Newborn Medical Decisions

You just spent 40 weeks (give or take, depending on when your little one decides it’s time) growing, nourishing, falling in love with a baby that’s about to make their entrance earth-side. You’ve packed your hospital bag, or prepared everything for an at-home birth. You’ve stocked up on all of your favorite snacks, and filled your freezer with easy meals for post-baby. You’ve picked out your birth team, and chosen who will have the honor of greeting this sweet babe when they arrive. But did you know that you’re going to have 1.76 millions decisions to make within the first few hours of your newborn’s life? Ok, the million might be an exaggeration. But it’s not off by much. From the moment babe is earthside, you are going to be bombarded with LOTS of decisions regarding baby’s next moves. It can be overwhelming, and if you aren’t prepared, making a decision on the spot might not be the choice you actually wanted. I’m a huge proponent of empowering yourself with information. Learn about every medical decision you’re going to be making on your newborn’s behalf. You’re their advocate, and your voice matters. I encourage you to make your own educated decisions. This is your child, your life, your family, your decision. Read as much as you can. Understand the benefits, the risks, even the unknowns regarding the various decisions that will need to be made post birth. A quick note before we get started – all of these decisions are personal to you and your family. My intent here is to provide you with just the facts – the newborn medical decisions that you will need to make – without biased information. It’s up to YOU to follow your heart and your gut, and do the research that can help you make your own decisions. A lot of these are controversial topics, and regardless of where you stand, these are decisions that you will be faced with. Ok, let’s dig into the types of decisions you’re going to have to make right after birth!

Pick a Pediatrician

Picking a pediatrician for your newborn well in advance is so important. The reality is, you’ll be spending a lot of time in the doctor’s office during their first few weeks of life earth-side. If you are birthing in a hospital, most hospitals will require you to have a pediatrician picked out prior to being admitted for delivery. If you haven’t yet chosen one, there is a chance that the hospital will assign your babe a pediatrician. If you’re having a home birth, often your home birth midwife will provide care for your newborn for the first 6 weeks of life and then you will transition to the pediatrician you’ve chosen. That being said, midwives highly suggest already having a pediatrician on board should anything major come up that baby needs to be attended to that’s out of the scope of your midwife. Schedule a meet ‘n greet with as many pediatricians as you like during your third trimester – make sure their values align with yours, and that it feels like a good fit with your family.

Hepatitis B Vaccine

Hepatitis B is a disease caused by the hepatitis B virus. The virus can enter the bloodstream, attack the liver, and cause irreversible damage. When babies get infected, the virus usually remains in the body for a lifetime (this is called chronic hepatitis B). About 1 out of 4 infected babies will die of liver failure or liver cancer as adults. In some cases, the hepatitis B virus passes from mother to baby during birth when the mother does not know she is infected. In other cases, the virus is spread to the baby during close contact with an infected family member, caregiver, or friend. As many people are asymptomatic carriers of the virus, they often don’t even know they have the virus and can unintentionally pass it on. Newborn babies usually receive their first hepatitis B vaccine shortly after birth, so they are protected as early as possible from any exposure to the hepatitis B virus. Babies and young children are not able to fight off hepatitis B virus infection as well as older people. It’s just the first of a long series of vaccines that are recommended by the American Academy of Pediatrics during childhood. If you’re choosing not to vaccinate your child or wish to delay the schedule, have that conversation with your pediatrician ahead of time. Vaccines are a super important topic that should be in alignment with your pediatrician’s views!

Vitamin K Injection

Our bodies need Vitamin K to activate molecules that help blood clotting. Without enough vitamin K, newborns can have vitamin K deficiency bleeding (VKDB) which is rare but dangerous. Early onset VKDB happens in the first 24 hours, classical VKDB happens in days 2-3, up to day 7, and late onset happens after that, typically age 3-8 weeks. Some believe that vitamin K supplementation is only necessary in a traumatic labor like a forcep or vacuum extraction birth and/or male circumcision, both which can cause the baby to bleed. And some believe that vernix may contain vitamin K. Instead of wiping it off, rub in this creamy substance to help support your baby’s well-being.

Circumcision

You may have strong feelings about whether your son should be circumcised (surgically removing the foreskin that covers the tip of the penis). In the US, just over half of boys are circumcised for religious or social reasons. Some cite the reasoning for circumcision as more hygienic or healthier, although in studies, the only risk factor that increases in uncircumcised males are UTIs, which are much less likely to occur in men versus women. The risk is so low that circumcision is classified by the American Medical Association as a non-therapeutic procedure and the American Academy of Pediatrics does not recommend routine infant circumcision.

Breastfeeding

Planning on breastfeeding? Set yourself up for success by taking the time now to learn all you can about the process. Knowing what to expect – and where to get help if you need it – can be key for getting through those first few weeks with your newborn. I’m a huge proponent of meeting with a lactation specialist prior to birth – she will help you understand what to expect, when to expect it, and how to get through every hurdle along the way. And once you’ve met her, keep her number in your back pocket for future questions! Know that the first week of breastfeeding is the hardest – especially if this is your first. The American Academy of Pediatrics recommends that mothers breastfeed exclusively for the first six months, followed by breastfeeding in combination with solid foods for at least a year – but at the end of the day, breastfeeding is always a personal choice.

Bathing

Newborn babies are born covered in a waxy, white substance called the vernix. For a long time, standard care was to give newborns a sponge bath a couple hours after birth to remove the vernix – but in recent years, experts are seeing benefits to delaying that first bath by at least 24 hours, or longer. Not only does the vernix help keep new babies warm, thereby also regulating their blood sugar, but it also may contain vitamin K so rubbing it in may give babies more of the vitamin K they need. It also gives new moms more time to bond and do skin-to-skin straight away. But delayed bathing isn’t always possible, depending on medical circumstances.

Antibiotic Eye Ointment

Antibiotic eye ointment, erythromycin, is given to newborns to prevent blindness that is caused by a mother infected with gonorrhea or chlamydia. The purpose is to kill bacteria that can cause blindness. A side effect is that it can cause blurring in the eyes, which can affect immediate bonding time with mama. The other concern is introducing an antibiotic into the systems of babies directly at birth and how that affects their gut health, immune health, etc.

Skin-to-Skin Newborn Care

Also known as kangaroo care, skin-to-skin care involves placing the naked baby directly onto your (or your partner’s) bare chest. The contact has been proven to help newborns – both those born full-term and premature – regulate body temperature and stabilize their vital signs, soothe their cries and lead to better weight gain and breastfeeding success. If you choose to do kangaroo care, depending on hospital policy, you can ask that your newborn be placed on your chest as soon as they’re born, potentially even if you’ve had a c-section.

Cord Blood Banking

Many parents are opting for cord blood banking – collecting the blood left in your newborn’s umbilical cord and placenta, which contains potentially life-saving stem cells, and storing it for future medical use. This decision must be made ahead of time (typically at 35 weeks) because the process requires a kit that the companies send to you that you then bring to the hospital to collect cord blood and the tissue.

Delayed Cord Clamping

Usually the umbilical cord is clamped within one minute of a newborn’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 newborn 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”. The American College of Obstetricians and Gynecologists recommends delaying cord clamping for at least 30 to 60 seconds, while the Word Health Organization recommends at least one minute and the American College of Nurse-Midwives recommends 2 to 5 minutes. If you decide to move forward with cord blood banking, you won’t be able to delay clamping the umbilical cord, otherwise the blood will clot and render it useless.

Placenta Release

Within about 30 minutes after giving birth to baby, your body will expel the placenta. In certain cultures, burying the placenta is symbolic of the child’s link to the earth. In other cases, some mothers consume it in smoothies or pills or in tea form in the belief that it helps promote postpartum recovery and can boost your mood, energy and breast milk production. If you do want to save your placenta, let your health care practitioner know ahead of time so it can be properly stored. And if consumption is your plan, consider lining up a professional service that’s experienced in placenta encapsulation to help lower the risk.

In a nutshell

Whether you’re a first time mama or a seasoned mother of four, know that knowledge is power. Do the research, discuss these decisions with your partner and your healthcare team, and make the choices that are best for you, babe, and family!

Resources

Centers for Disease Control and Prevention American Academy of Pediatrics American College of Obstetricians and Gynecologists World Health Organization American College of Nurse-Midwives

Let’s Connect

Are you trying to get pregnant? Balance your hormones? Thrive through the postpartum period? Or heck, maybe you’re on a completely different type of hormonal journey that could use some direction. Either way, find a time that works for you, and let’s get a date on the calendar.