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-   -   Newborn Procedures (http://www.mothering.com/forum/19-i-m-pregnant/638666-newborn-procedures.html)

jgracefrank 03-20-2007 05:21 PM

Can any of you seasoned mom's give me a general list of the standard newborn procedures that are administered at hospitals?

I'm planning a home birth, but I'm also preparing a birth plan in case of a transfer. I would like to make sure I have time to research what is necessary and what isn't. Opinions on the standard procedures are also welcome.

Thanks!
Jillian

becoming 03-20-2007 05:37 PM

Here are the ones my hospital does routinely:

Vitamin K shot
Eye ointment
PKU testing
Hearing screen
Hepatitis B vaccine

I think that's all. I'll come back and add more if I think of anymore.

HeatherB 03-20-2007 06:38 PM

And there's some basic stuff (that may or may not be done in room or to your liking) like cord clamping and cutting, bathing, "observation," etc.

AugustLia23 03-20-2007 07:23 PM

Same in mine, but if you are having a boy, don't forget to include instructions re: circumcision.

QueenOfThePride 03-20-2007 08:07 PM

Also you might want to decline airway suctioning (even with a bulb syringe) after a vaginal birth. It usually isn't necessary, but just a routine. They'll have to do suctioning after a C-section, because the fluids are only squeezed out with vaginal birth.

ETA: I forgot to say why! Some babies may avoid breastfeeding after suctioning because they believe that something in their mouth will be uncomfortable and invasive.

wombatclay 03-20-2007 08:46 PM

Some routine interventions are mandated by the state...I'm not sure what PA lists as "required" but if you contact a local hospital they should be able to tell you. A local pediatrician might be able to give you a list as well.

Other routine things are determined by the hospital...so again, if you know which facility you would transport to the labor & delivery staff (just call the desk, or ask a local doula who has attended mamas there) can tell you what the babe-routine might include.

At my local hospital there isn't a lot of "routine" intervention...but you need a letter from the NY state board of health BEFORE the babe arrives in order to decline some state mandated procedures (or you'll have a heck of a time of it, though the hospital will help you get the necessary forms and they tell you right up front it can take 3-4 weeks for the official letter to arrive so you can plan) and it is helpful to have your pediatrician informed about your birth/baby care decisions early on.

Oh, what my hospital offers more or less right away in terms of birth:
-delayed cord clamping if requested
-height/weight/head size done on or next to mama
-bathing the babe if mama wants and where mama wants

After the first hour:
-eye goop
-vit k (shot or oral)

Before leaving the hospital:
-PKU and other blood tests from a heel stick (during nursing or while babe sleeps)
-hearing test (again while babe sleeps)
-hep B vax

In terms of what we want and have done in the past...the only thing we've declined is the Hep B, and we do request the oral vitamin k. Other than that we don't have a real issue with any of our local "routines". But that's just us!

QueenOfThePride 03-20-2007 09:04 PM

Even if a doctor or nurse tells you a procedure is required by law, it really isn't. The law requires them to do it, unless the parent objects. You have the absolute right to decline any medical procedure for yourself or your child. It is your baby, not the government's baby, not the hospital's baby.

Lady Lilya 03-21-2007 02:14 PM

subbing

lyttlewon 03-21-2007 02:32 PM

I just wanted to mention my hospital didn't do PKU testing. We did that several days later at the lab. I wonder if I opted out of it...

I was attending a birth for a friend and they asked her if she had EVER done drugs. Not just recently but ever. She answered yes even though it had been a very long time. They drug tested her and wouldn't let her leave until the baby peed so they could drug test her too. Stupid.

trmpetplaya 03-21-2007 02:48 PM

I have been told by a mother of 13 AND my midwife that the PKU test isn't accurate until after your milk comes in, so you might as well decline that until then. It's not accurate in the hospital, they just like to catch you there in case you don't go see a doctor within the next week. My midwife does it on day three or four.

love and peace.

wombatclay 03-21-2007 04:55 PM

Quote:
Even if a doctor or nurse tells you a procedure is required by law, it really isn't. The law requires them to do it, unless the parent objects. You have the absolute right to decline any medical procedure for yourself or your child. It is your baby, not the government's baby, not the hospital's baby.
That is correct. However, in some states that "parental objection" needs to be on file with the state...not with the individual hospital. So a hospital can be legally caught in the middle if the parent has not filed the objection correctly. The hospital needs to decide if they will honor the parent's objection completely (but risk prosecution from the state), procede with whatever the intervention is against the parent's objection (often without telling the parent) in order to avoid that prosecution (but risk legal action from the parents), or honor the parent's objection but report the violation to the state (which can result in a case file being opened on that family but covers the hospital's legal butt).

So yes...each and every decision IS THE PARENT'S, but in some states there are hoops that must be jumped through in order to avoid difficulties resulting from those decisions and it's best to know what your state does or does not require in terms of newborn interventions and how to prevent those interventions if you chose without generating negative consequences.

HeatherB 03-21-2007 05:13 PM

wombat, is there any way to find out - easily - what states require what? I've never heard of such hoops here in Texas, but that doesn't mean they don't exist!

Lady Lilya 03-21-2007 05:50 PM

Quote:
Originally Posted by wombatclay View Post
That is correct. However, in some states that "parental objection" needs to be on file with the state...not with the individual hospital. So a hospital can be legally caught in the middle if the parent has not filed the objection correctly. The hospital needs to decide if they will honor the parent's objection completely (but risk prosecution from the state), procede with whatever the intervention is against the parent's objection (often without telling the parent) in order to avoid that prosecution (but risk legal action from the parents), or honor the parent's objection but report the violation to the state (which can result in a case file being opened on that family but covers the hospital's legal butt).

So yes...each and every decision IS THE PARENT'S, but in some states there are hoops that must be jumped through in order to avoid difficulties resulting from those decisions and it's best to know what your state does or does not require in terms of newborn interventions and how to prevent those interventions if you chose without generating negative consequences.
Wombatclay, you said you are in NY? So am I.

I don't want the eye goo or the vaxes. What do I have to do in advance to be able to refuse those in the event of a hospital birth?

wombatclay 03-21-2007 07:10 PM



Let me see what I can find...the hospital I used/will use has a handout on how to decline the various procedures, and they even offer assistance in making sure the paperwork is filled out and sent to the right places. We didn't have a problem with eye goop/etc so didn't fill out the paperwork, but I know I still have it... and remember, the hep b isn't required (just suggested) so you don't need to do anything extra beyond saying "no thanks" for that one!

But I should add...there are some hospitals that are fine with the "whatever" approach or where they will do the paperwork for you after the birth so a verbal or written "we do not consent" may be enough for them. You should ask at whichever hospital/birth center you are using or which you may transport to to see what they want. My hospital is very supportive of "alternative" approaches to health and parenting (we have a lot of nonvax/selective vax kids in this community) but as a result they get inspected by the state every now and then so they like to keep everything very aboveboard and by the book.

Anyway, I know the form must be on my desk at home somewhere (I'm at work now till 10pm) but I'll see if I can find it tonight and post the contact info...

Lady Lilya 03-21-2007 09:25 PM

Well, I am planning a home birth, but preparing for an emergency transfer to a hospital. So, I will not interact with the hospital in advance. Ideally, I would like to have all the paperwork and hand it to them if we walk in the door.

riomidwife 03-21-2007 09:37 PM

Quote:
Originally Posted by trmpetplaya View Post
I have been told by a mother of 13 AND my midwife that the PKU test isn't accurate until after your milk comes in, so you might as well decline that until then. It's not accurate in the hospital, they just like to catch you there in case you don't go see a doctor within the next week.
Well, in all fairness yes and no. Some of the conditions screened for can definitely be detected before baby has metabolized mom's milk. But not ALL cases of these disorders will be picked up on the first early screen, so yeah, that's why they do a second screen when a baby has already had the first early scren in the hospital.

Lady Lilya 03-21-2007 09:40 PM

I will be having a home birth. The midwife said she will visit me at least twice in the week following the birth. I guess there are plenty of opportunities.

riomidwife 03-21-2007 09:47 PM

Quote:
Originally Posted by Lady Lilya View Post
I don't want the eye goo or the vaxes. What do I have to do in advance to be able to refuse those in the event of a hospital birth?
Typically after a baby is born in the hospital, a nurse will take the baby at some point over to the "nursery" to be given a newborn exam, weighed, and all that. That's when they do the eye prophylaxis, vitamin K, etc. So I'd make sure someone accompany's the baby on this trip to the nursery so that s/he can be there observing, and remind the nurse that you are declining XYZ. I think this is more effective than just writing it out in a birth plan because the nursery nurse might not even be aware that there was a birth plan.

Lady Lilya 03-21-2007 09:55 PM

I want to do both: have it in writing AND have my husband accompany the baby everywhere and remind people.

I have heard that they neglect to look in your file before doing things to the baby.

wombatclay 03-22-2007 09:26 AM

Okay...so the paperwork I have from the hospital lists the eye goop and vitamin k as the two "contact the state" items. They say they have forms available at the hospital (I honestly don't think that that is common...I bet most hospitals just leave you hanging).

However, they also say that if you can't come to the hospital or would rather file directly, you can contact the NY State Bureau of Women's Health at 518-474-1911.

Hope this helps and that it's totally unnecessary (since I'm sure your homebirth will be wonderful!).

Lady Lilya 03-22-2007 09:38 AM

Super! Infinite thanks!

I don't think it is likely that I will have a hospital transfer either. No women in my family have ever needed an intervention. I think I have good birthing DNA. But, you never know.

hippy mum 03-22-2007 09:48 AM

Huh, I'd check on the hep b. So far everyone I've talked to that had babies recently (FL) they are not doing the nb hep b since there's the new dtap with the hep b included with it. my sis is in AZ and they didn't do one there either, waited for the combo shot.
Also we had to sign if we wanted the pku or something with ds. This time as well with our mw. And the vit K is optional with us as well. I'd call and talk to the nurses station there maybe and see if they can give you a rundown on thier particular procedures-rooming in, how long you can have baby until they take him to nursery etc.

lyttlewon 03-22-2007 12:47 PM

Quote:
Originally Posted by elriomidwife View Post
Typically after a baby is born in the hospital, a nurse will take the baby at some point over to the "nursery" to be given a newborn exam, weighed, and all that. That's when they do the eye prophylaxis, vitamin K, etc. So I'd make sure someone accompany's the baby on this trip to the nursery so that s/he can be there observing, and remind the nurse that you are declining XYZ. I think this is more effective than just writing it out in a birth plan because the nursery nurse might not even be aware that there was a birth plan.
That is hospital dependant. In Washington and Idaho all of those things are done in the mother's room.

riomidwife 03-22-2007 12:54 PM

Wow, that's great! I practiced in Idaho a year ago and they weren't doing it then.

lyttlewon 03-22-2007 02:14 PM

Quote:
Originally Posted by elriomidwife View Post
Wow, that's great! I practiced in Idaho a year ago and they weren't doing it then.
They do it in Kootenai County at least. I guess I shouldn't speak for ALL of Idaho

paquerette 04-03-2007 09:09 AM

Hi, I followed you over here from the local section, so hopefully this will be very helpful. : I was at MTH and was able to decline vit K, Hep B, and eye goop without much fuss. I had a girl so my breath was wasted vehemently denying circumcision or retraction as well, though if you have a boy I would definately be very, very careful with that around here. I was unable to convince them to give her to me right away, or not to wipe her off and dress and bundle her before I got to hold her. It was almost an hour before they'd let me hold her, in fact. I think they were probably convinced I was a crackhead, because who else would come in with no prenatal care. : I was also unable to decline the PKU. I waited until right before discharge, and the ped (who is a really great guy, as you've probably heard already ) suggested that we do it because the state keeps a closer eye on that and we'd probably come under greater scrutiny. I really would prefer to wait for the 1 week visit though. Oh, and the hearing test thing. DH went with her for that, so I don't know how that went, but I know it's not invasive. And their bili machine was broken so we didn't have that, and he wasn't worried because he knows that breastfed babies are unlikely to have a problem with that. He just said to give him a call if she turned really yellow. I think that works by putting something against their foreheads, also not very invasive.


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