You’ve educated yourself about pregnancy and made choices for your labor and delivery, but are you prepared to make medical decisions for your baby? In the first few hours of your baby’s life you will need to make 11 medical decisions for your tiny new person, or someone else will make them for you. I’ve attended deliveries for more than a decade at five different hospitals, and it’s shocking how few mothers are able to make educated decisions on these issues. So take a few minutes to think through these 11 issues, and include your preferences in your birth plan.
1) Delayed cord clamping: Usually the umbilical cord is clamped within one minute of a baby’s birth, but it seems that waiting just 1-3 minutes after birth to clamp the cord allows the placenta to give a few more pulses of blood to the baby. This extra blood from the placenta can be as much as 30-40% of the baby’s total blood volume. And all that extra blood can prevent anemia in the first six months of life. Waiting these extra few minutes before clamping the cord is referred to as “delayed cord clamping.” If you don’t request delayed cord clamping, it might not happen. Be sure to read up on the risks and benefits before you write your birth plan.
2) Cord blood banking: The unique stem cells of your baby’s umbilical cord are valuable! As technology changes, the utility of cord blood and umbilical cord tissue is rapidly increasing. You have a choice of either donating your baby’s cord blood to a public registry or privately banking his/her umbilical cord blood and tissue. Be sure to educate yourself about cord blood registries vs. banks. If you do nothing, your baby’s umbilical cord will go in the trash. Of note, it is possible to practice delayed cord blood clamping (as above) and still collect cord blood for donation or banking.
3) Skin-to-skin newborn care: Do you want to hold your baby skin-to-skin right after delivery, even if you have a c-section? You need to be clear about this in your birth plan. Some hospitals, especially those that have the BestFed Beginnings program, allow healthy newborns to spend the first few minutes of life “skin-to-skin” with their mother. This means that we place the baby, unwrapped, on mom’s bare chest, between her breasts. We usually put a warmed blanket over the baby. The nurse or pediatrician can evaluate the baby right on mom’s chest, if necessary. Routine infant care, such as antibiotic eye ointment, vitamin K, weight, measurements, footprints, bath, and full medical assessment can be delayed until after the infant is breastfed, parents have bonded with the baby, and mom is ready to rest.
4) Antibiotic eye ointment: Newborns usually get an antibiotic eye ointment called ilotycin squirted into their eyes in the first few minute of life. Most states mandate this prophylactic treatment of newborn eye infections, although parents do have the right to decline the medication. The purpose is to kill bacteria that can cause blindness. But most of these bacteria are from STDs, and many moms feel their risk of carrying such bacteria is essentially zero, and they wish to avoid giving their newborn an unnecessary medication. The risks and side effects of the treatment are essentially zero, also, and the antibiotics do kill common bacteria from the anus and genital area that can be passed during vaginal delivery.
5) Vitamin K injection: Shortly after your baby is born she will receive an injection of Vitamin K in her thigh to prevent bleeding. Without vitamin K, about 2% of infants will develop hemorrhagic disease of the newborn, or vitamin K deficient bleeding (VKDB). Although it’s usually okay to delay vitamin K until baby and parents are done bonding, it’s not a good idea to decline vitamin K all together. Vitamin K deficient bleeding can be catastrophic, especially when babies bleed into their brains.
6) Bathing: Babies are born covered in vernix, a waxy white substance that looks something like cream cheese. Most babies get a bath during the first few hours of life to remove the vernix. Some parents want to do their baby’s first bath themselves, often with their own special soap. This is fine, but be sure to put this in your birth plan or a nurse will do your baby’s bath before you know it.
7) Breastfeeding: About 20% of breastfeeding moms will quit before they leave the hospital. If you’ve made a decision to breastfeed, make sure you really know what it’s all about, before you have your baby. The first week of breastfeeding is the hardest. When you finally sleep after having your baby, exhausted from labor, you’ll be awakened every 2-3 hours by a nurse so that you can feed your baby. Ouch. Why not just supplement a bit? Because breastfeeding failure rates are much higher if you do. If you want to be successful with breastfeeding, make sure you read up on the common pitfalls.
8) Pacifiers: Who knew that pacifiers could be so controversial? The breastfeeding advocates discourage pacifier use until breastfeeding is well established, but there is also evidence that pacifier use can reduce the incidence of Sudden Infant Death Syndrome (SIDS). Other people think a pacifier habit is better than a thumb-sucking habit and give their baby a pacifier right away. Many people find pacifiers are essential for parental sanity—how else can you help a well-cared for baby to stop crying? Whatever your pacifier preference, be sure to note it in your birth plan or the nursery nurses may give your baby a pacifier without asking.
9) Circumcision: The U.S. circumcision rate fell to 55% in 2010, meaning that nearly half of US baby boys were not circumcised. Worldwide about half of men are circumcised, although the popularity of this procedure is falling, especially in Europe and the Western United States. A decade ago few people even questioned whether their son would be circumcised, but now new parents really need to be educated before they make an irreversible decision for their son. Don’t worry; no one will circumcise your son without your permission (and a signed consent form). But you will do yourself (and your son) a big favor if you read up on the issue before you sign. Dr. Kim Hamlin is a pediatrician at St. Louis Children’s Hospital who advocates for leaving the foreskin intact. Dr. Clayton Cummings, also a pediatrician at St. Louis Children’s Hospital, discusses the benefits of circumcision.
10) Hepatitis vaccine: Babies usually receive their first hepatitis B vaccine in the hospital. This is just the first of a long series of vaccines that are recommended during childhood. You will need to sign a consent before your baby is given the hepatitis vaccine, but it’s best to educate yourself on vaccines before a nurse hands you a pen and a stack of forms to sign. There are many myths on vaccination, especially online. To get all your questions about vaccines answered, talk to your pediatrician BEFORE your baby is born. Yes, you can schedule a visit while you are pregnant! Which brings me to #11…
11) Pick a pediatrician: If you deliver your baby in a hospital and have not yet chosen a pediatrician, the hospital will usually assign a pediatrician to see your baby. It’s a better idea to pick your own pediatrician and have them see your newborn in the hospital. Schedule a visit to meet with each of the pediatricians you are considering while you are still pregnant. You will thank yourself later when you are confident in your pediatrician!