Routine Newborn Procedures- Are they necessary?

Routine Newborn Procedures- Are they necessary?

Suctioning
For most hospital births, it is routine procedure to suction the baby's mouth and nose as soon as the head emerges on the perineum, in advance of its full birth. Either a deep suction hose or a bulb syringe will be used to extract any mucus or meconium that may be present.

According to the International Guidelines for Neonatal Resuscitation (2000), only approximately 5-10% of newborns will require some degree of active resuscitation (stimulation to breathe) at birth, which can vary from simple skin rubbing to suctioning or full resuscitation. This in turn means that 90-95% of all newborns need no assistance breathing at birth.

While it may seem wise to suction as soon as possible, the reality is that the baby is not at great risk of breathing difficulties at this point since it will typically not take its first breath until it has been fully birthed. As long as the cord is pulsating and is not clamped, cut, nor compressed, the baby will continue to receive oxygen via the placenta until after it has been fully birthed. There is rarely a clear need to hurry the neonatal transition to breathing room air at this early stage when only the baby's head has emerged.

Suctioning can be delayed until after the baby has been born. Alternately, suctioning can only be performed when indicated rather than a routine procedure for those infants who do not need it, as most infants will be able to clear their own airways with no outside assistance. Two excellent articles that address the importance of being "hands off" at birth are:

http://www.midwiferytoday.com/articles/phaseii_79.asp 

 http://www.nurturingheartsbirthservices.com/blog/?p=447

The next and perhaps most critical newborn baby care decision to be made for your baby's welfare is cord clamping - immediate or delayed. The benefits of delayed cord clamping, which is defined as waiting until the cord has stopped pulsating until clamping or cutting it, are well-documented. Once the baby is born, its entire circulatory system undergoes an amazing transformation to allow the baby to receive oxygen via its lungs rather than through the umbilical cord - a valve in the heart closes, the lungs perfuse with blood and eventually a first breath is taken. When this delicate balance is interrupted by prematurely severing the child's lifeline, its umbilical cord, numerous undesirable side effects can occur.

All newborns are born with a low level of Vitamin K which is responsible for preventing hemorrhage by enhancing the blood's clotting ability. In a small percentage of newborns, cerebral hemorrhage can occur which spurred the universal practice of newborn vitamin K injections in the United States. There are, however, some points to ponder when considering this intervention, especially the alternative of an oral dose.

Certain metabolic disorders, including a PKU test, are routinely screened for at birth through a heel stick blood sample. These disorders have devastating effects that are best handled with early detection and treatment to ensure the best possible outcomes. This is the least controversial newborn baby care procedure since the benefits clearly outweigh the risks.

The Hep B Vaccine, a disease that is transmitted via infected blood and sexual intercourse, is given at birth in the hope of catching as many people as possible. It is not required for administration at birth and may be given at any time in childhood or adulthood. In low-risk families, it may be advisable to delay the administration to the weeks after birth, rather than injecting a minutes-old baby, causing pain as one of its first experiences outside the womb.

To prevent the chance of blindness due to gonorrhea from an infected mother, hospital-born babies are given silver nitrate or other antibiotic drops in their eyes, even if the mother previously screened negative for this or other STDs in her pregnancy. Silver nitrate causes pain, burning, swelling and blurred vision for the first days of life and in the vast majority of cases, is not needed when the mother is known to be free from infection.

If there is one newborn baby care procedure that many families never consider, it's bathing a newborn. However, this may indeed be something a new family decides to decline. The vernix which coats the baby's extremely sensitive skin is the best natural moisturizer available and will protect it from infection when massaged into the skin. Additionally, a bath can cause a baby's body temperature to drop, thus necessitating further interventions to regulate it.

 

To Bathe or Not to Bathe

Silver Nitrate or Antibiotic Eye Ointment

Hep B Vaccine

PKU Screening

Newborn Vitamin K Injection

Cord Clamping