Your midwife performs a full newborn exam within the first hour after birth and repeats key assessments at 24 hours and 3-5 days postpartum. Most standard newborn procedures (vitamin K, erythromycin eye ointment, newborn screening heel stick) happen in your home. You'll need to schedule a pediatrician visit within 3-5 days of birth.
Planning a home birth means understanding who does what for your newborn and when. Most people assume certain newborn care only happens in hospitals, but midwives perform the same assessments and procedures in your home. Here's the specific timeline, what to expect, and what you need to arrange separately.
Your midwife performs an initial newborn assessment within the first hour, usually while you're holding your baby skin-to-skin. This includes Apgar scores at 1 and 5 minutes (sometimes 10 minutes if needed), heart rate, respiratory effort, muscle tone, reflexes, and skin color.
She measures weight, length, and head circumference. She checks for normal anatomical features, including palate, hips, spine, genitals, and anus. She listens to heart and lung sounds and palpates the abdomen.
She observes your baby's ability to latch and feed, typically within the first hour. Early feeding assessment catches positioning issues before they become painful problems. Most midwives stay 2-4 hours after birth to observe this initial feeding and monitor both you and your baby.
Yes, midwives carry and administer both vitamin K and erythromycin eye ointment. You decide whether to accept these interventions, just as you would in a hospital.
Vitamin K prevents vitamin K deficiency bleeding (VKDB), which occurs in 1.5 to 1.7 per 100,000 births without prophylaxis. The intramuscular injection reduces this risk to nearly zero. Some parents choose oral vitamin K instead, though it requires multiple doses and offers slightly less protection.
Erythromycin eye ointment prevents gonococcal and chlamydial conjunctivitis in newborns exposed during birth. If you tested negative for both STIs during pregnancy and you're in a mutually monogamous relationship, some parents decline this. The ointment can temporarily blur your baby's vision for the first hour or two, so some families delay application until after the initial bonding period.
Your midwife performs the newborn screening heel stick (sometimes called PKU test) between 24 and 48 hours after birth. Timing matters because some conditions won't show up if tested too early.
This screening tests for 30-60 conditions depending on your state, including phenylketonuria, congenital hypothyroidism, sickle cell disease, and cystic fibrosis. Your midwife collects blood spots on a filter paper card and sends it to your state lab.
Your pediatrician or midwife receives results in 1-2 weeks. Abnormal results require follow-up testing, which doesn't mean your baby has the condition, it means more testing is needed. About 1-2% of newborns get a call for repeat testing due to insufficient sample or borderline results.
Your midwife returns around 24 hours after birth for a full assessment of you and your baby. She checks your baby's weight (newborns typically lose 5-10% of birth weight in the first few days), jaundice levels, feeding effectiveness, elimination patterns, and general behavior.
She performs a more detailed physical exam now that your baby is more alert. She assesses muscle tone, primitive reflexes (rooting, sucking, grasping, stepping, Moro), and responsiveness. She checks the umbilical cord stump for signs of infection.
At the 3-5 day visit, she repeats weight and jaundice checks, evaluates breastfeeding or bottle feeding, and answers questions that have come up. By this visit, your baby should be close to regaining birth weight and producing adequate wet and dirty diapers. This visit often includes the newborn screening heel stick if it wasn't done at 24 hours.
Schedule your baby's first pediatrician appointment for 3-5 days after birth, even though your midwife provides care during this period. Some pediatricians prefer to see home birth babies within 24-48 hours. Call your chosen pediatrician during pregnancy to ask about their preferred timeline.
Your pediatrician performs another complete physical exam and reviews your midwife's records. They check weight gain, jaundice, feeding, and elimination. They may repeat the physical exam components your midwife already performed, this is normal practice, not a reflection on your midwife's competence.
You'll return for additional well-child visits at 2 weeks, 1 month, 2 months, and so on following the standard AAP schedule. These visits include vaccines if you choose them, developmental monitoring, and growth tracking. Your midwife's care typically ends at 6 weeks postpartum, after which your pediatrician becomes your baby's primary medical provider.
Hearing screening doesn't typically happen at home because the equipment (otoacoustic emissions or auditory brainstem response testing) is expensive and not portable. You can schedule this at a hospital outpatient clinic, audiology center, or sometimes your pediatrician's office within the first month. About 1-3 per 1,000 babies have hearing loss detectable at birth.
Congenital heart defect screening (pulse oximetry) varies by midwife and state. Some midwives carry pulse oximeters and perform this screening, others don't. This test detects critical congenital heart defects (CCHDs) that affect about 1 in 4,200 births. Ask your midwife whether she provides this screening or whether you need to arrange it separately.
Hepatitis B vaccine is not typically stocked by home birth midwives, though some carry it. If you want your baby vaccinated at birth, arrange this with your pediatrician within 24 hours. Most parents who plan home births either decline this vaccine or schedule it at the 2-month pediatric visit along with other vaccines.
Your midwife gives you specific parameters for what's normal and what requires immediate attention. Red flags include temperature above 100.4°F or below 97.7°F (axillary), lethargy or difficulty waking, refusal to feed for more than 4-6 hours, fewer than one wet diaper per day of life in the first week, absent or high-pitched crying, and grunting or flaring nostrils with breathing.
Jaundice that appears in the first 24 hours, spreads below the chest, or makes your baby difficult to wake requires evaluation. Excessive sleepiness (not waking to feed every 2-4 hours) can indicate serious jaundice, infection, or other problems. Your midwife checks bilirubin levels with a transcutaneous meter at each visit and will send you for lab work or phototherapy if levels are concerning.
Your midwife remains on call 24/7 during your postpartum period (typically 6 weeks). Call her first with concerns, she'll tell you whether to monitor at home, come to your home, or go to the hospital. Have a backup plan for transportation to your nearest emergency department, which you should have already identified during pregnancy.
Your midwife completes and files your baby's birth certificate application. You'll need to provide information for both parents, choose your baby's name, and decide whether the baby takes one parent's surname, a hyphenated name, or a different surname entirely. Requirements vary by state, but most midwives handle this paperwork within the first week.
She provides you with a complete copy of your baby's newborn records, including Apgar scores, birth weight and measurements, physical exam findings, medications or treatments given, and newborn screening information. You need these records for your pediatrician's first visit.
Your midwife files the newborn screening card with your state health department. She may also provide documentation needed for insurance to add your baby to your policy, though you'll need to contact your insurance company directly within 30 days of birth. Some midwives provide a letter for your employer regarding birth date and health status if you need documentation for parental leave.
Start by confirming exactly what newborn care your midwife provides and what you need to arrange separately, particularly hearing screening and early pediatrician visits. Call pediatricians during pregnancy to find one comfortable with home birth who will see your baby within 3-5 days. Write down the red flag signs your midwife gives you and post them where you'll see them during those foggy early days. Your midwife handles most immediate newborn care, but you're building a team that includes a pediatrician from day one.