Most of us are so fixated on keeping our labor interventions low that we don’t realize that we’ll be faced with many choices regarding post-birth interventions for our baby.

In this post, we review the standard newborn procedures, show how many are not evidence-based, and provide natural alternatives.

Antibiotic eye ointment

Antibiotic eye ointment, erythromycin, is given to newborns to prevent blindness that is caused by a mother infected with gonorrhea or chlamydia. Unfortunately, this has become a standard procedure, even with moms who tested negative for these two sexually transmitted infections. This is presumably because both infections can exist without symptoms.

Many women who want to raise a natural baby would rather not give unnecessary antibiotics for a few reasons. Use of antibiotics can harm a baby’s gut health, setting them up for increased risk of illness later in life. Also, erythromycin can cause blurred vision which interferes with bonding and establishing breastfeeding.

What are my options?

Most midwives and doctors will test you for many sexually transmitted infections, including gonorrhea or chlamydia, during pregnancy. If you test positive, it would be best to use the eye ointment, although you will also be treated for these infections during pregnancy and be tested to determine if they have been cured. Although, you can ask the hospital staff to delay eye ointment until you and baby have a chance to gaze at each other and bond. If you are not infected and in a monogamous relationship, then you can safely refuse this intervention.

Vitamin K shot

Our bodies need Vitamin K to activate molecules that help blood clotting. Without enough vitamin K, babies can have vitamin K deficiency bleeding (VKDB) which is rare but dangerous.

Early onset VKDB happens in the first 24 hours, classical VKDB happens in days 2-3, up to day 7, and late onset happens after that, typically age 3-8 weeks.

In 1961, the American Academy of Pediatrics recommended giving Vitamin K shots after birth to protect against VKDB.

However, many naturally-minded mamas are concerned about the vitamin K shot.

The shot contains 20,000 times the amount an infant has at birth and moms are concerned that giving a mega dose to a day old baby can be dangerous.

The synthetic vitamin K shot is a class C drug which means it is unknown whether it is safe during pregnancy. It is also possible to overdose on vitamin K and the shot contains 5,000 times the recommended daily allowance.

It may be that injecting the vitamin K shot into the muscle of the leg allows it to release slowly so as not to overwhelm the baby’s system.

However, there is also some debate about whether or not a vitamin K injection in the muscles is safe. The vitamin K shot drug insert warns that it can cause “severe, sometimes fatal, allergic reactions when injected into a muscle or vein, and is ideally taken by mouth or injected under the skin”.

Additionally, the vitamin K shot does contain some nasty preservatives like Phenol, Benzyl alcohol, Propylene glycol, Acetic acid, Hydrochloric acid, Lecithin, and Castor oil.

Even the preservative free vitamin K shot includes Polysorbate 80, Propylene glycol, Sodium acetate anhydrous, and Glacial acetic acid to help with the absorption.

What are my natural baby options?

If your child is formula fed, your baby’s risk for VKBD is essentially non-existent and supplementing is not necessary. (Of course, check with doctor or midwife!)

For breastfed babies, you can choose vitamin K oral drops, which are definitely protective but not as effective as the shot (The shot will account for 0 deaths per 100,000 whereas the oral vitamin K will result in up to 7 deaths per 100,000. Some of this increased risk was because parents didn’t administer all oral doses.)

The Danish oral vitamin K regimen is an adequate way to reduce VKDB risk substantially in breastfed babies. To follow this regimen you need to give baby 2 drops of vitamin k (4 mg) at birth and 1 drop (2mg) weekly for the first 3 months of life. Some midwives advise moms to continue for the first 6 months of life at which point baby’s natural vitamin K levels are highest. There’s no harm in continuing vitamin K supplementing this long. It is also helpful for the breastfeeding mother to take 5mg of Vitamin K daily, as this can boost her Vitamin K levels in her breast milk.

Finding vitamin K drops in the US can be tricky, however. Here are two brands to look for: Scientific Botanicals and Biotics Research. You may also be able to purchase them through your midwife.

Some midwives believe vitamin K supplementation is only necessary in a traumatic labor like a forcep or vacuum extraction birth and/or male circumcision, both which can cause baby to bleed.

One thing to note, some believe vernix may contain vitamin K. Instead of wiping it off, rub in this creamy substance to help support your baby’s well-being.

Early cord clamping (ECC)

It was thought that ECC reduced the risk for postpartum hemorrhage. Science has since disproved that theory, yet ECC it’s still standard care. There is substantial evidence to support delayed cord clamping instead.

Delayed cord clamping in very preterm infants reduces the risk for intraventricular hemorrhage and late-onset sepsis. It increases blood volume, reduces need for blood transfusion, improves oxygenation of tissues and increases the amount of iron in baby’s blood, especially in iron deficient moms. In fact, almost all premature infants receive either delayed cord clamping or cord milking–so why not full term infants too?

Delayed cord clamping has one potential drawback – slightly higher rates of jaundice. Some researchers conclude that delayed cord clamping is beneficial when access to phototherapy for jaundice is available. Others are skeptical of this finding. According to Science and Sensibility:

“The apparent association between DCC and an increased need for phototherapy is a bit controversial. As pointed out by Dr. Judith Mercer, an expert on the benefits of delayed clamping, this concern is based largely on a single unpublished 1996 study performed by one of the Cochrane review’s authors (McDonald).  McDonald’s study is one of only two of the nearly forty studies considered for inclusion in the current review that includes unpublished data; when that data is removed, the difference between groups loses significance.”

The most recent studies found no correlation between DCC and jaundice in babies. The reality is that most babies, especially those who are breastfed, will have some degree of jaundice in the first few days and unless levels are unusually high, jaundice is physiologic, which means it is totally normal.

What are my options?

Many natural mamas choose to delay cord clamping until 3-5 minutes after which is the minimum amount of time it takes for the blood to circulate to baby.

Others choose to delay cord clamping until the cord has stopped pulsating or until the placenta has been born, both of which would take longer than 3-5 minutes.

Including this in your birth plan as well as asking your doula to help you and your partner remind your care providers when the birth is imminent, is a good way to be sure your preferences are respected.

Hepatitis B vaccine

Routine newborn procedures often include a hepatitis B vaccine. Vaccines are a hot debate but with this one many people agree that giving a newborn baby, who has a newborn immune system, a vaccine for a disease that can only be transmitted sexually or through blood is not the best idea.

So why is it routine?

We have to remember that our healthcare system is trying to take care of the general population.  This means that giving a Hep B vaccine at birth can save a baby from contracting the disease from his mother or other family members, who may not know they have the disease due to lack of good healthcare. An extremely small percentage of babies may also require a blood transfusion, and although blood is carefully screened, there is always a very minute chance it is contaminated–this is another highly unlikely, but not impossible, way that your baby could contract hepatitis B.

However, for most of the population, if you know you and/or family members don’t have Hep B and your baby is healthy and full-term (thus likely won’t be receiving a blood transfusion), your baby has almost zero chance of getting it, at least any time soon.

What are my natural baby options?

You will be tested for hepatitis B during the routine first trimester blood work your provider offers. If you know you are negative for Hep B then you may feel safe skipping the hep B vaccine until later. Dr. Sears recommends 2-3 years of age.

Bathing baby

If you’re giving birth at the hospital, you’ll probably want to avoid bathing your newborn there. The hospital usually uses products that contain chemicals, parabens, or fragrances. (Stay clear of toxic baby powder!)

While the staff may urge you to do so, know that you have options and can always say “no thanks.”

Know that you can bring your own bath products and you can ask that you be involved with the bath or do the bath yourself (or have dad do it if you don’t feel up to it).

Another concern many natural parents have is that bathing washes away the vernix (a white cheese-like protective material that covers the skin of the baby) before it has had a chance to absorb. Vernix has many benefits to baby. It acts as an antimicrobial, defending baby against infections. It’s also a great moisturizer. SO good, in fact, that cosmetic companies researched it!

Finally, our skin contains good bacteria so we don’t want to wash this off with soap and water frequently, especially in newborns who are populating their gut bacteria rapidly.

What are my natural baby options?

Most midwives know the benefit of delaying baby’s first bath and won’t even mention it. Some moms like to wait 24 to 48 hours and others like to wait a good week before bathing child. It’s really a matter of personal choice.

Circumcision

Circumcision is another hot topic for debate. Many people choose to circumcise for religious reasons, other do it because they and everyone they know are circumcised. Still others choose to circumcise because they’ve heard it’s healthier or more hygienic.

However, routine circumcision is not necessarily more hygienic or healthier. In studies, the only risk factor that increases in non-circumcised males are UTIs, which are much less likely to occur in men versus women. The risk is so low that circumcision is classified, by the American Medical Association as a non-therapeutic procedure. The American Academy of Pediatrics has never, in it’s 75 years of operation, recommended infant circumcision.

According to Intact America:

“The foreskin is a normal, sensitive, functional part of the body. In infant boys, the foreskin is attached to the head of the penis (glans), protects it from urine, feces, and irritation, and keeps contaminants from entering the urinary tract. The foreskin also has an important role in sexual pleasure, due to its specialized, erogenous nerve endings and its natural gliding and lubricating functions.”

Circumcision is also becoming less common. About half of infant boys today are not subjected to routine circumcision (up from about 19% in 1981). So when those boys are teenagers about half of their peers will look just like them.

Here are more facts about baby circumcision.

What are my natural baby options?

You can allow your male child to make the choice for himself when he is old enough. Since circumcision is non-therapeutic, there is no medical reason it needs to be done in infancy.

Newborn proceudres: the bottom line

Whether you’re a first time mama or a seasoned mother of four, know that knowledge is power. Do the research, discuss with your healthcare team, and make the choices that are best for you, baby and family.

How about you?

What routine newborn procedures did you choose or refuse? Share with us in the comments below!

 

References

  • http://evidencebasedbirth.com/evidence-for-the-vitamin-k-shot-in-newborns/http://articles.mercola.com/sites/articles/archive/2014/08/12/vitamin-k-shot-newborns.aspx
  • http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/
  • http://www.scienceandsensibility.org/category/delayed-cord-clamping/
  • http://www.askdrsears.com/topics/health-concerns/vaccines/hepatitis-b-vaccine-and-disease-do-newborns-need-vaccine-sexually-transmitted
  • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595247/
  • http://www.intactamerica.org/resources/decision