Options for Newborn Care Procedures
What issues will affect my options for newborn care procedures?
While the most obvious answer is the health of your newborn, it may not be the determining factor in how your baby is handled. Most babies are born completely healthy, but there is wide variation in how newborns are cared for in the United States. This variation is caused by differences in policies between hospitals, standards set by the state governments, and whoever is with you when your baby is born.
Most states have public health law policy that regulates certain tests and procedures be done on your 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. Some of the options listed on this page only apply to hospital birth settings, such as nursery care and first bath.
What options for newborn care may be available?
As long as the placenta is attached to the uterus and the umbilical cord is still intact and pulsing, your baby is getting oxygen. This can be important if your baby does not breath right away. Some practitioners cut the cord right away to allow the baby to be cared for in a bassinet/warmer by the nurse. Some caregivers allow the cord to stop pulsing before they cut it to ensure the baby has the appropriate amount of blood in his system. 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 practitioners will perform the newborn procedures while mother is holding the baby. Some families find a significant meaning in the cord cutting. Other families are not interested in participating in the cord cutting. You may have options about who cuts the cord, and when the cord is cut.
Vitamin K, a necessary component for blood clotting, is normally at low levels in newborns, rises above adult levels around day 7 and settles in at adult levels around day 10. Newborns are given a dose of 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 that any baby with hemorrhagic disease will be safe. Depending on where you live, you may be offered an injection or an oral dose.
Other experts are concerned 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.
Some areas 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 instead of an injection, or to postpone administration of vitamin K for two or more hours.
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 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. Depending on the laws of your community you may be able to refuse this treatment or delay if for a short time.
Your baby's foot will be punctured and blood will be smeared onto a specimen card so the blood can be screened for various 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. In many communities this must be done before the baby leaves the hospital but not before the baby is 24 hours old.
Public health law requires the in hospital test to ensure all babies receive these tests before the conditions could cause damage to the baby's health. In your community, you may have the option to refuse this test, delay this test or repeat this test at a later date.
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 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. Some hospitals allow 24 hour rooming in.
Babies can have a hard time maintaining their body temperature. This is most commonly a problem when the baby is bathed, a process which can allow the baby to lose much body heat. 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. Instead, they feel the baby should be warmed 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.
If you are breastfeeding, you may choose 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. Some babies are not interested in nursing right away.
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 is a clamping and cutting of the foreskin of the penis. It is a surgical procedure that is painful, and usually performed without a parent to comfort the child. 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.
If you are considering a circumcision, you have the option to request pain medication for your son and to have a parent present at the surgery. You also have the option to do the procedure later in the child's life. You may prefer to have the circumcision done as part of a religious ceremony (religious circumcision is not the same cut as a hospital circumcision, and is not done in the hospital).
If you are considering an early discharge from a hospital, you will need to do some research before labor begins to determine what needs to be done before your baby can be released. In some cases it may only be for your 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.