The first 24 hours with a newborn

You will not remember most of this day. That is fine. The hospital staff will, and your partner will fill in the blanks for the next 18 years. What follows is what actually tends to happen, hour by hour, so you have a rough mental map walking in.

The first hour: the golden hour

Right after birth, your baby gets placed on your chest, skin to skin. This stretch is sometimes called the golden hour. The staff is doing two things at once: keeping a quiet eye on baby (color, breathing, alertness) and giving the two of you uninterrupted contact.

What your baby is doing in this first hour is wild. They will likely be quiet and alert, eyes open, looking around. This is the longest alert window you will get for the next couple of days. Babies often inch toward the breast on their own (the breast crawl) and may latch within 30 to 60 minutes if you are breastfeeding.

Apgar scores get logged at 1 minute and 5 minutes. These are quick checks of color, heart rate, reflexes, muscle tone, and breathing, scored out of 10. A 7 or above is reassuring. A lower score just means your baby got a little more attention from the team. It is not a long-term predictor of anything.

Hour 1 to 3: weight, length, vitamin K, eye ointment

After the golden hour, the team does a more thorough newborn exam. You may be moved to the recovery room. Here is what typically happens:

• Weight, length, head circumference. Standard measurements. Your baby will likely lose 5 to 10 percent of birth weight over the first 3 to 5 days, which is normal.
• Vitamin K shot. An intramuscular injection in the thigh that prevents a rare but serious bleeding disorder. Recommended by the AAP for every newborn.
• Erythromycin eye ointment. A goopy antibiotic gel applied to both eyes to prevent infection from anything baby was exposed to during birth.
• Hepatitis B vaccine. Usually offered within 24 hours. The first of a three-dose series.
• Temperature check. Newborns are bad at regulating temperature for the first 24 hours. The nurse may keep checking every couple of hours.

You can ask to delay any of these (the AAP supports a brief delay of vitamin K and eye ointment to extend skin to skin, usually up to 60 minutes). You can also decline. Talk to your pediatrician beforehand about your preferences and put them in your birth plan.

Hour 3 to 6: the first feed

Whether you are breastfeeding, bottle feeding, or combo feeding, the first real attempt usually happens in this window. A lactation consultant may pop in if you are breastfeeding.

What to expect on day one:

• Colostrum, not milk. Your milk hasn't come in yet. What baby gets is colostrum — thick, golden, and tiny in volume. A newborn's stomach is the size of a cherry on day one. They need teaspoons, not ounces.
• Bottle feeds are also small. If you are formula feeding from the start, plan on half-ounce to one-ounce feeds, not the 2 to 3 ounce feeds you may have read about. The cherry-sized stomach applies either way.
• Latching is awkward. Both of you are new at this. Ask a lactation consultant to watch a feed before you discharge.
• Baby may sleep through feeds. They are recovering from birth too. The standard guidance is to wake them every 2 to 3 hours for a feed on day one.

Hour 6 to 12: the first pee, the first poop, and a lot of sleep

By the 6 to 12 hour mark, you are watching for two specific things: a first pee and a first poop. The hospital nurses are tracking both.

First pee: within the first 12 to 24 hours after birth. Just one is enough on day one.

First poop: the first poop is called meconium. It is dark, almost black, and sticky like tar. Babies pass it within the first 24 to 48 hours. If your baby is later than that, the team will check in. You will go through several meconium diapers before stools transition to yellow seedy newborn poop around day 3 to 5.

Most of these hours, your baby will sleep. Newborns sleep 16 to 20 hours a day. This is not a sleep regression or anything to worry about. Day one is often the sleepiest, because they are tired from birth and not very interested in eating yet.

Hour 12 to 18: visitors, the bath debate, and the heel stick

If you are at a hospital, visitors usually start showing up in this window. Set boundaries early. You do not have to host. It is fine to ask everyone to wash hands, skip the kiss, and leave when you say so.

First bath. Most hospitals now delay the first bath by 24 hours or more. The vernix (the white waxy coating on baby's skin at birth) is protective and helps regulate temperature. Letting it absorb is better than washing it off right away. You can also ask to do the first bath at home.

Heel stick (newborn screening). Usually done at 24 hours. A nurse pricks baby's heel and collects blood drops on a card. The blood is screened for dozens of rare metabolic and genetic conditions. Most states require this. Baby will cry for a minute, then move on. The blood draw is brief.

Hearing screen. A small probe in baby's ear measures responses to soft sounds. Painless, takes a few minutes per ear.

Hour 18 to 24: the cluster feeding starts, and so does the cry

Somewhere in this window, the deep newborn sleep wears off. Your baby wakes up hungrier and louder. This is when cluster feeding starts (frequent, back to back feeds) and when you may hear what feels like the first real cry.

This is also when first-time parents start to panic a little, because the sleepy potato of the first 12 hours is now a person with needs. The good news: it is normal. It does not mean your milk supply is low (cluster feeding is the cue that builds it). It does not mean your baby is broken.

Cluster feeding in the first 48 hours is exhausting and expected. Keep offering the breast or bottle every 1 to 2 hours during the cluster, sleep when you can in between, and ask for help. The first night is the hardest for almost every parent.

What to remember (and what you will forget)

You will forget most of the order. The Apgar scores, the meconium timing, the exact minute of the first latch — none of it matters past the first week. What does matter:

• The vitamin K shot got done. Verify before discharge.
• The hearing screen and heel stick got done. Verify before discharge.
• You have your pediatrician follow-up scheduled. Usually 1 to 3 days after discharge.
• You know how to do a feed. Don't leave the hospital without watching a lactation consultant or nurse help with at least one feed.
• You know the warning signs. Yellow skin (jaundice), trouble breathing, fever over 100.4 F, not feeding, very few wet diapers. Any of these means call the pediatrician.

What to pack and what to skip

You don't need most of what online lists tell you to bring. The hospital provides diapers, wipes, swaddle blankets, an undershirt, formula if you ask, a hat, and pads for you. What is actually worth bringing:

• Going-home outfit for baby (one zip-up sleeper, no buttons).
• Car seat (installed and tested before labor).
• Your phone charger with a long cord.
• Snacks and a water bottle for the support person.
• Your insurance card and ID.
• A nursing bra or comfortable bra if you are not nursing.
• A pillow you like (hospital pillows are flat).

Check out our hospital bag checklist for the no-nonsense version.

When to call your provider

In the first 24 hours, hospital staff is watching for issues. Once you are home, you become the watcher. Call the pediatrician (or go to the ER) if you notice:

• Rectal temperature of 100.4 F (38 C) or higher in a newborn under 90 days — this is always urgent.
• Yellow tint to the skin or whites of the eyes that is getting more pronounced.
• Fewer than one wet diaper in the first 24 hours, or fewer than 3 by day 3.
• Difficulty breathing — flaring nostrils, grunting, ribs pulling in with each breath.
• No interest in feeding for more than 6 hours.
• Sunken soft spot on the head (sign of dehydration).
• Lethargy that is more than newborn sleepiness — baby is hard to wake, floppy, not responsive.