So much childbirth preparation focuses on labor, which makes sense. However, it can be easy to forget something important: birth isn’t over the moment the baby is born. What happens immediately after birth?
The first one to two hours after birth are sometimes called the immediate postpartum period or the fourth stage of labor, and also the golden hour.
During this time, the birthing parent’s body is undergoing significant physiological changes. The newborn is transitioning to life outside the uterus. And of course the maternity care team is closely monitoring both.
For doulas, understanding what typically happens during this period can help us continue to provide calm support. Providing support when families may be emotional, exhausted, excited is vital to maintain a positive birth experience.
While you learn all about the immediate postpartum period in training, this is an easy-to-read overview to ensure you remember all you need to support families.
The Placenta Still Needs to Be Born
After the baby is born, the uterus continues contracting. These contractions help the placenta separate from the uterine wall and eventually be delivered.
This is the third stage of labor.
Depending on the circumstances and the family’s care plan, management of the third stage may include medications such as oxytocin. When medication is used to encourage strong uterine contractions and reduce the risk of postpartum hemorrhage, it is called active management.
For low-risk families and those with preferences, as well as in many out of hospital settings, expected management may be used. This is where no medication is given unless a concern arises such as increased bleeding or a delay in the placenta detaching.
Once the placenta is delivered, the uterus needs to remain well contracted. The medical team will assess uterine tone and monitor vaginal bleeding closely.
Parents aren’t always prepared for this part of birth. They may be surprised by continued contractions, medications, fundal massage or the attention suddenly being given to bleeding and the placenta.
A doula can provide reassurance and explain what the family is seeing or experiencing. Ideally, of course, this has been discussed long before birth so parents are prepared for the third stage.
The Newborn Is Making a Major Transition
Meanwhile, the baby is doing something remarkable.
Before birth, the placenta performs much of the work involved in oxygen exchange. After birth, the newborn must transition to breathing through their lungs while major changes occur within their cardiovascular system.
Most healthy newborns make this transition without significant intervention.
When circumstances allow, placing the baby skin-to-skin with the birthing parent can support temperature regulation, cardiorespiratory stability and early feeding behaviors.
This is also why many routine newborn procedures can often occur while the baby remains with the parent or can be delayed until after the initial period of skin-to-skin.
However, doulas should prepare families for the possibility that a baby may need additional assessment or medical support after birth. Supporting a family’s preferences doesn’t mean promising that the first hour will unfold exactly as planned.
It can be helpful to discuss prenatally that around 10% of babies might need a bit of support to transition. This does not typically mean there’s something “wrong” but rather baby just needs brief support to adjust to life outside the womb.
Occasionally, true medical concerns arise, your calming presence can be vital if that occurs.
What About the “Golden Hour”?
You’ve probably heard the first hour after birth described as the Golden Hour.
It’s a useful concept, but doulas should avoid presenting it as a rigid deadline or another standard parents can somehow “fail.”
When mom and baby are medically stable, uninterrupted skin-to-skin provides an opportunity for bonding, newborn regulation and initiation of feeding.
Some newborns begin displaying feeding behaviors fairly quickly. Others need more time.
The important thing is protecting opportunities for closeness and early feeding when possible. Watching the clock and creating unnecessary pressure isn’t ideal.
And when immediate skin-to-skin isn’t possible because either mom or baby requires medical care, that does not mean bonding or breastfeeding has been ruined. Discussing this prenatally is important.
Early Feeding May Look Different Than Families Expect
If breastfeeding is planned, the first couple of hours can provide an important opportunity for initiation.
Newborns may lick, root, bring their hands toward their mouths, bob their heads and gradually move toward the breast.
This process doesn’t always look like the perfectly positioned breastfeeding session parents may have seen in educational materials.
That’s okay and to be expected.
As a doula, you can help protect a calm environment, encourage skin-to-skin and help parents recognize early feeding cues.
Depending on your training and scope, you may also provide basic breastfeeding support. More complex feeding concerns should be referred to an IBCLC lactation consultant.
Mom Is Being Closely Monitored
While everyone’s attention naturally gravitates toward the new baby, significant physiological changes are happening to the person who just gave birth.
During the immediate postpartum period, the healthcare team may monitor:
- Blood pressure, pulse and other vital signs
- Vaginal bleeding
- Uterine tone and position
- Placental delivery
- The perineum and birth canal
- Pain and overall condition
- Bladder function
If a perineal or vaginal tear occurred, the provider may also perform an examination and repair while the baby is skin-to-skin. You can encourage mom to focus on baby but if she’s feeling overwhelmed by the exams or repair, it’s okay if she needs dad or another person to briefly hold baby.
The room may suddenly become busy while the parent is simultaneously meeting their baby, being examined, experiencing discomfort and trying to understand conversations happening around them.
Sometimes our most useful role is simply helping preserve calm in the middle of all that activity.
What Changes After a Cesarean Birth?
The immediate postpartum experience may look different after a cesarean, but many of the same principles still apply.
Depending on the parent’s and baby’s medical condition and hospital policies, skin-to-skin may be possible in the operating room or recovery area. A support person may help facilitate contact while the surgical team completes the procedure.
If mom and baby must be separated, doulas can help families adapt.
That might mean supporting the birthing parent in recovery, helping the partner remain involved, facilitating communication or encouraging skin-to-skin and feeding when reunification occurs.
There is no single “correct” first hour.
Don’t Forget the Partner
Partners can become almost invisible during the immediate postpartum period.
They may be overwhelmed, emotional or unsure where they should be. If the baby needs to move across the room, or unexpectedly requires additional care, the partner may suddenly have to decide whether to remain with the mom or accompany the baby.
Doulas can be especially valuable here because there is another support person in the room.
We can help partners stay involved, remind them about preferences previously discussed, take photos if requested, bring water, help them get settled for skin-to-skin, or simply reassure them that they are doing exactly what their family needs.
The Doula’s Job Isn’t Finished When the Baby Arrives
Birth doulas are known for continuous labor support, but support shouldn’t abruptly disappear when the baby is born.
The immediate postpartum period is often one of the most emotionally intense portions of the entire birth.
This is a time for doulas to observe, listen and respond to what the family needs.
You might:
- Help maintain a calm environment.
- Support uninterrupted skin-to-skin when appropriate.
- Encourage early feeding according to the family’s preferences.
- Help the partner remain involved.
- Take photos when requested.
- Bring food, drinks or personal belongings.
- Help parents understand what is happening without interpreting medical information.
- Encourage questions and communication with the healthcare team.
- Notice when the family needs privacy rather than conversation.
- Help the family begin processing the birth they just experienced.
And sometimes the best doula support is remarkably simple: sit quietly and let the new family have their moment.
Birth Doesn’t End at Birth
For months, families imagine the moment their baby will finally be placed in their arms.
But that moment is actually the beginning of another important transition.
The placenta still needs to be delivered. The uterus needs to contract and shrink. The newborn must adapt to life outside the womb. Feeding may begin. Parents meet their baby. Partners find their new role. And sometimes unexpected medical needs arise.
As a knowledgeable doula, you’ll understand that continuous support means being present through this transition too.
Sometimes the most meaningful support we provide isn’t during the hardest contraction.
It might be during those quiet first moments afterward, when a family looks around the room and realizes: their baby is finally here.
Not already a doula ready to support families through birth and after? Get started today and begin your doula training.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...