Newborn Medical Procedures

Third Trimester

Feb 13

Immediately after Birth

Nuchal Cord: this is when the umbilical cord is wrapped around the baby’s neck at birth. This is actually quite common - around 30% of babies - and only rarely leads to issues, so don’t be super alarmed. If the cord is wrapped loosely, the doctors may be able to just slip it over baby’s head, but if it’s tightly wrapped they may need to quickly cut it.
Meconium: around 5-10% of babies have their first poop (meconium) in utero and breathe some in when they are born, which can be dangerous if untreated. If your doctor notices meconium in the amniotic fluid during birth, or sees other signs that the baby may have swallowed meconium, they will immediately try to suction out their airways and provide oxygen.
Delayed Cord Clamping: Waiting a few minutes to cut the cord allows for more blood to be transferred to the baby, which gives extra boost of iron. Delayed cord clamping is now best practice in most hospitals, but it’s still worth adding to your birth preferences to be sure.

“Eyes and Thighs”: this refers to two treatments that are typically administered in the delivery room after birth:

This is an antibacterial eye ointment that protects baby from infection if Mom has chlamydia or gonorrhea. It is very important in those cases, so the establishment practice is just to give it to all babies. But most moms I know in happy, monogamous relationships are pretty darn sure they don’t have either disease.
While the ointment is perfectly safe for baby, it does blur their vision for a few hours, which can impact eye contact, bonding, and breastfeeding. So consider declining its administration if you’re confident you don’t have an STD.

Vitamin K shot:
- This shot to the thigh gives babies extra Vitamin K because they are born with very little, and Vitamin K is essential to blood clotting. There are zero downsides of this!

A few hours after birth, you will be transferred to a postpartum room where you will spend 1-2 nights if you gave birth vaginally and 2-4 if via C-section
During your stay, there will be a revolving door of staff coming through: nurses checking on you and baby, pediatricians, lactation consultants, birth certificate officials, etc. While it can be comforting to have help from all these experts, it can also be very disruptive as you’re trying to fit in a little sleep. So you’ll probs be ready to head home for more peace and quiet!
Most hospitals today advocate “rooming in” - keeping your baby in your recovery room 24/7 throughout your stay, rather than having them spend time being cared for by nurses in the nursery. This is said to encourage bonding and promote breastfeeding.

However, there isn’t compelling randomized data to back this claim (paper) - in fact, if you’ve had a very exhausting and difficult birth, it may be safer for the baby for you to get a few hours break

Some parents have a fear about baby mix-ups in the nursery, but most modern hospitals (like CPMC) have electronic ID ankle tags
You might end up feeling like you don’t want to spend a minute away from your new baby, but it’s also completely understandable if you want to entrust the professionals for a bit while you recover from the serious and overwhelming ordeal that is birth!

With a quick heel prick, a sample of your baby’s blood will be sent off to be tested for a bunch of different conditions that are important to catch early
If you had gestational diabetes, they will be pricking the baby’s foot every few hours to test their blood sugar

A fancy machine will be brought in to test your baby’s hearing, since this is also important to detect early on for early intervention (e.g. hearing aids)
Know that there are a fair number of false positives, so if your baby fails the first test, try to get retested soon to determine if it’s real or not. For instance, our baby failed his first hearing test because it happened right after his circumcision and he was still upset and crying.

This is a very common (60%!) condition in newborns when the liver isn’t yet able to fully break down bilirubin (which comes from red blood cells). Too much bilirubin enters their bloodstream, which causes their skin and eyes to appear yellow and discolored.
Your baby will be examined for signs of jaundice and bilirubin levels in blood during your hospital stay, but since it can actually peak a few days after birth, continue to monitor for this once at home and reach out if you have any concerns about their coloration (your pediatrician will be on the lookout during your first appointments)
Mild jaundice will likely clear up on its own, but in more severe cases your baby will be given special light therapy (phototherapy) that helps their body to eliminate bilirubin. Untreated, high concentrations of bilirubin can lead to brain damage, so it’s important to take this seriously.

It is standard practice to administer the first of three HepB vaccine doses at the hospital, within 24 hours of birth (and even sooner - 12 hours - if Mom is HepB positive)
This vaccine will be required for them to attend school
Some people opt to instead give the baby the vaccine a few days later at their first pediatrician appointment - this is safe as long as you know with certainty that mom doesn’t have HepB (you’ll be tested during pregnancy)

In fact, in most EU countries and in most provinces of Canada, it is only recommended at birth for babies of infected mothers
More broadly, it’s unfortunate that the debate about vaccines has become so virulent that people fear being labeled an “anti-vaxxer” even if they have reasonable concerns. Personally, if my babies had a cold when they were scheduled to have a vaccine administered, I would postpone it a week or two until they were better. And I think there’s good reason to weigh the pros and cons of giving your child the COVID vaccine.

For many, the decision whether or not to circumcise your baby’s penis is a cultural/religious/aesthetic one
But if you’re trying to decide purely on health grounds, know that there are small benefits (lowers risk of UTI and some STIs), and even smaller risks (tiny risk of infection post-surgery)
The APA’s stance is that while the benefits do slightly outweigh the risks, it is not enough to recommend routine circumcision for all, and instead should be left up to personal preference

Delaying or Declining Bath:
- It is now best practice to delay baby’s first bath - some hospitals delay a few hours or days, but I recommend giving first bath at home, up to a week after birth. Here’s why:

Babies are born with a layer of white substance called vernix on their skin; it helps moisturize their skin and provides a protective barrier against infection. Bathing baby too early eliminates this useful protection
Babies are also initially very bad at temperature regulation - leaving the bath makes them very cold, the stress of which can affect their blood sugar levels and make them then too tired to adequately breastfeed