The birth of a new baby is one of life’s most wondrous moments, filled with a variety of different emotions and amazing physical changes. Whether your newborn baby arrives through vaginal delivery or a cesarean birth in the operating room, your care team will perform several immediate newborn assessments to support your baby’s health and ensure a safe transition to life outside the womb. Every step after the birth of a baby, from first breath to the first feeding, is part of this incredible journey.

In addition, during your hospital stay your baby will be offered a variety of newborn screenings and procedures. These checks help you and your healthcare team understand your baby’s overall condition and offer reassurance about their health and wellbeing. If you ever have questions, your care team is there to help. As your baby’s advocate, you always have the right to be fully informed and involved in every decision along the way.

The Golden Hour and Skin-to-Skin

After birth, your baby takes their first breath, shifting from fetal circulation to newborn circulation and starting the exchange of oxygen and carbon dioxide in the blood. Even in the first hours of life, newborns display amazing abilities such as rooting, sucking, and grasping. Holding your baby skin-to-skin during this special time—known as the Golden Hour—supports:

  • Regulation of temperature, breathing, heart rate, and blood sugar

  • Activation of your newborn's innate ability to self-attach and breastfeed

  • Bonding and comfort during your baby's first moments

Even a short time of uninterrupted skin-to-skin contact can support temperature regulation and bonding. Non-urgent procedures, like measuring weight, length, applying eye drops, or other newborn care can wait until after the Golden Hour. Including this preference in your birth plan helps ensure your healthcare team honors your wishes for immediate and prolonged skin-to-skin.

Which Newborn Procedures Happen Right Away?

Suctioning

In the delivery room, some newborns need extra suctioning of the nose or mouth to clear excess fluid after passing through the birth canal. If your baby is breathing well on their own, additional suctioning is usually not needed. The nursery nurse monitors for obvious signs of distress or breathing difficulty and provides support as needed.

APGAR Score

The APGAR test is a quick scoring system performed at 1 and 5 minutes of life to evaluate the condition of the newborn. It is a visual assessment by your healthcare provider that does not require any invasive procedures. It assesses:

  • Appearance (skin color)

  • Pulse (heart rate)

  • Grimace (reflexes)

  • Activity (muscle tone)

  • Respiration (breathing)

Each area is given a point value, for a total score between 0 and 10. Most healthy babies score 7–10, indicating they’re adapting well as they clear amniotic fluid and establish steady blood flow.

Delayed Cord Clamping

The American College of Obstetricians and Gynecologists (ACOG) now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth. This allows extra blood from the placenta to reach your baby, helping prevent iron deficiency. Clamping and cutting the cord can happen while you and your baby are skin-to-skin.

When Extra Care is Needed

Some newborns require care in special care areas or admission to the Neonatal Intensive Care Unit (NICU) due to prematurity, difficult delivery, or other health conditions. These babies may need:

  • Advanced technology for monitoring blood supply, oxygen exchange, or lung fluid clearance

  • Extra suctioning or support for breathing

  • Warming under a heat lamp if temperature regulation is difficult

  • Close observation for any difficulties of a sick baby

Even in these cases, skin-to-skin contact and breastfeeding can often be encouraged as soon as medically safe. In the meantime, hand expression and pumping should begin as soon as possible after birth to help establish an abundant supply.

Newborn Procedures After The Golden Hour

Physical Exam

Several newborn procedures are often delayed until after the Golden Hour to allow uninterrupted skin-to-skin time. These newborn procedures include a full physical exam to help determine whether your baby is appropriate for gestational age and whether additional monitoring (such as for low blood sugar) may be needed. This head-to-toe assessment checks every part of the body, including:

  • Weight and length

  • Head circumference and soft spots

  • Eyes, including red reflex (a quick screening tool to detect eye problems)

  • Ears, nose, and mouth

  • Spine and hips

  • Heart and lungs

  • Abdomen and umbilical cord stump

  • Genitals and newborn reflexes

Your healthcare provider will let you know if anything requires follow-up, treatment, or simply observation.

Antibiotic Eye Treatment

An antibiotic ointment (usually erythromycin) is applied to prevent neonatal conjunctivitis caused by untreated chlamydia or gonorrhea. Most states require this unless a waiver is signed. The ointment can be applied within the first 24 hours after birth—while your baby is in your arms after the Golden Hour—so that it doesn't interfere with immediate bonding and breastfeeding.

Blood Sugar Monitoring

Some newborns are at increased risk for low blood sugar (hypoglycemia)—including premature babies, babies born to diabetic mothers, and those who are small or large for gestational age. Blood sugar is usually checked with a quick heel stick, where a few drops of blood are collected. Mild hypoglycemia may only require frequent breastfeeding to improve levels. If needed, hand-expressed colostrum, donor milk, glucose gel, or formula may be offered according to hospital policy. Your care team will monitor your baby closely and guide you on how to keep them stable and comfortable.

Hepatitis B Vaccine

The first dose of the Hepatitis B Vaccine is recommended shortly after birth to protect against a virus that affects the liver. You may choose to accept, delay, or decline it; some hospitals require a waiver if you opt out. Breastfeeding or skin-to-skin can help comfort your baby during the injection.

Vitamin K Injection

A dose of Vitamin K given within the first 6 hours after birth, helps prevent rare but serious bleeding disorders. If declined, most states require a waiver. Holding your baby skin-to-skin can reduce the bit of pain they might feel during the shot.

24-Hour Newborn Screening

After the first 24 hours, a few drops of blood are collected to screen for dozens of health conditions. The Newborn Screening may cause brief discomfort, which can be soothed with skin-to-skin. A waiver is required if you choose to forgo this screening and some states have additional options, such as allowing private testing, requesting the blood spots be destroyed, or opting out of research use. 

Before Heading Home

In addition to the routine checks and newborn procedures performed during your hospital stay, your baby will also have a few final assessments before going home.

Newborn Hearing Screening

This painless test checks for potential hearing differences in your baby. Hearing is crucial for language development, social interaction, and learning, so early identification ensures the best time for treatment if needed. The screening usually takes only a few minutes and can be done while your baby is sleeping, resting quietly, or even breastfeeding

RSV: Seasonal Administration

From October 1 and March 31, most newborns whose mothers were not vaccinated in late pregnancy are eligible for RSV antibodies. Babies born during this window should receive the dose during their birth hospitalization or within the first week of life. If you have any questions about this, or any other treatment, reach out to your healthcare provider for more information.

Bathing

Many hospitals now recommend waiting 24 hours before the first bath. Delaying protects heat loss, supports blood sugar stability, and encourages breastfeeding success. Your nurse can guide you through a gentle first bath, if you'd like a demonstration prior to going home.

Discharge Exam and Scheduling Office Visit

Before leaving the hospital, your baby undergoes another physical exam and you'll need to schedule their first office visit. Most babies have their first pediatric visit within 24–48 hours after discharge. This early appointment allows the provider to:

  • Reassess feeding goals

  • Check weight trends

  • Examine jaundice

  • Recheck any findings from the hospital

  • Review any parental concerns

  • Provide ongoing support

If you have concerns about breastfeeding, this visit is an excellent time to ask questions or request additional lactation support.

Making Informed Decisions About Newborn Procedures

Every parent and newborn are unique, and every birth is different. Clear communication, informed consent, and involvement in every decision are essential to give your baby the best start. You can accept, delay, or decline any procedure, and your questions should always be welcomed. Choosing a healthcare provider who values your input can introduce you to new ways of supporting your baby’s health and development, both now and in the years ahead.

By knowing what to expect during your hospital stay—from the first checks in the delivery or recovery room to the discharge physical exam—you can approach your newborn’s first hours and days of life with confidence. Every interaction, every feed, and every moment of closeness allows you to discover your baby’s amazing abilities and lays the foundation for a strong, trusting bond.

Disclaimer: Our classes and accompanying materials are intended for general education purposes and should not replace medical advice. For personalized recommendations, please consult your healthcare provider and/or lactation consultant.