Newborn Procedures to Reconsider


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For me, being a first time mother, I never knew that there were routine hospital procedures that influenced the welfare of my child AND that I had the authority to manipulate them.

My advice to a new mama is to learn about what to expect in the hospital beforehand.

There are several routine practices that should can be considered for you to declined, delayed or modify.

Since your number one priority is to the welfare of your child, take the time review the information available on the procedures used in hospital maternity wards – surprisingly, most are not evidence-based practices, instead they are in place due to the ease and convenience of the staff or because that is what has been done in the past.


Cord Clamping

Clamping the cord within 30 to 60 seconds after birth is one of three steps in an "active management" approach to the third stage of labor in hospitals.

The reason for this routine medical procedure is because immediately following birth the new mother is most vulnerable to excessive blood loss.[1]


However, The Cochrane Library (a publication of The Cochrane Collaboration, an international organization that evaluates medical research-systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic) found that in terms of the amount of bleeding, delayed clamping did not reduce the mother's risk of bleeding.[2]

In fact, there are many benefits of delaying this procedure until the newborn’s umbilical cord has stopped pulsating. The benefits of waiting are well documented and many parents are not aware of the large impact this particular routine procedure can have on their new baby.

Here is a good resource to start learning about the many benefits to delayed cord clamping.
One benefit that has recently received a lot of attention is the effect of iron levels in a newborn. The amount of iron in the blood at birth influences health, particularly an infant's risk for anemia in the first months of life.


This is especially relevant when considering that iron deficiency is the primary cause of anemia which can lead to central nervous system effects and cognitive impairment. In addition, delayed cord clamping can increase the rate of transfer of hematopoietic stem cells to the newborn, which may play a role in the prevention of certain blood disorders and immune conditions.[3]


Please consider telling your partner to watch and be vocal about what you wish when giving birth. Delaying clamping of the cord is an easy one to watch for and your hospital should be able to abide by your request.

Vitamin K Injection

The injection of vitamin K to every newborn infant was a practice that began in the 1950’s. The injection is used to artifically alter the naturally occurring level of vitamin k in the baby and to promote blood clotting.

To account for a rare liver disease (called Hemorrhagic Disease) that occurs approximately about 5 out of 100,000 births – the answer the CDC has come up with to tackle this rare bleeding trauma is to inject all infants with not double the amount…not 10 times or not even 100 times ….but rather 20,000 times the newborn level of vitamin k.

Yikes.

You might ask yourself, why is every newborn baby born with a “low level” of vitamin k? From what research recognizes, the newborn’s tight regulation of vitamin k levels control the rapid rate of cell division (which is rather useful during fetal development). It has been documented that high levels of vitamin k may lead to cancer due to uncontrolled, rapid cell division. (Ahh….this may explain the link to the prophylactic use of the vitamin k injection and a rise in childhood leukemia).

If you opt out of the vitamin K injection, the baby will gradually raise their levels after birth by breastfeeding (colostrum is extremely high in vitamin k).

You can also consider giving vitamin k drops orally (liquid vitamin K9) which is a significantly lower dose then the 20,000x level of the injectable vitamin k. If you consider this - I would contact the pediatrician to determine how this will be administered and how to attain it.

If you are a mother at higher risk of having a baby with Hemorrhagic Disease or if your baby is at a higher risk, then you may want to consider the vitamin k injection more thoughtfully. Those mothers and babies would be:

-Women on anticonvulsant drugs during pregnancy (for epilepsy)

-Babies that had premature clamping or cutting of their umbilical cord (this deprives the baby of up to 40% of their blood volume which includes platelets which aid in clotting) - another reason to delay cord clamping!

-Women who had a vacuum extractor assisted birth (this often causes bruising and internal bleeding) – another reason to try for a natural birth

-Women/newborn on antibiotics


The administration of any injection into the blood stream of a newborn carries risk, particularly of infection…especially in an environment that contains the most hazardous germs.

It has also been known that trauma from injections during the first moments of life can jeopardize the establishment of the breastfeeding relationship. Breastfeeding assists vitamin k levels and absorption monumentally more then the synthetic vitamin k injection.


I imagine there is a very delicate, complex relationship between blood clotting levels and a newborn’s cell growth. To go all ‘willy-nilly’ (sorry no other term applies here) and inject a synthetic vitamin in the blood stream (20,000 times higher then normal, a level chosen with no rhyme or reason) to alter something we don’t fully understand seem a tad bit reckless.



Erythromycin Eye Ointment


Erythromy-what?

Erythromycin is an antibiotic ointment applied to a newborns eyes just minutes after birth.

The administration of erythromycin is on the grounds of preventing blindness from exposure to maternal gonorrhea.

Yes – if you have gonorrhea, then you might want to consider keeping this procedure in place – if not, pass on it.


Please note that it is common practice to screen mothers for STDs during their prenatal care so if you don’t have an STD

I’m not sure why it would make sense on administering it.


Again, the administration of this groundless routine intervention is waive-able, but could include a fine of $5.00 in most states (however, in New York it is much more difficult to decline).


If you are considering administering “just in case” - is there risk?

The antibiotics in the ointment enter the bloodstream through the eye – the potential for diaper rash, thrush, and digestive problems are all present when this happens.


The bottom line-is it necessary and effective?

According to the several medical studies listed below (and in more detail here), that answer is no:

Bell TA, Grayston JT, Krohn MA, Kronmal RA.  Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis.  Pediatrics 1993 Dec;92(6):755-60.

Chen JY.    Prophylaxis of ophthalmia neonatorum: comparison of silver
nitrate, tetracycline, erythromycin and no prophylaxis.  Pediatr Infect Dis J 1992 Dec;11(12):1026-30.



Black-Payne C, Bocchini JA Jr, Cedotal C.  Failure of erythromycin ointment for postnatal ocular prophylaxis of chlamydial conjunctivitis.  14: Pediatr Infect Dis J 1989 Aug;8(8):491-5.

 

Krohn MA, Hillier SL, Bell TA, Kronmal RA, Grayston JT.  The bacterial etiology of conjunctivitis in early infancy.  5: Am J Epidemiol 1993 Sep 1;138(5):326-32.



These studies “prove that the eye ointment routinely applied to newborns does not significantly alter eye infections as opposed to no ointment of any kind.  Also, there is evidence that the bacteria which cause these infections are not passed to the infant in the birth canal, but after birth.  Also, it has been found that a significant number of infants develop an infection even though they HAVE received the ointment.”



Circumcision

Being that this is a sensitive issue – I will not discuss this subject in detail or my personal views on the matter.

I will ask that if you are expecting son, please carefully assess the information available. This is definitely a procedure that the hospital will honor in declining, in fact, the rate of circumcision is declining because evidence-based knowledge is mounting.

If you are unsure, consider viewing a circumcision video to understand what your son will experience. (note-I did NOT view this video, I can’t handle stuff like that).

The majority of these surgeries in America are done without any anesthetic.  Some will utilize a topical cream which takes nearly 45 minutes to numb the skin, yet these creams have not been studied in newborns.


Please be diligent in this decision, many faiths that commonly recommend circumcision have large followings that support keeping sons whole. Please take time to learn more then what is offered in a brochure at your OBGYN.

Hepatitis B

To begin with, hepatitis is a viral disease associated with sexual contact, blood transfusions, re-use of contaminated needles and vertical transmission (mother to child).

Prevelance of Hep B

The virus has the ability to cause an infection of the liver that can have long-lasting effects. For infants – this disease can be exceptionally serious and this is found when the mother is positive for the hepatitis. 


Now in countries that have a much better infant mortality rate, such as Sweden and The Netherlands, medical professionals only administer the vaccine to mothers who test positive for the disease, not all newborns.


It’s also important to note that it has been recommended that the routine vaccination of all newborns for Hepatitis B is performed only in areas where the carrier prevalence is greater then 2% - this does not include the United States![*

You might say that the vaccine is safe, so why not be extra sure? However, do you know how many safety studies have been performed on the Hepatitis B vaccine for newborns?

None.


 

You may want to consider delaying this vaccine until your next pediatric visit (2 months) or declining it until the risk is more prominent. Click here to learn more about hepatitis B and the vaccine used.



First Bath

Although it might seem somewhat logical to wash a baby immediately after birth, there are significant drawbacks that you might not have otherwise considered.


Firstly – if you decline or delay washing your newborn in the hospital, you might find more resistance then any other routine produce listed here. You will be met with the counter, “It is hospital policy” – this may very well be true but it does not mean you are required to abide by the policy, you have every right to decide what or what not procedures or performed on your child. [4]

If you alter the routine schedule of bathing, the hospital staff may insist on wearing gloves to handle your child – which is fine by me – this is because the medical thought is that your child will be posing a hazard to the staff.

Consider this-who is posing more of a hazard to who?

Newborns have a valid risk of nosocomial infection (infection that is caused by hospital staff) especially with MRSA strains. Bacteria have adhesive pili on their surface to attach to skin – the vernix that is rubbed into the baby’s skin and is allowed to stay on the newborn significantly inhibits growth of bacteria, as well as being antimicrobial in nature (similar to breast milk).[5][6][7]


A baby is born with exceptionally senstitive skin. Vernix can be rubbed into the skin and is highly effective at deterring the growth of common pathogens found in the hospital: as group B Strep, K pneumoniae, L. monocytogenes, C. albicans and E coli.[7] 

The Department of Health (in conjunction with the World Heath Association) sets forth protocol for newborns: specifically in the section addressing the 0-3 minutes after the baby is born which states - Immediately dry the baby but “do not wipe off vernix” and “wait at least six hours to wash the baby”. [8]

Personally, I would wait longer – I would wait to wash my baby at home. Commercial products used in hospitals are harsh and can be harmful on neonatal skin. You could bring your own baby wash and ask the nurse if you could give your baby it’s first bath. I think that would be ideal if you choose not to wait until you get home. 

Remember, there are no evidence-based guidelines relating to newborn skin care in hospitals and postnatally, vernix exhibits antioxidant, skin cleansing, temperature-regulating and antibacterial properties.[9][10]


Conclusion

Remember, you have every right to choose what will be performed on your baby.

Cautiously take into account what care options you have. If you have questions about a procedure for your baby-speak up and ask.

You are the number one advocate and the only voice your child has. Your responsibly is to him or her, not out-dated hospital policies.          
          

[1]Umbilical Cord Clamping. ScienceDaily. Retrieved October 10, 2012, from http://www.sciencedaily.com­ /releases/2008/04/080415194222.htm

[2]McDonald SJ, Middleton P. "Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes (Review)." Cochrane Database of Systematic Reviews 2008, Issue 2.

[3]Gina Eichenbaum-Pikser & Joanna Zasloff. Delayed Clamping of Umbilical Cord: A Review With Implications for Practice: Benefits of Delayed Cord Clamping. J Midwifery Womens Health. 5(4):321326.2009  http://www.medscape.com/viewarticle/708616_3

[4]Andreas Matussek, Jan Taipalensuu, Ing-Marie Einemo, Malena Tiefenthal, Sture Löfgren. Transmission of Staphylococcus aureus from maternity unit staff members to newborns disclosed through spa typing. American Journal of Infection Control. Vol 35, Issue 2. Mar 2007 http://www.sciencedirect.com/science/article/pii/S0196655306011898

[5]Annika Nelson, Kjell Hultenby, Éva Hell, Hilde M Riedel, Hjalmar Brismar, Jan-Ingmar Flock, Joachim Lundahl, Christian G Giske and Giovanna Marchin. Staphylococcus epidermidis isolated from newborn infants express pilus-like structures and are inhibited by the cathelicidin-derived antimicrobial peptide LL37.Pediatric Research. 25 Mar 2009 http://www.nature.com/pr/journal/v66/n2/abs/pr2009183a.html

[6]Dao M. Nguyen, Elizabeth Bancroft, Laurene Mascola,  Ramon Guevara, Lori Yasuda. Risk Factors for Neonatal Methicillin‐Resistant Staphylococcus aureus Infection in a Well Infant Nursery. Infection Control and Hospital Epidemiology. Vol 28;No4. Apr 2007 http://www.jstor.org/stable/10.1086/513122

[7]Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B.  Host defense proteins in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology, 191(6), 2090–2096. 2004 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595247/
[8]Care of the Baby at Birth. Module 1Neonatal Divison, AIIMS, New Delhi http://www.newbornwhocc.org/enn/Care_at_Birth1.pdf

[9] Lynne Walker, Soo Downe, and Liz Gomez. Skin care in the well term newborn: Two systematic reviews. Birth. Vol 32 issue 3. Sept 2005 http://onlinelibrary.wiley.com/doi/10.1111/j.07307659.2005.00374.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

[10]Johann Wiechers, and Bernard Gabard. Vernix Caseosa: The ultimate natural cosmetic? Cosmetics & Toiletries. Sept 2009 Cosmetics & Toiletries Sciences Applied
[11] Giving Birth Naturally Webpage: Routine Newborn Baby Care Procedures. http://www.givingbirthnaturally.com/newborn-baby-care.html

43 comments:

  1. Bravo! Excellent article! I hope it inspires more people to take responsibility for the health of their child instead of just handing it all over to the staff at the hospital door.

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    1. Thanks so much Awesome Crunchy Dad lol - great name by the way!

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    2. Thanks for spreading the word. I had no idea I could refuse any of these with my first child. My little boy was born via scheduled c-section three weeks ago and I refused all the normal Vit. K, eye drops, circumcision, Hep. B. and the bath. I did just a few minutes of skin-to-skin in the OR and asked for delayed cord clamping, but some respiratory issues didn't allow the doctor to do it (or she just opted not to at that moment). Regardless, I was pleased with how everything went and that our baby never left our side during our stay in the hospital. We were allowed to leave a day early and baby slept in bed with me most of the time. No one gave me any problems about these requests thanks to our doctor paving the way and telling the staff these were our wishes. We also had an informal birth plan that stated our desires.

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    3. This is an awesome comment - thank you so much for sharing your story!!

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    4. that is great news!

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  2. Hi!! Very intesresting!! Can you put the sources about the vitamin K part? Thanks a lot!!!

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    1. I am adding some sources directly in that section : ) Thanks for the heads up!!

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    2. You mean where exactly? At the end of your article there's no sources about the vitamin K... Sorry! Maybe i'm bling ;)

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    3. There are links directly in the paragraphs - if you hoover over them and click they will direct you to the PDF,link,reference... hope this helps!

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  3. For the eye part, silver nitrate is not the same as antibiotic ointment. Silver nitrate is a chemical compound that causes oxidation, of skin, eyes, whatever. Antibiotic ointment is similar to Neosporin. Just differentiating. Either way, I agree that it should be skipped and if baby does develop an eye infection, a little breastmilk in the eye usually takes care of it!

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    1. Thanks dakover - I am going to revise that section to make things a bit more clear...

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  4. This is such a wonderful post, thanks for putting all this information together!

    I work as a birth doula in Vancouver, Canada and am always sending clients information about these procedures so it's nice to have an article like this with references to send them to!!

    Some of the procedures are slightly different here in Canada (we don't do the Hep B vax for newborns, and not bathing for 24 hours is standard practice in many hospitals) but most of the rest applies.

    I would LOVE if you added information on Group B Strep and IV antibiotics! ;) It is actually quite a small transmission rate for babies born to GBS+ women who DO NOT take antibiotics (1/200 or 0.005%). I always recommend people look at the risk factors for mom and baby who do take antibiotics at birth (same as what you listed for the eye ointment, but the dose of antibiotics is much higher) to make sure they are fully informed before making a decision.

    http://americanpregnancy.org/pregnancycomplications/groupbstrepinfection.html

    Warmly,
    Chloe Dierkes
    urbandoula.com

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  5. Hi thanks for a well balanced blog. I am curious; in the States do you also have the option to decline an ecbolic such as syntocinon as well for 3rd stage management? Here in New Zealand our national midwifery body supports physiological 3rd stage of labour as in birthing the placenta without the use of synthetic oxytocics and keeping our hands out of the process so no controlled cord traction either. Sadly it doesn't always happen this way but after reading your blog I really appreciative what a progressive maternity system women in NZ have fought hard for. Vit K is an option, delayed cord clamping is quite routine and even in our hospitals parents are discouraged from bathing baby within the first few days and if they choose to as is their wish they are encouraged to avoid using anything other than warm water.

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    1. Hi, Kirsty! I am a doula in the US. In answer to your question, I'd say the practice of synthetic oxytocin varies between practitioners. I have never seen or heard of a midwife at a home birth in a free-standing birth centers administering synthetic oxytocin (typically Pitocin around here) unless there is a hemorrhage. Hospital practice varies, of course. In some hospitals, signing admissions papers gives the hospital the right to use Pitocin, and many will do it without alerting the mother, during the first and/or third stage. Women have the right to decline it, of course, but in more medically-aggressive practices and hospitals, it may be a bit of a battle, particularly if the mother gave the hospital the right to use it when she was admitted.

      Things are definitely improving in the US as more mothers are learning that they need education and that they have rights. The overall impulse in the US is to "treat" pregnancy, rather than support it. We still have a long hill to climb.

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  6. This is wonderfully written. What I would expand upon would be the info on circumcision. I don't know why it's considered rude or sensitive to discuss it. I think there is so much ignorance in the U.S. about normal penile development. Probably the vast majority of parents who circumcise their son would be horrified to hear their foreign neighbor/co-worker/friend circumcised their daughter. And while one could argue male and female circ are not exactly the same, both are carried out due to many myths over cleanliness and sexuality (in the U.S., non-religious circ was promoted as a cure for masturbation in the 1800's). The common bond both male and female circ share is both remove non-diseased, healthy, functioning, sensitive tissue without medical need and without consent of the person the tissue belongs to. In addition to viewing a circ video, I would recommend parents research the negative effects of circ, including adhesions, stenosis, hemorrhage and even death. Research David Reimer's story. See what the medical organizations in places like Norway, Switzerland, Brazil, Japan, France, New Zealand and Germany say about routine infant circ. Those countries that have very low circ rates also have very low STD/HIV rates and also never have foreskin problems in babies nor adults. And those of both Christian and Muslim faiths need to re-read their scripture if they think they are mandated to circ. Infant circ is only mandated for Jews, and some of them are opting for a non-cutting naming ritual now.
    I was a maternity nurse for many years. Circumcision is horrible. Truly horrible and completely unnecessary. I'm so glad circumcision rates are falling but they need to be zero for the sake of the child.

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  7. Please stop advising people not to give their child Vitamin K. This is one procedure I totally disagree with opting out of doing. The side effects of being one of those 5 babies who needs it is TRAGIC. I would much rather give my baby an unneeded vitamin, no matter the dose, than have them hemmorhage and die or be disabled for life due to brain damage. I will stop with that, but please, please take that part out of your post. There are parents out there who may read this and not research and cause life long damage to their child based on your suggestions that they take as fact.

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    1. But they are facts. And people should make their own decisions. I opted for the oral vit K after much reading, although I seriously considered not having it at all.

      Facts help people make an informed choice. You are asking for people to have scars withheld from them do they make an uninformed choice, and I have to wonder why.

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    2. I agree, and as a nurse who has given subcutaneous injections of vitamin K, I can tell you that the vitamin K is not injected directly into the bloodstream as you said. It is injected into the fatty layer (subcutaneous) under the skin and absorbed into the body. Please get your facts straight before blogging about something as important and life saving as vitamin K.

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    3. Aneris,
      I completely agree! I am a nursing student and some of these suggestions are not based entirely in fact. For instance, with bathing, it can pose a serious risk to hospital staff if it is not done and the chances of the baby getting an infection from being washed are exponentially lower than the chance of a hospital worker getting infections from the mother's bodily fluids. Mothers who have had any sort of blood borne infection at all pose a risk to anyone who is handling their baby--hence why we wear gloves whenever touching anything potentially hazardous (this does not protect against everything!). Also it is really important to note the difference between IV injections and sub-q ones. Subcutaneous injections are designed to release over time and the baby should not get that whole dose at one time. I agree that people should make their own decisions based on a lot of research--not just one article like this. It is important that women understand what is and isn't important but I do think most of these are helpful--they are done because they are helpful.

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    5. Poor British midwives, however do they cope with the disgusting unwashed babies?

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  8. EXCELLENT! I've been sharing this forever but never all at once (once on the radio but not written!) WELL DONE!!! WELL DONE!!

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  9. Well done! I have been trying to get these across but only did once all at once on a radio show but never like this! Bravo well done!

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  10. My OB and I were discussing my birth plan last visit (we're expecting our third in three-ish months) and he said another woman requested that the eye ointment not be given to her baby after birth. So, he and she both went to the hospital nursery, where they learned that not administering the eye drops to a newborn is a misdemeanor in the State of Texas! So, while they would comply with the mother's request, they would be putting themselves at risk and could lawfully sue the mother for neglect for not allowing the procedure. I did a little research myself and found this may not actually be completely true, but the nurses clearly thought it was. Do you know anything about this?

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    1. The only state I've come across where its nearly impossible to decline is New York...

      But your story underscores the importance of doing your research!! Thanks for sharing!!

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    2. This is not true in the slightest. My three children, born in Texas, did not get any of these interventions. It is not a law, therefore it is not a misdemeanor to opt out of it. It is "standard procedure" and in some cases "hospital policy" but it is on no way mandatory or illegal to skip.
      Same as vaccines, though they're the standard and doctors/schools claim you "have to", the fact is that they are 100% optional.

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  11. I wish you had included just a little more info on circumcision. I know so many mamas who now regret having it done. Parents are not routinely informed of the risks and complications, the rates of which are very high! A friend who is an ER doc sees newborns with complications (usually bleeding or infection) at an alarming rate. I know an almost 4 yr old who is going to need surgery due to a relatively common complication. It is normal for a male to have a foreskin!

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    1. Perhaps it should be better discussed with more facts, such as a discussion of the functions of the normal natural foreskin. Many parents don't understand that circumcision is completely unnecessary and many don't even realize that foreskin is normal. IF parents had more information on the facts about foreskin being a functional part of their child's genitals...I think they would think a little deeper about doing this to their child.

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    2. Baby-care books do not inform of the dangers of performing unnecessary surgery on babies. In particular that very few men who are left intact would ever have their foreskin cut off. Cut babies suffer many times more sexual problems in adulthood, especially in later life with a lack of orgasm in intercourse due to the tragic loss of sensitivity. Also, the lack of natural lubrication also affects his partner. Penis dryness affected me all my life, with absence of orgasm after my 60's.

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  12. I'd love to give American parents a tour of British maternity services. I bet a lot of you will be horrified at the thought, but you'd be amazed the difference!

    I have never heard of a lot of these procedures before and I'm glad!

    I can't reply directly from my mobile so just wanted to say most female circumcisions aren't as extreme as male circumcision in hospital and even a ritual pin prick is illegal (as it should be!) if you really must get it done, a Jewish or Islamic practitioner will do a far less extreme version. Christians should know it's one of few things we are expressly told not to do! Only US Christians do it.

    As for the vitamin K. I'm a thrombophiliac, there's a good chance my children are but it's not seen as a good enough reason not to do it! The disease I have alone affects far more people than the vit k supposedly saves and a lot of people don't know they have it. Yes, that small percentage are at risk but so is the greater percentage from the jab! My son has just come out of hospital after what we think was a seizure, he has something caused by a lack of oxygen which could have been caused by a stroke which of course is a symptom of thrombophilia. He may have epilepsy or cerebral palsy but its too soon to tell. Still think it's harmless?

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  13. Thank you for this article. I will be remembering this for my next baby. My daughter was born last March and we didn't bathe her until she was about 10-12 hours old and I personally bathed her myself with my husband. The nurse wanted me to wait until she was ready, my feelings...this is my second baby, I can handle bathing her myself. Needless to say the nurse wasn't the happiest but she never said a word. As far as the shots and eye drops we prolonged those as well, we still got them (this was before we decided to be a non-vaccinating family) but we waiting til my daughter was 3 hours old to do any routine procedures and even then I insisted ALL procedures were done in my room. I was pleased with the birth and hospital stay this time around, but next time I have a whole new way to approach it since I have been educating myself and my husband on things and this article is a big help :)

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  14. I tried having a hospital birth. I had a birth plan that was approved by my doctor. So on my due date he goes out of town, and of course I go into labour. I called the doctor who was filling in for him, and he told me to come right away. When I got to the hospital, I was checked and was 3cm dilated and 60% effaced. I told the nurses that I wanted to decline this and that, and they told me that it was against the hospital's policy, then they brought in the head nurse who fought with me on that too. When the doctor came in, he preceded to read my birth plan and make fun of everything on it. I realized then that he hasn't seen a lot of natural births.
    Pitocin after birth, cutting cord as soon as the baby comes out, eye ointment, vit K shot, and hep-b vaccine, were all hospital's policies and were not negotiable. They also told me that I couldn't get up from my bed the whole time that I'm in labor.
    After all that fighting, my contractions stopped and when checked again, I went down to 1cm open and 30% effaced. My doula offered to help me do it at home with the help of a midwife that she works with.
    I went home, and had the baby 3 hours later. Women shouldn't have to deal with all that stress during labor. My body didn't want to bring the baby into a hostile environment like that. And I'm not a very sensitive or "in-touch" with my body kind of person, but I felt very stressed out and uncomfortable with being treated like I have no say in anything when it comes to my baby or my body.

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  15. That's an incredible story. So glad you had the help and support you needed to ultimately have a positive birth experience.

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  16. Thank you so much for this piece. So nicely done and will help so many parents make informed decisions. When I read posts like this I get so excited to have my next baby Empowered mommas we are helping each other to become!

    - Kimberley

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  17. Thanks for posting! In my prenatal classes I recommend that parents look carefully at each of these procedures before consenting to them. Many of the parents I work with refuse these procedures for the very reasons you outline above. Great to see them all in one convenient list!
    Another one that you don't mention here, likely because it's not standard for all women, is antibiotics in cases where mom has tested positive for GBS. A lot of women don't realize that if they refuse antibiotics during labour, antibiotics will likely be given to their newborn instead. It can be very difficult to fight this. Many moms would rather have antibiotics themselves than have them administered to their babies, but they aren't told that refusing the former will lead to the latter. While we should be able to refuse both, given the obstacles, many people would choose to have the antibiotics in labour. Having a saline lock so that the medication can be administered when needed (every 4-6 hours throughout labour) and the IV can be detached means that mom can still move freely in labour without being tethered to a pole. Not ideal, but a reasonable compromise for some.
    One other thing I wanted to note - I liked the graphic you used in the circumcision section, but I'd have to say that the vagina and perineum also belong on that list. Episiotomies are still performed by many doctors without consent and I know of a case in which refusal of an episiotomy resulted in the OB 'manually' performing one after he was asked to put his scissors down (I'll let your imagination illustrate what that means exactly as I can't bring myself to type it). I realize that that isn't a newborn procedure, but it is important to remember that vaginas, sadly, can also be added to that list (even though female genital mutilation - of infants and children - is illegal).
    Anyway, thank you again for your post, I'll recommend it to others for sure :)

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  18. I love your chart, but I did notice you said that the W.H.O. does not recommend the HepB vaccine at birth. That is not true. They DO recommend it. Evidence and links below:

    "Since perinatal or early postnatal transmission is an important cause of chronic infections globally, the first dose of hepatitis B vaccine should be given as soon as possible (<24 hours) after
    birth even in low-endemicity countries."
    -World Health Organization
    Weekly epidemiological record
    2 October 2009,
    http://www.who.int/wer/2009/wer8440.pdf

    HepB: "...as soon as possible after birth..."
    http://www.who.int/immunization/policy/Immunization_routine_table2.pdf

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    1. Thank you for the correction - I will reference the following source instead of WHO in the post. Thanks!

      "In countries where hepatitis B is endemic (prevalence of greater than 2% carriage), a universal birth dose is recommended where such a programme is feasible."

      http://www.influenza.org.nz/?t=752

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  19. Thank you for adding to my knowledge. I'll add to your "blindedbythelight" with this. Nelson Mandela (Xhosa Tribe) said his circumcision was "blinding white light of electrical fire burning throughout all his veins."

    Three videos I recommend on male circumcision.

    1. Pediatrician and National Children's Ombudsman of Norway www.youtube.com/watch?v=74NJSOjBTNI (7 min.)

    Dr. Anne Lindboe discusses children's rights and circumcision. Says: she has seen the complications, the pain is as mush as adults, there's no problem waiting until older, saving money is not important in saving children, circ. is a form of violence, children should be protected from violence, circumcision is not a harmless procedure.

    2. Child Circumcision: An Elephant in the Hospital http://www.youtube.com/watch?v=Ceht-3xu84I

    3. Circumcision is Child Abuse by Aldin Entertainment Music Group http://www.youtube.com/watch?v=mJVR_BBKncI

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  20. One thing that can be included is the use of a Jewish mohel for cicumcision instead of an OB. The Jewish mohel will perform it on the 8th day which is, amazingly, when a baby has the peak amount of Vitamin K in their body. The procedure a mohel uses is different than the hospital and much more humane. Be sure the mohel has good references as well.

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    1. There is no such thing as a humane circumcision. Mohels describe theirs as being more humane only because they hold the baby down on a pillow with his family members gathered around. Just as painful and traumatic and just as likely to suffer from death or other complications. And some mohels will even swish wine in his mouth and then suck the blood from the baby's penis. Yes, put his mouth on a baby's penis and suck on it. Oh yes, let us please include a recommendation for using a mohel!!! Get real, I hope you don't promote that to people you know. Promoting sexual violence and rape to children!

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    2. I agree Cassandra. I wish this procedure would be banned for good.

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  21. I delayed or avoided all of these. I had a home birth with a highly skilled and trained midwife. I had a birth plan just in case. I am glad I did some research before having children.

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Please be respectful. If you are about to say something that you would not let your child hear, then please refrain from saying it.