The journey

The one non-negotiable is the car seat. Your baby travels in a correctly fitted, rear-facing infant seat, never in someone's arms, on every journey including the first one. The AAP's guidance on bringing a baby home puts installing and checking the car seat before the birth near the top of the list, precisely because nobody wants to be reading a manual in a hospital car park.

Two practical points that get missed. Bulky outdoor clothing or snowsuits under the harness stop the straps tightening properly, so dress your baby in thin layers and put a blanket over the top of the harness. And a car seat is for travelling: once you are home, take your baby out rather than leaving them sleeping in it, which is standard safe sleep advice in every country.

The first afternoon

Very little needs to happen. The NHS's account of the early days is mostly about feeding, sleeping and getting to know each other, and about accepting help rather than performing competence.

Feed on cue, not on a clock. The NHS's guidance for the first days is to feed your baby as often as they want, for as long as they want. Newborns feed little and often, and cluster feeding in the evening is normal.
Skin to skin. It calms babies, supports feeding, and helps regulate their temperature. There is no limit on it.
Keep the house at a comfortable temperature rather than warm. Overheating raises the risk of sudden infant death.
Limit visitors on day one. The NHS advises against letting anyone with a cold sore or any infection kiss a newborn, and a newborn's immune system is at its most vulnerable in the first weeks.
Eat and drink something yourself. This is not filler advice — it is the thing most commonly skipped.

The first night

The HSE's description sets expectations better than any schedule: newborn babies spend most of their time asleep, have no set sleep pattern, wake regularly to feed, and it does not matter to them whether it is day or night. Newborns need around 9 to 18 hours of sleep in 24, averaging about 14, and may sleep for one to three hours between feeds.

The safer sleep rules, which come from the Lullaby Trust and are matched by the NHS and HSE:

On their back for every sleep, day and night.
In a clear, flat, separate sleep space — a cot, crib or Moses basket — with a firm, flat, waterproof mattress in good condition.
In the same room as you for the first six months, for both day and night sleep.
Feet to the foot of the cot, with no pillows, duvets, cot bumpers, loose bedding or soft toys.
Keep them smoke-free, before and after birth.
Do not let them get too hot. Check the chest or back of the neck rather than the hands and feet, which are normally cooler.
Never sleep with your baby on a sofa or armchair, which carries a very high risk.

The Lullaby Trust's advice on bed sharing is that it should never happen if anyone has drunk alcohol or taken drugs or medicine that makes them drowsy, if anyone smokes, or if the baby was premature or of low birth weight. Plan where your baby will sleep before you are exhausted at 2am, because that is when the sofa becomes tempting.

What to have ready

Less than the shopping lists suggest. A safe sleep space, nappies and cotton wool, a few sleepsuits and vests, muslins, a thermometer, and whatever you need for feeding. The NHS's own list of what you will need is similarly modest — around six stretch suits, six vests, two cardigans, a shawl or blanket, and a crib, carrycot or Moses basket with a firm, flat mattress that fits snugly. It adds two firm warnings: baby nests are not suitable for a baby to sleep in because of the danger of suffocation, and pillows and duvets are not safe under a year old.

Two things worth having that are not equipment: the phone numbers for your midwife, health visitor or public health nurse and your out-of-hours service, written somewhere you will find them at 3am; and your baby's record book, so that anything you are told gets written down while you still remember.

The appointments that follow

Do not try to hold these in your head. NICE's postnatal care guideline NG194 sets out the pattern in the UK: a complete examination of the baby within 72 hours of birth and again at six to eight weeks; weight and head circumference measured in the first week and around eight weeks; newborn blood spot screening and newborn hearing screening in the first weeks; and vitamin K offered for the baby after birth. NICE also says that at each postnatal contact you should be asked whether you have any concerns about your baby's wellbeing, feeding or development — so those visits are the place to raise things, and you do not need to save them up.

The things that will surprise you on day one

The first poo is black and sticky. That is meconium. NICE says that if a baby has not passed meconium within 24 hours of birth, this may indicate a serious disorder and requires medical advice.
Newborns are noisy. Grunts, squeaks, sighs, sneezes and hiccups are all ordinary.
They lose weight first. Weight loss in the first days and regain over the following weeks is expected, and your midwife will be tracking it.
Their hands and feet may look blue while their body is pink. Blue lips or tongue are different, and are an emergency.
They may look yellow from about day two or three. Jaundice appearing in the first 24 hours needs checking straight away.

When to call

Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand) if your baby:

Has a temperature of 38C (100.4F) or above, or below 36C (96.8F).
Looks pale, ashen, mottled or blue, or has blue or grey lips or tongue.
Is unresponsive or unrousable, or has a weak, abnormally high-pitched or continuous cry.
Is grunting, breathing over 60 breaths a minute, or drawing their chest in under the ribs.
Has a bulging fontanelle, neck stiffness, or a seizure.
Has a rash that does not fade when you press a clear glass against it.
Is vomiting green or yellow-green, or vomiting forcefully after every feed.

That is NICE's own red flag list for serious illness in young babies, and NICE's instruction is immediate assessment rather than watchful waiting.

Contact your midwife, health visitor, public health nurse or GP if: your baby is not feeding; has fewer wet or dirty nappies; looks yellow, especially in the first 24 hours or after two weeks; is much sleepier than they were; or you simply think something is not right. NICE tells professionals to treat parental concern as valid, which means you do not need a symptom to justify a call.

What to let go of

The nursery does not need finishing, the thank-you cards can wait, and nobody is judging the state of the kitchen. The first 24 hours have four jobs: safe travel, safe sleep, feeding on cue, and knowing who to ring. Everything else on any checklist you have been handed can be done next month.

Bringing a Newborn Home