The first 6 hours postpartum. 

Your baby has arrived. 💞

Traditionally, the first hour or two after birth are referred to as the “Golden Hour” — when you meet your baby for the very first time and baby comes skin-to-skin with the birthing parent to release a cascade of hormones that kick off bonding, breast/chestfeeding, and life outside the womb. 

I’m so excited for us to talk about the first 6 hours because while birth professionals are well versed in these “Golden Hours” it can be a very unexpected time for many families. The books about labor helped you prepared the sensations of birth and the postpartum books talked about adjusting those first few weeks, but this window where your baby is birthed - but you aren’t yet into normal life - is often left out when we talk about labor or postpartum.

To begin, I want to start by setting some new (or first) expectations. 

1 - Let’s expand this window to the first 6 hours because while the evidence is about the first 2 hours, there can be so much going on that I really think giving a longer window is helpful for planning. 

And 2 - let’s include this “golden hour” in your birth preferences* planning. 

Speaking of planning, here is where we are going in this article: skin-to-skin, the placenta, medical needs, starting nursing, communication, moving to your postpartum space, resting-eating-drinking.

First up, that rush of oxytocin: skin to skin contact with your newborn. 

After the birth of a healthy baby (vaginal or cesarean) you can expect your baby to be placed on your chest or belly whether you are at home, in a free-standing birth center, or in a hospital room or OR. 

The needs of the baby and birthing parent will always be put first, so even with this standard of care, if a provider knows you or your baby needs immediate medical attention where you cannot be skin-to-skin they will attend to the medical care first.This is why including this in your birth preferences can be so important. Talk ahead of time with your partner and care team about the various scenarios. 

Hear me out, I totally get it! We all only want to imagine a birth where our baby arrives, gives a cry, and moves straight onto the chest. It is often true that any care you or baby need can be provided right in the room with everyone staying together. Midwives in birth centers and at home are trained to care for infants immediately after birth and hospitals have OB’s and pediatricians. BUT if something is needed for the birthing parent or baby, it can feel so good to have a plan ahead of time. 

Birth Preferences: Planning for these scenarios can be as simple as deciding

My partner always remains with me. 

If the baby needs to go to another room for care, my partner will prioritize remaining with our baby and our doula will stay with me (or the reverse). 

If I need medical attention, our baby will go skin-to-skin with my partner. 

Even in a birth where everyone is healthy you might still communicate these preferences - perhaps you let your care team know that you or your partner want to hold the baby on their way to be weighed next to your bed or hold them for any exams. This is your baby, you get to decide.

In the final stage of labor you give birth to the placenta. The gorgeous organ that was nourishing your baby. This experience varies.Some feel starry-eyed at meeting their baby for the first time and these contractions that expel the placenta are not too intense while they are wrapped up in the emotions.  Others notice the contractions, but for most they are not as intense as the vaginal birth of a baby. 

If you had an effective epidural you will still be covered by the epidural for pain management during this time. 

In a cesarean birth, the placenta is removed through the same incision where your baby arrived! Your provider will then inspect the placenta to be sure it is fully intact. If there is any placenta retained in the uterus it requires medical management. 

Birth preferences: You will want to decide ahead of time whether you want to keep your placenta after birth. Let your care team know so they can dispose of it or secure it. We can go WAY deeper into placentas another time, but the brief version of reverence for the placenta - for those who may be thinking, “why would I keep this medical biohazard?” - is that because it is a full organ that your body grew along-side your baby, many people choose to honor their placenta in some way. Check out this RadioLab episode if you want to be amazed by the placenta. 

A few options I’ve seen families choose in my years as a postpartum doula: 

• Cooking and eating the placenta.

• Dehydrating the placenta into pills.

• Burying the placenta in the ground and/or planting a tree or plant over it.

• Art prints created by the placenta's unique shape. (This is a service some doulas offer!)

Ok, so in these first few hours you have given birth to a baby, gone skin to skin, and given birth to the placenta.

Quick tip: Be sure to take a photo of the baby's weight to help you remember and in case you need to show it later. Our doula did this for us and it was such a gift! My son's weight was accidentally translated to grams incorrectly at first so our care providers thought he had lost far more weight in the first few hours out of the womb than he actually had. When we could show them the photograph of him being weighed with his actual birth weight everyone took a sigh of relief and let us return to feeding on demand. 

If you or baby need more extensive medical intervention I encourage you to “restart the clock” on these first few hours when you are brought back together or even to do a full “do over” of this skin to skin contact when you are feeling safely settled at home in the following days or weeks. While the research covers the benefits of the first few hours, the bonding that is possible when we slow down with our baby and re-create this sacred space is incredibly powerful. If you had a traumatic birth consider getting the support of a therapist skilled in birth and postpartum as you process the event and in resetting your early connection with baby.

Colostrum is a thick, yellowish whitish substance that comes from the nipple just like milk. If you are in your third trimester now, with just a little effort you can typically squeeze just a bit of colostrum from the breast. 

Because feeding babies can be simple/challenging/amazing/disappointing/tricky/exciting/frustrating/pick-your-favorite-adjective-here I’m not going to get too deep in this article. If it is available to you and you are interested in giving breast/chestfeeding a try, I highly recommend a prenatal breastfeeding class and/or connecting with a local lactation consultant or IBCLC (Internationally Board Certified Lactation Consultant - these people are like PT’s for babies mouths, parent’s chests, and getting the two to word in tandem!) 

This video of babies initiating breastfeeding by Global Health Media Project is amazing and absolutely worth the 10 minute watch!!!

Please check our Client Resource page for a list of amazing local IBCLC’s to help you get started.

Moving to Your Postpartum Space

After everyone’s immediate medical needs have been cared for it will be time to move to your postpartum space. 

In the hospital you will move from the birthing room to your recovery room where depending on your birth and baby you will remain for up to a few days. Some hospitals have you stay in the same room, but many have a section for labor and delivery and a separate area for new families after birth. Nurses will continue to check on you to monitor vitals and firmly massage your uterus to check blood flow from the uterus. 

In a home birth there is no need to move anywhere! You may briefly move from your birthing space while it is cleaned and then you will likely settle into your bed with your baby. Around the 6th hour after birth, your midwives will once again check vitals and then leave you in peace to bond as a family.  

In the freestanding birth center you will remain in the same room where you gave birth while you rest and receive monitoring. Depending on what time of day you gave birth, typically by 6-8 hours after birth you will feel ready to head home. If everyone is sleeping peacefully after birth, some families stay just a bit longer. 

In all of these settings, for much of the rest of the six hours after birth once medical needs are attended to your care team will continue to check on you but they will also be giving you a bit of space to bond, begin the feeding journey (as many say, breastfeeding may be natural but that doesn’t necessarily mean it comes easy!), and rest after the big work of birth.

As an ayurvedic-inspired postpartum doula I would love it if every family could have their first postpartum meal be fresh, full of warming spices, and easily digestible (like the amazing postpartum porridge we make new families) but eating is the most important thing! 

And if the hospital menu is accessible, simple, and delicious, order from that! My first meal was salmon, broccoli, and potatoes which was, ironically, just about the same thing I ate in early labor and (then threw up later in labor).  I know many midwives have families prep a crockpot at the start of labor to have a warm nourishing meal ready for everyone after birth. Some families also pack a postpartum meal in their birth bags just like they pack snacks for labor. 

Just be sure you attempt eating and getting plenty of fluids in those first few hours amidst the bonding, care interruptions, and, ideally, taking a bit of rest. And perhaps if you and your partner went through our Partner Massage for Pregnancy course you can receive your first postpartum massage :)

*Birth Preferences is the term I use instead of “birth plan” because it expresses more the realities of birth - which is that we can have preferences, but we can never plan or predict exactly how any given birth will go moment to moment.