Originally Posted by mylilmonkeys
As an apprentice, I have done the heel stick a number of times. We preferred to let the baby cry, as the increased heart pumping helps the blood to flow faster. It is really difficult, sometimes, to get all the blood needed to fill the sample card, and they will send the card back and insist on a retest if there is the slightest spot not covered, or if it takes too long to fill the sample, allowing areas to dry before it is filled. No one likes to retest just because the first test was refused for one of these problems.
It sounds to me like you have been using a far less effective method of blood collection than you could be. Let me suggest the following, so you can prevent a lot of baby distress and have an easier time with the collection yourself:
1. Use a neatnik or tenderfoot lancet--these are small blades, not pin-hole type. The blade mades a shallow slice instead of a tiny hole--a slightly larger wound that bleeds more initially. The babies clot pretty quickly nonetheless once you're done. These blade-lancets cost only a few dollars and are well worth it all around!
2. Warm the baby's foot/lower leg thoroughly before using the blade-lancet. A heating pad is a great tool for this--just fold the heating pad around the baby's leg for several minutes while mom holds baby comfortably. A warm leg will make the blood flow more freely, no need whatsoever to cause the baby more distress just to get the blood pumping well.
3. Mom should hold the baby upright against her shoulder (like when burping a baby, facing mom's shoulder). This way you will also have gravity's help with sufficient blood flow--and baby will be in mom's arms in a comfortable position, also reducing baby's distress from the small pain of the lancet.
4. Have your stuff all ready, so that the instant you make the cut, you are ready to catch blood.
Since using this method, very few babies cry--and those that do, cry very little and generally are settled before the blood is done being collected. Even those that cry a bit all through, do not cry nearly as hard, and are soon settled the second you stop messing with their leg. All that is needed is several drops of blood--this can collected within 30-60 seconds, depending on how freely the baby bleeds. It is only rarely necessary to gently milk downward on baby's calf to promote a little more flow; only rarely necessary to use an alcohol wipe over the cut to interfere with clotting and thus promote a little more flow.
For the parents: insist that your provider use a blade lancet, not a point. You can buy one with your birth supplies if you are having a homebirth. Hold your baby during the process, make sure your baby's leg is nice and warm. If your providers don't already do the things suggested above, then tell them this info first so they understand what you want---those who are unaware of this method may be quite pleasantly surprised to learn something new that prevents baby's distress during the collection.
Having once used the point-type heel stick--and not warming, the leg either--I can tell you, some babies cried so hard! I hated that I was distressing them and of course babies and parents weren't too happy either. Much nicer for everyone to use a method that causes less pain, requires less prodding/milking of the foot to get the blood. The point-type stickers are great when you only need a drop or 3 of blood....but the blade lancets, used on a warmed leg, are by far superior when you need more like 12-15 drops for the collection card.
ETA: The test is best done at about 3-4 days pp, when the milk is in or starting to come in. Earlier testing may not be conclusive and will just need to be done again. It is done at 24-48hrs in the hospital MAINLY because that is when they have you/baby on hand--and the possibility of false positives is why they may want the test repeated a 2nd time later. Also--if for any reason the screening is not done by 3-5 days pp, then it's best to wait until 2wks, IMO. That is mainly because baby's clotting factors have reached their peak at 8days; it can be much harder to get a good blood flow at/around that time. If you wait til 2wks, then clotting factors have backed off a bit and testing is easier. Of course, if baby seems symptomatic (of anything, really) then it's best to get med eval ASAP, no matter what the baby's age.
Edited by MsBlack - 12/16/10 at 6:24am