In this blog I will be discussing the procedures that routinely happen in the hospital when you have just given birth to your new baby. There is a lot that happens in a short amount of time right after your birth. Read below about details of each procedure so you can make the best decision for you and your baby on how best to navigate each of them.
APGAR Score–
The APGAR score is an assessment done by your care provider to evaluate your baby’s well being immediately after birth. Determining your baby’s APGAR score is done to identify if he/she needs immediate intervention. The provider is assessing your baby’s transition to being outside of the womb. Your baby’s heart rate, breathing, muscle tone and color are assessed and given a score from 0 to 10. An APGAR score of 10 is very unlikely as most infants have discoloration in their hands and feet after birth (acrocyanosis). A score of 6 or less indicates to the care provider that your baby will need some level of stimulation and possible medical intervention quickly. The assessment is done a couple times just after birth to ensure your baby’s transition and condition is stable and improving.
Delayed Cord Clamping–
Delayed cord clamping is an option for all births where mama and baby are doing well immediately after birth. Even in cesarean births! It is now known that delayed cord clamping provides several benefits to your baby. These include increasing blood iron levels (reducing anemia) and improving your baby’s work of breathing. Also, it can decrease the size of the placenta and help with it’s detachment from the uterine wall. Delayed cord clamping will look something like placing baby skin to skin with mama until the cord stops pulsating (usually about 2 to 3 minutes) then it is clamped and cut for final separation of baby from mama.
Your Golden Hour-
The phrase, Golden Hour, is used to describe the 1st hour after giving birth to your baby. The Golden Hour is associated with implementation of several evidence based practices for mama and her newborn to support their wellbeing and encourage bonding after birth. Evidence based practices that you can advocate for in your Golden Hour include: delayed cord clamping, immediate skin-to-skin contact for at least an hour, completing your baby’s assessments on your abdomen, delaying non-urgent tasks for at least 60 minutes and the early initiation of breastfeeding (Neczypor & Holley, 2017). Your Golden Hour will help with your baby’s body temperature and breathing regulation, help your baby’s and your own stress levels after birth and start the bonding process between you and your baby (Neczypor & Holley, 2017). The practices of the Golden Hour have also been correlated with increased rates of breastfeeding. I encourage you to advocate for your Gold Hour. Take that time if you can and really soak in those 1st moments of your postpartum journey.
Vitamin K–
Vitamin K will be offered to your baby after birth. It is given to prevent a deadly but rare brain bleed in the first 6 months of life. Vitamin K is a vitamin we need to clot blood. Our body does not make Vitamin K. We have to get it through our diet. It is thought that babies are born without enough Vitamin K putting them at risk for brain bleeds during and after birth. It is also important to note that there is very little Vitamin K in breast milk and because of this babies who are exclusively breastfed tend to have low Vitamin K levels until they start eating solid foods at six months (Dekker, 2019). Dekker (2019) states, “a baby who does not have enough Vitamin K can start bleeding spontaneously, without warning. This type of bleeding can happen after birth (early bleed), in the first week of life (classical bleed), and from week two until six months (late bleed)”. Late bleeds occur in 4 to 11 babies out of every 100,000 who do not receive any Vitamin K at birth, 1 to 7 babies out of every 100,000 who receive 3 doses of oral Vitamin K after birth and 0 to 0.64 babies out of every 100,000 who receive injectable Vitamin K after birth (Dekker, 2019).
There is an oral and injectable Vitamin K option for your baby. If you choose oral Vitamin K, most likely you will need to order it and bring it to your birth (check with your provider).
Please note all of the following summarized from Dekker (2019):
- Bleeds can start spontaneously and not only occur after traumatic births.
- Delayed cord clamping does not appear to have an effect on the statistics of brain bleeds after birth due to the low Vitamin K content in cord blood.
- The injectable form of Vitamin K does have many additional ingredients besides just Vitamin K.
- An effective oral does is 2 mg orally at birth plus 1 mg weekly while breast milk makes up > 50% of feedings.
- There is no FDA-approved oral version in the U.S.
Dekker (2019) also mentions that, “multiple researchers found that giving Vitamin K1—whether it was a shot or an oral dose—significantly improved the baby’s lab results in the first week of life, when compared to nothing or a placebo”.
Erythromycin Eye Ointment–
This ointment is offered to your baby soon after birth to help prevent the development of pink eye from exposure to gonorrhea and chlamydia (sexually transmitted infections). It is recommended through research that screening for gonorrhea and chlamydia before giving birth is a more effective means of preventing these serious eye infections (Simkin, 2018, p.363). If a newborn develops pink eye, it is most often caused by chlamydia. The most serious type of newborn pink eye is from gonorrhea, which now causes less than 1% of cases but can cause blindness in less than 24 hours (Dekker, 2019). According to Dekker (2019), “researchers have found that erythromycin is about 80% effective at preventing pink eye from gonorrhea and might also offer some protection against pink eye from chlamydia”. Other bacteria from the mother, hospital, or home environment cause 30%-50% of newborn eye infections and are easily treated and not serious. The research on erythromycin use shows it might be effective at reducing overall bacteria in the eye, but due to antibiotic resistance, erythromycin is probably less effective at preventing newborn pink eye today (Dekker, 2019).
If you are wanting to decline giving your baby erythromycin eye ointment after birth, you should be screened for gonorrhea and chlamydia before birth as first line protection against the serious infections that can be transmitted to your baby. Also, you could follow a wait-and-see approach, in which eye infection treatment is initiated only when symptoms are seen in your baby. In this case, parents should seek immediate care and treatment if symptoms in the baby do arise (Dekker, 2019).
Hepatitis B Vaccine–
Your baby will be offered the hepatitis B vaccine within 24 hours of your birth. Before I continue discussing this newborn procedure I want to tell you I take a unique stance on vaccinations, but in this section I am leaving my personal opinion out of it. My goal with this section is to inform and provide resources for you to decide if giving a vaccine in the 1st 24 hours of your child’s life is something you want to do or not do.
Hepatitis B is a blood-borne virus affecting the liver. Blood-borne meaning there must be contact with infected blood (Hepatitis B positive blood) in order for your baby to get the virus. If infected with the virus in the 1st year of life, your baby has a 25% chance of having life long liver problems (Simkin, 2018, p.364).
Mama, it is up to you to weigh the risks and benefits of vaccine side effects with the possibility that your baby comes into contact with Hepatitis B and decide if you want to vaccinate your baby after birth.
Newborn Screening-
This is a very important topic of discussion. Here is a short summary. I would like to encourage you to read my Newborn Screening blog post which has additional critical education on this topic with included resources on next steps.
Newborn screening is a blood test routinely done between 24-48 hours after birth. The newborn screening blood test screens for many genetic, endocrine & metabolic disorders that are considered to be rare, but if diagnosed early can be cured or treated with early intervention to increase the child’s long term health and quality of life. Early diagnosis and intervention can prevent disability and even death from some of the disorders. Also included in the complete newborn screening process is a hearing test and a pulse oximetry test which I discuss next in this blog.
Newborn screening is important because the conditions that are being screened for can cause a child severe disability, chronic (long term) health complications and even death. Not only is it important to have the test done but also to have it done in a timely manner. Newborn screening is typically completed within 10-14 days after birth. For some of the conditions, screening can be done as late as one year after birth and with immediate intervention can still yield improvements in the child’s quality of life if diagnosed. Simply stated, the earlier testing is done, the better. The next important thing you need to know about newborn screening is that every state’s list of included conditions have many conditions that were chosen to be left out. Yes, you read that right. Your child could end up with a condition that was excluded from the newborn screening process of your state. What this means is that even though you might choose to do the testing, the testing is not as complete as it could be because there are a list of conditions that are being excluded.
Pulse Oximetry Screening-
This simple and non-invasive exam will assess your baby’s blood oxygen levels using a sensor [typically] on the hand or foot. This takes just a couple minutes and can alert providers of possible heart conditions that need further assessment.
Newborn Hearing Screening-
This simple and non-invasive exam will assess your baby’s hearing over several minutes using a sensor in the ear or headphones. This quick procedure can alert providers of possible hearing deficits that need further assessment. Early detection of hearing loss and implementation of a plan of care can result in improved language development in your child.
Infant Security-
If your birth place is outside of your home your baby will most likely be given a security tag to be worn at all times after birth until your baby is discharged home. These tags are not removable without cutting the anklet band. If the anklet is not disarmed prior removing or cutting the band, the alarm is triggered to prevent your baby from being taken out of the mother and infant areas as well as out of the hospital unknowingly (aka baby kidnapping).
Baby’s First Bath-
Delaying your baby’s first bath for at least 8 hours after birth is an evidence based practice. At birth your baby’s skin is covered [in varying amounts] with vernix caseosa. How far along you are in your pregnancy at the time you give birth does impact the amount of vernix your baby will have, with shorter gestational age typically showing more visible vernix. Vernix proves to be a layer on top of the skin that reduces friction during the birth process. It also provides an antimicrobial barrier to the skin, protecting the baby as he/she passes through the birth canal (Smith & Shell, 2017). Vernix has benefits to your baby even after birth as well.
Benefits of delaying bathing for at least 8 hours after birth:
- protects the newborn’s skin from bacterial invasion
- keeps their skin more hydrated with less cracks & dryness
- promotes a stable blood sugar
- encourages successful breastfeeding
- enhances bonding
- facilitates early and prolonged skin-to-skin
One study concluded that there was a significant likelihood of increased breastfeeding if the bath was delayed (Smith & Shell, 2017).
Vernix is 81% water, 9% protein containing lipids and 10% other fat (Smith & Shell, 2017). 39% of the vernix proteins have properties of immunity and 29% have direct antimicrobial properties (Smith & Shell, 2017). This is how vernix plays a role in protecting your baby’s skin from bacterial invasion.
Please note that there are times when the newborn bath is recommended immediately and a bath is done to reduce chances of transmission of disease and microbes.
- Babies born to HIV positive mamas
- Babies born to Hepatitis positive mamas
- Possibly for babies born to mama’s with chorioamnionitis
- Possibly for babies with significant meconium staining
There is no set time that the 1st bath is being recommended to happen. It is becoming more common to delay the first bath past your hospital stay and do it at home when you feel ready (Smith & Shell, 2017).
So there you have it mama. I hope going through the details of routine newborn procedures will help you make informed decisions about each of them during your birth experience. Thank you for being here with me on the blog. Reach out with any comments or questions. I love hearing from mamas who read my blogs.
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References
Dekker, Rebecca. (2019, April 9). Evidence on: The Vitamin K Shot in Newborns. Evidence Based Birth. https://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/
Dekker, Rebecca. (2019, November 6). The Evidence on: Erythromycin Eye Ointment for Newborns. Evidence Based Birth. https://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/
Neczypor, J. L., & Holley, S. L. (2017). Providing Evidence-Based Care During the Golden Hour “[Abstract]”. AWHONN, 21(6), 462-472. DOI https://doi.org/10.1016/j.nwh.2017.10.011
Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2018). Pregnancy, Childbirth, and the Newborn: The Complete Guide (5th ed.). New York, NY: Da Capo Press, Incorporated.Smith, E. & Shell, T. (2017). Delayed Bathing. International Childbirth Education Association. https://icea.org/wp-content/uploads/2018/02/ICEA-Position-Paper-Delayed-Bathing.pdf
