Newborn Procedures to Reconsider

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