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So, embarrassing confession time:

With my first son, I didn’t explore my options, I didn’t research, and I trusted that if I want to have a natural, unmedicated birth all I would have to do is tell the medical staff and they would all smile and be proud of me. It was going to be a beautiful, bright-hospital-lights-on-my-crotch-in-my-open-in-the-back-hospital-gown-knees-in-my-throat-bland-walls kind of moment during which I was going to look like a GODDESS!

Pausing for the appropriate amount of laughter…

yeah… so maybe not so much a ‘goddess’

Hi, my name is Jaime, and I am guilty of being a poorly informed patient.

I’ll save that story for another post, though. Because, what’s worse is that although I knew I wanted this natural and unmedicated birth experience, it never even occurred to me that I should care what would happen to the baby afterwards.

Certainly you’ve seen the shows – Crazy delivery room scene, baby whisked away to a warmer, wrapped up like a little sausage and kept in the nursery so mom can ‘get some rest’. They paint a scary scene where if they don’t do ‘stuff’ to baby, nothing will be ok. And even worse, giving birth is going to be so hard that it’s better you just don’t have baby at all. In fact, they’ll schedule your feedings for you. For your convenience.

Image by: http://crunchynurse.blogspot.com/2010/05/from-nurse-to-gentle-birth-advocate.html

There are so many factors that will determine what procedures are standard – the state in which you live, the location you choose to give birth, the type of care provider you choose. But, ultimately, no matter what, the care you and your baby receive should be a choice. Here’s a list of procedures that are pretty common in newborn care, and what you should know about them.

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Cord Clamping:

So, obviously at some point the baby is going to become detached from the placenta. But, did you know that it doesn’t have to be the immediately after birth?

When you cut a baby’s umbilical cord in the moments just after birth, you are cutting of up to ONE THIRD of its blood supply.

That’s right. ONE. THIRD!

Image by: http://www.nurturingheartsbirthservices.com/blog/?p=1542

Of course baby will begin to eventually produce more blood to make it up, but in those first moments of life, after immediate loss of its lifeline, baby is likely to appear distressed and not well, which could lead a whole other string of interventions. Penny Simkin has a great visual representation of this.

Some also choose a Lotus Birth in which the cord is kept intact until it naturally separates from the placenta over the course of many days.

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Eye Prophylaxis:

The eye ointment is to help prevent eye infections and conjunctivitis that can cause blindness after birth. Thing is, the bacteria that causes the blinding infections are from chlamydia and gonorrhea. As for other, less serious forms of conjunctivitis, you know is a really great treatment? Breast milk.

Image by: ourmuddyboots.com

Additionally, the bacteria that causes these infections are also transmitted through the vaginal canal, so use after a csection is highly debatable. If you are in a high risk group for STDs, or if you are unsure if you have an STD, it’s always safest to get tested.

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Hepatitis B Vaccine:

Babies at the greatest risk for Hepatitis B are those with mothers who have the disease.  Although the CDC considers the HepB Vaccine to be relatively safe, in recent years, a lot of criticism has surfaced about adverse reactions to the vaccine.

According the CDC Fact Sheet, the risk group for Hepatitis B is those who often come in contact with bodily fluids, including those working in the medical community, those with immuno-deficiency disorders, people who do not practice safe sex, and those who are intravenous drug users. In other words, unless you, the parent falls into one of these categories, your baby is not likely to be considered at risk.

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Vitamin K Shot:

Vitamin K is a naturally occuring vitamin in humans that helps the blood to clot. Most newborns are born with insufficient levels of Vitamin K, but only a small percentage are born with levels so low that they are considered to have Hemorrhagic Disease of the Newborn(HDN). This affects approximately .25-1.7% of newborns and there are specific factors to babies who are at high risk of being in trouble.

Without these specific risk factors present, it is debatable whether or not babies should be given the injection. For babies with normally low levels of Vitamin K, breastfeeding mothers can make sure that they are eating a healthy diet full of leafy greens and feeding on demand to ensure baby gets all the Vitamin K it needs.

Ultimately, if you are concerned about your baby’s Vitamin K levels, but are wary of giving your fresh new baby a shot, there is an oral alternative that is also highly effective.

Note from Kate: There is also some research to show that babies whose cords are not cut and clamped until after they have stopped pulsing are not actually deficient in vitamin K.  The original “babies are deficient” research was done in the 1950s, when moms were put under twilight sleep, had their babies forcibly dragged out, and the cords cut immediately.  Due to the highly interventive nature of this birth, and the trauma and drugs given, the babies were at much higher risk of hemorrhage.  However, most new research shows that babies who are born under typical circumstances — even those with minor trauma, such as lengthy pushing or use of forceps — will do fine if the cord is left intact.

The shot itself also has been linked to childhood leukemia and other issues, because it contains such a massive dose and other additives.  There are oral vit K preparations available if it is decided that baby really needs something.  However, mom using alfalfa tea or supplements or eating lots of leafy greens in the final weeks of pregnancy usually ensures that baby will be fine.

http://www.rawplus.com/vitamin_k.html

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APGAR Screening:

Immediately following birth and five minutes after birth, babies are given an APGAR test, as well as several observational tests to ensure baby’s joints are ok, and there are no abnormalities of major organs. These are not interventative, and can be done in a gentle manner, and mom can request to have these tests done by her side, or with baby on her chest or at the breast.

Apgar_Newborn_Scoring_Chart

Caregivers will perform several other observational tests to ensure the baby is measuring in a certain and healthy range. Additionally, they will make sure that the baby doesn’t have any dislocated joints or abnormalities of any major organs.

Again, there is no reason that any of these things cannot be done while the baby is immediately around the mother. Also, if there are any observations that cause alarm for the doctors, it is your right to know and understand those concerns before treatment is administered.

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Heel Stick Test:

The March of Dimes recommends babies be tested for about 29 metabolic and genetic disorders. The heel stick test is a slight puncture in your baby’s heel to draw blood for analysis of these diseases.

Research these diseases and know if you are at risk for some of these through family history. Here is a great, in depth resource for the disorders. If you feel like it is in your best interest to have the heel stick done, baby can always be at the breast to ensure better soothing than if he were on a warmer. After all, mama is a baby’s best warming pad!

Note from Kate: This test is usually known as the PKU test.  If PKU is not caught early it can lead to mental retardation and death.  If it is, a special diet can be chosen and the baby can thrive.  It is very, very rare.  This test is best performed when baby is 3 – 4 days old in a pediatrician’s office because it is more accurate once baby has begun receiving breastmilk instead of just colostrum.  This is why hospitals will not do it until the baby is a full 24 hours old.  If you opt for a home birth, a visiting nurse may come to your home when baby is a few days old to perform the test.

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Circumcision:

Perhaps one of the most highly divisive of all the newborn procedures, circumcision has vehement advocates on both sides of the issue, but trends are showing it is on the decline.

In 1999 the American Association of Pediatrics released a statement explaining that the research available that demonstrates the potential benefits of circumcision is not sufficient to recommend routine neonatal circumcision, reaffirming their position in 2005. The American Medical Association backed the AAP’s stance. In 2007, both the American Academy of Family Pediatrics and the American Urological Association released statements saying that there are risks with circumcision and an intact penis, and parents should be well informed of these as well as be the decision makers.

Note from Kate: Recently, the AAP came out to actually recommend neonatal circumcision.  This is not a position that Modern Alternative Pregnancy shares.  We do not feel that the evidence is sufficient to recommend circumcision for medical reasons, and do not believe that it should be considered by all parents.  Please do your own extensive research into this procedure before agreeing to it, and consider waiting until the baby is 8 days old, at which time newborns better handle the procedure.  However, know that complications from circumcision kill about 100 babies per year, and that many more end up with infections, regrowth of the foreskin, and other complications.  This is a cosmetic procedure that needs to be very carefully weighed.  There is also the issue, for many parents, of “his body, his choice” — the idea that the infant ought to have some say in whether his body is unnecessarily surgically altered.  There are various religious reasons for this decision too.  It is not one to take lightly.

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I know – it’s overwhelming and there are a lot of decisions to be made about the care you and your baby receive! If you don’t feel like you can navigate the choices and options on your own, hiring a doula can be the best tool to help you make informed decisions about your care. 

Did you face resistance when it came to your newborn’s care? Did you feel equipped with the tools to make informed decisions?


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Faith is first a daughter of the King, second a wife to Kerry and third a mommy to Julian and Margo. She is blessed to be able to be a stay-at-home mom, which was always her answer to the “what do you want to be when you grow up” question as a little girl. She delights in serving her family real food and blogs about favorite recipes, family life and other random topics at Storms Stories. She is also the editor of Modern Alternative Pregnancy.

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83 Comments

  1. I regret hugely not being an informed patient with my first & second, especially since I was forced into a c-section because the baby was breech. I walked to the OR with no mess & was later informed when they began the “emergency” c-section because the spinal caused my blood pressure to crash. ( my husband was not allowed in the OR until they were removing my daughter because it took that long to stablize my pressure. They also later informed me that while I was walking to the OR my daughter was crowning breech! I had a very very easy delivery with my first and I know I could have safety delivered my daughter breech, especially since she was frank breach, butt first. I was very upset when I discovered I had been bullied into a c-section.

    I switched OB’s and with my son my ob was very supportive about waiting until I went into labor and delivering 100% natural v-bac at our “banned hospital.” however my son was very high risk and at 37 weeks they discovered I had NO amniotic fluid and had to be induced. In such a situation a vbac at my hospital of choice was not an option & we would have had to drive 2 hrs to a hospital that allowed it, so I went with a repeat c-section. But that was my informed choice this time! I also was very glad I was informed on the tests too! The only one we allowed the hospital to perform was the PKU and only b/c I couldn’t convince my husband it was unnecessary. In retrospect I feel so much happier with my sons birth than my first two, because I felt I was in control instead of the hospital. Also, I would not enter the OR until the staff allowed my husband to walk in with me! He sat with me thru 2 (yes two spinals!) the first one didn’t work & neither did the second they had to use an alternative drug! Lol I was beyond happy to have my husband in the OR as he was the only one who believed me when I said the first two hadn’t worked! But that’s another story. Lol

    Ps sorry for any misspellings and grammar issues. Typing on my phone. :)

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  2. I believe the APGAR score actually consists of five, not four, factors. I raise the issue because I know you want to present the most accurate information available.

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  3. Just fyi–the AAP did NOT change their official stance in favor of circumcision. They did note that there are ‘benefits’ that outweigh possible ‘risks’ (debatable, of course), but that any benefits are *not significant enough to recommend routine infant circumcision*. Basically, they still encourage parents to look into it and make their own choice.

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  4. Informed or not, you can still get bullied… And there’s the fact that in NY State you cannot decline eye prophylaxis OR Vitamin K. I was able to decline the Hep B, but declining the other two would’ve had CPS called on me (and potentially my baby taken away).

    Anyway, a very informed birth this last time around, but I still got bullied into delivering in a position I didn’t want (on my side instead of squatting), I got bullied into managed 3rd stage (after many discussions with the midwife, she still did it). It took me a while to allow myself to hurt this time around because I felt I *should* feel better about it… Anyway, in the end, we have to accept our births and move on and love on our children. Do your best and forget the rest. :)

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  5. Do you have any more information on the link between delayed cord cutting and vitamin K levels? I’d never heard about this before, but it does make total sense. I’d love to read those studies if you happen to have a link or a citation you could provide to point me in the right direction.

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  6. My midwife has done extensive research into newborn procedures and strongly encourages parents to do their own and make their own informed decision. We followed her recommendations for many procedures, but others we differed on and she respected our decision.

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  7. Great, great, great post! I am a child birth educator and we talk in great lengths about these procedures in class! I will be sharing this with all my families from now on!

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  8. I have had 3 babies born at home. I appreciate this information very much. If blood needs to be taken. Only allow it from the cord, not by pricking the babies heel. Not necessary. Thank you for informing that the cord need not and should not be cut until it turns white, which means all the blood has gone to the baby. It’s almost funny in movies when an emergency childbirth happens, everyone just panics at the thought of not cutting the cord immediately! I remember one of our childbirth class teachers, said “hey, they could drag it around with them all their life if they want”!

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  9. Anyone who decides against what you called the “heel poke” test is a fool! Yes, that may seem harsh but my daughter has PKU. Neither my husband nor myself have been able to find anything in our family histories to indicate that it was present but it is. I love my daughter and other than her special diet she s no different from any of her friends. Had we opted out of the test and not found out, our daughter would most likely now be severely be mentally retarded. Why would you not want to save your child from that if possible?!

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  10. Just an FYI, it is actually not recommended to wait to circumcise 8 days after birth, and many doctors won’t do it then. Doctors will either circumcise a boy within 48 hours of birth (when no stitches or anesthesia are needed), or they wait until the child is approximately 8 months old at which age it’s considered surgery. The reason they wait is because a baby’s skin within 2-3 days of birth is paper thing. After this time, a certain gene is activated which produces a protein that thickens up the baby’s skin. At 8 days old, the skin is too thick for a circumcision without stitches, but the child is still too young for anesthesia. After that initial 48-72 hour window, circumcision becomes surgery, and doctors now need to wait until the child is almost a year old before they can safely administer anesthesia for the procedure. Because of this reason, it’s recommended to circumcise within a few days of birth. There are less complications involved, and it’s a faster and more painless procedure. There are no OBs around here that will circumcise a week-old baby. It’s just not done.

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    • Here in Washington they will only circumcise at 7-10 days in the pediatrician’s office. They do a local anesthesia and the whole procedure only takes 15 minutes.

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      • Are you referring to WA DC, or WA state? I work for a pediatrician in WA State and they will circ up to 13lbs, doesn’t matter the age of the baby.

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    • OBs shouldn’t be circumcising babies at all.

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  11. I have to disagree with Emily, some OBs WILL circumcise when your baby is weeks old–my son was born 5 weeks early, was in the NICU for 2 weeks and had the procedure done at 6 weeks old in my OB’s office. While I feel HORRIBLE that he had to have it done when he was older (not something that I would normally choose), our circumstances led to that happening. Also, in the same vein, many hospitals REQUIRE that if you’re getting your son circumcised, he must have a Vitamin K shot done for clotting reasons (our state requires it). Check with what your state requires for a hospital birth to be truly informed. You can also ask for the eye ointment, Vitamin K and heel prick to be done after you’ve had some bonding time. And I agree, ALWAYS ask for delayed cord clamping!!

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  12. Emily: If a baby is too young for anesthesia until it is nearly a year old, why do we hear of babies having surgeries, some immediately after birth? Where did you get your info?

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    • If a newborn is having surgery, it is probably life threatening and cannot wait.

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      • My daughter was 3 months old and had general anesthesia to keep her still during a lumbar puncture. It wasn’t anything “life threatening”. Babies can safely go under anesthesia from birth, but like at ANY AGE, there is always risk. I would like to know where you think your getting your great information from lol

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    • I work for a urologist, and after a baby is sent home from the hospital, peds refer them to us for circs. None of our docs will do it on a child under a year old, because its not a “necessary” surgery, and not worth the risks of anesthesia.

      Reply

  13. As an RN, I agree you should be informed about what is happening during and after the birth of your child. I have a few issues with this list though. Several states require vitamin K and eye antibiotics, meaning you really don’t have a choice. A heel stick, or PKU, should be be drawn 24 hours after birth and tests for several abnormalities which could otherwise go undiagnosed. Circumcision cannot be preformed without consent from the parents. And the APGAR posted here is not for people.
    Be informed, but get your information from a reliable source. Also know that the doctor and nurses are there to help. If they are doing something you are unhappy with, ask why…but be aware that it might be for the best. Child birth can be dangerous for Mom and baby.

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    • This is the best thing I read on this whole page. Way to call it as you see it;)

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      • I agree Bridget. I am a mother/baby RN. People should become of informed about their care… but get it from a reliable source. Google is not a reliable source. A few things may be unnecessary in the hospital, but for the most part not getting certain interventions could cause more harm than good.

        Hospitals are changing the way they used to do things by keeping infants at the bedside 24/7 instead of separated from mom like they used to. Nurses are trained to always be the patient advocate. If we administer something to prevent hemorrhagic disease of the newborn or eye prophylaxis to prevent blindness of your baby, I would want that for my own children.

        People need to research journal articles to become educated on pros/cons of why we do certain things. Become informed everyone… but don’t trust everything you see on a blog page either.

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    • Bridget, you’re right on target. So many of my patients have declined certain procedures based on the info they’ve received or researched online. Yet ALL of their info is flawed, biased, or just plain illogical and unreasonable. Like this blog for example, there are many half-thruthes in every paragraph.

      I’m in full support of all parents educating themselves about childbirth and infant care before being admitted to a hospital and having to make these decisions. However, I’m also in support of parents getting the real deal about the info … rather than someone’s biased opinion on why mom’s and babies ‘need this and don’t need that’.

      Get informed, and let it be from valid sources. Then talk to the medical professionals you’ve chosen to handle your care. This blog is definitely NOT a valid source. There is nothing here to support any of the claims written on this blog.

      For the record:
      APGAR scoring is done at 1 minute of life, and 5 minutes of life. A 10 minute of life APGAR score can/will be done if needed.
      A= appearance (color)
      P= pulse
      G= grimace (irritability)
      A= activity (muscle tone)
      R= respirations

      Reply

    • I agree with Mandy. This is the best comment on this page. I cringe when I hear people refusing procedures recommended by PROFESSIONALS! These procedures are in place for a reason. People that post information like this often scare mothers into making poor decisions that could ultimately harm their child.

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      • Are you kidding me?? Cord clamping before it is finished pulsing DOES retain 1/3 of your BABYS blood! If these doctors are “professional” why in the would they insist on cutting the cord prematurely? The Hep B shot is the most unnecessary shot I have ever heard of. I do not have hep B, why the heck does my baby need a foreign chemical shot into her body? Not to mention they have been proven to be dangerous as it is. You know the Gardisil shot? It’s been recalled because it has killed people. That shot was recommended by “professionals” for a good while. I think it is so foolish to say something like “trust the professionals!” I also think it is so extremely foolish to say that people who write these articles are just trying to scare us. Do you really think that a mother would opt out of these “routine” procedures because some lady wrote an article? Bull crap. We don’t opt out of these things because we are uninformed. If anything, we are well aware and more informed than people like you who blindly follow these “professionals”.

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  14. Good for you for trying to educate yourself. I feel that a lot of your resources are biased, however. A great place to start would be a Maternal Nursing textbook. This resource will explain the procedure, the rationale behind it, and patient teaching. The anti-doctor/anti-medicine/anti-vaccination movement is a dangerous one… Anyone can post anything they want on the internet. It would be wise to ensure that your resources are credible before taking the information offered as gospel. Good luck!

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  15. I am a maternity nurse…. The babies who wait to have their cords cut can have extremely high bilirubin levels…Vitamin K IS NECESSARY! If you can live with your child dying of a brain bleed or be permanently disabled fine don’t give it….Hepatitis B is something I would CONSIDER waiving however I do recommend it… Kids are around each other and get in accidents all the time that can lead to Hepatitis B…. Just saying from my personal experience.

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    • Thanks, Kristen, but I must admit that we don’t appreciate scare tactics. I have personally waited 10 minutes with each of my children before having their cords clamped and they have both had exceptionally LOW bilirubin levels. We did not do the Vitamin K shot with either of them and they are happy, healthy kids. Hepatitis B is primarily a sexually transmitted disease, so we felt that was not a necessary injection to give our newborns.

      Reply

      • As an L&D nurse I can say that waiting to clamp the umbilical cord for 10 minutes is ridiculous! One of the biggest risks for a baby is getting cold, from there you start having blood sugar issues…..and let’s face it, with the 10 people you have crammed into your labor suite the nurse responsible for drying & assessing your baby isn’t going to be able an easy task. So many people come in with so many stipulations for their labor I sometimes wonder why they don’t just stay at home! My job is to protect mom and baby during the labor process and when a parent is demanding interventions or lack of interventions it makes my job that much harder. You came to the hospital so the nurses and doctors can care for you safely so stop trying to do my job and I promise I won’t try to do yours!

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        • I am sorry to hear that you feel that way, Stefanie. Again, we waited no less than 10 minutes with both of my children to clamp their cords with absolutely no problems. I am not sure what you are referring to when you say, “the 10 people you have crammed into your labor suite”, but both of my babies have bee born at the hospital and the only people in the room were myself, my husband, my doula, my midwife and the nurse assigned to me. Women should e able to come in with stipulations for their labor because it is THEIR labor!

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        • Well said, Stefanie! I hate when people think they know more than nurses or doctors because they read it not e Internet.

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        • Stefanie,

          While I love nurses, your attitude is one of the things wrong in the hospitals today. You are there, because our insurances are paying you. You are there to take care of patients and provide the best care possible not make people conform to practices that may or may not be accurate. Yes, we choose to be in the hospital to deliver, but it doesnt mean we have to conceed to every policy.

          I have done my research unlike most expecting moms and have found a lot of hospital procedures to be out-of-date. Can you tell me one death from aspiration in the last year from a laboring mom who ate in labor? The policy of not allowing women to eat during labor was established when they were put completely out during labor and delivery. At one time, it was thought safe to knock woman completely out or to tie them down to the bed during labor. Just recently, the recommendation for yearly Pap smears was changed…because it wasn’t beneficial to have them that often. Medical policies and procedures are always changing and some haven’t been changed, but there is current research proving it’s irrelevancy.

          I believe that women should do their own research for any decision being made for them or baby and not just be a sheep doing exactly what they are told.

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        • But you ARE trying to do the mother’s job when you assume to know best what procedures/shots/methods should accompany the birth of someone else’s baby. And many times, the mother would much rather deliver at home but due to insurance, lack of midwives in the area, etc…she feels she has no choice but to labor at the hospital. However, once there she does not sign away all rights as the patient and mother. It is her prerogative to labor and deliver in the way that she is most comfortable with – not what makes the nurses or medical staff comfortable or what they typically do. Your attitude is exactly the reason so many women avoid hospital births like the plague…..because nurses like you show contempt and disdain for any mother seeking delivery and newborn care that varies from the nurses’ training and/or personal preferences. Seems incredibly arrogant for you to assume your (or the hospital’s) norms somehow trump the mother’s.

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        • But with an attitude like that I wouldn’t want you to deliver my grandbaby. You may be able to be there to help & do a JOB but it is at the request of the person you are to be helping. If they want something done a certain way & it isn’t unreasonable then they should have it done for them. We are all different & you should be listening to the person you are trying to help & their concerns not yours & the way you want to do it, just because you have always done it that way. Just saying! This girl is just trying to give others options as to what they can or cannot do. So many things are decided for us & we really aren’t certain if they are good for us or not just because they tell us it is.

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      • Hepatitis b can live on a hard surface for three days and still be contagious. It can also be passed person to person through touch, not just sexual touch but any touch.So if u live in a community that has umm people in it, I would highly recommend your children and yourself be vaccinated.

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        • Thanks for your opinion, Shellby.

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        • Hep B can NOT be passed “by touch”. As confirmed by the CDC website (me and my silly Internet research), it is a blood bourn disease which can only be spread through sexual or blood-to-blood contact. Two open wounds would need to make contact for transmission. Also, it is not a permanent disease, nor is it one with a high (or even moderate) fatlity rate. Statistically speaking, a child was less likely to contract the disease prior to when routine vaccination began than they are to now experience a serious or fatal reaction to the vaccination.

          If you expect your infant to share needles or be sexually active, then it is a wise vaccine to get. Otherwise, this shot can wait until the child is much, much older.

          The number one “what if” scenario most healthcare providers offer to support infant hep b vaccination is that babies can bite each other, draw blood, and pass it that way. However, this is not evidence-based, as there are no documented cases of it ever happening.

          Our family practices evidence-based care, not cultural/routine care.

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          • When i read “by touch” i assume that meant the possiblilty of a wound touching against another wound where blood would be involved.. is it extremely likely? Probably not. Is it possible, of course, anything is possible.

            I would rather get a routinely used vaccine than have a child that contract Hep B because I opted out For them.

      • This is scary. Please do not provide information that you do not fully understand. Hepatitis B is not primarily a sexually transmitted disease. You can educate yourself below.

        http://www.who.int/mediacentre/factsheets/fs204/en/

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    • Thanks for the concern about Hep B, Kirsten, but I will be opting out since the risk of my baby contracting Hep B from infected blood or bodily fluid is extremely remote. I wouldn’t have my baby vaccinated for AIDS either if and when such a vaccine exists.

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    • My first two sons we did not delay cord clamping, and they both had very mild jaundice. My third son we DID delay clamping, and he had no jaundice at all. I realize this is anecdotal evidence, but it just makes no sense to me that delaying would decrease bilirubin levels.

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  16. I tested positive for Step-B bacteria shortly before my daughter was born. Due to this, my daughter’s pediatrician refused to discharge her until she had the Hep-B vaccination. Beyond this I refused everything else.

    I am constantly amazed: #1, how birth is treated as an illness in this country, #2 how the US has the highest cost of delivering a child, #3 how some parents INSIST that you are crazy if you don’t bow down to every demand from your doctor. Medicine constantly changes as more research is done. Doctors are not *required* to keep up with changes nor alter their views/practices in response. Certainly, doctors deserve respect for their knowledge, but everyone on this earth is fallible. Do your own research, weigh the pros and cons. Knowledge is power to do what is right for you and your child.

    One week after my daughter was born, at a “well baby visit,” I was informed that my daughter was not gaining enough weight according to the handy Enfamil chart my daughter’s pediatrician had on hand. The pediatrician threatened that my breastfeeding was simply not cutting it, and my daughter would NEED formula if she didn’t gain enough weight in 24 HOURS. I never went back to that doctor. I learned – quite easily online – that breastfed children grow at a slow and steady rate, while formula fed babies plump up quite quickly due to all of the extra calories added to formula. Did the pediatrician mention this? Why no. Perhaps her doctorate, earned 20+ years ago didn’t mention it.

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    • To say a doctor is not required to keep up on current practice is a joke. I’m not sure what your occupation is, but from your post I can attest with 100% certainty it is not in the medical field. If parents do not want the advice of doctors, who spend innumerable hours each week providing education and attempting to better the health of their patients, I suggest you do not visit them. Simply care for your family on your own. When I want my taxes done, I visit h&r block, when I need the oil changed in my car, I head to my mechanic. Think about it. I will echo former posts. Do your research, but actually research. Google doesn’t count.

      Reply

    • I had my sons first pediatrician tell me that my breast feeding wasn’t cutting it alone according to the Enfamil chart. I was sent home with 4 sample cans of it and told that I had to supplement if I wanted him to be healthy. I didn’t know any better and I wished that I would have before just doing as I was told out of fear of possibly harming my child or having him taken from me for being a “bad mom” by not listening to the Dr :( After doing this my milk supply dropped significantly and I had no choice but to continue to supplement. I was later informed by his new pediatrician(we switched when a closer office opened) and WIC that my son was overweight and they didn’t see a need for me to have been supplementing to begin with because he hadn’t lost any weight and was only a few ounces under what the chart said he should be at that time. Lessened learned, this time around I will know better and ask questions or get a second opinion.

      Reply

  17. I have been a NICU/well baby nurse for 15+years and some procedures are optional, Per state, some are not.
    1. Full explanation of the Lotus birth is really risky. Not clamping the cord can cause an air embolsum or cause the baby to bleed out. To me not worth the risk.
    2. Eye ointment is not an option in my state, check your states regulations. Br milk is best but there are reasons that mom’s can not nurse.
    3. PKU screening does test for 29 metabolic disorders without a correction in a baby’s feedings these disorders can cause death, again not worth the risk.
    4. Circumcision is optional, totally your decision.
    5. Apgar scores are to assess the babies transition to life outside of the womb, so nurses and MD’s know what steps to take next to help your baby.
    6. Lastly, Vit K it is given to babies, is optional in my state, it help prepare the colon to digest the baby’s feedings. When I started in the nursery I always wanted to call the MD for blood results. MAJORITY of times the baby has an excess of blood cells, not a lack of blood as indicated by the writer of this blog. Unless there is a trauma related to the delivery blood levels are normal or higher than normal……
    Please women research your information and sources. By all means ask what has to be done by state regulations.

    Reply

    • Regardless of state regulations, you are still the parent and can refuse anything you desire. In my state, STD testing is “mandated” in pregnancy. I refused these blood tests each and every time because I find it dishonoring to my faithful husband to take an STD test “just in case”.

      Reply

  18. I’m a military wife so I’m speaking for base state and home state. Child was born in base state and was required to have a hearing test done and PKU. Failed hearing because the machine was acting up. Week later, yes a week, went to home state. Since I had no record of a PKU performed, child had to undergo the heel stick once more required bylaw of home state. Also had to re do hearing test because the nurses told everyone that day, they should get the hearing test done again at the pediatrician. It is base state law for newborns have to have a hearing test. Home state thought base state was a little crazy.

    Reply

    • As a speech pathologist (and military wife and mom), your home state/pediatrician is actually the one off base. Newborn hearing screenings are rapidly becoming the norm as a tool for early detection of hearing loss in many states. The fact that the military bases are keeping up with that is a huge kudos for them and a bonus for all us moms relegated to having babies on a base. Early intervention of hearing loss is paramount to helping with a more normal acquisition of language (be it spoken language with assistive hearing aides or sign language, etc) and this screen is just the beginning of identifying a potentialproblem. A hearing screen is not an invasive assessment in any way. Most of the time the babies sleep through the beeping of frequencies presented in their ears. Because mom and baby are in the hospital for ~2 days, a follow up with the pediatrician for further assessment is the appropriate recommendation when a hearing screen results in anything but a ‘pass’. I think that if a better explanation was provided to you rather than “the machine was acting up” your opinion of the test might be different.

      Reply

  19. OK. I’m just saying that the fact that they used an apgar chart for horses(seriously. It says”foal” right on it) kinda kills their credibility. Come on ladies. By all means do research and be informed. But please don’t listen to a bunch of garbage with a bare minimum of facts from an author who is to dumb to use the right apgar chart. I think we are all smarter than that. When looking for info scholarly publications are your best bet for proven facts

    Reply

  20. I would like to encourage parents not to make decisions based out of fear. It is hard, I am a parent and I know I have made choices out of fear of harming my baby or worried that getting my child vaccinated could do her harm. FYI I she is up to date on all her vaccinations but I worry regardless.
    I know some have used to argument that medicine changes all the time so why should we trust their knowledge. But isn’t that the beauty of medicine is that they are always evaluating and looking at themselves and doing things by evidence based medicine. Not saying that the system is flawless, because it isn’t. But try to balance your information with the education and experience of your health professional. It is also important to realize that to gain knowledge and concrete facts, studies have to be conducted, now here is the hard part studies involving pregnant women/infants are hard to control and do because it can be unethical and immoral. (the how much alcohol is too much during pregnancy is a classic example, it can’t be tested)

    1. Delayed Cord Clamping
    It is interesting and I did a quick search and according to WHO and PUBMED. There are pros and cons and how early or late is hard to determine. I know when I delivered, even if I had wanted to delay it wouldn’t have been an option because her cord was wrapped around her neck twice. So, this may be something you want but be flexible because circumstances can take it out of the equation.

    2. Eye Prophylaxis
    Hard one. Many patients lie. Period. So, do you mandate that everyone is required to do this so you don’t discriminate or do you trust the patient and the history that they give. This is hard also because Great Britain doesn’t do prophylactic eye ointment and they have similar numbers as US. (a study done in 2009, which is old for a medical journal, by clinical trials.gov)

    3. Hep B
    You can get this done at anytime in your life and if you end up going into a profession where there is a high risk of coming in contact with blood (medical, police, etc) you can get it done. That being said, a lot of people that have hep b don’t know they have it because they feel fine and are healthy but can still spread it. We did it because both my husband and I are in the medical profession and there is a high risk of coming in contact with someone with hep b and you drag it home with you.

    4. Vit K and Cancer
    According to the blood transfusion journal in 2011. The cancer scare occurred in the early 1990s and two retrospective studies were done one by the US and one by Sweden and both studies found no evidence of that link. You can do oral vit K but there are two types of hemorrhagic bleeding that infants are at risk for, early and late. Oral is less likely to prevent late onset bleeding. All newborns have low vit K because it does not readily cross the placenta.

    5. Unless there was a complication during labor, it is usually done while the mother is holding the baby. I think a lot of labor and delivery teams are aware that mothers want to hold their baby and want to promote bonding. More studies are showing that sooner is better and that is being promoted in hospitals.

    6. PKU test
    It is such a small stick with life saving benefits. Family history is not always reliable because a lot of genetic issues are recessive and may not show for a generation or two. An easy example is sickle cell: you can be two healthy adults and be sickle cell carriers and have a 25% chance of having an affected child. (a picture makes a lot more sense) Also, just a side note: adoption is much more open these days but I still know of people that haven’t found out that they were adopted until late adulthood. I am adopted and it was hard to hide it (I am asian and my parents where white as snow :) ) But depending on the family (yours or your spouse) it may not be an open topic.

    7. Circumcision
    Totally your choice as a parent. But if opting not to circumcise make sure you teach good penile hygiene. Its easier to get fungal infections if you don’t clean it properly. And as they get older STDs and HPV etc if good hygiene is not in place.

    One final word, worry this was long winded but we have so much information at our fingertips please use a reliable source. If you don’t want to use a US medical journal a lot of the UK information is available to us. I feel that the links and sources of this blog are more biased than educational. I also get the feeling that you have to be up in arms , almost pitting you/baby against the big bad hospital. You can catch more flies with honey.

    Reply

    • Circumcision is indeed a parent’s choice, but the risk of infection from a circumcised penis is much higher than the risk of “improper hygiene” from an uncircumcised one. The foreskin is self-cleaning, just like the vagina, and needs no extra care (we don’t scrub out our baby girls’ vaginas!) Babies do not die from NOT being circumcised…

      Reply

  21. If your are banking the child’s cord blood then do you no longer have the option to delay cord cutting?

    Reply

    • YES, You can still choose to Delay cord clamping & bank your childs cord blood!!
      I work in Cord blood banking & before I started, I thought it was one or the other & I was relieved to know you can still to both!

      Reply

  22. I really feel strongly that encouraging people to refuse the PKU test is dangerous and stupid. (Same for refusing erythromycin and vitamin K. Sure your baby may not need it, but seeing as there are NO side effects to this and it prevents potential harm to your child, why wouldn’t you?) Why on earth would you risk your child’s health that way? I understand seeing your new baby’s foot poked and hearing him cry is hard, but it’s the responsible thing to do. As a parent you have to be strong and do what’s best for your child, even if it’s hard for you. Besides a little bit of pain, there are absolutely NO negative side effects to this! Sheesh, what’s next? Are parents going to start refusing APGAR scoring and hearing screens? It seems some people are just looking for problems that don’t exist.

    Reply

    • I don’t think the article is encouraging people to not do the pku test, it’s just talking about the test and how to make it more comfortable for baby. I do really none of the other screenings or medications but I do pku.

      Reply

    • What is “responsible” to you may be “irresponsible” to someone else. I personally feel that it is irresponsible to pump my babies full of synthetic Vit K, antibiotic eye drops, and vaccines before they are even a day old. The author is simply suggesting that we each research and find what we are most comfortable with and then decide for ourselves. She is not advocating for your rights to choose these procedures to be taken away, merely that others also have the right to deny them. And as for the “no negative side effects whatsoever” comment, that is simply not true. ALL of these procedures are new (in terms of human history), and in all honesty, no one (not even doctors) understand how they will affect society as a whole long term. What we do know is that cancer, obesity, diabetes, gluten sensitivities, soy sensitivities, Etc….are all “modern” ailments, and the medical community has only just begun to research WHY these diseases are affecting disproportionately large numbers of people today when throughout all of history they have not. Does modern medicine cure diseases and help preserve life? Sometimes. Are all medical practices and interventions curative or preventative? Hardly. The author merely wants us to be critical consumers and then decide for ourselves. It is just as much her choice to choose no as it is yours to choose yes.

      Reply

  23. As a labor and delivery nurse, I feel hurt when it comes across that those at the hospital are out to hurt everyone. I hate being grouped into s category because i take my job seriously. I feel like I follow evidence based practice.
    Where did you get the study about cord clamping and 1/3 of your blood? I would like to read it

    Reply

    • Jessica,

      There was a recent post on cord clamping. I am mobile right now and can’t post the link, but if you search the blog you will find it.Thanks!

      Faith

      Reply

    • Jessica,

      I totally agree with your comment.. I’m an L&D nurse, and I absolutely love it. I take pride in bonding with my moms and making them feel comfortable, i’m genuinely excited to see a family started and meet their new little blessing. This post read to me as implying that we are out to harm and not to help, which is definitely NOT the case. I’m all for being informed and making decisions, truly I am, but please be considerate of those “bullying” healthcare professionals because, for most ( I do realize there are some that truly are unruly), this is our passion.

      Reply

  24. I’m a stay-at-home Mom with a girl, 6, and a boy, 20 mo. I don’t regret any of the decisions I’ve made for my kids and don’t think others here should either. I’d just like to say that after I read through this, I think others should know that the things they do to the newborn are meant to provide the best possible outcome. I would encourage others to understand the reasons behind why these things are done, not in relation to them being unnessessary, and therefore declined, but as a safety measure to the infant. Personally, I don’t want my infant to have ANY eye infections or continue to bleed, so I would want my baby treated. I agree with getting the PKU test because it could ruin your child’s life if present and untreated. I also got the Hep B for both my kids. I felt it was best to start protecting them now because you just don’t know what the future holds for your child. I feel I can sleep at night knowing that if my kids come in contact with an infected person, they will be covered on that at least. And before you scoff, please note that while I still worked at the hospital, I saw a good handful of prenatal work ups done on children as young as 10 about once a month.

    Also, I just wanted to say to everyone who felt bullied or lied to about an emergency C, don’t. Just go hug your child and put the unnessessary guilt aside. My sister-in-law refused to be “bullied” into an emergency C-section and lost her son as a result. So please don’t dwell on the past. Just know that the OB’s job is to care for and be an advocate for your baby.

    Reply

    • Thanks for your thoughts, Kim. Everyone has to weigh the risks and benefits of every decision they make in pregnancy, labor and regarding their newborn. This post is not meant to be prescriptive, but to simply share the “other side” that you (probably) won’t hear about from your OB. If you feel as though you made the best choices for your family by choosing these newborn procedures, good for you! I know I made the best decision for my family by declining them.

      Reply

  25. Does anyone know if blood sugar screening is standard/required for newborns?

    Reply

    • I ave never heard of that, bt perhaps it is just not a requirement in my state. Also, any “required” test can still be waived by the parent. You will probably have to sign some sort of form, but there is no test or procedure that can be forced on you.

      Reply

    • It depends on if the mother has risk factors. As a nursery nurse, we do blood sugar checks on babies who are born to moms that might have failed one of their blood glucose tests (not necessarily diabetic). And we also do mandatory blood sugar checks for diabetic moms, and small (less than 5lb 13 oz) and large (over 8 pounds 13 ounces) because those babies are more at risk for hypoglycemia. Blood sugar checks are also recommended when babies are cold (less than 97.6 degrees) or are jittery as these are signs of hypoglycemia. And we will do blood sugar checks if a baby has not eaten in 6 hours ( per hospital policy).

      Reply

  26. Wow, well if you dont want anything done to your baby then just go have him at home or in a cave! shees you crazy tree hugging people!

    Reply

    • Wow, this a hostile, judgmental, arrogant comment. Simply because the author has a different viewpoint on labor, delivery, and newborn care she is suddenly a “treehugger!?” Do you realize that the “modern” notion of childbirth is less than 100 years old and that throughout the rest of human history childbirth was seen as a natural part of life, not needing medical intervention other than in RARE cases? Do you also know that the US has one of the highest infant mortality rates of all industrialized nations in the world? Why is that? The author is suggesting we take a closer look at all of the “modern” techniques and procedures done in hospitals and choose what we feel, as the parent, is the best. She is not denying or bashing your right to elect to have these procedures done. Why can you not show her the same respect when she chooses not to?

      Reply

  27. It is so hard for me to understand why people believe things they read on blogs like this. Please get your information from a credible site. Why would you base the care you get for yourself or your child off of someone’s blog and not evidence based research. So foolish.

    Reply

    • I think the problem here is that you are assuming that the author of this post made all this information up and that parents will just read this post and base their decision off of it. The author of this post did research based on evidence based research before sharing her thoughts here. Also, this is meant to be a jumping off point for parents to become aware of what is “standard procedure” and therefore enable them to look further into the issues at hand.

      Reply

  28. [...] most popular post ever on Modern Alternative pregnancy is titled, “You Want to Stick that in my Baby Where?! Informed Consent in Newborn Procedures”. As of last night, the post has 58 comments. It is viewed thousands of times every month by many, [...]

    Reply

  29. Just thought you should know before posting things like this to make sure and do and little more research mainly talking about the clamping of the cord they have to clamp the cord by a certain amount of time it actually shuts a valve in the babies heart so the heart can beat regular

    Reply

    • I would love to see where you found that information, Sarah. We did a post here recently on delayed cord clamping and the contributor who wrote that never came across that in her research. I have also never heard that information when I looked into delayed cord clamping for my children.

      Reply

      • What I think Sarah means here, as NICU nurse myself, is the one of the parts of fetal circulation in the heart, the ductus arteriosus, shrivels up and “closes” to allow proper blood circulation to the lungs in the baby, the previously were not being used. So beating is wrong, but she is right that clamping the cord is a portion of this, as well is the taking of breaths, which is not initiated by the infant until the cord is clamped. Please do your research from reliable sources.

        Reply

        • Did you seriously just state that an infant doesn’t breathe until their cord is clamped?!

          If that were true, all of my boys would be dead. We didn’t clamp their cords until they were an HOUR old. But no, they are all here and healthy…. I think you might be the one who needs to do some research.

          Reply

  30. Thank you for this post. My husband and I had our first baby a few months ago. We declined the eye ointment and Hep B. We were told we’d get a call from CPS and someone came into our room later to talk to us about it. We stuck to our guns because I was not at risk. I passed the group beta strep test and was only ever with my husband. We did our research and learned that the ointment wasn’t necessary. It’s a shame that because of the way the world is, we’re all suppose to be treated the same way. CPS called me the next day, left me a voice mail that they’d call back and neve did. If they would have I would have told them they should be calling the people that do have those diseases who’s kids are at a higher risk that someone who is at zero risk.

    Reply

  31. The AAP does NOT recommend routine infant male circumcision. They just think they should still get paid by insurance companies and medicare to perform the surgery. Because they’re a trade organization and they’re in it for the money.
    “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns”

    And the AAP’s latest statement is full of bias.

    Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision
    “The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves. “
    http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf

    Reply

  32. Parents should speak with their doctor before making any of the decisions posted here. Taking advice from a blogger with no medical training from “research” done via Google is not a great idea. Please speak with someone who has a medical degree before making medical decisions.

    Reply

  33. As a Nurse Practitioner and Midwife, I agree with most of this article. It makes me so sad to read some of these comments by women (I’m assuming) who assume every doctor and nurse is looking out for your best interest. Did you know that doctors know nothing about most drugs they prescribe? Other than what is in the brochure or what the pharmaceutical rep tells them. It is foolish to me that anyone would say to “just trust them”. Babies HAVE died from routine procedures in a hospital! Please, do your research (yes that means surf around on google, you CAN find some good stuff starting there) and know what you’re jumping into when you go to the hospital… Or birthing center.

    Reply

  34. As a labor and delivery nurse, I’d like to say we are not trying to hurt you or your baby. We have seen the worst. We know that while labor bring pain and joy, it sometime leads to danger. We want you to have the delivery you want. We want you to deliver in hands and knees, reach down and pull your naked screaming baby up to your chest. We also want to push you and your healthy uncompromised baby to your postpartum room. Most units delay cord clamping. Most units delay interventions so that moms and dads can do skin to skin. We want you to have your beautiful birth. We are your advocate. Please make you birth plans but realize they are plans not law. Your safety and your baby’s safety are our ultimate goal.

    Reply

  35. As a pediatric nurse, I can tell that the benefits out way the risks of all of the items listed. For one CPS can be called if you do not do them, that is a judgement call that any medical staff can make even if they are not manditory and those are thi ngs CPS takes very seriously. As far the circumcision is concered, I could care less what you, but if you choose not to please please please make sure you know what you are doing when it comes to cleaning it the proper way. We see so many little 4 and 5 year olds who has penis infections because mom never teached them how. Secondly, the cord should never be cut before pulsation stops, but should never be left attached any longer than that. There is too high of a rick for infection with that. Now the vaccines, unless you have some religious reason not to do them (which would need to documented with state!) then the child should get, public and private school are no longer allowing children to attend school without ALL of the required vaccines. So instead of putting it off and then traumatizing the child when they are about 5/6 going it to kindergarten and have to get 22 vaccines in a mater of a few weeks to able to go to school, parents should follow the CDC vaccine schedule. Believe me, the nurses or doctors arent trying to hurt your child, on the contrary, we are trying to give your children the best opportunity to have a healthy life as possible.

    Reply

    • Hi Janell,

      I need to reply to your comment because there are so many misconceptions in it.

      “For one CPS can be called if you do not do them, that is a judgement call that any medical staff can make even if they are not manditory” I SERIOUSLY hope you NEVER call CPS just because a parent didn’t follow recommended protocol. It is their decision, not yours, and a call to CPS can ruin a family’s life. It should only be used in the most extreme, necessary circumstances, and not just because you disagree.

      “… if you choose not to please please please make sure you know what you are doing when it comes to cleaning it the proper way. We see so many little 4 and 5 year olds who has penis infections…” You shouldn’t. The only way to clean the boy’s penis is to wipe the outside of it. It should *never* be retracted forcibly. Once it retracts on its own, then the boy should learn to retract in the bath to clean it. If you forcibly retract it, you can cause tears and THAT can lead to infection. Most of the little boys with infections were probably forcibly retracted and improperly cleaned as babies. That can cause scar tissue and painful erections later, so it’s really important not to do that.

      “Secondly, the cord should never be cut before pulsation stops, but should never be left attached any longer than that. There is too high of a rick for infection with that.” I agree with you on the first point — don’t cut before it stops pulsating. But there is no risk of infection, really, from leaving it longer. Where is the risk coming from? How is it going to get infected? It’s an intact cord…. An open wound (i.e. being cut) would be more susceptible to infection.

      “…public and private school are no longer allowing children to attend school without ALL of the required vaccines.” Complete and total lie. I don’t know who told you this, but they’re flat-out wrong. 22 states offer medical, religious, and philosophical exemptions. 48 offer medical and religious (and NO you do not have to explain your religion to the state…that is illegal due to separation of church and state). All 50 offer medical. It is entirely possible for children to go to school without some or all vaccines.

      “…the nurses or doctors arent trying to hurt your child, on the contrary, we are trying to give your children the best opportunity to have a healthy life as possible.” I believe you mean that. But I also believe that you were taught that this is the ‘way things are’ and haven’t questioned it. Please do question it. Please do your own research. Consider that what you were taught in medical school might not be the whole story.

      Reply

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