Routine Newborn Baby Care Procedures
Choices for newborn baby care procedures begin immediately at birth. The best preparation is to have considered them and decided beforehand what procedures you desire (or don't want) for your newborn. For a hospital birth, there are numerous routine procedures which can be administered, delayed or even refused. Unfortunately, first time parents are often unaware that many of these routine procedures are not grounded in evidence-based practice, but are rather the product of ease and access for staff.
Many parents don't realize the impact that these procedures can have on their newborn child. Once you have decided what procedures you prefer and whether you want them performed immediately or on a delayed schedule, the best way to communicate them to staff/caregivers is to include a Newborn Baby Care section in your birth plan. This will ensure that your preferences are on paper before the birth and remove any doubt as to your wishes for your new child after birth.
Another critical point to remember is that you can and absolutely have the right to receive information about each and every procedure that will be performed, as well as the right to either request the procedure be performed in your room or that a parent/guardian accompany the newborn for each one. This includes weighing, measuring and the pediatrician's evaluation of the baby - all can be performed right there in the mother's room. Remember, your first responsibility is to the welfare of your child, not to the comfort of the hospital staff nor arbitrary hospital policies.
The most commonly performed routine newborn baby care procedures to consider are:
*Delayed Cord Clamping Vs. Immediate
*Vitamin K Injection
*PKU Test
*Erythromycin, Silver Nitrate or Antibiotic Eye Ointment
*Hepatitis B Vaccine
*APGAR Score
Restricted Umbilical Cord Problems
The most common source of restricted umbilical cord problems in childbirth is completely preventable and due to a procedure documented as harmful to the baby - early cord clamping.
What is Early Cord Clamping?
Early cord clamping (ECC) is defined as any method by which the cord is manipulated to stop the flow of blood to the baby while it is still pulsating. This includes clamping, cutting, hand squeezing, tying or holding the baby too high or too low.
In a natural vaginal birth with no medications, the cord pulsates on average for 7 minutes. In a medicated birth, including c-sections or babies with a compressed cord, the cord will pulsate for as long as 20 minutes. Good practice is to leave the cord alone for 12 minutes or until it turns white/silver in color.
Serious Risks Associated with Early Cord Clamping
Whenever a pulsating umbilical cord is clamped, 20-60% of the baby's total blood volume is trapped inside the placenta. A 9 pound baby manufactures only 10 ounces of blood during gestation. It will take over 6 months for the baby to replenish the volume of blood lost by early cord clamping.
In essence, newborns become involuntary blood donors. HALF their blood volume is lost when their cords are early clamped.
This decrease in necessary blood volume causes the babies to become anemic. In most cases, the anemia is not diagnosed and the infant is sent home in a weakened state, more susceptible to a host of complications, including SIDS.
Restricted umbilical cord problems associated with anemia are Autism, heart perforations, thyroid disorders, brain tumors, leukemia, hormonal imbalances and liver/kidney disease.
Male infants will suffer more than females. They have higher metabolisms that require 10% more blood. This trend is also seen in that males represent a greater proportion of children receiving special education services in schools and higher incidences of disabilities such as ADD, behavioral issues, and Autism.
Currently, 1 in 16 babies are revived after birth. For how many is this due to low blood volume, an inflicted condition? In effect, medical personnel must undo the wrong they're created. Another critical correlation is the fact that the United States ranks 29th for infant mortality in the world and practices early cord clamping as a routine procedure.
Any baby whose cord has been early clamped is weakened. Weaker babies become more susceptible to infection, especially at the site of the cut cord. There are 25 known infectious strains resistant to all antibiotics and they are primarily found in hospitals. This mix is just asking for trouble.
Another of the restricted umbilical cord problems is engorged placenta, a direct threat to the mother and future pregnancies. When the blood flow is restricted by clamping, the blood can pool in the placenta, causing it to rupture or backflow the baby's blood into the mother's. This cause lead to serious side effects, such as maternal hemorrhage and can even prohibit future pregnancies due to the blood mixing.
Why are Cords Early Clamped?
Restricted umbilical cord problems caused by early cord clamping occur for many reasons, none of them acceptable or in the best interest of the child. The first is ignorance. Many doctors are unaware of the risks of early cord clamping. This is in part due to poor training. Some commonly used medical texts still detail the use of early cord clamping. However, this represents a serious concern in that ACOG guidelines now refute the use of early cord clamping. Early cord clamping was first documented as harmful in 1801 and again in 1957. It wasn't until after 1923 that it began to be mainstreamed.
The second is convenience and time management. Doctors want to be in and out of the birthing room. Waiting an extra 20 minutes for the cord pulsation to stop naturally and the placenta to detach on its own may not fit into their agenda. They put your child at risk of developing restricted umbilical cord problems for their own convenience. Someone should remind them of that oath they took to do no harm.
False Reasons for Clamping
Short cord, maternal hemorrhage, c-section, respiratory distress are just a few of the worthless reasons to clamp a cord. Even a baby in distress can be revived with the cord intact. It also allows better access to the umbilical vein as it remains uninjured. All of the restricted umbilical cord problems are usually the result of drugs given during labor, including oxytocin, pitocin, iv fluids, and pain medications, not a result of leaving the cord intact.
The cold truth is that hospitals operate under the assumption that something will go wrong. This subconscious message is transmitted to every mother birthing in a hospital - from the sterile, cold environment to the brisk pace of the nurses. What they don't want you to know is that the interventions cause the complications. 93-95% of all births proceed normally with no complications whatsoever. If this information became widespread, they'd be out of business, fast.
When Should a Cord be Early Clamped?
The only situations in which a cord should be early clamped is when the cord has torn or with a placenta previa. Babies born via c-section can be delivered with their cord and placenta intact. Multiples can also be delivered without risk of restricted umbilical cord problems.
Prevention of Restricted Umbilical Cord Problems
- Birth in a warm room or warm water - cold temperatures cause blood flow to slow
- Wrap the baby immediately head to toe in warm blankets or allow skin-to-skin contact with the mother with blankets covering both.
- Do not manipulate the baby to breathe. While the cord is pulsating, the baby is receiving oxygenated blood, thus not triggering the need to take an additional breath. As the blood travels into the baby's expanding lungs, once they become filled, the baby will feel its own signal to breathe and will do so with fully expanded lungs.
- If the cord is wrapped around the baby's neck, have the birth attendant insert a finger between the neck and the cord, allowing the birth to proceed normally.
- If you choose a hospital birth, request your placenta. Take it home and plant it under a new tree that will grow as your baby does or better yet, have it encapsulated to assist in your birth recovery.
Newborn Vitamin K Injections
What is it?
In the United States, the practice of newborn vitamin k injections has become almost universal. However, this routine newborn procedure is controversial in other nations. This practice was born (pun intended) during the hospital age of routine separation of mothers from their babes, before rooming-in was an accepted practice.
Why is this done?
The rationale for newborn vitamin K injection at birth is that newborns are born with a "deficiency" of vitamin K. This perceived "deficiency" can lead to decreased clotting ability of the blood, that can leave the newborn more susceptible to hemorrhage. The risk is quite small, only about 1 in 200, but it does exist. The following factors increase risk of hemorrhage in newborns:
Risk Factors for Cerebral Hemorrhage
- Precipitous Labor
- Prolonged Labor
- Significant Fetal Head Molding
- Birth Trauma
- Forceps Delivery
- Vacuum Extraction
- Variable Heart Decelerations in Late Labor
- Circumcision
Points to Ponder on Routine Injection
- While newborn vitamin K injection may sound like an acceptable intervention, there are several points to ponder.
- The amount of Vit K injected is 20,000 times the newborn levels at birth. Yes, I kid you not. 20,000 times. Additionally, the injection may also contain preservatives which are known toxins to the infant.
- Large doses of Vit K are a cause of jaundice in the newborn. A "cure" for one perceived ailment then becomes the cause of another.
- Colostrum, which precedes breastmilk, is rich in Vit K. Thus, an infant who is breastfed immediately at birth will receive a natural source of Vit K, in most cases significantly raising the Vit K level.
- Vit K is typically designed to be absorbed by the gut from foods we eat. However, the injection is an intramuscular one, which bypasses the gut and delivers the Vit K in a way the body wasn't designed to receive.
- Birth is an overwhelming sensory experience for the baby - it has never before been cold, hungry, been blinded by light, felt the touch of cloth or the pull of gravity. Sticking a needle into its body and inflicting pain isn't the best way to allow the sensory system to gradually adjust to the outside world. Not a very warm welcome, is it?
- Subconsciously, it sends the message that nature is inadequate, that medical interventions are are necessary to save us from ourselves.
Simple Solutions
1. Request an oral dose rather than an injection.
This eliminates the overdose and lessens the risk of hemorrhage and jaundice, as well as the pain of the injection and exposure to harmful preservatives. Also, the Vit K is absorbed through the gut, as it was intended to be. While this may seem like an easy solution, be sure to discuss this option first with your care provider. Since hospitals are accustomed to standard operating procedure, it can be difficult for them to correctly determine the oral dosage for your infant. We personally had to wait for several hours while the correct dose was determined. To give the hospital the benefit of the doubt here, our daughter was born on a weekend, which means that less staff is available and even simple procedures take longer than usual.
2. Nurse immediately after the birth with no supplementation given.
3. During the last few weeks of pregnancy, load your diet with foods rich in Vit K.
While this hasn't been shown to improve newborn vitamin K levels, it has been shown to increase the amount of Vit K in breastmilk.
PKU Test
What is it?
The PKU test is another common procedure performed by obtaining a newborn blood sample via heel stick to screen the baby for Phenylketonuria (PKU) and other metabolic disorders. All states currently screen for PKU, hypothyroidism and galactosemia and some screen for sickle cell anemia and congenital adrenal hyperplasia (CAH) as well. In other states, as many as 30 metabolic disorders will be ruled out.
Why is it done?
This screening is used to determine the presence of serious metabolic disorders which can be fatal or debilitating if not caught and treated early. PKU. or Phenylketonuria, is one of the primary offenders that is ruled out by this screening. Other disorders can all have devastating effects if not caught and treated early.
Preparation
When completed by a skilled nurse or phlebotomist, the baby may not even wake after the stick. To ensure that the baby only needs one stick, make sure that the baby's heels are very warm to increase blood flow to the area. This procedure will have to be repeated if a large enough sample isn't obtained the first time.
Hep B Vaccine
What is it?
The Hep B vaccine, the first of many such vaccines that are routinely administered to US children, is injected into the newborn shortly after birth. It is given over three doses: the minimum recommended dosing intervals are 4 weeks between the 1st and 2nd and 8 weeks between the 2nd and 3rd. The minimum interval between the 1st and 3rd dose is 16 weeks.
The injection will be given in the thigh or the upper arm muscle for infants whereas the biceps are the preferable injection sites for adults/teens.
Hepatitis B is caused by virus which attacks the liver. Transmission occurs through several sources, including:
- blood born contact
- unprotected sex with an infected person
- sharing drug paraphernalia
- infected mother to baby during birth
- from workplace accidental exposure to sharps or other infected items
Those are greatest risk for infection include:
- Intravenous drug users
- Contact with chronically infected people
- Multiple sex partners
- Diagnosis of an STD
- Homosexual activity
- Healthcare workers
- Patients who receive hemodialysis
- Children of infected mothers
- Residence in areas of high infection
Who should not be vaccinated?
The Hep B vaccine is grown in a yeast culture, so persons who are allergic to yeast should not receive the vaccine.
Precautions
- When pregnant, get a blood test for Hep B. Infants born to infected mothers should be given HBIG (hepatitis B immune globulin) and vaccinated within 12 hours after birth.
- Carefully consider the advisability of getting tattoo or body piercing during pregnacy. If you do choose to do so, ensure the artist uses the appropriate universal precautions to prevent the transmission of infection.
- If you work in an at-risk profession, observe barrier precautions and follow all approved safety precautions for handling and removal of sharps.
Why is The Hep B Vaccine routinely given at birth?
The reasoning for vaccination at birth is the theory that widespread prevention will occur by catching every baby early, despite the fact that newborns have minimal chance for infection since all newborns aren't engaging in unprotected sex or doing drugs yet. Additionally, prenatal screening for maternal infection also reveals those infants truly at risk.
Prophylactic Eye Ointments for Newborns
What is it?
The application of silver nitrate or an antibiotic ointment such as tetracycline or erythromycin into the eyes of newborn babies just minutes after birth is another routine procedure unique to the United States.
Side Effects:
Silver nitrate bonds with the eye membranes which results in redness, blurred vision, and swelling for several days.
Early visual perception development is altered which impacts the baby's ability to adjust to the world outside the womb.
Why is it done?
The routine administration of eye ointment is required in most instances by state law on the grounds of preventing blindness from exposure to maternal gonorrhea during birth. The masterful theory behind this routine procedure is that it's impossible to determine which babies will really need it, so just do it to everyone.
The glaring flaw in this logic is that STD screening is also standard procedure as part of prenatal care. Even if a pregnant woman has screened negative for gonorrhea earlier in her pregnancy, the law assumes that either she or her partner will be unfaithful in that time and unwittingly expose her to STDs again.
If that wasn't enough, the eye ointment doesn't have a 100% success rate in preventing blindness.
Simple Solutions
1. Choose delayed administration.
This will allow bonding time between you and your new baby without inflicting pain as one of the child's earliest sensory experiences.
2. Request a non-irritating eye ointment, such as tetracycline.
You can reap the benefits of prevention without introducing the painful side effects.
3. Refuse the procedure if it is not state law and you know you don't have an STD.
If you don't need it, why take it? You may have to sign a form refusing the procedure.
APGAR
APGARS are your baby's first "test." In most places it is done without ever being noticed by the parents because it's simply an evaluation of the way your baby looks and sounds.
A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitation measures, and a baby with an APGAR Score of 3 and below requires immediate resuscitation.
Despite what parents will tell you this doesn't correspond to your child's SAT scores later in life. In fact, in some circles this test is criticized for not being very useful. For example, a baby obviously in distress will not be left alone until the one-minute APGAR says that they need help. All in all this is a harmless test that many parents look forward to hearing their baby's score.
