You've just done the hardest work of your life, ushering your baby out of your body and into the world. One would think that we should let Mom, Dad, and baby catch their breath, literally and figuratively, before starting a cascade of procedures. But many hospitals' default protocols are designed to begin as soon as the baby is born. It is important to know that you have choices in how everything in these initial moments is handled. Yes, you read that right...You. Have. Choices.
Yay! Choices!
If you feel like you would be happiest and most at ease with hospital staff taking baby right away to go through the checklist of newborn to-do's then that is your choice. If you want to delay procedures - or in some cases forgo procedures - to celebrate your amazing effort and new little life and to help encourage bonding and breastfeeding that is equally your choice.
Side note: While we always have choices, in complicated medical births or emergency situations it is wise to get you and/or your baby examined at the recommendation of your care providers.
Double side note: In the case of cesarean births some care providers will agree to delay these procedures and let mom and baby stay together for some type of skin to skin. This can be lovely so if this is important to you, please talk to your doctor to determine the best plan for you and your baby.
Whatever your decisions on newborn procedures, it is wise that if it deviates from standard hospital or birthing center policy to make sure that your medical team, birth partner, and any other labor support person know your preferences.
But, you ask, "What ARE newborn procedures?!"
You aren't alone. Interestingly, many of us don't understand the things that will transpire in those first precious minutes and hours of life. Below is an overview of the medical procedures. I've tried to present them in the most balanced way. In nearly all cases when and how to do these things are your decisions as the parent(s). Please note that this is just the tip of the iceberg in terms of resources and information. It is my hope that this a good place to start a conversation between you, your partner and your care provider.
Immediate Newborn Procedures:
APGAR SCORE
What it does: Gives the medical team a picture of how baby is doing based on a series of physical traits and behaviors. Baby's are checked 1 minute and 5 minutes after birth. This can be done easily on mom's chest.
Side effects: None, it's just a benchmark to ensure baby tolerated birth and is adjusting well to life in the big, bright world. If baby's score indicates an issue the medical team will spring into action to address it.
More on APGAR Scores: KidsHealth.org Overview
CORD CLAMPING
What it is: It is fairly widely recognized today (though not always practiced) that delayed cord clamping is a really good thing for baby. Not cutting or clamping the cord immediately allows for the blood that is constantly going back and forth between the placenta and the baby to get into and stay in the baby. Added blood volume, more iron stores and higher oxygen levels are all good things. Plus, there is some science that says the most valuable cells are in the cord, so letting those get through and into baby may also be super beneficial.
There is a wide range of practices when it comes to delayed cord clamping - so people delay for 30 minutes, while others just a few moments. If you decide to pursue delayed clamping, you should tell your doctor that you want to delay either for one-two minutes (if planning to bank) or until the cord stops pulsing (if not planning to bank).
Resources on Cord Clamping: An article from the NYTimes, an article from the Huffington Post, and the study that is cited as background in both articles
Side note: If you are planning to bank baby’s cord blood you will need to ensure that a) your hospital offers this and b) they know that you want to bank the blood. The cord is handled in a different way if banking and there are some collection times that may not always align with when baby decides to enter the world, so the hospital needs to know. There is not a right or wrong choice when it comes to blood banking, all you can do is try to make the best choice you can for your family.
PROCEDURES THAT CAN be delayed for an hour (or more):
(New York state just passed a law allowing 6 hours of delay, which is amazing for moms and dads who want it! But remember, just because 6 hours is allowed, doesn't mean it will be the norm. You're the boss, so make your wishes known.)
ANTIBIOTIC OINTMENT/EYE DROPS
What it does: Protects babies born vaginally from any sexually transmitted diseases that could affect their eyesight. This is generally required by law in a hospital setting regardless of mother’s STD history. In certain settings and instances it may be able to be refused with documentation that you are going against medical advice.
Side effect: Will make the baby’s vision blurry for a short while.
WEIGHT AND LENGTH
What it does: Allows mom and dad to brag to all their friends and gives baby a baseline for growth.
Side effect: Separation from mom, a few moments of chilly air, and flailing limbs, but nothing long-term of note.
VITAMIN K INJECTION
What it does: Helps baby’s blood clot while they are building their ability to clot their own blood thereby preventing life threatening (albeit rare) clotting issues in newborns.
This is generally required by law in a hospital setting. In certain settings and instances it may be able to be refused with documentation that you are going against medical advice.
Side effects: Causes pain to the newborn at the injection site. Extremely rare ocurrence of allergic reaction (1 reported case).
Resources on Vitamin K Shots in Newborns: CDC Q&A on the Vitamin K shot and an evidence based article on Vitamin K shots
Other procedures to expect in your first 12-48 hours in the hospital or birthing center:
Newborn Bath – this will be done once the baby’s temperature is stable a few hours after birth. You can refuse this all together or delay 24-48 hours, whatever you prefer. Many people believe that the incredibly rich vernix that babies have on their skin is both healthful and protective, so allow baby a day or two before giving him/her a bath. Baths usually take place in the nursery, where the baby is put under radiant heat to warm up afterward, but you can ask for baby to be bathed in your room and then placed in contact with you and covered with a blanket to keep warm (more skin to skin!).
Hearing Test – this will be done within 24 hours of birth and is generally very quick and non-invasive.
Heel Prick – this will be done before baby can leave the hospital, generally 24-48 hours after birth. Baby’s heel will be pricked and a few drops of blood taken to test for phenylketonuria (PKU), hypothyroidism, and other disorders. All 50 states require newborn screening tests. Dad can go with baby during this test and let mom rest. If baby cries (which is likely), singing, talking in a soothing voice, swaddling, and allowing baby to suck on a pinky are all comfort measures that Dad can use. When reunited with mom it is a good time for skin to skin and nursing for mom and baby.
Hepatitis B - Your baby will get a dose of the hepatitis B vaccine before being discharged from the hospital. This may happen during the pediatric exam or at another time.
Pediatric Exam – Your baby will get a complete pediatric exam. Like the bath, this may be done in the nursery or your room at most hospitals.
Circumcision – Circumcision for many is not longer the default option and as such is not a choice that most parents take lightly today. Medical research is changing everything from trends to insurance coverage. This means that parents are approaching this decision with more thought, debate, and active decision-making than ever before. There are a lot of strong opinions out there and lots of information, some of it quite sensational (on both sides). The most important thing is to look at trusted, balanced resources and make the choice that you feel is right for your baby and your family taking into consideration medical facts, religious or cultural obligations, and a thorough understanding of the opportunities and risks for your situation. It is important to note that this is a medical surgery if done in the hospital and carries with it certain risks. It can also affect breastfeeding because of pain and fatigue experienced by the newborn. This is a topic that I and most moms of boys I know struggled with in some way, so I hope to address it in future posts.
Rooming-In - This is another place you'll need to make a choice. Different mothers prefer different things when it comes to rooming with baby. Some mothers prefer to have their babies spend time in the nursery so the mother can rest, while others don't want to be separated at all, including for exams and procedures. Be sure to let the staff know your preference. If you are breastfeeding, it may make things easier in the short term and more effective in terms of building your milk supply to have baby in the room to feed and offer your breast on demand. If you are breastfeeding and send your baby to the nursery, be sure to let the staff know that the baby should be brought to you at any sign of hunger.
Remember, you're the boss and you know your body and your baby best. Trust yourself to make the best choices you can with the information you have applied to your unique situation.
Love + Light,
Ali