Birth Plans

Newborn Care Options

Most babies are born completely healthy, but there is wide variation in how newborns are cared for throughout the world. This variation is caused by differences in policies between hospitals, standards set by governments, and whoever is with the mother when the baby is born.

Most governments have public health policy that regulates certain tests or procedures be done for a child to ensure their health and well-being. It is a good idea to find out the differences in standards of care between hospital, birth center and home birth in your area.

Cord Cutting

As long as the placenta is attached to the uterus and the umbilical cord is still intact and pulsing, the cord ensures the baby is getting oxygen. This can be important if a baby does not breath right away. Some midwives cut the cord right away to allow the baby to be cared for in a bassinet/warmer. Some midwives allow the cord to stop pulsing before they cut it to ensure the baby has the appropriate amount of blood. Sometimes the decision is made due to health conditions, such as if a woman is HIV+ the cord will be cut immediately to help prevent transfer of the virus to the baby. If a baby needs more care than can be provided while being held by the mother, the cord may be cut quickly to move the baby.

The average length of an umbilical cord is 21 inches, long enough for the mother to hold and nurse the baby without the cord being cut. Some midwives will perform other newborn assessments while mother is holding the baby. In some hospitals the cord is quickly cut and the baby set aside so the mother can be assessed and receive any care quickly, then moved from the birth area to the postpartum area to make room for the next birth.

Some families find a significant meaning in the cord cutting, choosing to have a loved one cut the cord. Other families are not interested in participating in the cord cutting. A family may have options about who cuts the cord, and when the cord is cut.

Vaccinations

Your baby will be expected to begin the vaccination program for your country before leaving the birth place. Government standards vary, so it is a good idea to research the vaccination program where you live. For example, in some countries a tuberculosis vaccination is standard at birth. In other countries, Hepatitis B vaccination is standard. These variations are due different levels of health risk for specific diseases and the amount of money available to the health department for purchasing vaccinations.

Vitamin K

Some countries have laws regulating the administration of Vitamin K to newborns. Depending on the laws in your community, you may have the option to refuse vitamin K, use an oral dose vitamin K or an injection, or to postpone administration of vitamin K for two or more hours.

Vitamin K, a necessary component for blood clotting, is normally at low levels in newborns. The level rises above adult levels around day 7 and settles in at adult levels around day 10. Newborns are given a dose of vitamin K as a precaution against hemorrhagic disease, a condition in which the baby suffers from internal bleeding. Less than 2% of babies are affected by hemorrhagic disease. Some experts feel that the vitamin K is a safe way to ensure any baby with hemorrhagic disease will be safe. Depending on where you live, you may be offered an injection or an oral dose.

Some experts voice concern about the wisdom of injecting a newborn with unnatural vitamin K levels. One of the concerns is about the other substances in the solution being injected. Another concern is that increasing the vitamin K may cause blood clotting in the newborn. Some experts feel that injecting a healthy baby with vitamin K causes increase risks without any benefit. However, vitamin K injections have been shown to be better than oral doseing at elevating vitamin K level in the newborn.

Eye Treatment

Women with infections of gonorrhea or chlamydia can pass the infection to their baby as the baby passes through the birth canal. To prevent the baby from becoming infected, an antibiotic ointment is placed in the eyes. In some places, public health policy recommends providing this treatment for every baby. In many communities, mothers are tested for these conditions early in pregnancy, because the mother can have these conditions without having any symptoms.

Some experts feel the administration of antibiotics to every newborn is unsafe. Other experts express concern that the antibiotic ointment blurs the vision of the baby, making it difficult for the mother and baby to bond. If eye treatment is standard in your community you may be able to refuse this treatment or delay if for a short time.

Newborn Testing

A variety of tests are available to ensure the health of a newborn. One test uses some of a baby's blood to look for a variety of metabolic diseases and conditions. In most cases, this is a screening, not an actual diagnostic test. That means it only tells if a baby should be tested further. The main condition being screened for is phenylketonuria - an inability to digest a particular protein which could lead to serious damage for the newborn if left undetected. In many communities this must be done before the baby leaves the hospital but not before the baby is 24 hours old. Another test often available is a hearing screen, intended to alert families to problems so the child can have interventions early.

Public health law dictates which tests are availailable and required to ensure all babies receive these tests before the conditions could cause damage to the baby's health. If these tests are available in your community, you may have the option to refuse testing, delay testing or repeat tests at a later date.

Rooming In and Nursery Care

If you are giving birth in the hospital, you may be given the opportunity to choose between nursery care for your baby or rooming in with your baby. Advocates for nursery care believe it is important for the mother to rest and recuperate after having given birth, and that it is safer for the baby to be monitored in a nursery rather than left in a room with one sleeping adult.

Advocates of rooming in feel that the first few days of life are important for bonding between mother and baby. They also express concern that the mother should be allowed to mother her child just as she will at home, including spending time sleeping. They feel that having the nurses as a back up while the mother adjusts to and lerns the skills of mothering can make the transition easier.

In some hospitals babies are not allowed to be in the room unless the mother or father is in the room awake and alert. In some hospitals there are no nursery services for healthy babies.

Temperature Regulation

Babies can have a hard time maintaining their body temperature, especially premature babies. For some hospitals the standard procedure to ensure the right body temperature is to place the baby in a warming bassinet. Some experts feel that this causes unnecessary separation of the mother and baby. In other places the baby is warmed by wrapping in multiple blankes. Another option is to use the mother to warm the baby by placing the baby skin to skin with the mother and placing a blanket over them both. Studies have demonstrated that skin to skin warming is faster at achieving correct body temperature for the baby and more effective at maintaining that temperature.

Breastfeeding

If you are breastfeeding, you may have the option to try to nurse your child immediately after birth. Studies indicate this helps to expel the placenta and stop uterine bleeding. Some experts feel that immediate nursing is a strong first step toward a good nursing relationship. You have the option to attempt immediate nursing, and to ask for assistance in changing position and supporting the breast or the baby. Some mothers find it difficult to nurse in the semi-reclined position they may be in after giving birth.

Immediate breastfeeding is not always possible. Some babies are not interested in nursing right away. Some hosptials do not have policies that support immediate breastfeeding. Some babies experience health issues that require them to be places in a special care nursery. In any of these situations, a mother should be encouraged to breastfeed as soon as possible.

Hospitals have different policies about pacifier use for newborns. Some hosptials have pacifiers available and will use them without alerting a parent. Some hospitals have them available for parents to request. Some hospitals do not provide pacifiers under any circumstance.

Diapering

Some hospitals (nearly all in the United States) provide diapers for newborns while they are in hosptial. Diapers available at hospitals will be disposable. If you have decided to use cloth diapers, you have the option of bringing your diapers to the hospital or birth center to use, or asking the hospital to use their cloth diapers (if available) for your baby.

Circumcision

Circumcision is a clamping and cutting of the foreskin of the penis. It is a surgical procedure that is painful, and usually performed in the nursery without a parent to comfort the child. The American Academy of Pediatrics considers it a medically unnecessary procedure, as numerous studies have found no connection to circumcision and improved health. The foreskin is a working tissue that does perform a job in the human body. Some parents choose circumcision for religious, cultural or other personal reasons.

Parents considering a circumcision have the option to request pain medication for their son and to have a parent present at the surgery. They also have the option to do the procedure later in the child's life. Many prefer to have the circumcision done as part of a religious ceremony as religious circumcision is not the same cut as a hospital circumcision, and is not done in the hospital.

Early Discharge

Hospitals have an expected "pathway" a mother will move through for a hosptial birth. This pathway will include a particular amount of time for recovery in the hospital. When a mother leaves before that amount of time, it is considered an early discharge. Parents considering an early discharge from a hospital will need to do some research before labor begins to determine what needs to be done before the baby can be released. In some cases it may only be for a pediatrician to sign the baby out. In other cases it may be necessary to sign waver forms and go through a set of tests or procedures.