Newborn Decisions

During the moments directly after birth, you need plenty of time to rest quietly with your baby. Don’t let anything stand in the way of that.

If you give birth in a hospital, there may be some pressure from nurses who want to take the baby to a warming bed in the nursery or to an examination.

Your midwife or doctor will want to see that your baby is in generally good health. It should be possible, however, to do all that is necessary while you are holding the baby. These factors will be checked:

  • The baby’s weight and length at birth
  • The baby’s air passages. Many birth attendants routinely suction the airways, while others feel it best to leave the baby to do this on her own and only intervene if necessary.
  • The baby’s heart rate
  • The baby’s tummy, to see if the liver and spleen seem to be all right
  • The baby’s skull
  • The roof of the baby’s mouth, to check for cleft palate
  • The genitals, if it is a boy, to see whether both testes are present

Apgar Rating
Your baby will be tested at 1 minute after birth, and again at 5 minutes, using the standard Apgar scoring system. This checks five points:

  • Appearance (skin tone)
  • Pulse (heart rate)
  • Grimace (response to stimulation)
  • Activity (muscle tone)
  • Respiration (breathing effort)

A baby can get 0, 1, or 2 points for each category, with a maximum score of 10 for all the points together. Most babies score a 7 or higher. Many infants score in the low range on the first test, but then score much higher on the second one, after they’ve had a few minutes to adjust to their surroundings. It should be possible to conduct this test right at your side.

Keep in mind that the Apgar rating is subjective. It is an evaluation done only with a visual check, and one person may tend to score very differently than another.

Vitamin K Shots
Babies are born with extremely low levels of vitamin K. In fact, most mammals are born with low levels of this vitamin. Scientists are not sure just how vitamin K is metabolized in the body, but is known to promote coagulation of the blood, although it is not a clotting agent in and of itself.

A few infants get newborn hemorrhagic disease soon after birth, a potentially life-threatening disorder that causes severe bleeding. Other infants, about 1 in 17,000, get this same disease later, between 2 and 12 weeks of life. Because of this risk, it has become general practice to give all newborns a vitamin K injection shortly after birth, whether or not that infant is in a high-risk category for hemorrhagic disease.

In many states in the United States, having a vitamin K shot is mandatory. In other states, it is possible to refuse the treatment without risk of intervention, but a great deal of pressure is put on parents to comply with it.

In many other countries, including Canada, Sweden, and Britain, it is considered to be much more humane to give the supplement orally, rather than subject a newborn infant to the pain of a shot. This approach has been shown to be effective, as long as parents are diligent about giving the follow-up doses—but unfortunately oral vitamin K is not always available in the US.

The safety of vitamin K supplements is a matter of great controversy. There has been some speculation that they may increase risk for leukemia and other cancers in children. More recent concerns focus on high percentages of newborn jaundice in infants who have been given this shot, perhaps because vitamin K is synthesized by the liver.

In fact, some vitamin K packaging warns of this possibility and adds the disclaimer, “Little is known about the metabolic fate of vitamin K.”

Some newborns are at higher risk for early hemorrhagic disease. If the mother has been treated with anticoagulants, antiseizure medications, or antibiotics during her pregnancy, for example, there is an increased chance. Women who have used extremely excessive amounts of vitamin E, aspirin, mineral oil, alcohol, or have been exposed to rat poison are also in a high-risk group.

There might be a good reason why most mammalian infants are born with low vitamin K levels, and we just haven’t figured out why. Unfortunately, proponents of vitamin K injections suggest that breastfed babies are at higher risk for the later onset type of hemorrhagic disease. This is because human milk is naturally lower in vitamin K than cow’s milk. This does not mean, however, that the levels in breastmilk are not enough. Colostrum, the first fluid a breastfeeding infant receives from his mother for three to four days, is quite rich in vitamin K.

Eye Treatments
Another routine newborn treatment is the application of antibiotics to the infant’s eyes shortly after birth. Midwives do this after homebirths, and in hospitals and birth centers to prevent gonorrhea, or other infections, from attacking the newborn’s eyes and potentially causing blindness.

About 5 percent of women who give birth do have gonorrhea. Most are not even aware of it. Unfortunately, tests for this disease are notoriously inaccurate—it is quite easy to test a false negative.

On the other hand, blindness from gonorrhea does not happen instantaneously. No tests have been conducted to see if having the eye drops as a preventative is any more effective than watching your baby for signs of trouble. If you choose to skip the antibiotic treatment, report any signs of irritation or infection, such as oozing or redness, to your baby’s health care provider, explaining that she was not given antibiotic eye drops at birth.

Hospitals used to apply a solution of silver nitrate to infants’ eyes before the use of antibiotic ointments became common. A few still do use it, so be sure to ask. Avoid silver nitrate because it stings and appears to be quite painful to newborns. It causes puffiness and oozing in the eyes. It is also not effective in treating chlamydia, another sexually transmitted disease that can affect a newborn’s eyesight.

If you decide to go ahead with the eye treatments (and in some states you have no choice), be sure to delay it for one hour. The ointment will temporarily blur your baby’s vision—so take some time to bond and cuddle together first.

PKU Screening
Phenyhlketunuria, or PKU, is a rare error in the metabolism of an essential amino acid, phenylalanine. The bodies of afflicted infants are unable to process this amino acid, which is found in animal proteins, including dairy products.

If your baby is born with this problem and it is left untreated, it will eventually result in some degree of mental retardation, possibly severe, and other physical problems. Although it is not curable, if it is caught early and dietary changes are put in place, it is possible to bypass most or all of these troubles. To be effective, these dietary changes need to be started as soon as possible, hopefully before the age of three months.

In most states, it is mandatory for all infants to have this screening within two to six days of age. The baby needs to eat for two to three days before the test can be effectively processed. If you have given birth in a hospital, you may not be permitted to leave until this has been completed. If you give birth at home, you will need to go to a hospital or doctor’s office to have the PKU screening done.

Blood samples to test for PKU are usually taken by pricking the baby’s heel with a sharp lance. In most hospitals, protocol forbids the mother from holding the infant during this procedure, which is clearly a painful one.

One carefully conducted study in Stockholm compared the response between newborns who had blood taken in the standard way, via heel lancing, to infants that had blood drawn with venipuncture (a small needle inserted into a vein). The result was quite dramatic. The infants who had blood drawn with venipuncture cried less vigorously and for a shorter period of time. It was also easier to complete the procedure. With venipuncture, it only took one try in 86 percent of the babies. With lancing it took one try in only 40 percent of babies.

Informed Decisions

You will be faced with decisions regarding medical procedures and tests for your newborn within minutes of birth. Learn about the routine procedures in your birth setting, and consider the following:

Weigh the pros and cons of each procedure or test. Gather information from both sides. Do this as early as possible.

  • Involve your partner in the process.
  • Ask if there are alternatives to the accepted treatment.
  • Seek medical providers who are sympathetic to your needs and wishes.
  • Consider the implications of both sides of the decision.
  • Consider delaying procedures, if that is an option.
  • Do one procedure at a time.
  • Hold your baby during each procedure, if you can.
  • Make peace with your decision, knowing you’ve tried your best to safeguard your baby’s health.