximately 50 cm. Remember, small women have small babies and many genetic factors also play a role in determining the length of the baby.

  • Head: Your baby’s head appears large for the body and may have an elongated shape or appear to have some ‘bumps’. This is due to changes called molding, which occurs in labour and delivery. Small bumps called ‘caput’ usually disappear in 1 – 2 days. Soon the head gets rounder. The head circumference is 33 – 35 cm.

  • Soft spots or FontanellesThere are 2 areas on the head where bone formation is incomplete at birth. The larger one, in front of the head closes by 6 – 18 months. The smaller one at the back usually closes by 6 weeks.

  • Hair: As all people vary, so does their hair. Your baby may have lots of hair or none at all! It depends on familial and racial factors.

  • Heart beats: Usually the heart rate is 120 – 140 beats per minute.

  • Respiratory rate (breathing): It is faster than adults, usually 30 – 40 breaths / minute. Breathing may be noisy or stop for many seconds. This is not uncommon.

  • Colour: Depending on the parents, the skin colour of newborn varies. In general, newborn babies look flushed and pink all over. However, the palms and soles of the feet may look dusky or little bluish soon after birth.

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Immediate Care

There are certain standard procedures followed by a health personnel in the delivery room. These are described below:

  • Suction of airway

At delivery     of the head (even before the shoulders and body deliver), the mouth is gently suctioned by a rubber or plastic device. This cleans the airway and is especially necessary in cases where the liquor was meconium stained.

After the baby is born completely, the birth attendant supports the baby’s head and body, keeping them at the same level as your perineum, while the cord is clamped and cut.

It was the lifeline joining the baby to you until birth. This now has to be cut. There are different views on when and who should cut the cord. Usually, the cord is cut once the pulsation stops to allow maximum blood from the placenta to reach the baby. In certain medical conditions however, your doctor may feel it is necessary to cut the cord earlier or later.The cord is clamped and cut by the doctor or nurse. If you wish your birthing partner (spouse) can cut the cord.

Your baby has come from your nice warm womb into the cold world outside. A very important adaptation is maintenance of body temperature. Your doctor will gently dry the baby, especially the head, and wrap her / him in a warm dry towel. The baby is now kept under a warmer light to maintain temperature. A small or pre-term baby may require a special machine or incubator for this.

Initially, more importance was given to the mother, as labour was often hazardous. It was an anaesthetist, Virginia Apgar, who described the "Apgar score" which is used in most hospitals to describe the condition of the baby at birth. Assessment by this score at 1 minute from birth indicates the need for neonatal resuscitation by identifying a baby who is sick.
Repeat scores at 5 – 10 minutes indicate how well the baby is maintaining herself / himself with the doctor’s help.


Score 0

Score 1

Score 20

Heart rate.


< 100

> 100

Respiratory effort.



Good crying.

Muscle tone.


Some limb tone.


Reflex irritability (of catheter in nostril)


Cry or grimace

Vigorous cry cough or sneeze.



Body pink extremities blue.

Completely pink.

The maximum score is 10. A baby born in good condition score 9.

A newborn’s eyes are reflex tightly closed and often smeared with blood, amniotic fluid and vernix. Hence they are usually wiped gently with sterile saline swabs. In some hospitals, to prevent neonatal conjunctivitis, your doctor may recommend using medicated eyedrops (1% silver nitrate) or eye ointment (such as erythromycin).

In most centres, a single intramuscular injection of vitamin K 0.1 mg is given to the baby. This helps the baby’s blood clotting system and prevents bleeding.

It is recommended to start breastfeeding as soon as possible. In fact, some believe in putting your baby to your breast as soon as the cord in clamped and cut. Allowing the baby to suckle immediately stimulates release of oxytocin, a hormone which helps your placenta to separate. This option should be discussed     by you with your doctor earlier.
Often the baby is handed over to the neonatologist (doctor who specialties in babies) if present at delivery, or the attending nurse. They will usually finish the initial evaluation of the baby including Apgar scoring, and will wipe the baby and suction the mouth, as discussed above. After the cord is tied (by sterile linen ties or a disposable plastic cord clamp) and you are through with delivering the placenta, the baby is given to you for feeding. Feeding can be started even before the episiotomy     is sutured. Remember, the sooner you start to feed the baby, the better it is, since the newborn baby bonds and suckles more enthusiastically. Even if you feel too tired to feed, your spouse or relative or a nurse can help you by supporting the baby     at your breast to make it easier for you.

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Care on 1st Day

Other than the immediate care discussed above there are a few more important issues on the first day of your baby’s life.

  • Measuring and recording weight, length and head circumference.
  • Taking baby’s footprints for hospital records (usually).
  • Examine the body orifices (openings) to detect potentially risky conditions like imperforate anus, tracheo-oesophageal fistula.
  • Assessing the gestational age and maturity of the baby to confirm adequate development of various reflexes and body systems. This is most important in babies born early or late.

Prevention Of Infection
Newborns are very vulnerable to infection. Careful hand washing by those handling the baby including yourself is important. Preferably avoid over exposing the baby to too may visitors. Visitors are inevitable – it is easier to keep the baby in the nursery during visiting hours. So that you don’t have to tell people to be careful!

Screening Tests as indicated
Usually, your doctor or nurse collects blood from the umbilical cord after the cord is cut at delivery. These samples are sent for baby’s blood group and haemoglobin in all cases. In select cases, additional tests such as Coomb’s test and cord bilirubin are done if you are Rh-negative Tests for infections (VDRL, HIV) or for blood disorders (G-6PD deficiency) are sometimes asked for. In selected cases, a spot test using blood collected by pricking the heel of the baby may be done for TSH (to detect hypothyroidism) or Guthrie test (for phenylalanine to detect phenylketonuria) or others may be required where a particular disease is suspected.
Continuation of Breastfeeding: Remember that mother’s milk is the best for a baby. Even if you are tired, or your breasts and nipples feel sore, or you feel there is very little milk coming out, DON’T give up. The first day is the toughest. Persist in giving the baby only breast milk. Resist from giving any other feeds. Your baby will soon settle down to a proper routine!
Father’s Role     :   Let the Dad also spend time holding the baby and being with you both. This helps in bonding .

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First Week of Life

  • Being Prepared:  In the 9 months of anticipation of delivery, we are sure you must have made enough preparation at home to receive your ‘prize’ – the newborn baby. Few essentials to keep ready at home include:
    Baby clothes (at least ˝ dozen ‘jhablas’ or dresses that open completely).
    Cloth diapers or nappies (a large 24" square cloth, if folded properly is an efficient nappy – however you get pre-stitched cloth diapers with central padding and Velcro fasteners which may be easier to use).
    Baby wraps (cheerful prints on cotton or cotswood materials, about 21/2 feet square or rectangle make good swaddling clothes).

Washing items only for baby:

  • a small tub,
  • a receptacle for dirty linen (such as a bucket with a lid),
  • a mug.
  • Towels (2 large and 4 small).
  • Plastic squares or small sheets.
  • Toiletries:
  • Baby soap, preferably one, which is hypo-allergenic and non-scented, is most suitable for baby’s tender skin.
  • Oil or Vaseline for applying on baby’s body.
  • Hair oil for baby.
  • Powder.
  • Cotton swabs or babies wipes for wiping your baby’s bottom after passing stools.
  • Disinfectant such as Savlon or Dettol which can be put into the bucket containing dirty linen until wash.
  • Fabric softener is useful to use at least once a week to make baby’s towels and diapers soft.

Your room should be prepared so that both you and baby are comfortable as soon as you reach home. In particular, plan your baby’s sleeping arrangements in advance. You may want a separate baby cot. Some mothers prefer to have baby sleeping with them on the same bed for a while. In either case, you could place a plastic sheet under the bed clothes to prevent soakage of the bedding in case baby’s diapers leak!

  • Going Home: After a normal delivery, most first-time mothers will be home by the fourth or fifth day. In case of moms who are experienced, they may be sent home earlier. Your doctor will assess both your baby’s and your condition to decide when it is safe for you to go home.At discharge, make sure you have got all your baby’s records and the investigation reports with you.
  • Bathing your baby: As discussed earlier. It is now common practice not to bathe the baby on the first day. Often, till the cord falls off, you may prefer to give a sponge bath rather than a full tub bath to the baby. This helps to keep the cord dry, but is more time-consuming
    In most Indian homes, there is a trained massage-lady-cum-bath-lady (the ‘bai’) who comes to massage and bathe the baby. It is not a must to have such a person. It can be fun for you to bathe the baby yourself. However having someone to do it for you, gives you time off to relax and catch up on some sleep!

If you are bathing the baby yourself, keep the following tips in mind to make bathing more enjoyable:

  • Keep all bath items ready (soap, wash cloths, cotton, towels and change of clothes).
  • The room or bathroom should warm, with windows closed.
  • Always test the water first. Remember to fill cold water first in the tub, then add hot water till the temperature is right, to avoid accidental use of very hot water.
  • Hold the baby firmly at all times supporting her / his neck properly.
  • Wash the baby’s face carefully with minimum of soap, using swabs or a washcloth to clean the eyes.
  • Avoid getting water in the ears.
  • Dry the areas of creases and skin folds – groin, armpits, back of knees, neck, etc.
  • Take the baby wrapped in a blanket away from the bathing area before powdering / dressing up.
  • Do not apply kajal in the eyes or oil to the nose and ears.

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Care of special areas

  • Nails

Trimming can be done with nail scissors (available in a child care store). It is best done immediately after a bath, when nails are soft. If your baby is a sound sleeper you may do it during the sleep. If not, occasionally you may draw blood because the baby is restless – most mothers do so at sometime. Applying pressure stops bleeding and needs no further care.

  • Penis / Vulva

During the 1st week you may see an excessive discharge or even bleeding from the genitalia of your baby girl. This is normal and due to the hormones passed from the mother to the child. The vulva and vagina needs no special cares, except that while washing, the movement should be from the front to the back.

  • Penis   

The uncircumcised penis needs no special care. Do not try and retract the foreskin, as it is generally adherent to the glans. Activity. During the 1st few weeks, a cheesy white substance may be seen at the tip of the penis, which is a collection of the dead cells from the glans and is normal.The circumcised penis needs special care only till the wound heals.Plain soap and water cleaning is ideal for cleaning the penis.

  • Ears

No special cleaning is needed. Do not put cotton swabs, etc. to clean the ear. Do not put oil in your baby’s ears.

  • Nose

It is self-cleaning. If there is excessive mucus, just wipe off the mucus. Do not use cotton swabs, tissues, fingernails to remove mucus as the delicate membrane of the nose may start bleeding.

  • Keeping Clean

Even if you do not bathe the baby daily, there is no problem as long as you keep the baby clean by taking care of the following things:
Wipe your baby’s bottom from front to back with a wet wipe or wet cotton swab, then wash with water, everytime he/she has a bowel movement.
At least twice a day, wash your baby’s bottom with soap and water after a bowel movement. Make sure all the soap is rinsed off.
Brush or comb your baby’s head daily to remove scaling dry skin and keep her / his hair tidy.

Your baby will pass urine and stools many times a day, more so in the first week. Do not worry, most babies settle down to a routine after the first few weeks. In particular, you may notice that everytime your baby feeds she may wet or soil himself/herself. This is due to an inbuilt mechanism called the ‘gastro-colic reflex’. This will also settle with time, but remember to check his/her nappy after every feeding. You need to decide on what is the type of underclothing you will provide for your baby.

Nappies or cloth diapers are re-usable, and eco-friendly. More importantly, until your baby grows a little older, preferably a month old, his /her tender skin may not tolerate disposable diapers. This is often seen that disposable diapers which have perfume,  makes some babies break out in a rash Cloth diapers should be washed in warm or hot water using detergent. Addition of an antiseptic, which also acts as a bleaching agent may be advisable. This is more important if you do not wash the diaper immediately. The diaper should be rinsed well to remove all traces of the detergent. Once a week, a fabric softener may be used to keep the diapers soft.

  • Changing a diaper/nappy

A wet or dirty diaper makes your baby’s skin sore or red, and can lead to rash.
Frequent changing should be done as necessary, particularly before and after your baby sleeps.
While cleaning your baby’s bottom, wash the diaper area from front to back (never the other way) to avoid infection.
If your baby has a rash, let her bottom dry after each diaper change. Keep her diaper off for some time to allow ventilation.
A zinc-oxide cream can be used on your baby’s clean, dry bottom to prevent and treat rash.
Talcum powder is better avoided as it can worsen a rash, and may act as an irritant.

A newborn baby has no other means to express himself/herself other than crying. He/she may cry for different reasons, and may cry loudly or softly. Listen to him/her, hold him/her and don’t get hassled yourself. The various causes for crying include:

  • Hunger – your baby may want a feed.
  • Wet or Dirty diaper – your baby needs changing.
  • Temperature – your baby may be hot or cold.
  • Gas or colic – the baby's tummy may be hurting. Try to burp him/her or change position  .
  • Attention – your baby may just want you to talk to him/her, play with him/her or hold him/her.
  • Noise or crowds – your baby may want a little peace and quiet too!
  • Most importantly, don’t get nervous if your baby seems to be crying a lot. He/she will settle down soon. If you are tired or need a break, ask your spouse or other family member to take over for a while until your feel better.

Babies have big head in relation to their bodies, and their necks are not strong enough to support the head for the first few months. Hence special care is required when carrying them.

Remember a few things to do:

  • Support his/her neck and head well whenever you lift your baby.
  • Wrapping or swaddling the baby before carrying often helps.
  • Do not change position suddenly or toss him/her in the air.
  • Do not let children handle your baby unless an adult is there to supervise or help.
  • A ‘startle’ response of throwing out his/her arms and legs is not unusual when trying to pick up your baby. Being gentle yet firm is the key to making your baby comfortable.


The small stump of the umbilical cord usually dries up and shrivels up. It may become brown or blackish in colour .Do not worry, this is normal. It is important to see that there no foul smell or greenish yellow discharge. Link to when to call your doctor in Care of the new  born. That could be a sign of infection.

In the daily hygiene routine, you must keep the cord stump dry and clean. It may be better to give only sponge baths until the cord stump falls off. Your doctor may recommend wiping the cord with spirit or eau-de-cologne after baby’s bath. The umbilical cord stump will usually fall off in 5 to 10 days.

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When To Call Your Doctor?

If you notice any of the following changes in the cord area, let your doctor know:

Bad smell from cord area.
Bleeding from the cord stump.
Brown, green or yellow discharge from the bottom of the cord.
Reddish and / or hot, painful area at the bottom of the cord.

There are many minor things related to your newborn baby that are really normal, but cause worry, as they appear different or abnormal. These are a few things that you may notice which are harmless or will subside with time.

  • Colour of skin :
    The baby’s skin and mouth are usually pinkish, more so in fair skinned babies, the hands and feet may appear blue sometimes. This is usually due to feeling cold. So see that your baby is kept warm.
  • Skin texture and feel :
    Some babies may have dry, cracking or peeling skin. This is more common if your went beyond your due date. Link to postdatism. Other babies have seemingly excess soft furry hair on their upper body. This will go away soon. Skin peeling may also occur. As long as the area underneath is healthy, do not worry.
  • Milia:
    There may be small white bumps (like acne) on the face, especially on the nose, chin or cheeks. These are just distended sebaceous glands. They should not be rubbed or squeezed. They will disappear on their own within a few weeks
  • Erythema toxicum / ‘fifth disease’ :
    These are reddish patches like a ‘slapped check’ appearance on the face or trunk. These typically may be seen in the first week and will clear up on their own.
  • Stork bites:CARTOON:
    Many babies have small pale pink spots on the nose, eyelids and back of the neck. These were believed to be due to the legend of the stork holding the baby to deliver it to the mother’s womb! They vanish after a few months.
  • Birthmarks and Mongolian spots :
    Some babies may have a birthmark. Your doctor will check before you go home. Some babies, more often in dark-skinned races, may have bluish spots that look like bruises on their bottom or back. These well-defined areas are called Mongolian spots. They are harmless. Some people believe that they are a sign of good luck! They will go away in several months, but usually by the first birthday.
  • Breast swelling :
    In the first few days after birth your hormones may still be affecting the baby’s breast tissue. Many babies, male or female, may have slightly engorged or swollen breasts. Whitish discharge, often called ‘witch’s milk’ can be seen oozing from the nipples. Remember do not press or try to remove this, as it will stop automatically within a few days.
  • Genitals:
    Due to mothers hormones some girl babies may have a little clear or blood stained discharge from the vagina. The labia may look little swollen. This will settle by the end of the first week, so do not do anything about this. Baby boys have a foreskin covering the tip of the penis. In many newborn boys, the foreskin cannot be slid back completely. As long as this does not interfere with passing urine, there is no need to do anything about it. link to circumcision. Do not try to retract the skin forcibly either. A baby boy should also have both his testicles in the sac below his penis.
  • Newborn Teeth :
    Some babies may have one or more teeth at birth. This is not uncommon. But these teeth are usually shed by 6 months. If they hurt you while breastfeeding or are loose, they can be removed.
  • Jaundice:
    Physiological jaundice is very common in babies. It usually starts after the first 24 hours and will disappear within a week. You can tell that your baby is jaundiced if;
  1. the skin looks yellow,
  2. the whites of the eyes look yellow,
  3. You press on a skin area (e.g.: nose, skin) and the yellow colour shows when the pressure is cleared.

Jaundice is more common if your baby is low birth weight, Link to birth weight, or you had a difficult labour and delivery, you were diabetic in pregnancy, or the baby had bruises during delivery. If your doctor feels the jaundice is significant, your baby’s blood may be checked for bilirubin level. Usually the levels do not exceed 10 mg % in physiological jaundice, and as such no specific treatment may be required. One important thing to do is feed your baby as often as possible. By increasing excretion of bile salts and pigments in stools, this helps the jaundice to disappear quicker. Another treatment is exposure of baby’s skin to light. You may be advised to keep the baby uncovered in the sunrays near a window at dawn or dusk. Please remember to avoid excess exposure to direct sunlight and follow your doctor’s instructions at all times. Your doctor is the best person to tell you if any special treatment is necessary.


  • Babies with special needs

Some babies may need some extra attention from you and the doctor after birth. These include:

  • Low birth weight babies (less than 2.5kg).
  • Babies born too early (premature).
  • Babies with pathological jaundice.
  • Babies with infection.
  • Those needing an operation soon after birth.
  • Those with low blood sugar.
  • Babies of diabetic mothers.
  • In such situation your baby may need to stay in hospital for a longer time and may even be kept in an intensive care unit for newborns. Your doctor and other medical staff will help you and teach you how to take care of your baby.

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Your first week of motherhood is now over. How does it feel? You are now more experienced at handling your baby’s daily routine. There are still a few things you may want to know or that are not yet settled completely. These include.

(1) Sleeping Pattern

When talking about newborns, one of the first pictures that comes to mind is a weary mother with lack of sleep.

Remember that things can only get better with time. Your baby will develop his / her own sleep pattern, but this may take sometime, usually many weeks. Some babies sleep fitfully for just an hour or two at a time. Some may sleep many hours at a stretch. Some days may be good for you, with your baby sleeping well and giving you time to rest. Some days may not be so good.

These are a few things that help babies to sleep better.

  • Most babies sleep well after feeding well, (like adults).
  • Some babies sleep better often being tied in a cloth (swaddled). Link to swaddling the baby in Care of the newborn.
  • Some sleep well after being rocked (such as in a crib or swinging cradle).
  • Some babies sleep well after a bath or massage.

You will soon find what works best for your baby. Try to avoid carrying the baby around to put her to sleep, as this habit will be difficult to break.

(2) Play

As your baby is growing up, she will stay awake for longer periods. Each baby has his/her own personality, even so soon after birth. By a few weeks of age, you will get an idea as to what he/she wants to do. Newborn babies recognise the mother by smell, voice and appearance, although proper fixation of gaze on an object or person may not be obvious till a month or more from birth.Your baby may want to look at moving objects like a hanging toy on the crib, or pictures. Some find music enjoyable while some like mirrors.

(3) Clothing

Just like adults dress according to the weather, babies also need to be dressed suitably. However a general guideline is that clothing should be soft, not tight, and should not have prickly or poky attachment (like stiff laces or sharp buttons).

  • See to that appropriate under-clothing is used (nappies or diapers). Check the nappy frequently.
  • In warm weather, look out for heat rashes. A red, raised rash may appear if the baby is too warm. While going to the sun, use a bonnet or a sun-umbrella to keep his/her head covered. Remember that babies have a delicate skin, so it is best to avoid over-exposure to the elements like sun, wind or rain.
  • In cool or cold weather it is better to have more layers of clothes than a single thick garment. Woollen clothing like sweater, bonnet or booties should be made of soft wool and preferably worn over cotton under-garments. A light woollen blanket can be used as a swaddling cloth.
  • How to wrap / swaddle your baby - picture.

    (4) Temperature

If your baby is not looking or acting normal, looks down or sick you may need to check his/her temperature. If he/she is sweating first of all check that you have not over-clothed him/her!You may need to check the temperature if your baby is

  • Having persistent diarrhoea or vomiting.
  • Is unusually fretful or fussy.
  • Feels hot.
  • Has a dry mouth or flushed skin.
  • Has a rash.
  • Is not feeding.
  • Breaths differently (noisy, fast or irregular).
  • A special rectal thermometer may be used for this purpose but your doctor/nurse will instruct you how to use this. Never put a thermometer in baby’s mouth at this age.
    Normal body temperature is about 37 C (36.1 C to 37.8 C). A temperature higher than 37.8 C (100 F) should be reported to your doctor.

    (5) Umbilical Cord

The umbilical cord stump usually falls off by the 10th day. If the cord has not fallen off by the 14th day or there is redness or discharge at the base, you need to call the doctor.

(6) When to seek help?

You may need to call your doctor if you feel your baby is looking sick or having any of the following problems:

Fever, temperature above 38.8 C (100 F).

Vomiting repeatedly or in a forceful manner.

Loose, watery, greenish stools more that 3 – 4 times a day.

Keeps refusing to feeds.

Does not pass enough urine (at least 5 – 6 times daily).

Behaves unusually, is irritable or fussy, despite all your efforts.

(7) Circumcision

In certain families or communities you may want to get your baby boy circumcised i.e.: remove the foreskin at the tip of the penis.This is a personal choice and should be made by both parents together, with your doctor’s help, if necessary. It is a minor surgery and can be done before discharge from hospital (within the first week) or later. Medically it is required only for severe phimosis where the foreskin is very tight and interferes with passing urine.

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Recommended:  book
"The new parent"
by author Martha



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