Do you cut the cord immediately or leave it clamped for a few minutes? Save the cord blood or not? Circumcise or go natural?
Whether you choose a home birth or a traditional hospital birth, there are a wide variety of decisions that you need to make in the hours, even minutes, after your baby is born. Some of these decisions will stay with your baby for the rest of their life. So, it’s important to consider your options carefully before the big day.
Let’s look at some of the most common medical decisions you’ll have to make post-delivery, and analyze the pros and cons of each option.
Common Medical Decisions for Newborns
1. Delayed Cord Clamping
Many new parents think that their baby’s cord will be cut immediately after delivery, usually within 30 to 60 seconds. This rite of passage is often given to the partner in the room. However, you can choose to delay the cord clamping by several minutes. Why might you want to wait?
There are several benefits to delaying cord clamping by one to three minutes, or even longer.
First, delayed cord clamping enables the baby to receive more blood from you. According to the American Pregnancy Association, those extra few minutes can boost your baby’s total blood volume by as much as 30% or more.
There are other benefits as well. A study published in the journal Obstetrics, Gynaecology & Reproductive Medicine found that delaying cord clamping leads to lower iron deficiency rates. Higher iron is vital for healthy brain development. The study also found that in preterm babies, delayed clamping can lead to greater cardiovascular stability and possible reduction of intraventricular hemorrhage.
Another study, published in the journal Pediatrics, found that delayed cord clamping helped prevent late-onset sepsis in low birth-weight babies, especially males. Additionally, some doctors believe that the last rush of blood from mother to baby can help the baby better cope with the transition from the womb to the outside world.
Of course, there are possible side effects from delayed clamping. One of these side effects is a slightly higher risk for jaundice. However, the Journal of American Medical Association (JAMA) analyzed several high-quality studies on delayed cord clamping; they came to the conclusion that delaying cord clamping by at least two minutes is beneficial to newborns, and that these benefits extend well into infancy.
So, delayed cord clamping has many positives. However, this decision is directly affected by the next one on the list: whether or not to bank your baby’s cord blood.
2. Banking Cord Blood
The blood contained within the umbilical cord is unique and powerful because it contains stem cells. Stem cells can be used to grow new tissues, blood vessels, and organs.
Think of stem cells as shape-shifters. When they divide, they can either become a stem cell, or they can become another type of specialized cell. For example, stem cells can be used to repair worn-out cells in your bone marrow. They can become blood cells, brain cells, or muscle cells.
Stem cells can help treat a number of very serious diseases, such as leukemia and Hodgkin’s disease, as well as some cancers and blood disorders. It can help treat some conditions that are often fatal for infants, such as Krabbe disease.
You can choose to donate your baby’s cord blood for others on a waiting list, or for research purposes. You can also choose to have it stored in a blood bank so that it’s available if your baby ever develops a serious medical condition.
You need to determine if you want to bank your baby’s cord blood weeks or months before they are born. Here’s how it works.
Immediately after your baby is born, the cord is clamped and cut. Then, your doctor inserts a needle into the umbilical cord that’s still attached to the placenta and begins to draw blood, usually one to five ounces. This blood is collected and then shipped off to whatever provider you’ve chosen to process and store the cord blood.
You might also decide to have some tissue removed from the umbilical cord. Umbilical cord tissue contains stem cells that are different from cord blood stem cells. This is another research field that’s still in its infancy; doctors are currently studying the potential of these tissue cells for organ regeneration and disease treatment.
It’s important to realize that if you do decide to bank your baby’s cord blood, you might need to cut the umbilical cord fairly quickly (often within 30 seconds). Delayed clamping might affect the volume and quantity of stem cells needed for banking. Talk to your doctor ahead of time about your options here.
3. The Hepatitis B Vaccine
The hepatitis B vaccine is routinely administered to newborns before they leave the hospital. So, how serious is hepatitis B, and why should you consider the vaccine?
Hepatitis B is a liver disease caused by the hepatitis B virus. It’s contagious, and if your newborn is infected with the virus, they can develop one of two types of infections.
Acute hep B infection refers to the infection in the first six months of acquisition. In some people, the illness is mild with few or any symptoms; others can develop a serious, life-threatening infection that requires hospitalization.
The other type of hep B infection is chronic, which means symptoms don’t get better after six months. The person stays ill, and the virus remains active. Chronic hep B can cause serious, long-term health effects. According to the Immunization Action Coalition, one in four babies infected with chronic hep B will die of liver failure or liver disease as an adult. And because babies have such weak immune systems, it’s estimated that nine out of ten babies who contract hep B in their first year will stay infected for life. There is no cure.
Hepatitis B is passed from mother to newborn, often because the mother does not know she is infected. Other times, babies can contract the virus from family members who, again, do not know they’re ill. The virus spreads through body fluids, so even a child who picks up another person’s toothbrush and puts it in their mouth can become infected. The virus can survive up to seven days on objects.
Fortunately, the hepatitis B vaccine is very safe. Side effects are rare and mild (typically just a sore area around the vaccination site or a mild fever).
4. Vitamin K
The other shot you’ll have to make a decision about on delivery day is vitamin K.
Vitamin K helps prevent bleeding, and newborns are born with very little vitamin K in their systems. Vitamin K deficiency can cause unexpected bleeding, called vitamin K deficiency bleeding (VKDB), even in previously healthy infants. VKDB occurs in almost 2% of newborns during the first week of life. However, VKDB can manifest weeks or months later as well; this is called “late VKDB.”
This bleeding can be catastrophic, especially when it occurs in the brain.
What if, in her first few weeks, your baby needed emergency surgery? Without enough vitamin K in her system, she might not be able to undergo the treatment she desperately needs.
If you’re breastfeeding, the nutrient-dense milk you produce the first few days after delivery is very high in vitamin K. So, your baby will start building her stores of vitamin K day by day, as long as she continues breastfeeding. However, the shot can provide a big boost of vitamin K for your baby, just in case.
There has been some controversy surrounding vitamin K injections at birth, as some researchers have claimed that the intramuscular vitamin K injection might be linked to cancer. However, research published in the journal Pediatrics concluded, “There was no association between the intramuscular administration of vitamin K and childhood leukemia or other cancers.” Thus, the American Academy of Pediatrics recommends that all infants receive a vitamin K shot within their first 12 hours of life.
If you have a baby boy, you’re going to be faced with the tough decision of circumcision.
Circumcision is the surgical removal of the foreskin on the penis, typically within the first few days of life. According to Children’s MD, it may be the oldest recorded medical procedure in history, dating back to 2200 BC. Some religions, such as Islam and Judaism, see circumcision as an important part of their culture and faith.
While circumcision used to be quite common, it’s becoming less so. Children’s MD reports that circumcision rates have fallen to 55% nationwide, but rates vary considerably depending on your location. In the Midwest, 71% of male newborns are circumcised; however, out west, this number drops to only 40%.
The procedure has its advocates and dissenters, even within the medical community, and there are arguments to be made on both sides.
In 2012, the American Academy of Pediatrics assembled a task force to analyze the evidence regarding circumcision’s benefits, and to determine whether or not they could recommend the procedure. After reviewing over 1,000 studies, they found that circumcision can help prevent urinary tract infections, transmission of some sexually transmitted infections, acquisition of HIV, and penile cancer. Circumcision also makes genital hygiene easier. However, these benefits were not enough for them to recommend the procedure.
As you might imagine, the procedure is painful and relief is left up to the attending physician. It’s most common to give the newborn two numbing shots at the base of the penis. When effective, the newborn experiences no pain. However, the shots are not always effective, and sometimes the procedure is still carried out even if the baby is experiencing pain (as evidenced by increased heart rate, breathing, and cortisol levels).
Another drawback is the level of care a newly circumcised penis requires. The penis must be well coated with ointment for several days to ensure that it does not stick to the diaper as it heals. It must also be kept very clean, which is not easy to do during messy diaper changes (especially when you can’t bathe your baby for at least a week after the procedure).
Many parents believe that a circumcised penis is easier to keep clean once it has healed. However, intact penises (the medical term for a penis that has not been circumcised) require no more care than a circumcised penis. For newborns, you simply wash the penis as you would their fingers and toes. Once the child reaches the age of five, the foreskin has retracted from the penis; at this age, you’d simply show your son how to gently pull the foreskin back during his bath to wash it, and then let it go back to its usual position.
Circumcision is a controversial topic, but there’s only one right decision: whatever you feel is best for your son. It’s an irreversible decision, however, so it’s important that you fully understand the pros and cons so you can make the best choice.
6. Skin-to-Skin or Swaddling
In a home birth environment, newborns are immediately placed on the mother’s chest the moment after they’re born. They’ll typically stay there for an hour or more to bond and begin feeding.
However, in a hospital, you have to outline in your birth plan whether or not you want skin-to-skin contact immediately after delivery (often called “kangaroo care”), or if you’d rather rest first and connect with your baby after they’ve been examined by the nurses and attending physician.
The World Health Organization (WHO) recommends that all mothers and newborns, regardless of feeding preferences, have uninterrupted skin-to-skin contact for at least an hour following birth. They also state that all newborn care can either take place while the newborn is lying on the mother’s chest, or be delayed for a few hours.
One of the biggest benefits of skin-to-skin care is that it increases the mother’s level of oxytocin. Oxytocin, often called “the love hormone,” helps promote a stronger bond between mother and child. It also helps alleviate stress in both mother and child, and helps ease the newborn’s transition to the “outside world.”
According to “Healthy Birth Practice #6: Keep Mother and Baby Together—It’s Best for Mother, Baby, and Breastfeeding,” a study published in the Journal of Perinatal Education, newborns who do not receive skin-to-skin time during the first hour after birth are at a greater risk for suppressed protective behaviors and have more difficulty breastfeeding and bonding. Delayed skin-to-skin might also negatively affect maternal behavior; this can show up as rougher handling of the infant during feedings, lower effective responses, and fewer maternal behaviors in response to the baby’s cues.
Additionally, the study found that “compared with newborns who did not have skin-to-skin care, newborns who had skin-to-skin care cried less; had enhanced cardio-respiratory stability, including oxygen saturation levels; more stable blood glucose levels; and, enhanced thermal regulation.”
However, it’s important to remember that labor and birth are exhausting and overwhelming. If you’d rather have some time to yourself to recover and rest, that’s fine. The best decision is what you need at the time.
7. Antibiotic Eye Ointment
Last, you’ll need to decide whether or not you want your baby to receive an antibiotic eye ointment – usually erythromycin – right after birth.
If you currently have a sexually transmitted infection (STI), such as gonorrhea, herpes, or chlamydia, your baby must have the eye ointment within an hour after delivery. The eye ointment can help protect against blindness caused by an infection, which can manifest as a result of the STI. If left untreated, the damage is permanent.
However, the ointment also protects against eye infections from E. coli and neonatal conjunctivitis (pink eye). These bacteria are commonly found in the genital and rectal areas, so even babies whose mothers don’t have an STI still run the risk of eye infection if they are delivered vaginally. While infection risk is low, it’s still common enough for the American Academy of Pediatrics to recommend that every infant be given the antibiotic ointment.
Having a baby is an overwhelming experience, and these seven decisions are just a drop in the ocean of choices you’ll have to make for your child during their lifetime. Some of these choices aren’t easy, but by researching each choice when you can and listening to your inner voice, you will make the best decision for your child, and for yourself.
Which of these decisions did you find hardest to make when your child was born? Is there anything you wish you would have done differently?