A newborn who had a rough — or even a typical — birth does not look like a pink, chubby-cheeked Gerber baby. Don't worry if your first thought is that your baby looks like something from another planet. Give him a little time for the effects of traveling down the birth canal to wear off. Here's what's happening in the first few hours after delivery:

Apgar Scores

Within five minutes after being born, your baby will have his first checkups. In the delivery room, the doctor will give a quick evaluation of your newborn at one minute after birth, and then at five minutes after birth. This is an Apgar score, a professional evaluation of a newborn's physical condition.

It tells the medical team if the baby needs any immediate medical or emergency care. It measures the baby's heart rate (pulse), breathing, grimace (responsiveness), activity (muscle tone), and appearance (skin coloration). The medical team assigns a score of 0, 1, or 2 for each of these five categories, with 10 being a perfect score.

Remember: the Apgar test was designed to give your medical team a quick assessment of your baby's overall physical condition to determine if he needs immediate medical attention. It doesn't predict your baby's long-term health.

Few babies score a perfect 10, and many perfectly healthy babies have low scores at birth. You often see lower scores after a long labor and delivery, after a high-risk pregnancy, after a cesarean section, and in premature infants. If you have any concerns, talk to your doctors.

Appearances Can Be Deceiving

Coming through the birth canal can be tough on baby and mom. Your baby may have:

• Head molding (misshapen or pointy) — it will return to its original shape in about a week or even longer. (The heads of C-section babies tend to be round because they haven't been squeezed coming through the birth canal.)

• A caput (a swelling on the head caused by fluid squeezed into the scalp).

• Swollen eyelids. Eye color at birth may not be permanent (usually set by six to nine months).

• Flattened nose (from the pressure during the delivery).

• Floppy ears (cartilage will harden in the next few months).

• Fine body hair.

• Swollen labia or scrotum, swollen breasts (both boys and girls). The nipples may leak a little milky substance. Girls may have a little white discharge or blood-tinged vaginal mucus. These characteristics are from the pre-birth extra maternal hormones.

• Peeling skin.

• Bluish hands or feet (due to developing circulatory system — it will improve in the first few days).

• Reddish-purplish skin. Babies of all races and ethnicities are born with reddish-purplish skin, which will change to pinkish-red in a day. It seems pinkish because you're seeing the red blood vessels through his thin skin. Permanent skin color will develop over the next six months.

• Slightly bowed legs (from being curled up in the uterus for months). Will cure itself in a few weeks.

Your Baby's First Tests

All states require newborns to undergo certain tests shortly after birth. While it's unlikely that your child will suffer from any of these disorders, many of these diseases can be devastating if left unchecked and untreated.

• In the first 48 hours, a pinprick to your baby's heel will provide the blood needed to test for phenylketonuria (PKU), hypothyroidism, and other disorders. But states differ on the number and types of genetic and metabolic disorders for which they test. You can pay for additional testing, but you may need to make arrangements ahead of time. Talk to your doctor about what tests are part of the routine screen, and which others may be advisable.

• While it is not required in all states, the March of Dimes and the American Academy of Pediatrics recommend that all babies undergo a newborn hearing test (which is noninvasive). Talk to your doctor to see if your baby will be tested and, if not, arrange for this simple test. Should there be a hearing problem, early intervention is key.

• All states require that newborns be treated with antibiotic ointment or eye drops within an hour after birth. This prevents eye infections that may result from bacteria or sexually transmitted diseases that your baby may have been exposed to during labor and delivery.

• Some newborns are deficient in vitamin K, which is necessary for normal blood clotting. Therefore, the American Academy of Pediatrics recommends administering a single injection of vitamin K to all newborns because of the risk of internal bleeding that might result from any trauma during delivery (for example: while unlikely, forceps pressure or vacuum extraction might cause a brain bleed). There has been some concern about a link between vitamin K injections and childhood cancers. Further research has failed to prove any link, but if you have concerns, talk to your doctor.

• The Centers for Disease Control and Prevention (CDC) recommends that all children receive the first dose of the Hepatitis-B vaccine at birth. This is particularly important for children whose mothers are chronically infected. Three doses of the hepatitis B vaccine are needed for full protection.

  The second dose is recommended at one to two months and the third between 24 weeks and 18 months. If you do not live in one of the 36 states that require newborn Hepatitis-B vaccination, talk to your health care practitioner about when your baby will be vaccinated.