Homebirth and a Newborn Exam with PKU Screening?

[eastkygal]

I'm curious how some of you in rural communities are planning to deal with having your baby receive a newborn exam from a doctor and PKU Screening.  Anyone feel PKU is unnecessary or very necessary?  If so, could you share with me some of your sources for making that decision.  Thanks!

[fruitfulmomma]

My  midwif did all that...hav you askd yours? 

[iowaorganic]

To be honest we chose to have a PKU just for the random chance that it came back positive- more of a liability issue I guess.  And I knew someone who missed having it done on their new baby unintentionally (the hospital screwed up) and it was positive and that is really really bad :(  Anyway- we waited about a week to take in DS3 and I just had it done at the hospital lab after the well baby visit (the only well baby visit we do actually).  I didn't want to do it any earlier because we don't do Vit K and I didn't want to deal with a lab tech going on about how much he would bleed.  And at a week old they have enough clotting that it isn't a big deal.  

The thing to watch is that these drs if you give them an inch they will try to take a mile :)  So they will probably try to push all sorts of junk on you like Hep shots, Vit K, and whatnot that is not necessary.

As for the rural aspect- our hospital/backup dr is an hour away- I couldn't find one closer who actually would follow my rules of "I pay the bill and you don't try to push me around".  

I kind of sound like a jerk huh?  I'm not :)

[katt]

We did the PKU after my milk came in and baby had actually digested some.

We only did it one time.

that was the only newborn invasive procedure we did.  Honestly, we did it cause DH thought it was a good idea and since I made most of the previous decisions, I didn't fight at all on this one.

[eastkygal]

I'm kind of torn.  I'm in a unique situation.  My midwife does not do PKU and refers to ped. However, where I am homebirth is not very rare, so I'm not sure what to do.  There is a ped. here who has told someone I know that she will do one, but right now we see a family doc and I don't know if it is worth the switch if I end up not liking her - just for a PKU. 

[fruitfulmomma]

Have you asked your family doc if they can? I think they would just need to get the kit from the state lab where they are sent to for testing 

[Peony]

We are quite rural, I have had multiple HB or UCs. One MW did a 7 day PKU, others did not or it was not an option like with a UC. Our pedi did one on one child at around 7 days as well, and another child I elected not to test. The one child I did not test is when we didn't have a pedi either just a ND, that child ended up having medical problems above and beyond what a family doc will do (not anything PKU related) so we quickly found a pedi who we still see 5+ years later. 

[bethandanna]

WE did the test. our MW did it at our 48 hr f/u visit which was at our home, she them mailed in the sample to be processed.  I spent a year working for a company that serviced kids with metabolic disorders, it's better to catch these early, so even though the test is a little traumatic for the parents and baby, it's totally worth it

[Thandiwe]

Our HB midwife doesn't do a lot of the testing, which is fine because we've chosen not to have any of the testing done on the last 2 births (nor will we have it done on the next one due in a few months).  I wish I could say it was because of a lot of thorough research, but my research is older (I did it nearly 5 years ago now and can't remember all that I read) and it ended up just being a gut decision based on what we had read about the risks and likelihood.  But we do things pretty hands off anyways; we only do the 20 week u/s for pregnancy, no blood work.  I have my usual prenatals with urine screens, but I don't do blood work and have decided not to do GBS testing this time (previous two I saw my family doc to have that done).

Good luck as you make your decision!

[lilbsmama]

We did the PKU when ds was 3 weeks old. We took him to the hospital and they did it in the nursery, and we were right there with him. It's one of those things that, while unnecessary, the test indicates some very serious metabolic disorders, and I was happy to know that I didn't have to worry about them.

[iowaorganic]

Originally Posted by eastkygal 

I'm kind of torn.  I'm in a unique situation.  My midwife does not do PKU and refers to ped. However, where I am homebirth is not very rare, so I'm not sure what to do.  There is a ped. here who has told someone I know that she will do one, but right now we see a family doc and I don't know if it is worth the switch if I end up not liking her - just for a PKU. 

I don't think this will matter.  My MW is a CPM and doesn't do it either.  We only have a family dr and that is the one who ordered the PKU.  I think the only limiting factor is if the hospital lab you will use delivers babies.  The hospital closest to me doesn't deliver and said they won't test because of that.  I wouldn't switch- just call your family dr.'s nurse and chat with them about having it done.  It really isn't a big deal and I can't even remember if I was charged for the lab or if our state pays for it.  I think your family dr will want you to have one done and won't mind ordering it for you.

[Plummeting]

Does your local health department not do it? My midwives have done it, so it didn't matter, but I know that in TN, the health department would do it for you if you hadn't had it done elsewhere, for whatever reason. I know because my CPM there said that the reason she did it herself was because she remembered being a new mom and having to sit in the office at the health department, waiting, with a week old baby, and she didn't want to have to make mothers do that. So I know that they do it at the HD, at least in some states.

Oh, and personally, I think it's very necessary and important. Sure, odds are good that there will be nothing wrong, but if you don't get the test, and there IS something wrong, your baby could be SERIOUSLY affected in permanent ways before you would ever know. It's just not worth it.

[JudiAU]

Our state requires and pays for PKU as well as a fairly large scan of a variety of inherited disorders that need immediate treatment after birth. In our state there are 5-6 lives saved by the program which is worth it to me. 

One of the midwives I administered does it. One does not and refered me to my ped. The ped wasn't a problem but she said she preferred me to get the newborn screening at the hosptial which her medical group is affiliated. She just said that they see more newborns and would be a better choice. She does rounds at the hospital but has a lot of faith in their on staff ped and they sometimes catch "weird things" she might miss.

[poppylove]

Originally Posted by katt 

We did the PKU after my milk came in and baby had actually digested some.

We only did it one time.

that was the only newborn invasive procedure we did.  Honestly, we did it cause DH thought it was a good idea and since I made most of the previous decisions, I didn't fight at all on this one.

This is our plan as well

[JudiAU]

Our state requires and pays for it plus a quite large range of rare disorders. Every year they find a couple of kids who would otherwise not thrive so I think it is worth the time. Our midwife does it and our ped was also willing to do it. 

[DesireeH]

My midwife came back to my house on day 2 to do it and mailed it to the lab, she did it while I was nursing so it was a little less traumatic. I was glad we did it because that lab paper is how the stupid social security place finally gave in and gave us a card (they wanted vaccine record which we do not have.)

[kawa kamuri]

I'm not rural, but my midwife came a couple times after birth to check up on us, I went to the office at two weeks postpartum as well as the pediatrician's office around that time. We went to the children's hospital for PKU. I can't imagine turning down the PKU for my child. When I had an OB attended HB he came the next day but otherwise we didn't see or hear from him. Same procedure for PKU.  

[mothercat]

In Ohio parents can have the midwife pick up the form at the local health department for no charge. They even provide the return envelope, postage paid.

Are any of you also getting the screening for critical congenital heart defects? It is becoming mandatory in more and more states. Ten so far, with bills pending in several more.

Linda

[dannic]

We get the testing done.  My reasoning is that it is not putting anything into the baby, but the information may very well be pertinent.  We refuse a lot of things, but we do the pku.  Our mw does it at her 2 day pp visit.  Or our nd will do it also if we would rather.  But my mw does it very easily and I breastfeed during...

[fayebond]

dannic has  a good point.  I would add, in my state, you get a little envelope to take home afterward with baby's DNA recorded in it, just in case something were to happen like she went missing and you had to prove she was yours.  Just for the little envelope thing with the state lab seal, I would totally do the bitty blood draw.  There doesn't seem to be a downside to it, either, especially if you wait until you're ready to show up.