Birthowl’s natural childbirth

Routine Newborn Procedures

There are a number of routine newborn procedures that will be offered or recommended at the time of your baby’s birth. It is helpful to learn about these procedures beforehand so that you can gather as much information as you need to make educated choices for your baby. Remember that in your home you have the freedom to create your birth like you want it.
In the hospital, your midwife or obstetrician almost certainly will not provide care for your newborn baby; care will be provided by hospital staff according to the standard protocols of the hospital unless you request otherwise. In some very rare cases, your pediatrician may be present to provide this care. In most cases, there will be an attempt to obtain “informed consent”, but busy hospital staff may simply announce that they are about to perform a procedure and take your silence as consent.

If you choose to decline some of these procedures, you may be asked to sign waivers to satisfy a state requirement. In most cases, you do not have to give a reason for declining any particular treatment. However, in California, you will be asked to sign a religious waiver if you choose not to have a heelstick done on your baby for the newborn screen (aka PKU) within six days after the birth.

This handout contains some introductory information; be sure to ask your pediatrician if you have any questions about these procedures.

baby feet

Cutting the Umbilical Cord

Premature cutting of the umbilical cord deprives your baby of about 30% of your baby’s blood volume that nature intended to flow from the placenta and cord after birth. Although this “extra” blood usually isn’t necessary for survival, the iron in this blood is meant to help meet the baby’s iron needs during the first six months, since breastmilk is low in iron. In the days immediately after birth, your baby’s body breaks down this surplus blood and stores the iron in the liver. One of the byproducts of the breaking down of the surplus blood is bilirubin, which may cause a mild case of benign jaundice. Because many parents and health care professionals do not understand that this jaundice is normal and harmless, practices have evolved to cut the umbilical cord as soon as possible after the birth to prevent your baby from receiving the normal amount of blood and potentially experiencing jaundice, even though normal.

There is also some thinking that allowing your baby’s blood to flow back from the placenta reduces the size of the placenta, facilitates quicker and easier placental delivery and reduces postpartum hemorrhage.

In addition, cutting the umbilical cord before your baby’s breathing is well established may deprive your baby of life-sustaining oxygen that continues to flow from the placenta for several minutes after birth. Some people suggest waiting until after the umbilical cord has stopped pulsing before cutting the cord. In fact, this may still be too early. As part of the normal adaptation to breathing outside the womb, your baby’s body stops sending blood back to the placenta (which is what causes the pulse) some minutes before it stops receiving oxygenated blood from the placenta and umbilical cord, which doesn’t pulse.

Unfortunately, many institutions do not have personnel trained in resuscitating your baby while still receiving oxygen through the umbilical cord – their training is limited to working at the baby warming station across the room. This means that babies that most need to continue receiving oxygen through the umbilical cord (because they’re having trouble breathing or are in some other kind of distress) are the babies who are most likely to have their oxygen source – the placenta and umbilical cord – disconnected prematurely so they can be moved to the baby warming station.

Because this procedure is usually carried out without receiving parental permission, it is wise to discuss this with your care provider if the issue is important to you.

About cord blood collection – “Cord blood” is blood that would flow into your baby’s body if the cord weren’t cut to collect it. If you wouldn’t allow your baby’s blood to be drawn and 30% of the baby’s blood volume removed, then you probably don’t want to allow “cord blood collection”.

Suctioning the Baby’s Stomach

Many hospitals routinely suction or “pump” the baby’s stomach after birth, even if there was no evidence of meconium at birth. This procedure has no benefits – it can cause a sudden drop in the heart rate and can cause throat irritation that will interfere with breathing and breastfeeding.

Eye Antibiotics

The purpose of routine administration of antibiotic medication (erythromycin ointment) to your baby’s eyes about an hour after birth is to prevent infection from any germs that your baby may have been exposed to in passing through the birth canal. Some people object to this procedure on principle because of their objections to the routine use of antibiotics without proven benefit. Discomfort to the baby is minimal, and there is little disruption of the bonding procedure if the procedure is delayed until after the baby has fallen into the post-birth stupor. However, the benefits of routine administration are also minimal; if the baby does develop an eye infection, it will be very obvious to observant parents, and then there is plenty of time to administer antibiotics to prevent serious consequences.

Vitamin K Injection

Routine injection of vitamin K is controversial. It is generally accepted that administering vitamin K will increase clotting factors and reduce the incidence of Newborn Hemorrhagic Disease (NHD), a very rare situation in which a baby bleeds internally. NHD is seen much more commonly in babies who have experienced a traumatic birth, such as by forceps or vacuum extraction, or who are visibly bruised at birth. Although giving vitamin K to increase clotting factors does reduce the incidence of NHD, it also appears to increase the likelihood of death from bacterial meningitis. Nature obviously intended for newborns to have lowered clotting factors at birth, although science does not yet understand why.

Opposition to routine vitamin K administration centers around the injection itself, and many people who oppose the injection will accept an oral administration of the same formulation. (A study conducted at Children’s Hospital, University of Missouri, Columbia, found administration of oral vitamin K to be effective. [Journal of Pediatrics, vol. 127 #2, Aug., 1995, page 301, “Twenty-seven years of experience with oral vitamin K1 therapy in neonates” by Clark and James.] Oral doses of vitamin K should be twice the injected dose, and there are suggestions to repeat the dose at two, four and six weeks of age.

Colostrum contains high levels of vitamin K, and if your baby experiences a gentle birth and nurses readily at birth, your baby will probably receive exactly the dose intended by nature. If you choose to have your baby receive supplementary vitamin K, it might be worth discussing oral administration with your pediatrician in advance. Even if they don’t have a special oral preparation, they can use the preparation meant for injection.

Whether or not your baby receives vitamin K supplementation, it is best to contact your baby’s care provider if you notice that your baby seems to have a lot of bruises or an unusual amount of bleeding from the umbilical cord stump. This is a common precursor to more serious bleeding problems.

Hepatitis B Vaccine Injection

For the last few years, it has been the standard of care to vaccinate all newborns with a Hepatitis B Vaccine before they left the hospital. However, on July 7, 1999, it was reported that the American Academy of Pediatrics is now recommending that newborns not be vaccinated because the mercury used as a preservative in the vaccines has been implicated in mercury poisoning occurring in babies. Some hospitals may still be vaccinating newborns as they use up their store of vaccines. If you do not want your baby to receive the Hepatitis B vaccine, it is important that you be very clear about this with the neonatal team, the nursery staff and your pediatrician.

Photo by Sean Dreillinger


1 Comment so far
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mmm from what I understand, they do not suction the stomach, they suction the airways to make sure nothing remains there that could cause an infection. Indeed, this practice has proven to be of no benefit to the newborn however, even not when there is meconium.

Comment by maria

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