When your baby is born, the following 24 hours is full of hospital procedures and you have many options of what will happen next. In this blog we are going to go over these different newborn procedures, what is required in the state of Nebraska and what options you have.
Cord Clamping/Cord Banking
Right after birth, one of the first options you will have is if you would like to delay cord clamping or if you want to pay to bank your child’s cord blood. If you want a deeper understanding of what that all includes you may like this blog of ours on delayed cord clamping.
You may request to have little to no suction of the mouth and nose right after birth by a bulb syringe. Some parents wish to avoid this suction if possible, while others leave it to their OBGYN or Midwife to decide if that is something that needs to be completed or not.
Skin to Skin Contact with your Baby
You have the option to do skin to skin (your bare chest touching your baby’s bare chest) right after baby is born, barring there are no complications that would need baby to get extra help from doctors or nurses. In the case of a cesarean birth, baby is typically taken to a warmer within view of mom. The nursing team makes sure baby is breathing normally. Babies born via cesarean don’t receive the pressure of the vaginal birth that can aid in pushing extra fluid out of mouth and nose. The time spent making sure baby looks great is typically only 5-10 minutes and then baby can come onto mom’s chest in the operating room.
The APGAR is a standard assessment to see how baby is doing after one minute of being born and five minutes of being born. Occasionally there will be a repeat at 10 minutes, but that tends to happen mostly when the one-minute and five-minute scores are not high enough. This assessment is usually done without you even know it is being done.
Your baby will get a score of either 0, 1 or 2 (with 2 being the best) on these five topics:
1. How baby is moving/muscle control.
2. Baby’s heartbeat per minute.
3. If baby is crying/sneezing/reacting to their
new environment well.
4. How pink baby’s skin appears (plenty of oxygenated blood is getting to baby).
5. Their breath rate (how well they are breathing and at what speed).
Babies that have a score of 7-10 are deemed “good”. A Score of 4-6 are deemed “let us see if we can help this kiddo out to have a higher score”. Lastly, three and under is “this baby needs lots of help right now”. Most babies typically will have a 6-8 at one minute and nine at five minutes. While some babies will get a 10 it’s not as likely as a nine because the hands and feet will stay slightly less pink or even a
little blue…which is okay right now, their body is smart and is making sure all the important things like the lungs, heart, brain and other organs are receiving plenty of good quality oxygenated blood.
Weight and Measurements
With a thriving and healthy baby, typically baby goes onto mom’s chest for skin to skin (as long as that’s okay with mom) and stays there for an hour plus. Some sort of feeding is completed within that hour and then baby is taken to the warmer in the room to get a height, weight, and sometimes a head and chest circumference measurement. If you choose to do any of the three medication options (eye
ointment, Heb B or Vitamin K) they will typically give those also at this time. The nurse will then do a few tests on hip mobility and other body function test.
Erythromycin Eye Ointment
This antibiotic began to be used around the 1800’s. It is typically used to prevent infant blindness caused by untreated gonorrhea and chlamydia. There have also been some small studies that this antibiotic eye
treatment can potentially be helpful to an infant that has a staph infection of the eye that was given by mother at birth. In the state of Nebraska, this medication is an optional routine medication for newborns. If you plan on having your child receive this antibiotic you do not need to do anything special. They will always ask if this medication is okay to administer. If you say yes, they will give it. If you choose
no, you will just need to sign a waiver of refusal.
Hepatitis B Vaccine is an injection that is given in the hopes to prevent Hepatitis B virus (HBV). If the birthing mother has HBV she can expose the HBV virus to her child with a vaginal. Other ways to contract HBV are direct contact with someone’s blood who has HBV, sexual encounters with someone with HBV, the sharing of dirty needles, toothbrushes or razors, or household contact of known people with HBV. In the state of Nebraska, this vaccine is an optional routine for newborns. If you plan on having your newborn receive this injection you do not need to do anything; your nurse will always ask if this medication is okay with you. If you say yes, your nurse will give it at the time of measurements of your baby. If you are wanting to delay the start of the four-injection series, or you do not want the vaccine at all, you will just need to sign the waiver of refusal.
This injection is administered to assist with blood clotting. Newborns are not born with large amounts of vitamin K in their system since vitamin K is made via food we eat, or vitamin supplements we take. Foods like spinach, kale, and brussels sprouts are higher in vitamin K and newborns don’t quite have these in their diet yet. Breastmilk passes a little vitamin K to the newborn while formula has vitamin K
supplementation in the ingredients.
The reason vitamin K is a routine newborn injection is because some babies anywhere from ages birth to six-month are at a risk for vitamin K deficiency bleeding (VKDB). If a baby has VKDB their blood is not clotting well and is allowing some form of excess bleeding to occur.
The highest rate of risk for VKDB is the classical version in which is within the first week of life. The rates of bleeding for newborns 0-7 days are anywhere from 0-1.5% or 0 – 1500 out of 100,000. This bleeding is commonly seen at the umbilical or circumcision site. The other type of VKBD is known as late VKBD, which is deemed the more serious type of VKBD via the website Evidence Based Birth.
The risk of a serious bleeding incident of newborns who do not receive the injectable vitamin K at birth have a .0044-.0072% or 4.4 – 7.2 out of 100,000 infants have a chance of a life threating bleeding issue. You also have the option to give your baby drops instead of an injection. The study goes on to show that a baby who is given 1-3 mg of vitamin K drops have a risk of .0014-.0064 % or 1.4 -6.4 of having issues from late VKBD. If you choose the injection of vitamin K, your risk now becomes 0-0.4 infants per 100,000 to have late VKBD.
Some parents will decide to do the vitamin K injection, some will decide to do the oral vitamin K and some will choose to do neither. In the state of Nebraska, this injection is an optional routine injection for newborns. If you plan on having your child receive this injection you do not need to do anything special. Your nurse will always ask if this injection is okay with you. If you say yes, they will give it at the time of measurements of your baby. If you are wanting to provide your own oral vitamin K drops, or you do not want the injection, you will need to sign a waiver of refusal.
It is worth mentioning that if you choose to circumcise your son in the hospital you will not be able to refuse the vitamin K injection. You may circumcise your son at a later date via a medical provider who will do the procedure after adequate oral drops of vitamin K or a specialty personnel who will wait until a certain number of days after birth even without the oral drops administrated.
If you are having a boy, you will decide if you want them circumcised or if you want them left intact. If you choose circumcision you will need to decide if you will want the procedure to be done in the hospital before you are discharged or if you will seek an outside care provider to perform the procedure at a later time. If you choose to keep the penis intact you will not need to do anything other than let your provider and nurses know you are choosing to not circumcise. If you plan on circumcising in the hospital you will also be required to allow the administration of the vitamin K injection. If you choose to circumcise at a later date you will want to ask your care provider which vitamin K option, if any, they are comfortable with before performing the procedure.
This is a required simple test in the state of Nebraska. For this simple test, a small earphone is placed in a baby’s ear. A sound is played and essentially the echo is measured. 98-99% of babies pass this test on the first test. If your child is the 1-2% that does not pass their test, another test will be perform, usually quickly, but definitely before 3 months of age.
Blood Sugar Testing
Some babies may need their glucose tested after birth. A baby will need tested if baby is not eating well, the mother was gestational diabetic, the mother is type one or type two diabetic, or baby has symptoms of possible low glucose.
Some hospitals ask that all newborns after their first feed or two have this heel poke blood test performed. You can ask your midwife or doctor if the hospital you are delivering at requires all babies or just babies with a higher risk of low blood sugar get tested.
Newborn Screening Test
In Nebraska, this screening is mandated by law. It is a blood test that needs to be ran after 24 hours of birth. This test screens for over 40 different illness and diseases that aren’t otherwise discovered at birth and that can be serious medical conditions. Early intervention has been deemed helpful in providing the proper care for these infants who might have a rare medical condition. Since the test needs to be
completed after 24 hours of birth if you give birth at home or leave the hospital before 24 hours, you will need to go back to the hospital to have this screening completed. Some places will want this test to be ran again later for a more accurate testing.
You also have the choice to breastfeed or formula feed, as well as pacifiers or no pacifiers, bathing your baby before you leave the hospital or doing it at home, rooming in with your baby the entire stay or using the hospital nursery (if they are open).
We hope this helped you to understand your options and what procedures are offered or required to be completed within your baby’s first 24 hours of life.