Parenting • Nov 04, 2014

11 medical decisions to make for your baby before delivery (or someone else will make them for you)

You’ve educated yourself about pregnancy and made choices for your labor and delivery, but are you prepared to make medical CordBlooddecisions 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!


  1. As boys grow older and become aware of their bodies, many come to deeply resent that they have been circumcised without their consent. As more accurate information becomes widespread, boys will become acutely aware of what has been done to them, the harm that has resulted, and what they are missing. Many hate the large scars and the other damage that results — they can never recover and become natural, intact males.

    Today’s parents have enough information to understand that there are no therapeutic reasons that healthy tissue should be removed from someone’s body. The touted benefits are very dubious and keep shifting from relief of one disease to another as these “benefits” are subsequently disproved. We now know that there are a number of serious harms that come from circumcision. There is also excellent scientific information showing possible connections to many problems males experience in their later life, such as erectile dysfunction, lack of sensitivity, and emotional problems.

    Boys will become aware of this information: it is becoming very widespread. These boys will know that most males alive today are not circumcised and will view intact penises as normal and natural. And then they will look at their own scarred and damaged penises, and many will hate what was done. Boys will know who made this decision and know that not only did their parents not protect them, but actively consented to their disfigurement.

    Circumcision remains horribly painful, disfiguring, therapeutically unnecessary, and harmful: it is not at all beneficial.

  2. This article could have been better researched by a trained llama. Your information on the popularity of circumcision worldwide and in Europe is so far out of the scope of reality, its frankly funny. Circumcision rates are not “falling” in Europe. They are already at an all time low, and have been for decades. The global rate is 30%. The Nordic countries have a circumcision rate below 5% and have the fewest incidences of STDs and HIV, so any “health benefits” that circumcision is supposed to bring, are completely bogus.

  3. No newborn needs the hepatitis B vaccine unless someone near and dear to them is Hep B positive. It can wait until they are older. Also, no newborn needs to be circumcised. The foreskin is there for a reason, it is easier to care for an intact boy than a boy that has been cut, giving you a newborn with wound care in a diaper for the first few weeks of his life. With an intact boy, you only clean what is seen. Never retract a boy’s foreskin, the only person who should ever move it away from the glans is the boy himself. Let him grow up with his whole sexuality, so he can experience his sexual life as nature intended it!

  4. Regarding #9

    ‘Pediatrics’ is the official journal of the American Academy of Pediatrics. This is the most recent item regarding circumcision in this journal. This unambiguous and powerful statement is endorsed by 38 world renowned and eminent physicians, including the heads of 15 national pediatric associations.

    “There is growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys because non- therapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations’ Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm.”

  5. Circumcision is unnecessary, with proper care its true medical incidence is uncommon as demonstrated in non-circumcising cultures especially inhabiting European countries.

    If a parent chooses not to have their child circumcised, its important that the parent ensure that visits to the doctor are monitored (by the parent) so that the doctor doesn’t perform premature retraction (scarring preputial sphincter and tearing resulting in phimosis and/or infections, resulting to the recommendation for circumcision via iatrogenic manipulation.) Premature retraction is a standard procedure in countries containing circumcising cultures.

  6. “Worldwide about half of men are circumcised,”
    No, much less, perhaps one quarter to one-third. The only countries cutting a majority of babies are the USA and Israel. They do it later in the Muslim world, tribal Africa, the Philippines, South Korea, parts of Melanesia, eastern Polynesia, and among outback Australian Aboriginals – and nowhere else!

    “although the popularity of this procedure is falling, especially in Europe”
    It could hardly fall any further: only Muslims and Jews still do it, and the rate among Jews is anecdotally as low as 40%.

    “Don’t worry; no one will circumcise your son without your permission (and a signed consent form).”
    That wasn’t the case for these parents: Many others on that page were nagged relentlessly.

    “But you will do yourself (and your son) a big favor if you read up on the issue before you sign.”
    An even bigger favour if you don’t sign. Too many discussions start with cutting, instead of with the foreskin, a normal, healthy part of the anatomy with important protective functions (lifelong) and erogenous functions (in the adult). Once these are properly understood, discussion of cutting it off becomes redundant. Fathers, far from wanting their sons genitally reduced to match themselves, should rejoice that their sons can have something they lack, just as they do when the sons get into a better college or on to a better team.

  7. I think you under emphasise that many of us men deeply resent being circumcised without our consent. What would be really eduational for prospective parents would be this site: Canadian Foreskin Awareness Project.

  8. It’s wonderful that this article addresses circumcision. So many people still do it without question…or because family or friends did it. There is sooo much most people don’t know about this horrible practice…and sadly, many doctors are unaware of the benefits and protection the foreskin provides…and in the hospital, they always neglect to tell you about the enormous risks involved. It’s a completely unnecessary, torturous procedure that was outlawed on baby girls 20 years ago, but is still legal to do in the U.S. to infant boys. The stats on worldwide circumcision are off in this article, though.- 85% of men around the world have their whole penis..without any problems. It’s primarily the U.S., Israel and a few African countries that still practice this… Please become informed before allowing this to be done to your child. Go to and watch videos of it being done. Visit the Whole Network or Saving Our Sons or Men Do Complain or Doctors Opposing Circumcision or Nurses Against Circumcision

  9. You need to fact check better. The U.S. Is the ONLY place routinely circumcising their boys on the erroneous assumption that there are medical benefits. Most are done for religious reasons, and it’s nowhere near half. Try 15-20% and falling. Effort by big Medicine to compensate for the loss of this RESOURCE in the US (yes, it’s sold and used) by attempting to victimize Africans is failing because they are refusing. You should too, your child deserves his whole healthy body. \ /,,

  10. “The U.S. circumcision rate fell to 55% in 2010..”
    ME. This does not count the growing number of circumcisions that take place in pediatricians’ offices.

    “… meaning that nearly half of US baby boys were not circumcised.”
    ME. Circumcision is a minority practice among Latino families, and west of the Rockies.

    “Worldwide about half of men are circumcised…”
    ME. At most 30%.

    “…although the popularity of this procedure is falling…”
    ME. Only in the English speaking countries and South Korea. Continental Europe and Japan have never circumcised routinely.

    “A decade ago few people even questioned whether their son would be circumcised…”
    ME. The questioning began in the 1980s.

    “…but now new parents really need to be educated before they make an irreversible decision for their son.”
    ME. The need for research and better education is a timeless one.

    “…no one will circumcise your son without your permission (and a signed consent form).”
    ME. Last century, it was common to cut boys without asking the mother.

    “But you will do yourself (and your son) a big favor if you read up on the issue before you sign.”
    ME. Better yet, DON’T SIGN.

    I wish to add that routine infant circumcision can have major implications for adult sexual pleasure and function, in both genders, but that this fact is known only from anecdotes shared via social media. American medicine declines to research those implications, even though RIC in the USA goes back to the 1880s.

  11. I wanted to make some comments about breastfeeding and circumcision. When my son was born, I breastfeeding exclusively. The first few days, he would nurse for five minutes and fall to sleep. This is perfectly normal. Secondly, there have been cases where boys are circumcised without consent. My nurse told me they were going to clean my baby up and take him to be circumcised even though I wrote DO NOT CIRCUMCISE on my information. She said there was no record of that request. If I had been asleep, they would have taken my child to be cut. Also, the statistics about half the world’s men being cut is incorrect. The world health organization says only 1 in 3 men are cut, 68% of which are Muslim, even though the quran makes no mention of a circumcision requirement.

  12. #9. Take her advice and do your research on the risks and complications of circumcision and the many benfits and functions of the foreskin. My partner was badly scarred from his procedure and had to have corrective surgeries, complications are very common, dont believe you are doing whats best for your son by not giving him the opportunity to grow up and weigh the pros and cons for himself. I am very angry that my boyfriend will never have foreskin and that I will never get to have comfortable sex that foreskin provides. #ifiwasaboy #iamnotthankful that my parents would have decided to sever off a part of my penis, even if the supposed benefits were worth it, which they are not!

  13. If there isn’t a medical condition present, how can circumcision even be called a “medical decision?”

    Without medical or clinical indication, can a doctor even be performing surgery on a healthy, non-consenting minor, let alone be giving parents any kind of “choice” in the matter? What other non-medical surgeries do doctors “discuss options” with parents? Isn’t reaping profit from non-medical surgery on healthy, non-consenting individuals the epitome of medical fraud?

    Some of the information presented on this article is inaccurate; something lie 70% of the world’s male population is intact. The popularity in Europe died down a long time ago. The US is pretty much the only Western, English-speaking country where healthy newborns have their foreskins removed routinely. Yes, parents ought to make sure and make it clear to the doctor if they do not want their child circumcised, because he may be circumcised without their consent. This happened in a recent case in Florida (Mario Delgado). Parents need to make sure the doctor and his nursing staff know they do not want their child circumcised, because in some clinics and offices, circumcision is by default.

    Thank you for wanting to inform parents about this. Now please present up-to-date, factual information, thank you.

    It must be asked why the “options” of performing non-therapeutic surgery on a healthy child are being discussed with parents. Without medical indication, isn’t soliciting surgery to parents of healthy children medically fraudulent?

  14. 9) Circumcision : Your worldwide figures for percentages of males who are circumcised are way off. You stated only 50% when in fact more than 80% of males are intact and the 55% rate for the US is already out-dated. Today, it is more like 35% of US children being robbed of their foreskins by the circumcision industry. There is NO medical excuse to impose this surgery on infants who cannot consent. Parents are more informed, thanks to the internet and have opted to keep their children intact.

  15. When you bank your child’s umbilical cord blood you are insuring that you have a powerful weapon against future illness or medical conditions that were once thought to be a death sentence. The immature stem cells in umbilical cord blood have miraculous properties that can keep your family healthy should disaster strike in the form of illness or chronic disease.
    Many diseases and conditions are passed on from generation to generation. They are embedded in our genes and referred to as congenital diseases. Until recently there was little that could be done other than work towards a remission and a few more years of life. Now, with the discoveries being made in stem cell research, doctors can change the very cells in our bodies to affect a cure when they have immature stem cells. These stem cells are a biological insurance that reside in the blood of the umbilical cord & placenta, and can be used to alter diseases and conditions once thought hopeless To find out more and up to date info on cord blood banking look here –

  16. Great Article. Thanks for the info. Does anyone know where I can find a blank parent consent form to fill out?

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