large babies and heel sticks

[aprildawn]

ok. i've noticed several of you predicting larger than average babies. my first was 9 lbs 1 oz and i figure this one will be the same or bigger. we're having a hospital birth even though it's not my first choice. (can't afford homebirth with the midwife i want and insurance won't pay anything because, well, if you can't say anything nice... )

my question -- those of you anticipating large babies, are you planning on birthing at a hospital? if so, did they heel stick your previous babies to check their sugar? they did mine - repeatedly - and looking back i wish i hadn't let them. but i was naiive and didn't know to tell them to leave her the heck alone. are you going to let them stick your babies this time if they want to check their sugar? how are you planning to stop them? what risks are there if they don't check their sugar? is there another way to know the baby has a sugar problem?

even if you aren't predicting a large baby and you know something about this topic, please chime in. the more info the better.

[ctdoula]

I'm sure Dana will know more about this than me, but did you have Gestational Diabetes last time? I think that's the reason a baby would get a heel stick.... because if they're born with elevated glucose levels & then they crash after birth, it could be a problem. I've not heard of babies getting tested just because they're bigger.

[aprildawn]

ctdoula -- no gestational diabetes. just a large baby. also, my husband and i aren't tiny people, i'm 5'11" and he's over 6'. i was 9lbs 1oz when i was born and he was 8lbs 13oz, so, as my midwife said at the time, what did they expect? some teensy baby to come out?

in hindsight, i was frustrated that they took her from me so often to test her and prick her foot. poor thing. now that i know more about it i won't let this one go so easily unless there's really good reason to be concerned about his/her size.

oh -- dd was also 22" long. so, she was by no means a chunky baby. still isn't. i can't figure out how to keep her pants up!

[FreeRangeMama]

I dunno, 9 lbs seems like a pretty average weight for a healthy, full-term baby who's mama has taken good care of herself. I know on the UC lists there are many, many 9, 10 and 11 lbs babies. Especially if you and your husband are not real petite. I am 5'3 and 105 lbs not pg (really small build) and I have 8.5 lb babies, MIL is small and had 9 lb babies. I can't see any reason why they would want to test blood sugar.

[mrzmeg]

Here in MO, the heel stick is state law and they'll report you to CPS if you refuse.

Of course, the test isn't even accurate until they've had milk in their systems for 24 hrs, so if you only stay a short while it will come back inconclusive and they'll have to stick the poor babe again

ETA: the heel stick test is not just to test for blood sugar. It's to test for a rare condition that makes the baby unable to digest protein properly; can't remember the term right now.

[Cajunmomma]

Where I live, it's one of the few tests that neo-natal nurses can run without specific orders from a doctor. So they run them. 3 of my babies were over 9 pounds--no gestational diabetes for me, either--and my pediatrican finally ordered them to stop running the tests without his permission.

The other test that I found the nurses can run without orders is the one for bilirubin. And if you breastfeed, there is a higher risk that the baby will have "breastfeeding jaundice". Again you need to watch the nurses and try to talk to your doctor about the tests in advance.

I think that the test that mrzmeg it talking about is the PKU. The odd thing about that test (and I never complained to the hospital about it because the consequences can be so bad) is that they doctors have to run it again when the baby is over 10 days old.

[mrzmeg]

I think that the test that mrzmeg it talking about is the PKU. The odd thing about that test (and I never complained to the hospital about it because the consequences can be so bad) is that they doctors have to run it again when the baby is over 10 days old.

That's the one! Thanks
Yeah, with my ds my midwife had to stick him again at his one week home checkup. Grr.

[ctdoula]

The "PKU" tests for many inborn metabolic disorders that could be fatal if not known about. It tests for many things (the number varies from state to state) including PKU, Maple Syrup Urine Disease, Cystic Fibrosis, Sickle Cell Anemia, Glactosemia (sp?) and many others. It's a heel stick after the baby is 24 hrs old, and repeated again at 1 week. They do it again because maternal hormones may skew the results of the first test & it's important they have accurate readings. It's not a diagnostic test, rather a screening.

As for the OP, I'm not sure why they would keep testing the baby, but I would have serious issues w/it since you're not a GD. Perhaps you can write on your consent form when you enter the hopsital that you will only consent to the PKU & any other sticks must get your written consent.

[wasabi]

I don't think any of my three had heel sticks for blood sugar and they were all 9lbs or more. Maybe they were getting stuck and I didn't know about it. The first two were kept in the nursery because that's what they did 12 years ago and DD was in the NICU but I wasn't ever told about her having blood sugars checked. She did have the PKU done but as far as I remember it was not redone at 1 week. Now that I know it's more accurate later I'll refuse it at birth and just have it done once.

[danaalex]

it is routine newborn care to have your baby's blood sugar checked if they weigh over a certain weight. in most hospitals it is right around 9 lbs. if you delivered in a hospital and your babe weighed around or above 9 lbs, and they ever disappeared from you they were getting their blood sugar checked. it's a heel stick. this is not restricted to babes of gestational diabetes moms.

personally, i think it is worth it to have the sugar checked the first time. if it is OK, then you don't need to worry. if it is low, then tell the staff that you are breastfeeding and it is NOT OK to give the babe a bottle of any kind to increase the blood sugar. tell them you want to nurse the babe a couple of times on each side. if it is still low after that, then discuss with your ped how to treat, you can syringe feed sugar water or something like that if you want to avoid formula.

the reason that the sugar is concerned in a baby that size is because they have been living off of your sugars for so long, that the birth and no longer having that can drop their sugars severely low and quite quickly. low blood sugar in an infant can have many undesirable outcomes, such as low body temp, which in turn affects their heart rate and their ability to arouse to eat. long term can affect them on a more cellular level. the reason i say test is because it's easily treatable. if you DON'T know the baby has a low blood sugar, you might be inclined to let them sleep for longer periods right after birth ( like all newborns do ) and you might not recognize when it becomes a sypmtom of having the low blood sugar. but that's just my opinion. my last dd was 9 lbs 4 oz at birth, her sugar was checked once after birth and it was fine, so no other follow ups or anything i thought it was worth it.

the other heel stick is the PKU or HMD depending on where you live. it's a good test to have done. totally worth it to know if your child has a metabolic disorder. though, if done too early it can yield an inconclusive result. the test should be done 24 hrs or more AFTER the child has had food in their belly. the system has to digest inorder for the test to be accurate.

[ctdoula]

Originally Posted by wasabi

She did have the PKU done but as far as I remember it was not redone at 1 week. Now that I know it's more accurate later I'll refuse it at birth and just have it done once.

Actually, it's really important to have it done both times, since they don't re-run all the tests at the 1 week, only certain ones.

[danaalex]

Originally Posted by ctdoula

Actually, it's really important to have it done both times, since they don't re-run all the tests at the 1 week, only certain ones.

the retesting is only routine in certain states. like in DE the HMD (PKU) is done at 48 hrs after birth and then again, at a week. if the retest was off then the babe was tested in a more direct way. in FL they only retest if the first test is abnormal. my DD#2 was born in FL and her first PKU was done at 18 hrs after birth, so she had not had food in her system for 24 hrs yet. the first test was abnormal and had to be repeated. the second one was done when she was about a year, and it was normal.

if you deliver in a hospital, they might have a protocol about not letting you go home until the PKU/ HMD is done. you can always work something out with your Ped. like, take the test home with you and bring it to the first appt and get a lab order for the PKU to be done. JUST MAKE SURE it's done via heel stick, because it requires more than just one drop of blood and you DO NOT want a lab person milking their tiny little finger!!!!!!!

if you deliver at home with a midwife, i believe she will come back and do it for you at your postpartum visit. home visit nurses also do them. so if there is a program in your area for first time moms to receive a visit at home from a nurse, take them up on it. because they can do the HMD/PKU for you at home and then mail it in. they can also draw labs for jaundice, which is nice ( you don't have to leave your house ). and weigh your babe .

[wasabi]

Originally Posted by ctdoula

Actually, it's really important to have it done both times, since they don't re-run all the tests at the 1 week, only certain ones.

I am about 99% sure my DD was not retested. We didn't see our ped until she was two weeks old. So I would guess that in my state they do not do two tests. If there is only going to be one I would rather have it be the one that is more accurate. If I state that she has not been tested at all I would assume they would know to do a full test rather than a retest.

[FreeRangeMama]

I don't believe either test is necessary in the vast majority of cases and I don't have any testing of any kind done unless proven necessary. Of course if there were genetic factors that indicated PKU screening might be called for I wouldn't hesitate, but I wouldn't do blood sugar at all. I think it is one of many unnecessary hospital proceedures that I am more than happy to avoid. Of course that is just my opinion, but I thought I would throw it out there

[aprildawn]

i'm glad to know more about it. they were testing her sugar because she was over 9lbs though i wasn't GD. one or two tests doesn't bother me nearly as much as repeated testing. they tested her every hour for several hours (maybe 24) right after she was born. then they cut back to every few hours. and i know they tested her one last time before they sent us home. seems excessive if she was ok the first time. she even gained weight in the hospital which i know is unusual.

i had a 4th degree tear and couldn't get out of bed to go with her to find out exactly what was going on each time they took her from the room. this time dh and i have talked about how if i can't go for some reason (fingers crossed i won't tear so bad this time) he or one of the grandmas will accompany the nurse and baby.

the pku isn't a concern to me. again, because it's not repeated every hour after birth. it's the repeated sticking of the poor baby when everything has been fine that irks me.

[danaalex]

Originally Posted by wasabi

I am about 99% sure my DD was not retested. We didn't see our ped until she was two weeks old. So I would guess that in my state they do not do two tests. If there is only going to be one I would rather have it be the one that is more accurate. If I state that she has not been tested at all I would assume they would know to do a full test rather than a retest.

i would suggest you discuss this with your ped before you deliver. let them know how you feel about the testing being done too early. if you nurse your babe right at birth and then leave the hospital AFTER 24 hrs. the test could be done at discharge, and would be ok. if you are going to try and leave shortly after delivery ask your ped if it is ok for you to take the test home with you and then bring it back in to your 1 week check. they probably won't be able to do it in the office, unless they draw labs in your office. so, you will need a lab order slip to have it done.


freerangmama, if you are delivering at home you won't have to worry about a heel stick. i doubt a mw cares how big the baby is.

something you all have to realize is that hospitals don't do these things to be mean or cruel or "just because". they do them because they have found that a percentage of large for gestational age babies have hypoglucose ( low blood sugar) at birth, because they aren't able to get the same amount after delivery that they were getting in utero. hospitals have to come up with protocols to make sure they cover every child, and themselves from law suits. imagine you did have a hospital delivery, and you had a 9.5 lbs baby. and they didn't check to see if the sugar was ok, and it dropped low enough for the baby to be unarousable. then of course the staff would freak out even more and want to do a how lot of intervention. they do these simple little tests to ensure that they don't have to do more intervention.

you can always refuse certain things they do in a hospital. you can sign a form that you are not going to allow certain things to happen, but you also have to assume the responsibility of whatever outcome follows. i respect eveyone's decision, whatever it might be, as long as they are able to tell me that they can live with whatever outcome occurs. i think that's what we all do as moms. working in a NICU with the babes that had poorer outcomes i know the ramifications of ceratin things, such as not checking blood sugar at least once. so, for my peice of mind i let them test once and if it's ok, then we leave it alone. i also do the HMD/PKU, because there are NO genetic indications for most of the metabolic disorders that those tests test for. that's just me though. i couldn't live with having my child stuck with an IV to receive fluids with glucose in them to wake them up, and i definitely couldn't deal with my child being deathly ill at the age of 2 and not knowing why, because i didn't do the HMD/PKU.

[aprildawn]

danaalex -- you sorta addressed this already, but i'll ask to be sure (you know, pregnancy brain and all...)

so, if they test the baby's sugar after birth, and it's ok, is it necessary for them to test again? should they test before or after the baby has had a chance to nurse? how soon after the birth is a good timeframe to test in?

like i said, i'm not against the sugar testing in general, but i was big as a baby, my husband was big, dd was big and didn't have a sugar problem, so i'm wanting to avoid the hourly heel stick they did with dd. she has a scar on her heel from all the sticks they did those 48 hours we were in the hospital.


thankfully, the doctor who's delivering this baby will also be the pediatrician, so we can hash this all out ahead of time.

[wasabi]

Originally Posted by danaalex

i would suggest you discuss this with your ped before you deliver. let them know how you feel about the testing being done too early. if you nurse your babe right at birth and then leave the hospital AFTER 24 hrs. the test could be done at discharge, and would be ok. if you are going to try and leave shortly after delivery ask your ped if it is ok for you to take the test home with you and then bring it back in to your 1 week check. they probably won't be able to do it in the office, unless they draw labs in your office. so, you will need a lab order slip to have it done.

I will definitely be nursing right away but hopefully will go home before 24 hours. My ped is coming to the hospital to check the baby out so I'll definitely talk to her about it beforehand. That is a good point that they may not have the tests at the office.

[danaalex]

Originally Posted by aprildawn

danaalex -- you sorta addressed this already, but i'll ask to be sure (you know, pregnancy brain and all...)

so, if they test the baby's sugar after birth, and it's ok, is it necessary for them to test again? should they test before or after the baby has had a chance to nurse? how soon after the birth is a good timeframe to test in?

like i said, i'm not against the sugar testing in general, but i was big as a baby, my husband was big, dd was big and didn't have a sugar problem, so i'm wanting to avoid the hourly heel stick they did with dd. she has a scar on her heel from all the sticks they did those 48 hours we were in the hospital.


thankfully, the doctor who's delivering this baby will also be the pediatrician, so we can hash this all out ahead of time.

talk to your ped about the hospital's protocol. if they test at an hour and it's fine then they should be able to leave you alone ( unless the babe is showing symptoms like low temp or being unarousable, both of these things can cause a babe to drop their heart rate or stop breathing periodically). if it's low then make sure you and your ped are on the same page, you simply make your case that your are nursing and you want to give the baby enough time at the breast to correct the low sugar. so maybe they wait several hours. you place the baby to breast as much as possible in that time. the every 15 min then every hour is just a rule of thumb. if you talk to your ped and they are aware of how educated you are on the risk of big babes and low blood sugar they will be more inclined to listen than to a mom that is just flat out refusing their care.

trust me, no nurse wants to hurt you or your baby. they are simply following a protocol that is put in place to protect everyone from a medical liability. if you and your ped agree on something different and the orders are written then the nursing staff with follow that. same goes for anything in the hospital. a birth plan is an excellant idea, but it's even better if you have discussed it with your MW or OB before hand, because then they can write specific orders FOR YOU!!!! and not use their standing orders that they have at the hospital for all of their patients that are in labor and delivery. ultimately, if you want or don't want something done and you express this before hand and make the staff aware that you are taking responsibility for that decision, then you're in control of the situation. the standards of care are simply placed there to protect, that's all.

[moondiapers]

Originally Posted by aprildawn

i'm glad to know more about it. they were testing her sugar because she was over 9lbs though i wasn't GD. one or two tests doesn't bother me nearly as much as repeated testing. they tested her every hour for several hours (maybe 24) right after she was born. then they cut back to every few hours. and i know they tested her one last time before they sent us home. seems excessive if she was ok the first time. she even gained weight in the hospital which i know is unusual.

i had a 4th degree tear and couldn't get out of bed to go with her to find out exactly what was going on each time they took her from the room. this time dh and i have talked about how if i can't go for some reason (fingers crossed i won't tear so bad this time) he or one of the grandmas will accompany the nurse and baby.

the pku isn't a concern to me. again, because it's not repeated every hour after birth. it's the repeated sticking of the poor baby when everything has been fine that irks me.

Refuse to let them take the baby out of the room. There isn't any reason for them to take your baby. They can do the testing right in your room.