hats on babies

[homemademomma]

i am being called to defend my practice of not putting hats on babies right after birth. anyone have any good resources (peer reviewed journal articles would be great!) i can use?

[Paige, CPM]

Nothing for you...

But, in school I was so inspired by a Dutch homebirth video I saw where the babies came out and were not instantly assaulted with blankets and hats that I made it one of my goals to try to make that a practice. And guess what, I know that they don't have a higher morbitiy and mortality rate in the Netherlands, so there is the proof.

[Peppamint]

Subbing. :

[Midwife Kris]

Who is calling you to defend this practice? Doesn't Karen Strange have information on this since I recall it is she who advocates waiting for "hatting" babies (and thinking of hats as a resuscitation tool)?

[georgia]

Not peer-reviewed or anything, but I remembered this old thread about hats that might be of interest and some support for your POV

[homemademomma]

Originally Posted by Midwife Kris

Who is calling you to defend this practice? Doesn't Karen Strange have information on this since I recall it is she who advocates waiting for "hatting" babies (and thinking of hats as a resuscitation tool)?

i shouldnt have phrased it that way, i guess. no one is interrogating me. its a deviation from the "standard of care" and i am being asked to back it up.

[riomidwife]

i agree the hats are bogus. Karen Strange does have some lit on it I think. you can email her through her website.

[GatorNNP]

I am sure it really depends on the environment of the birth. In a cold room then I would use a hat. If everyone agrees to keep the room a little warmer like 78 to 80 degrees at first then maybe not. Newborns lose around 40% of their heat from the head due to a large amount of blood flow, when they are wet after birth then it is increased. While they may not necessarily need a hat in all situations I think it does decrease the energy used by the baby to maintain the internal temperature, which is done chemically and not a visible process. So keeping a baby good and warm and they can tolerate things like not feeding well a little better since they would have more energy reserves.

I do agree at the minumum that a hat is not a cord clamp and doesn't need to emergently be placed and never removed. It probably doesn't need to be all or nothing.

[pamamidwife]

See, I view it differently, GatorNNP (I know we're coming at it from very different areas on the spectrum of birth, but it's still a good conversation):

Babies are born from a very warm environment. Even if the room was 85 degrees, it would still chill the baby. Ideally, babies should be skin to skin with mom, in her arms.

I think there is something deeply beneficial about this cooling off - and even chilling a bit with normal newborns. Many babies have vernix - and this vernix needs to be left alone. It's antimicrobial and also aids in keeping the baby warmer.

Skin to skin without a doubt is the only solid, natural way to keep baby's temperature normal. I don't feel like many providers really talk about the benefits of mother's skin - how the area around her breasts is biologically sensitive to the needs of her baby as far as temperature regulation.

I think that, just like the cord around the neck issue, we apply many extrauterine comfort needs to these neonates. What I feel is true is that nature has this sytem (and this is a HUGE system to ignore the design) that obviously reflects the needs of babies. I don't know that babies necessarily lose 40% of their body heat through their head. This is an assumption that we make, based on what we know about people outside the neonatal transition.

This is all very different from the baby with issues.

Still, if we are going to cover heads, we need to stop using those gross polyester hats. Seriously. If we're talking about retention of body heat, a thin polyester hat (or even poly/cotton) isn't cutting it much.

I just happen to believe that the bonding effect of the mother to baby and the ability of providers to not needlessly touch the baby is key. For me, the secondary physiological benefits of the transition also come into play, but at a lower level. I still fundamentally believe that there is a true benefit in some immediate cooling of a newborn. Once that baby is skin to skin with mom, the chance of that normal baby being chilled so much that it affects his/her health is very, very small.

If baby has to be covered with a blanket, skin to skin with mom, then cover both with a blanket. Her own body thermoregulation will help keep her newborn at a perfect temp.

Guess I'm not sold on the hats at all - so for me, it's more a 'nothing', but it's not really up to me..it's more a parental issue.

I'm really interested, though, by the number of parents who have had babies before in the hospital or had hats put on them immediately that ask for hats right after birth. Clients that are first-time parents typically will NOT ask about hats. They may sometimes inquire about the water/baby being too cold, but not about hats.

Interesting!

[jessjgh1]

I viewed the old thread when I was pregnant... just wanted to say that I'm glad I did, because I requested no hat after my daughter was born and really enjoyed stroking her hair, smelling her, etc. Of course, she has a lot of hair- so soon everyone was commenting on that.

Funny afterthought was that when they finally went to weigh her (after an hour or so, at my okay) I did ask for a hat, because I thought she would benefit from it since she was going to be briefly away from me and on the scale. They forgot. I asked about the hat again later (our room was chilly at times), and they forgot. But when we left, they remembered and we went home with 3 hats.
It was so hot here, I never used any of them, and she rapidly grew out of them anyways.

Sorry, that was a little o/t...

Jessica

[GatorNNP]

While I agree that the healthy term infant will cool off some after birth, I don't think they need to cool off as most of their physical characteristics are supporting preservation of heat. Well distributed body fat, brown fat, and flexion etc. I think we can agree that the healthy term infant could take or leave a hat with it not being a necessary intervention.

A compromised infant loses some of the heat preserving mechanisms, such as less tone and not maintaining good flexion, as you may have seen in infants born after medicated births, or less early feeding behaviors where the infant will be close to an adult body. It does make a difference in the temperature in prematures to have a hat placed (even the junky poly ones,but we often use two on very small babies) as they maintain at least a close to normal body temp instead of going below 98 degrees, a temp that supports all chemical processes in the body. However, no trials have looked solely at the effect of temperature after birth at later outcomes, so it is still doing what we "think" is best.

On a side note, Some infants with asphyxia are being treated with selective body cooling to minimize brain damage. So infants are able to tolerate cool temps, but they are also the ones supported with IV nutrition etc...
It is pretty weird to see a baby hanging around at 35 degrees C.

If parents at a birth specifically requested no hat, I would not have a problem respecting that.

[Ruthla]

They really make polyester hats for newborns? Eww! I've only seen them in soft 100% cotton!

The MW put a hat on each of my DDs when they were first born- not immediately, but within the first hour or so. I put a hat on DS and wrapped him in a blanket in my arms after he was born.

[Peppamint]

The hat we had at the hospital with dd1 was definitely at least partially poly. Probably a poly/cotton blend. We used it a bit with ds and dd2 we used a wool hat I knit.

But honestly, after the first day or so we quit using hats. I just didn't want to use them but didn't know why.

[homemademomma]

thanks for the thoughtful replies

nak

i am not against hats altogether, but i feel that the first minutes after birth are SO important to the family, and mom has worked so hard for this moment. she deserves to actually see her whole baby for aminute before he/she is covered in a blanket and hat, you know?? i never used hats with my kids (florida babies ) but i dont have aproblem with them. i just want the first few minutes to be hat free. i alwats turn the AC and fan off prior to birth, and baby stays skin to skin with mom (or other family member) at all times

as an aside, speaking of cord clamps, i usually clamp the cord 6-8 inches from baby using a plastic clamp whenever we cut the cord . this way we do not have to disturb the family. then it is trimmed up when we do the newborn exam, and we use a bander at that point.

[~Heyokha~]

Originally Posted by elriomidwife

i agree the hats are bogus. Karen Strange does have some lit on it I think. you can email her through her website.

I just took her NRP class today and she was discussing this topic. She gave us a list of resources and websites-I will see if there is anything pertaining to this.....

[fourgrtkidos]

What I've noticed is that no hat means lots of skin to skin, kissing, smelling and nursing. Once nursing, one of moms hands goes to the baby's head, nearly cobering the whole of the head..... interesting!!! Then I just throw a blanket over both of them!

[jessjgh1]

Originally Posted by fourgrtkidos

Then I just throw a blanket over both of them!

: What cover up a nursing mother! Don't post that on the lactivism forum. ((Joking))

Jessica

[mendomidwife]

If you look at vintage baby/nursery/newborn photos the babies don't have hats on.....
It is important for premies because they lose heat through their skin - especially the head. It burns calories to make heat - so premies need to stay warm. I think that the practice of putting hats on smaller babies probably got translated over to the normal newborn nursery at some point and then became standard of care.
Hypothermia, even in a normal newborn could potentially cause problems..(i.e. hypoglycemia), but with skin to skin, nursing, etc....it not a common issue - at least I haven't seen it.

Carla

[crsta33]

When did hats become common practice in the hospital setting? I know many, many years ago babies most always wore bonnets, but when I was born in the early 70s I don't think they used hats in the hospital at all, and although I had an Easter bonnet, I didn't wear bonnets either (but then, I've always hated to wear a hat).

So what's the "history" of hat use?

Christa

[sevenkids]

UNless the room is FREEZING cold, then there's no need for hats. I never saw hats put on babies until I came to Florida, and my preceptors were always reminding me to put a hat on the baby. Why? It's 98 degrees out!

I think the practice started in hospitals because they're kept so flippin COLD, and babies are kept in the nursery by themselves, so those babies don't benefit from being held in mama's arms.