The Motherhood Café Presents: NEWBORN HOSPITAL PROCEDURES
Clair McStacy: CNM at CMG Women's Center
Erica: Today we’re going to talk about those crazy first hours and days with a newborn. We always feel that the more a mama does to educate herself proactively, the less fear and doubt play into the exhaustion of the newborn days. We’ll discuss common tests and procedures, as well as, some wonderful changes that our local hospital has recently undergone.
Per usual, I’m here today as a facilitator of conversation. Our audience and panelists are always welcome to jump in at any point with questions and comments.
Erica: So Baby pops(!) out and we have an immediate decision to make: cord clamping . Can you talk a little about traditional vs. delayed cord clamping? Pros and cons?
Clair: We want to provide best start for baby. By delaying clamping, all of the blood from the placenta is getting into baby, which will increase blood cell count, boost immunity, etc. It’s now best practice here at our hospital. Started research in premature babies and what gives them the best start. The blood flow from the mom to the placenta…when baby is born, the placenta is still attached, so it’s still pumping blood from mom to baby.
Erica: Would you say many OBs and midwives practice delayed cord clamping? With whom does this decision lie?
Clair: Definitely communicate it. Personally, I prefer to wait, but it’s never a bad idea to communicate your desires to your care provider.
Erica: So, the baby’s out, the cord decision is done. Let’s talk about “ skin to skin.” Can you tell us a little about the changes our hospital has made with its Baby Friendly designation and how that relates to the first hours after birth?
Clair: First couple of minutes: baby comes out and has nice clear fluid, then we give baby right to mom, on her belly. We leave the baby there to regulate respiratory and circulatory systems. They can regulate temperature and are more stable and comfortable smelling and hearing mom. We leave them for an hour and like for babies to start nursing within that hour.
Erica: To recently delivering new mothers: What are some of the changes you observed?
Keri: went straight to NICU, also had pacis within an hour.
Brittany: had to cut cord while he was still inside because it was wrapped so much, but once he was out and they knew he was stable they gave him to me and we did skin to skin, etc.
Alicia: With my first I was researching and heard everything about ‘fight for yourself! Be an advocate!’ but once I was there and in labor I didn’t know what was going on. I think it’s important to remember that even with hospital best practices, it may depend on the individual care providers that you have.
Erica: Is the NICU a different animal?
Clair: Yes. Their job is to really grow the babies and get them breathing on their own. So their focus is different.
Erica: What is the thinking on immediately bathing vs. not bathing a newborn? Does a mother’s choice to have her baby remain unbathed require additional cautionary procedures for their time in L&D or the mother/baby unit?
Erica: with my first, I held her for a couple minutes, then they took her and gave her a bath then gave her back. With my third, it was very different. What does the research say/what does it look like at the hospital?
Clair: it used to be routine, you got Johnson baby wash, would wash the baby’s hair, baby would get cold then need to be in the warmer. Now, it’s a choice. Babies have vernix when they are born (that white filmy stuff). If you rub that in it keeps their skin softer and is a protective barrier. Baby may have body fluids (blood, meconium, etc.) so they will be treated as a body fluid contamination. One of the things they may worry about is passing on something like Hepatitis. So the nurses may wear gloves and even a gown when holding and checking baby.
Erica: Can you tell us a little about the shots and ointments a newborn receives? Erythromycin, Vitamin K, Hep B? How they are administered? Can you opt out of these? If yes, how is this done?
Clair: These are all choices!
Erythromycin: it’s an antibiotic gel that comes in an ointment. The origin was that Gonorrhea can cause infant blindness. So when they started in the early 1900s, every baby got it on their eyes just in case. Some people argue that it could help with other issues like conjunctivitis, etc. The downside to it is that they’ll have gunky eyes for a couple of hours after.
Vitamin K: it’s a clotting factor. We’re not born with it, it’s something we create in our bowels that we get from plant matter. We recommend it at birth to prevent an intracranial hemorrhage, and helps so there isn’t much bleeding if you have a baby boy getting circumcised. It helps with clotting.
Some people ask about oral Vitamin K. You have to do it every week for 6 months.
Hep B: vaccination that they offer in the hospital so you can start the series before you go home. You can get it in the first 24 hours, or if you skip it you can get it at 2 months of age if you choose. It’s to help prevent passage of Hep B to baby if mom has it; if she doesn’t, it doesn’t really prevent/treat anything at that point.
Circumcision: we usually want to have the baby pee first, so will do it sometime in the first 24 hours or so.
Erica: If you don’t want to do something, what do you do?
Clair: say ‘I don’t want to do that.’ And you sign a paper.
Erica: Birth plan? Yay or nay?
Clair: sure! I think they’re good to have, but do so by also communicating with your care provider throughout your pregnancy about your wishes and questions, so you’re on the same page already.
Erica: There are two tests administered a bit later and before discharge from the hospital. Could you touch briefly on the PKU Test & Hearing Test? Under the new protocols, how and when are these tests now performed?
PKU test: part of a metabolic panel that the state tests for, where they are looking for specific genetic abnormalities where they may not be able to process certain foods that have PKU in them and it can damage their neurons and they will have a developmental delay.
Hearing test: I don’t understand it a lot actually…I just know they put cute little earmuffs on them and say if they heard something. Erica: I heard that they watch to see if hair follicles vibrate a certain way, etc. You can also do it at your doctor’s office later. If baby is crying, they can’t administer the test. (at least at the hospital)
Erica: Would you recommend interviewing/and securing a pediatrician before birth? Would that be a good time to talk through some of these topics? What did you do personally? How did you pick out a pediatrician?
Clair: I had a friend who was a pediatrician, so I went with them. I think things to ask are if they aren’t available personally, who would be the back up? If you have concerns about vaccinations, find out about how that works, ask questions about your personal ideas and desires from the pediatrician.
Erica: Any recommendations for our mothers as they seek to approach their first hours and days of motherhood as “thinking women” that still wish to have a pleasant relationship with their nurses?
Erica: We hear a lot from people that they have felt pressured to maybe feed formula or do tests if baby isn’t gaining weight…this is in the hospital from the pediatrician. What would you suggest people do if they feel like they’re being unduly pressured in that situation?
Clair: Do your research. Find out how many wet diapers baby should have a day. Know that most babies do lose weight. My first baby was premature so we rented a scale, because I wanted to see them gain the weight.
We have lots of options … if you want a second opinion, get a second opinion. Talk to a nurse, find someone else to talk to. A lactation consultant! We have fabulous ones at the hospital.
Erica: Trying to encourage breastfeeding from the start, how do you do that?
Clair: Try to leave baby alone for that first hour to see if they’ll try to nurse. We’re all trained in latch. We recommend feeding on demand, so you can learn baby’s cues. Baby stays with you now in the room so you can work on it while there.
Audience comment: Be aware of tongue-tie. It’s not routinely checked for in the hospital, but it’s something to ask. Ask the lactation consultant to check, ask the nurse, ask the doctor.
You may even decide to request to have an ENT specialist come into hospital to evaluate your baby.
Also, don’t pretend everything is OK if it’s not. When you’re in the hospital, and you have the help, ask the questions. ‘Can you come look, really check and make sure things are OK? This is hurting, etc.’
You can call the warm line or Baby Café anytime if you don’t think of a question until later!
Centra’s 24-hour lactation support services: (434) 401-9344
Erica: For those who have either decided from the beginning that they don’t want to breastfeed, or after they get into it a little bit it isn’t working for them, how does that work? What do you do?
Clair: we would like to provide you the tools to help you breastfeed, however, we know that this is your life, your child, and we will support you. You don’t have to bring your formula to the hospital.
Erica: Is there anything you see often enough that you think ‘I wish more moms would know about xyz…?’
Clair: Hmm…probably the most important thing to me is for mom to know that you need to sleep when the baby sleeps – especially in the hospital. You don’t need a whole stream of visitors keeping you company. It’s time for mom and baby to work on getting to know one another and work together. When you get home, have people over. And then have them do laundry and dishes and bring you food and leave.
Erica: Jaundice levels – what’s normal?
Clair: Most every baby gets a physiological jaundice, which is where their body doesn’t break down blood cells very well, and they get a high level of bilirubin. That’s where the yellow comes from. Jaundice at high levels can cause some serious problems, but getting fluids in does help it move through their bowels. If they levels are high, they put them under a blue light blanket to break down those bilirubin levels in their skin.
We’ve heard some moms say formula was pushed in this instance, to get more fluids in.
As you can see, your choices abound! We strongly encourage you to use this short time of discussion as a launching point. Dig deeper, discuss with your pediatrician and care provider, do research, be prepared.