Antibiotic eye ointment is routinely applied to the baby’s eyes upon birth to combat and prevent eye infections commonly caused by gonorrhea or clamidyia. This procedure is routine, even for mothers who have negative STD testing. While the eyes are very sensitive, especially at birth, the necessity for this procedure is highly questionable, especially for low risk moms who have no history of STDs.
PKU/Other Blood Testing
Many hospitals will also do a heel prick to test the baby’s blood for a number of metabolic disorders, including PKU. Many of the disorders tested for are treatable and if caught at an early age can mean the difference between lifelong health problems, or generally normal development. The necessity of these tests is debated, especially for babies born to mothers with low risk factors, or those who have already had genetic testing. For more information about this, it is best to discuss what testing is done with your provider in an effort to make a decision about whether or not you feel this is necessary for you.
Additional practices are:
Suctioning Of Baby After Birth: When baby comes out of the womb it is common practice to help the baby breathe for the first time by suctioning the mouth but this has some debate around it. Read more
Placement of Baby Immediately After Birth - Many hospitals have different protocols for where baby should be placed immediately after birth for follow up exams and testing. Read more
Cord Clamping, Pulsing and Cutting: It is routine for most hospitals to immediately clamp the cord upon delivery. Read More
Vitamin K Injection: Vitamin K injections are routinely given to newborns to prevent the rare risk of bleeding in the brain due to a newborn’s low vitamin K levels. Read more
Vitamin K injections are routinely given to newborns to prevent the rare risk of bleeding in the brain due to a newborn’s low vitamin K levels. While this is a rare risk, bleeding can cause permanent brain damage and may not be noticed until after the damage has been done. Risks of vitamin K injections for newborns include many of the risks associated with any injection, but also leukemia. A newborn’s vitamin K levels will naturally increase as they age.
Though vitamin K levels will increase more quickly with formula fed infants than those who are breastfed because formula has added vitamin K, this is not a reason to consider formula over breastfeeding. A newborn will receive vitamin K through the mother’s milk, but at a slower rate to allow for the baby’s body to adjust slowly without being overwhelmed. There is also evidence to suggest that rather than one large dose injection, multiple smaller doses administered orally reduces the risk of leukemia, and will allow the baby’s system time to adjust appropriately. A more detailed discussion can be read here.
Cord clamping is a routine at most hospitals immediately upon delivery unless specified by the parents that they wish otherwise. This is done for two reasons; to bank the remaining cord blood, and to reduce the chances of bleeding.
While these don’t seem to be all that problematic consider that some of a newborn’s blood volume is being immediately cut off from them at the most crucial time in their new lives. The cord blood is full of oxygen and stem cell rich blood, two vital components for the baby. Delaying cord clamping until the cord stops pulsing (indicating that the placenta has shut down and all of the blood has completed its transfer to the baby) gives the baby a jump start with everything that was meant for him. Here is more information on how long to keep the cord attached and pulsing.
Leaving the placenta and cord intact also serves as back up life support. In the event that the baby is in distress, the continued supply of oxygen rich blood to the baby may serve to help save the life of a baby in distress, especially when the baby is placed skin to skin on the mother while any necessary procedures or examinations are done. There is a great Facebook page here that frequently posts articles about the benefits of delayed cord clamping here. This is also a great article written by an OB on delayed clamping.
Most hospitals will allow the mother to have the baby placed on her abdomen immediately after birth if there was no meconium present in the amniotic fluid and there is no immediate concern for the baby’s wellbeing. However, if there is any reason to believe that the baby should be examined immediately, hospital staff will bring the baby to the lighted bassinet in the room to examine him before he is given to you. This is also a hotly debated subject because more and more research suggests that a baby in distress or a premature baby actually has a quicker recovery time when examined while skin to skin with the mother. Skin to skin contact is now known to have a number of health and psychological benefits to both the mother and baby, and can be read more about here.
Suctioning and Placement of Baby Immediately After Birth: When the baby is born, most hospitals will immediately use a bulb syringe to suction out the baby’s mouth to reduce the chances of the baby getting any leftover amniotic fluid or meconium in his lungs. Even though this is a common procedure meant to protect the baby, its necessity is becoming widely debated. If there is meconium present in the amniotic fluid and the baby aspirates some of the meconium, there is an increased risk of the baby developing breathing problems and infection. The presence of meconium can be a sign that the baby is in distress, though it is not something to be concerned about if there are not other risk factors involved. The natural birth process puts pressure on the baby’s body which serves to force remaining amniotic fluid from the baby’s lungs as he descends through the birth canal. The same is true for meconium. The intense pressure of contractions and being squeezed through the birth canal often forces meconium out of the baby’s digestive system.
Many midwives arguing that the suctioning of the baby’s mouth can not only disrupt the natural process of beginning to breathe but also cause trauma to the palate that can cause pain and discomfort leading to difficulties breastfeeding. The natural process of beginning to breathe occurs differently for all babies. In many homebirths where clamping of the umbilical cord is delayed (see below for further information on this), the baby will not immediately begin to breathe on his own. This is not a cause for concern though, because the baby is still receiving oxygen rich blood through the placenta and umbilical cord. As the cord and placenta begin to shut down, the baby’s body slowly adjusts and begins breathing on its own. Thus, immediate cord clamping and suctioning can interfere with the baby’s natural methods of transitioning into the outside world.
Cesarean Sections, also known as a c-section, is the surgical removal of the baby directly from the uterus. While many women now elect to skip labor altogether (and their practitioners usually oblige,) others are determined to avoid a c-section at all costs. C-Sections are major abdominal surgery despite the short duration of the procedure. An epidural or spinal block is typically administered, although in a true emergency the mother will often receive general anesthesia and be completely sedated for the procedure. The baby is usually born within the first 15 minutes of the procedure and another 30-45 minutes are spent closing the incision.
Maternal risks involved with having a c-section include blood loss, adhesions, organ damage, infection, and extended recovery time. Many mothers who have had a vaginal birth and then a c-section report significantly increased pain and healing time. Having a c-section also increases the risk of needing a c-section for subsequent births. VBAC (vaginal birth after cesarean) is a hot topic among the birthing community. Many OB’s will encourage a mother who has already had a c-section to elect to have another one rather than attempting VBAC citing risks for uterine rupture.
Babies born via c-section are at an increased risk for lower APGAR scores, breathing difficulties, and injury from the procedure. Elective c-sections (performing the procedure before labor begins) also increase the risk of premature birth, since gestation is an approximate estimate rather than an exact science. Some mothers carry all of their children past 42 weeks and go on to have natural deliveries with healthy babies. Other moms go into labor naturally around 38 weeks and have the same outcome. Waiting for labor to begin decreases many of the risks to the baby because the hormones from both the mother and baby work together immediately before and during labor. It is suggested that in a healthy pregnancy, the baby in some way triggers labor (possibly when her lungs have matured enough) through a biological process that we have yet to determine. Electing for a delivery before the baby has finished gestating is likely to increase complications after birth.
It should be noted that cesarean section may be the best option in a few circumstances where it is best for the safety and wellbeing of the baby, the mother, or both. Some of these situations include placenta previa, placental abruption, uterine rupture, cord prolapse, fetal distress, preeclampsia, and active genital herpes in the mother. There are a number of other reasons for a c-section, (including gestational diabetes, baby being in the breech position, failure to progress, and previous c-sections) but these reasons alone are not often reason enough to elect for a c-section prior to the onset of labor.
Many moms who are having c-sections are speaking to their provider of having an assisted-cesarean where the mother assists bringing the baby out of the uterus.
There are two common tools used to “assist” delivery when the head of the baby is near the vaginal opening; the vacuum and forceps. Many practitioners will perform an episiotomy before using one of these tools unless you explicitly request otherwise.
The vacuum is a suction device that is placed on the baby’s head and used to “gently guide the head.” The forceps function the same way, but are shaped like tongs. Assisted delivery is most common for women who are also using an epidural or other pain medication that is inhibiting her ability to productively push, or she has become exhausted. If a provider recommends assisted delivery to a mother who is not yet receiving pain medication, they will strongly suggest the use of a puedendal block (an injection of local anesthetic into the nerves just inside of the vagina).
Side effects of assisted delivery include bruising on the head and face of the baby, nerve damage in the baby’s face, and discoloration of the face or head. A small blister on the top of the head is also common for babies who were born with vacuum assistance, and will typically resolve within two months.
"Purple Pushing" (or directed pushing), is commonly used for women who have had pain medication and are not able to fully feel their body’s natural urge to push through the contractions. Purple pushing is directed by the nurses and the OB who will tell you to begin pushing as a contraction begins and count slowly to ten while telling you to keep pushing for the duration of the contraction. While this type of directed pushing can serve a purpose for a mother who is unable to feel anything below her waist, it often leads to an increased need for an oxygen mask, quicker exhaustion, increased chances of assisted delivery, and increased risk of tearing because the mother isn’t able to “listen” to her body by way of backing out of a push when it feels appropriate and stop when her body needs time to stretch and rest.
Routine episiotomy is performed less frequently in many hospitals now and is not recommended as a routine procedure during childbirth by the ACOG. Despite these recommendations it is still common in many hospitals so it’s best to find out what your practitioner and hospital’s guidelines are for this procedure. An episiotomy is an incision made in the perineum, the skin between the vagina and anus. It is intended to widen the vaginal opening to facilitate birth. The risks of this include an increased risk of greater tearing, sphincter muscle dysfunction, pain during intercourse, increased risk of infection, and increased pain and healing time after delivery.
Many women are afraid to tear during delivery; however, many women who tear report significantly less pain and recovery time after a tear than women who had an episiotomy. It is also thought that a tear will heal more quickly and naturally (even if stitches are needed) because the skin will essentially graft itself back together easier than it would from a clean cut. Consider when you get a deep paper cut on your finger versus when you get a scrape or an injury that is not a clean cut; both are painful, but the latter tends to hurt less and heal more quickly than the paper cut.
Some women chose to have narcotic medications administered through an IV or a patient controlled pump because the medications (if administered in appropriately small doses), can reduce the pain without eliminating all feeling the way an epidural or spinal block can. The benefit to this is that the pushing stage of labor is not as challenging as it may be with an epidural. The effects are fast acting and typically last for a few hours.
Common narcotic medications used in labor are opioids and opiates and include Demerol, Stadol, Fentanyl, and Nubain. These all carry a number of risks to the baby including but not limited to breathing difficulties, central nervous system depression, neurological side effects, challenges with initial breastfeeding, and body temperature regulation problems. The mother is also at risk of side effects including but not limited to breathing difficulties, nausea, itching, dizziness and sedation.