Newborn Care in the First 24 Hours

To reach the midwife call or text 360-421-5140

IMPORTANT NOTE: YOU are all your baby needs in the first 24 hours. All your baby needs in the
beginning is a safe place to sleep, comfort, warmth, to eat every 2-3 hours, and their diaper changed
when soiled.

Breasts/Feeding
Your baby may take up to a 5-hour nap after the first feeding. After that you should attempt to feed
your baby every 2-3 hours for a minimum of 15 minutes. Be patient and ensure a good latch each time
to avoid trauma to your nipples. Using a light for night feeding, and pillows for support can help insure
you have a good latch. You can use Lanolin to help protect your nipples from chafing. Keep track of how
long it is between feedings and how long the feeding is, it is helpful to write it down and keep a log.
Once your milk comes in you can feed your baby on demand. Your milk will come in by day 3, with this
your breasts may become engorged. Feeding your baby on demand helps regulate the supply. Avoid
pumping for now. If your breasts are engorged you can hand express some milk until they are softer so
baby can latch on better. You can use ice packs or stand in a hot shower with the water beating on your
breasts to help with discomfort as well.
When to call: if you are considering putting anything in your baby’s mouth beside your breast call first. If
you have redness, swelling, and hot to the touch spots on your breast you should call. If you are having
any questions or concerns about breastfeeding you should call.

What to Eat
In the first 24 hours after your baby is born, what you eat does not affect your breast milk. After the first
24 hours you may need to pay attention to what you are eating if it appears that your baby is extra gassy
or uncomfortable after a feeding. Things that can cause that are dairy, broccoli, cabbage (etc.), garlic,
spicy food, coffee, to list a few. To help your body have what it needs to make enough milk for your
baby you need to make sure you are eating enough calories from healthy, whole foods and drinking lots
of water, like when you were pregnant. Concentrate on non-constipating foods until you establish
regular bowel movements again.
When to call: if you are having a difficult time accessing enough food.

Baby’s Diapers
To help monitor if your baby is getting enough colostrum or breastmilk keep track of how many times
you change a wet diaper and how many times you change a poopy diaper. Your baby should have one
wet and one poop for each day old he/she is. In the first 24 hours there should be one wet and one
poop, on day two there should be two wet and two poops and so on up to day 6. From day six forward
you should have 6-8 wet and 6-8 poopy diapers a day.
When to call: if your baby is not having the correct number of pees and poops for how old he/she is,
more is ok.

Temperature
To monitor for signs of infection take the baby’s temperature every 6 hours.
The baby’s temperature should be between 97-99. If you find it is below 97 put baby skin to skin with
warm blankets over the both of you and retake the temperature in 20 minutes. If the baby’s
temperature is over 99, take a layer or two off of the baby and retake it in 20 minutes.
When to call: if the baby’s temperature persists, below 97 or above 99, after you have added or taken
away layers.
 Newborn Care in the First 24 Hours

Umbilical Cord Care

There is no need for special care of the umbilical cord. Keep it out of the diaper so it is exposed to the
air. The cord clamp will be removed at the 24-48-hour home visit. If poop gets on the umbilical cord you
can clean it with a q-tip dipped in alcohol. Do not immerse your baby in a bath until the cord has fallen
off in 7-14 days.
When to call: if the umbilical cord is actively bleeding or oozing, if it is showing signs of an infection: the
area around the cord is red, swollen, pus or foul smelling discharge is present.

Blocked Tear Ducts

If indicated, to open blocked tear ducts, gently press inside the bridge of the nose, placing the tip of your
fingerpad adjacent to the inner corner of the eye on one side. First stroke upward to remove stagnant
material, then stroke with firm pressure downward parallel to the nose, stopping at the nostril. Use 3-4
strokes at a time several times a day.
When to call: if your baby’s eye(s) has pus, is red, swollen, or repeatedly crusted over.

Baby’s Skin
Your baby’s skin should be pinkish in hue regardless of ethnic background; however, they may
experience some normal transitional skin conditions. Things that may occur in the first 24 hours that are
normal include: bluish discoloration of the hands and feet (only the hands and feet); Milia - little, raised,
white spots on the nose; Mottling – a lacy pattern of dilated blood vessels under the skin caused by
general circulation fluctuations; Harlequin sign – one side of the body becomes deep in color and the
other side stays pale, it should resolve in a few seconds or up to 30 minutes and is caused by immaturity
of the baby’s brain and blood vessel communication (call if it doesn’t resolve in 30 min.); Erythema
toxicum – little white or yellowish pimple like spots that are at the hair follicles, could be caused by
irritation (your baby has never worn clothes before!), it should not be on the palms of the hands or soles
of the feet.
When to call: if you notice skin rashes and/or any red patches, pimples or red bumps. If your baby’s skin
becomes pale or blueish all over or around the mouth and/or chest area. If your baby has jaundice - your
baby’s skin appears to have a yellow tinge to it, even if it is slight or not all over.

Baby’s Fingernails
Your baby’s fingernails are delicate and connect to the tip of the fingers, use caution when using clippers
to not cut the tip of your baby’s finger. It’s better to chew or peel long fingernails because you can feel if
you are too close to the skin.

If you have urgent concerns do not hesitate to call, if it is not urgent – write down your questions and
ask them at your next visit.

References

Frye, A. (2013). Holistic Midwifery: Volume II Care During Labor and Birth (2nd Ed.). Portland, OR: Labrys
Press.

King, T.L., Brucker, M.C., Kriebs, J.M., Fahey, J.O., Gegor, C.L., & Varney, H. (2013). Varney’s midwifery
(5th ed.). Burlington, MA: Jones & Bartlett Learning.