When your baby is born, she may not look exactly as you expected. If you have not spent much time around newborn babies up until this point, you may be downright surprised at her appearance.
Head and face
If your newborn baby was born vaginally, the shape of her head may be elongated. This is referred to as a “conehead.” There are two reasons for this sometimes unexpected appearance:
- During delivery, your baby’s skull bones may have shifted and overlapped so that her head could fit through the birth canal. This is called moulding, and it will be particularly apparent if you had a very long labour.
- Also during delivery, pressure on your baby’s head from your uterus, pelvis, or vagina may have caused your baby’s head to swell, thus adding to the conehead appearance.
Don’t worry about her somewhat pointy head. The swelling will go down, and your baby’s head will round itself out with time. Soon she will look as perfect as those cherubic babes so often seen on television advertisements.
On the other hand, if you had a caesarean section without any labour at all, your baby’s head may be round and perfect, right from the start.
You may be able to see, or feel, the two “soft spots” called fontanelles, which are diamond shaped and normally located in the midline on the top of a baby's head. You may be able to see or feel your baby's pulse through the fontanelles.
The tight squeeze of vaginal birth causes babies’ faces to swell, their noses to flatten, and their cheeks to bruise. Your baby’s eyes may be puffy and bloodshot, and her ear might be folded over; these are common marks of the birthing process. Don’t worry. Soon everything will spring into its normal position and your baby will look just fine.
If your baby was delivered with forceps, you may see marks or scrapes from the forceps on her face and head. Forceps marks usually disappear within a day or two, but sometimes they can last as long as a couple of months.
At birth, your baby’s eyes may be closed. This is because the bright lights of the birthing room are hard on her sensitive eyes. In a few minutes she will open her eyes. You may notice sticky secretions coming from her eyes, and one of her eyes may appear to wander. This is normal. The secretions should disappear in a few weeks when your baby’s eyes start to make real tears. Her eyes should gradually stop wandering over the next few months.
Most babies are born with dark blue or greyish eyes, but don’t assume that this will be your baby’s eye colour for the rest of her life. The colour may change over the first few months, and her true eye colour will not be established until she is about three to six months of age.
Babies are legally blind at birth; when held to the breast, they can see their mother’s face, and not much beyond that. Over the first few months, your baby’s vision will improve considerably.
At birth, your newborn baby’s skin may be covered with amniotic fluid, blood, and vernix, which is a white, cheesy material that protected your baby’s skin while in the womb. Much of the material coating your baby’s skin at birth may be wiped off before she is bundled up and presented to you. Your baby may also have some fine, downy hair called lanugo all over her body, especially if she was born prematurely. The lanugo will rub off and disappear after a week or two if she was full-term; if your baby was premature, the lanugo will take longer to completely disappear. If your baby has a bowel movement before she is born, she may be covered in meconium, a greenish-black tarry substance.
Your baby’s skin may be dry and flaky, and somewhat translucent. You may be able to see blood vessels in certain areas such as over her nose, eyelids, or neck. Her hands and feet may be bluish rather than pink, and they may be cool to touch. These are signs of an immature circulatory system, and they are all quite normal. Over time, these problems will fix themselves.
If your baby was born full-term, she may have smooth, wrinkle-free skin. However, if she was premature, her skin may be somewhat wrinkly, or conversely very glossy and swollen. Babies born post-term will have more dry skin that peels. Time will help to restore normal skin, as your baby grows and gains weight.
Between the third and fifth days of life, about two-thirds of babies develop a condition called jaundice, which causes their skin and eyes to take on a yellowish hue. This is because of a build-up of a chemical called bilirubin in the body. Although the liver and bowel are usually responsible for getting rid of the unwanted bilirubin, many babies have an immature liver that cannot do this effectively. Jaundice normally resolves during the first few days of life. If bilirubin levels are very high, they can pose a risk to your baby’s hearing and other brain functions. Severe jaundice is treated using phototherapy to modify the yellow pigment in the skin, and therefore, allow better removal of the bilirubin by the baby.
Your newborn baby may have birthmarks or other skin conditions that you may be concerned about. Usually these should not be a cause for worry. Ask your primary care physician about these markings for further information.
Arms and legs, hands and feet
Your newborn baby’s arms and legs are rather short at birth compared with the rest of her body. Her hands may be bluish and wrinkled, and pulled up to her face in a tight fist. Babies’ feet are often bluish in colour, which is completely normal for the first few days after birth. Their feet may be a bit turned in, and their toes may overlap each other.
Even though your newborn baby’s fingernails may appear soft and thin, she is capable of clawing and scratching at her face. Keep her fingernails trimmed in order to avoid scratching.
A newborn baby’s genitals may be swollen, red, inflamed, and larger than you might expect. This is due to the rush of hormones that occurs before birth. If you have a baby girl with an enlarged vulva, the swelling should go down within a couple of weeks. For baby boys, the swelling in the scrotal sac may take weeks or months to return to normal.
Newborn girls may have whitish secretions or slight menstrual bleeding up to about a week after birth. This is due to a decrease in estrogen hormones after birth.
In boys, the testes usually descend into the scrotal sac before birth. However, sometimes one or both of the testes remain undescended after birth. When this happens, the doctor will need to locate their position, and monitor them while he waits for them to move into the scrotum on their own. If the testes do not descend by the age of two, surgery is required to bring them down to the right place to ensure long-term sperm production and function.
At birth, your newborn baby’s umbilical cord was clamped and cut. The clamp will be removed within 24 to 48 hours. The stump of the umbilical cord on your baby’s navel will look bluish-white and moist at first. However, the umbilical cord stump will quickly lose water and become black and dry. The stump will dry more readily if it is exposed to air, and therefore a dressing is not required. Try not to cover the stump with your baby’s diaper. You may need to roll down the diaper a bit at the point where it comes close to the stump. Within a week or two, the stump should fall off.
While waiting for your baby’s umbilical cord stump to fall off, you may be advised to leave the stump alone and let it heal on its own. Avoid putting your baby in the bathtub until the stump has fallen off and the site has fully healed. Use sponge baths instead.
Stool and urine
Babies are born with their intestines filled with a greenish-black, tarry substance called meconium. Over the first couple of days of life, your newborn baby will pass the meconium out of her system. This type of stool is extra messy and difficult to wipe off the skin. Your baby will also start to urinate during that time. If she has not passed any stool or urine during the first two of days after birth, she may need to be checked for birth defects involving the anus or urethra, which is the tube that brings urine from the bladder to the outside.
After three or so days of life, your baby’s bowel movements will change to a lighter tan colour, and will become more frequent. Your baby may pass three to four bowel movements per day during the first couple of weeks, especially if she is breastfeeding. After then, the frequency of her bowel movements may become less frequent.
Most newborn babies do not take in much nourishment in the first three to four days of life. Until a regular breastfeeding or bottle feeding pattern is established, newborn babies progressively lose weight during those first few days. If they lose more than 10% of their birth weight in that time, they may have jaundice or another condition that needs to be treated. Most newborn babies stop losing weight around the fourth day of life and, if they are nourished properly, then start to gain weight. Excessive weight loss in the first few days of life may make jaundice worse. By about the 10th day of life, newborn babies usually are back to their original birth weight. They will continue to gain weight gradually thereafter. Failure to gain weight as expected may indicate that the baby is not taking sufficient milk or that the baby is unwell.