The first twelve weeks at home: your baby, your recovery, our visits

What do the first twelve weeks actually look like?

Two people are recovering at once. Your obstetrician or midwife leads your recovery. We look after the baby, and we ask how you are doing at every visit, because that changes how the baby is doing.

• Weeks 1 to 2: feeding around the clock, day and night the same. Back to birth weight by about 2 weeks. Your bleeding is heaviest now.
• Weeks 3 to 6: crying peaks around week 6, milk supply settles, social smiling starts.
• Weeks 6 to 9: longer awake stretches, the 2-month visit and the 2-month vaccines. Many parents return to work here.
• Weeks 9 to 12: crying drops off, one longer night stretch appears, and your baby holds their head steady.

How often will my baby feed, and when are the growth spurts?

Plan on 8 to 12 feeds in 24 hours. Breastfed newborns nurse about every 2 hours, measured from the start of one feed to the start of the next. Bottle-fed newborns eat every 2 to 3 hours, 8 times a day at minimum. Feed on cues rather than the clock: rooting, hands to mouth, stirring. Crying is a late cue.

Growth spurts land around 7 to 10 days and again between 3 and 6 weeks. Your baby feeds far more often for two or three days, sometimes back to back through the evening. That is how supply gets raised, not a sign you have run out of milk.

Diapers are the simplest check: 2 to 3 wet a day in the first few days, at least 5 to 6 after day 4 or 5. Babies gain steadily from about day 5, roughly an ounce a day, and almost all are back to birth weight by 3 weeks.

How much will my baby sleep, and where should they sleep?

Newborns sleep about 16 to 17 hours a day, in stretches of only 1 to 2 hours, and have no regular sleep cycles until around 4 months.

Safe sleep is the same every nap and every night:

• On the back, for every sleep
• Alone, on their own surface, with no one sharing it
• On a firm, flat surface in a crib, bassinet, portable crib or play yard, with a snug mattress and a fitted sheet only
• In your room, on that separate surface, for at least the first 6 months
• Nothing soft in the sleep space: no pillows, blankets, quilts, bumpers or stuffed toys. Use a wearable sleep sack instead of a blanket

People will ask when you are going to sleep train. Most babies are not ready before 4 to 6 months, once sleep cycles have matured, so the first twelve weeks are not the time. What helps now is smaller: keep daytime bright and social, keep night feeds dim and quiet, put your baby down drowsy rather than asleep, and split the night with someone so one of you gets a four-hour block.

Why does my baby cry so much, and what helps?

Crying rises for about six weeks and then falls. Fussing peaks at around 3 hours a day by 6 weeks and drops to 1 or 2 hours by 3 to 4 months, usually worst between early evening and midnight. About one in five babies meets the definition of colic, inconsolable crying in a baby who is otherwise healthy and growing. It also ends, generally by 3 to 4 months.

Check the basics, then soothe in layers:

1. Hunger, a wet or dirty diaper, too hot or too cold, a hair wrapped around a toe
2. Swaddle in a thin blanket, arms in, hips loose
3. Hold your baby on their side in your arms and rub their back
4. Steady sound: a loud shush, white noise, a fan
5. Steady motion: walking, rocking, a carrier, a stroller
6. A pacifier

If you feel your patience going, put your baby on their back in the crib, shut the door and take ten minutes. A baby crying in a safe crib is safe. Never shake a baby. Call us if you are at the edge of it, and read our after-hours guide.

Which visits do we do in the first twelve weeks?

1. 2 to 3 days after discharge. Weight, jaundice, feeding, the hospital screening results, cord and bath questions, safe sleep, and how you are doing. Babies sent home before 48 hours need to be seen within 2 days.
2. 2 weeks. Back to birth weight, feeding without pain, vitamin D, and your mood. Most feeding problems get fixed here.
3. 1 month. Growth, development, a depression screen, and a hepatitis B dose if one is due.
4. 2 months. Growth and development, and the first vaccines since the hospital: hepatitis B, rotavirus, DTaP, Hib, pneumococcal and polio. The full schedule is on our immunizations page.

Expect a fussy, sleepy evening after the 2-month shots. That is the immune system working, and it passes in a day or two. If you have not chosen us yet, start at new patients and book the free meet-and-greet through expecting a baby.

What is normal for my own body after birth?

Bleeding, called lochia, is heavy and bright red for the first few days and may contain clots. It gets lighter and paler over the following weeks, and spotting can continue for a month or more. Afterpains, the cramping as the uterus shrinks, are strongest during feeds in the first days. Perineal soreness responds to cold packs, warm baths and the pain medicine your obstetric provider approved.

Postpartum care is not a single clearance visit at six weeks. ACOG recommends contact with your obstetrician or midwife within the first 3 weeks after birth, care as you need it after that, and a full visit no later than 12 weeks. Call them for bleeding that is getting heavier instead of lighter, a fever, a red or hot painful area on a breast, pain or swelling in one leg, or a wound that is opening.

Is this the baby blues, or is it something more?

Baby blues is common, affecting up to 80% of new mothers. It starts 2 to 3 days after birth and fades within about 2 weeks: tearfulness, mood swings, feeling overwhelmed, trouble sleeping. It comes from the drop in pregnancy hormones, not from anything you did.

Postpartum depression and postpartum anxiety are different. They can begin during pregnancy or at any point in the first year after birth. The feelings do not lift after two weeks, they get in the way of daily life, and self-care alone is often not enough. Roughly 1 in 8 mothers develops postpartum depression, and treatment works: talk therapy, support groups, and medication including antidepressants considered compatible with breastfeeding.

Keep these numbers where you can find them at 3 a.m.:

• Postpartum Support International: call or text 1-800-944-4773
• National Maternal Mental Health Hotline: 1-833-TLC-MAMA (1-833-852-6262), call or text, free and 24 hours
• 988 Suicide and Crisis Lifeline: call or text 988
• Our office: (770) 615-7000

We screen for postpartum depression at your baby’s visits, with the Edinburgh Postnatal Depression Scale at the 1-, 2-, 4- and 6-month checkups, and we ask earlier as well. Answer it honestly. We see you more often in the first months than anyone else does.

What should I eat and drink while I recover and breastfeed?

Eat regular meals, not a diet. Restrictive eating postpartum does not change milk much, but it does drain you. Keep energy-dense snacks where you feed: trail mix, yogurt, a smoothie, toast with avocado or peanut butter. Keep water there and drink when you are thirsty.

• Calories: an extra 330 to 400 kcal a day while breastfeeding
• Calcium: 1,000 mg a day from ages 18 to 50, or 1,300 mg if you are a teenager. Three servings of dairy or fortified alternatives covers it
• Vitamin D: at least 400 IU a day, and some experts suggest up to 1,000 IU
• Choline: 550 mg a day while lactating, most easily from egg yolks, then soy, beans and cruciferous vegetables
• Omega-3 fats: 8 to 12 ounces a week of lower-mercury fish such as salmon, sardines, cod or canned light tuna. Skip shark, swordfish, king mackerel, marlin, orange roughy, bigeye tuna and Gulf tilefish
• Iron: 9 mg a day while breastfeeding, or 10 mg if you are under 19. That is lower than pregnancy’s 27 mg, because most breastfeeding mothers are not menstruating. Take more only if your doctor prescribes it for anemia after a blood test

Iron and calcium compete, so keep an iron supplement away from a dairy-heavy meal and pair it with vitamin C instead. Tell your obstetric provider or a dietitian about ongoing fatigue, no appetite or a history of disordered eating.

How do I go back to work and keep breastfeeding?

Start pumping a few weeks before your first day back, so you can practice and your baby gets used to a bottle. At work, pump about as often as your baby would feed, usually every 2 to 3 hours, and expect 15 to 20 minutes each time. Under the PUMP Act, employers owe you reasonable break time to express milk for one year after birth and a clean, private space that is not a bathroom.

Milk storage, following CDC guidance:

• Room temperature at 77°F or cooler: up to 4 hours
• Refrigerator: up to 4 days
• Freezer: 6 months is best, up to 12 months is acceptable
• Thawed in the refrigerator: use within 24 hours
• Warmed or brought to room temperature: use within 2 hours, and never refreeze

Label every container with the date and store it toward the back of the shelf, not in the door. For childcare, ask how the caregiver places babies down for sleep, what the sick policy is, whether children and staff are up to date on vaccines, and how many infants each adult has. Tell us your start date and we will have the forms and vaccine record ready.