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After Birth Procedures Involving the Baby

Umbilical Cord

As soon as your baby's head is delivered, the doctor will usually feel for a loop or more of umbilical cord which may be around the infant's neck. Loops of cord occur in approximately twenty-five percent of all deliveries. If it happens, and if the cord is loose enough, the doctor gently maneuvers it out of the way and tries to slip it over the baby's head. This procedure is done to prevent interference with the infant's oxygen supply; this could result from pressure on the cord. However, if the cord is too tight, the doctor must clamp and cut it before the shoulders are delivered arid then deliver the baby immediately, since the cord will no longer be supplying oxygen.

Draining Of Mucus

When your baby is born, he or she will be held with the head lower than the body to encourage the clearing of mucus and amniotic fluid from the upper respiratory passages. In order to prevent inhalation of this matter, the nurse or doctor promptly clears the baby's nose and throat by using either a small rubber syringe (which is squeezed by hand) or a soft rubber suction catheter (one end of which is attached to a mechanical suction aspirator or placed in the doctor's or nurse's mouth). If there seems to be a lot of mucus present, the doctor may continue to hold the baby with the head down to encourage more mucus to drain from the passages. If the baby has not cried by this time, he or she usually cries or gasps as soon as the mucus is removed. The act of crying can itself aid in the expulsion of mucus.

Breathing And Crying

Since the placenta begins to separate from the wall of the uterus soon after birth, the blood and oxygen supplied through the umbilical cord will soon stop and the baby must get oxygen by way of his or her own lungs. Therefore, if breathing is not initiated on its own or by immediate suctioning procedures, it is usually further encouraged by gently rubbing the infant's back or tickling the soles of the feet. If the baby does not breathe, cry, or cough within thirty seconds, additional resuscitation procedures are undertaken. If within a few minutes these attempts do not get the baby to breathe, oxygen must be administered.

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Years ago, physicians vigorously slapped the baby's buttocks or the soles of the feet to induce crying. Today this is considered too shocking to the infant and is no longer routinely practiced.

Skin Tone Indications

If the baby's color appears extremely reddish-blue at birth, this may mean that body temperature is too low and the baby needs warming. The baby will be placed in a special heated unit or warmer, or on a table with an overhead heating lamp.

Apgar Scoring

Notation is made of the time of the infant's first breath and cry. The baby's condition at one minute and again at five minutes after birth is evaluated by means of the Apgar Scoring System, developed by Dr. Virginia Apgar. The infant is rated on a scale of 1 to 10: the higher the score, the better the baby's condition. If a baby receives scores of 7 to 10 at five minutes after birth, he or she requires no special treatment. If, however, the five-minute score is less than 7, special treatment is necessary. The degree and type of treatment is determined by the seriousness of the baby's condition.

The Apgar Scoring System rates five vital areas: heart rate, respiration, muscle tone, reflexes, and color. The infant is given a score of 0, 1, or 2 in each of these areas.

Cord Clamping

After the doctor has seen to your baby's immediate welfare, the infant may be placed on your chest or abdomen with the head kept low and the body covered to prevent chilling. The doctor then clamps the umbilical cord in two places near the baby's abdomen and cuts it between the two clamps. The exact moment of clamping varies among doctors; some clamp within the first forty-five to sixty seconds after the baby is born; others clamp from one to three or even five minutes after birth; still others wait until cord pulsation stops. The pros and cons of early and late clamping are currently being argued in medical circles.

In most hospitals the cord stump is not covered by a gauze dressing but is left exposed to promote healing. The umbilical cord at birth is bluish-white and moist-looking, but its stump will darken as days go by, until it appears almost black before it falls off, on or about the seventh day.

Heated Crib

After clamping of the cord, the doctor attends to the delivery of the placenta. If you are awake, your baby may remain with you during this third and final stage of labor, or may be taken by the nurse to the heated crib or table with an overhead heating mechanism which has been set up in the delivery room. The baby is usually placed with the head slightly lower than the rest of the body to aid further drainage of the breathing passages.

At about this time, you may notice that the baby's crying has stopped or decreased. This is normal and nothing to be concerned about.

Suctioning

It may be necessary for the nurse to further suction mucus from the baby. If so, the electric infant resuscitator, the bulb syringe, or the rubber catheter suction apparatus may be used. If mucus is obstructing the nasal passage, the nurse may insert a special small suction catheter into each of the baby's nostrils.

Vitamin K

Many doctors prescribe the administration of Vitamin K to the baby soon after delivery to enhance coagulation.

Eye Treatment

If gonorrheal organisms are present in the mother's birth canal, blindness can afflict the newborn. Therefore, state laws provide that the eyes of all newborns (including those born by Cesarean) be treated with either silver nitrate followed by rinsing with a warm salt solution, or with an antibiotic ointment such as penicillin or tetracycline. Silver nitrate might cause swelling of the eyelids, redness, and discharge from the infant's eyes for twenty-four to forty-eight hours. If given in the correct concentration, there is no permanent damage to the baby's eyes.

Penicillin ointment is often preferred over silver nitrate because the incidence of irritation is much lower and, if present, is usually milder. To lessen the possibility of allergy to penicillin, the antibiotic tetracycline is sometimes used instead. It is worth noting that it is mandatory in many states that silver nitrate be used, although antibiotic ointments are preferred by many physicians. People in the health care field believe the statutes should be changed to include the use of antibiotics.

Eye Contact And Bonding

Eye treatment is usually done in the delivery room but can be safely delayed until the baby is taken to the nursery or after the mother, father, and baby have had some time to “look” at each other and some degree of bonding has taken place. The newborn can see and look directly at you within the first few minutes after birth and that this is a part of the natural process which helps establish the important bond or attachment between parent and baby. This is nature's way of helping you identify emotionally with your baby. If eye treatment is given during these early minutes, it may blur the baby's vision, making eye contact difficult during the first forty-five minutes after birth - considered to be the optimum period of time for bonding to occur. If it is important to you to have the eye treatment delayed and if you plan to be awake for the delivery, discuss it in advance with your doctor and then remind him or her about it in the delivery room. Of course, if the mother is asleep at the time of delivery or if the baby's eyes remain closed, maternal-infant bonding is delayed. This does not mean that you will not “bond” with your baby; it simply means the process is delayed.

Leboyer Method

If you have arranged for a Leboyer-style delivery, the bright delivery room lights will be dimmed moments before your baby's head emerges and the doctor will work with indirect lighting. Imagine what it is like to be in darkness for months and then to be thrust into extreme brightness and you can see why Dr. Frederick Leboyer, French obstetrician and author of Birth Without Violence, advocates subdued lighting for the baby's first encounter with our world. Bright lights cause babies to squint or close their eyes; dim lights allow their eyes to remain open and make contact with the people around them.

Following the Leboyer method, your doctor may also encourage a quiet environment for the moments of birth, with those present requested to speak very softly and to minimize metallic and other sounds as much as possible. Your baby will be handled especially gently and his or her back will be allowed to straighten from the curled fetal position slowly, at its own pace. Dr. Leboyer believes it is wrong to hold the newborn upside down by the heels with the back straight. Such abrupt straightening of the back after being in the curled fetal position for so long, he believes, causes trauma to the spine.

When the infant's breathing is established, he or she may be placed on your abdomen or chest, skin-to-skin, and you may be encouraged to soothe the baby, gently massaging the back while the infant gets acclimated to the new environment. If yours was a Cesarean delivery and if you are awake, some hospitals will permit the free use of one or both of the mother's arms to hold the baby skin-to-skin at your shoulder.

A warm bath may be set up near you in the delivery room and the baby will be gently dipped into the water (usually by the father) and held there in an attempt to simulate conditions in the amniotic fluid within the uterus. This, Dr. Leboyer claims, gives the baby a sense of security because the feeling of being immersed in liquid is a familiar one.

Dr. Leboyer's concepts are quite controversial. Most doctors in the United States refuse to dim the lights, claiming they need all the light they can get to properly estimate the baby's condition; doctors sympathetic to Leboyer's thinking claim there is no need for the usual glaring delivery room lights and that the indirect lighting they do use is adequate for safety.

Leboyer believes there is no need for the newborn to cry; the usual shock of birth in traditional delivery procedures, he believes, is the cause of most newborn crying - because of the insensitive handling of the baby. A full-grown healthy adult from earth thrust through space and onto a foreign, cold planet would be shocked, frightened, panicky. And so, new babies, reasons Leboyer, thrust from their warm, wet, quiet, dark, secure environment into the dry, cool, noisy, bright, and alien world, are downright shocked. Of course they will flail and kick and scream! Of course they will shut their eyes to the brightness, etc.

Most doctors in the United States believe that for proper lung development it is a physiological necessity for the infant to cry after delivery. Further, in contrast to Leboyer's belief in delaying the cutting of the cord so the baby will get as much of the placental blood as possible for a good start in life, most U.S. doctors believe the increased blood supply is too much for the young liver to handle and might intensify newborn jaundice.

Whether to cut the cord early or late is always a subject for argument. By holding the newborn at or below the level of the placenta and delaying the clamping of the cord an amount of blood equal to approximately one third of a fetus' entire blood volume is added to the baby's system. Called “placental transfusion,” one benefit is that the infant receives additional iron, which may reduce the chance of iron deficiency anemia later in infancy. However, this is sometimes believed to be detrimental, as in the case of premature infants. Some doctors believe that too early clamping of the cord - before respiration is well established - may be a cause of respiratory distress syndrome (RDS), not an uncommon problem.

As for the immersion in water, most doctors think it a waste of time and confusing instead of soothing to the newborn. After being in the watery environment of the amniotic sac, the baby is exposed to the dry air and is kept in our dry environment while being massaged on the mother's abdomen and while the cord is being cut and then is placed in the warm water tub, after he or she has already had some time in our atmosphere. Further, many doctors believe this adds to the risk of chilling to the newborn, whose body temperature is unstable.

Breastfeeding In The Delivery Room

In some hospitals, breastfeeding is permitted while you are still in the delivery room. Some babies take to the idea very easily and immediately upon delivery, while others are not interested and will begin to nurse later on. When trying to interest the baby in your nipple, keep in mind the rooting reflex. If the infant is touched on the cheek or the side of the mouth, the instinctive reaction will be to turn the face in the direction of the touch - nature's way of helping the baby find food. If, in your well-meaning desire to induce sucking, you hold the baby's face in such a way that both sides of the mouth or both cheeks are touched at the same time, he or she will be confused and frustrated. Also, remember that if you have had any medication during labor, even a minimal dosage of Demerol, sucking may be lazy or delayed. Just relax, let the baby relax, and try again later - perhaps while in the recovery room.

Identification

While still in the delivery room, a footprint (and sometimes palm print) of the baby and fingerprint of the mother are taken for identification purposes. Should there be any question of identity afterward, this procedure can always be repeated and prints checked. Before the baby leaves the delivery room, another method of identification is used. Some hospitals use linen tapes marked with the mother's name and hospital number, fastening one to the mother's wrist and the other to the baby's arm or ankle. Other hospitals use a bracelet made of beads spelling out the mother's name; this is placed around the baby's wrist or ankle and sealed with a lead bead; the bracelet must later be cut in order to be removed.

Still other hospitals have a special identification apparatus which produces plastic strips previously imprinted with identical numbers for each mother and baby; these are fastened with a permanent lock around the mother's wrist and the baby's wrist and/or ankle – and must be cut to be removed.

Whatever method is used, the baby's identifying bracelet is not removed until the moment the baby leaves the hospital, preferably by the mother, as she identifies the baby as hers.

Recovery Room: Togetherness and Breastfeeding

In some hospitals, mother, baby, and father can spend some time together in the recovery room before the baby is taken to the central nursery. If breastfeeding is desired, the nurse will help you. Some babies will breastfeed at this time, while others will not be interested and in fact will prefer to sleep off their exhaustion after having been born.

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If the baby has a fever or is in any way in need of close attention and care, she or he will not be permitted to remain with you during your recovery period. If you have a fever, you and the baby will be separated until your temperature is normal.

In some hospitals, there is automatic separation of baby and mother after a Cesarean delivery. The baby is taken to the nursery and placed in a warmer and watched for possible signs of infection and respiratory problems, which are more likely to occur in Cesarean babies. There are some attempts being made to forego such automatic separation and to replace this procedure by treating each case on an individual basis.

The Nursery

When it is time for the baby to go to the nursery, she or he may be transported through the hall in a warmer. Its use does not indicate any serious condition of the baby.

In some hospitals, the newborn is weighed and measured while in the delivery room, while in other hospitals this is done in the nursery, where further cleaning of the infant takes place.

Early Feeding Procedures

In many hospitals, the baby is given glucose water when taken to the nursery after birth. This practice is currently being questioned by a growing number of breastfeeding mothers because they believe it is unnecessary and decreases the baby's appetite, thereby minimizing sucking, which in turn postpones the mother's milk production. Besides, the baby benefits more from the colostrum in the mother's breast than from glucose water.

Some pediatricians are beginning to agree with these mothers, while other doctors continue to claim that this “test feeding” of glucose and water is important to determine the infant's digestive abilities. Colostrum, argue believers, is nature's magic formula which actually aids the maturation of the digestive system and helps clear the tract of intrauterine digestive matter.

Later Feeding Procedures

It is the procedure in most hospitals to designate feeding times at four-hour intervals. This is most convenient for the staff. When it's time for feeding, the babies are brought by the nurses to the mothers' bedsides. No visitors are allowed on the floor at these hours to protect the babies from possible infection. Many hospitals have liberalized their policies to permit fathers to visit at special times (in some hospitals, all day).

If you are breastfeeding, it is recommended that you feed your baby whenever she or he is hungry, and not wait for prescribed feeding hours. The reason for this is to allow as much sucking as possible on your breasts in order to stimulate the production and let-down of your milk. If the nurses are not willing to bring your baby to you whenever she or he is hungry - assuming this is your preference - you can offer to come to the nursery yourself to feed the baby, provided, of course, you are notified that your baby needs you. If this is difficult for you to arrange, your pediatrician may be willing to ask the nursing staff to cooperate with you.

It is also recommended that you request that the nursery staff not feed your baby the glucose water or formula between regular feedings because this will tend to fill the baby up. Then, when regular feeding time arrives, the baby may not be interested in what you have to offer. This can be one of the greatest deterrents in establishing your milk supply. Again, if you cannot make this arrangement with the nursery, ask your pediatrician to arrange it for you.

Rooming-in

If your hospital offers rooming-in, this usually means that your baby can share your room during specified hours. In some hospitals, you can have your baby in your room night and day. However, most hospitals have modified rooming-in arrangements whereby the baby can stay with you all day, but is returned to the nursery during visiting hours, for the night, and any other time you choose. These rules protect the baby by not exposing him or her to visitors and by affording nursery observation and care while you are asleep or out of your room. They protect you by allowing you as much rest and sleep as possible without the responsibility of caring for the baby during certain periods.

Some hospitals offering rooming-in facilities have special mini-nurseries, each housing four babies. Each nursery adjoins a four-bed room for mothers and is staffed by one nurse. This allows each mother to observe her baby at any time through the adjoining nursery window and she may take her baby out of the nursery to feed and hold at any time.

Circumcision

Circumcision of male newborns continues to be a topic of controversy. This operation consists of removing the foreskin - a thin piece of skin which covers the glans, or head, of the penis. If the foreskin is not removed, urine and a substance called smegma can collect beneath it and, if the area is not adequately cleansed, can cause infection. Some religious groups (Jews and Muslims, among others) require that all male infants be circumcised. Aside from religious indications for this procedure, there is the medical consideration that circumcision may decrease the likelihood of penile infection and cancer in later life. However, some people choose not to have their sons circumcised because of the small possibility of infection or hemorrhage due to the surgical procedure, because they believe it is painful for the baby, and/or because they think that proper hygiene will prevent other difficulties.

If you decide to have your baby circumcised and your religion does not prescribe that it be done ritually, the procedure will be done by your obstetrician in the hospital. Within two to four days, if the baby is in good health and weighs at least six pounds, you and the baby will be discharged. Your doctor will give you instructions on the care of the circumcised penis, which usually involves keeping the area covered with sterile gauze pads and antibiotic ointment for several days.

Immediately after circumcision, the penis will appear red and sore. The redness soon disappears and there is rapid healing. Sometimes the wound may be irritated by the baby's diaper and you may notice a bit of blood; this is normal.

PKU Test

Usually on the third day of the baby's life a special blood or urine test is routinely taken in all hospitals to test for Phenylketonuria (PKU). This is a metabolic disorder which, if undetected and ignored, leads to brain damage. If PKU is present, the baby is put on a special diet which prevents the debilitating effects of the disease from occurring.

Hypothyroid Test

This test is taken from the same spot of dried blood used for the PKU test. It is not yet routine in all states, but there is a movement in that direction. This test can prevent severe mental retardation, stunted growth, and coarse features due to low thyroid levels and the condition should be treated before the infant reaches three months of age, or else there is irreversible damage. Hypothyroidism affects about one baby in 5,000 (making it two or three times more prevalent than PKU).

Health | Reproduction | Pregnancy


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