Standard Procedures In The Seconds After Birth – did you know about these?

There is a lot of information out there on what your options are during childbirth. If you are out there getting yourself informed, you likely will have armed yourself with information on the common interventions and procedures that are standard practice during birth: fetal heart rate monitoring, cervical exams, induction, pain medication, etc.

But do you know about the common procedures that are performed on you and baby immediately after birth? There are several, and it’s worth educating yourself about them so you can decide whether to refuse or consent to them.

Standard Procedures For Your Newborn:

Vitamin K Injection

Vitamin K is standardly administered to newborns immediately after birth. The goal is to prevent a rare condition called hemorrhagic disease of the newborn, or Vitamin K Deficiency Bleeding.

Please read the document Vitamin K Prophylaxis.  It goes over the risk factors for VKDB, explaining which newborns are at higher risk for the disease. It also discusses potential risks of Vitamin K Prophylaxis (namely, it has been associated with childhood leukemia).

Please note, if you decide you would like prophylactic Vitamin K to be administered to your newborn, you have the option of choosing either an injection or oral drops.  Some parents prefer the oral dosage form, as it does not involve a potentially painful injection, and because it is possible to have it made without any of the preservatives found in the injectable version (ask your pharmacy what their preparation is like; not all pharmacies prepare oral Vitamin K without preservatives).  Oral Vitamin K is something that needs to be prescribed by your doctor or midwife and prepared by a compounding pharmacy for you ahead of time.

Why do some parents decline Vitamin K? 

For some women, the probability of baby having this disease seems too low to make potential risks of a Vitamin K dose and the unpleasant injection worthwhile, so they decline this intervention altogether. There is an argument to be made for high-intervention birth practices being the cause of problems with newborn bleeding. For information on this philosophy, the Natural Pregnancy and Breastfeeding blog has an interesting article worth reading. One thing to consider is that newborns are naturally born low in Vitamin K, and one school of thought is that there may be a biological reason for this that we don’t fully understand yet. It’s possible that in the future we will discover why newborns are naturally born low in Vitamin K and stop administering this supplement to newborns. Often, people who plan to decline this medication will make sure they themselves are getting a lot of vitamin K in their diets from leafy green vegetables, etc, in order to give the newborn some of this vitamin through breastmilk.

Antibiotic Eye Oinment

You may have heard people talking about the newborn “eye goop”. What is being referred to is an antibiotic eye ointment that is routinely applied to the newborns eyes just after birth. The purpose is to prevent gonorrhoea or chlamydia infection in the mother from infecting baby’s eyes and leading to problems. Please read Newborn Eye Prophylaxis for detailed information.

Why do some parents decline Newborn Eye Prophylaxis?

Many women decline antibiotic eye ointment when prenatal testing shows they do not have or are not at risk for carrying these infectious bacteria. The antibiotic eye ointment interferes with your baby’s natural adaptation to world outside the uterus through slowly opening the eyes and beginning to look around, and if the mother is infection-free there is typically no real reason to interfere with these first moments of your baby’s introduction to the word.

PKU Test / Heel Prick Test

The BC Newborn Screening Program tests for a series of potential newborn problems that are better treated with early diagnosis. If you have a midwife, she can conduct this test in the early days after birth in your home, as opposed to doing it immediately after birth.

Why do some parents wait to do this test?

Many parents believe baby’s initiation to the world should be peaceful, gentle, and loving. Having the first things you experience be injections, skin prick testing, and ointment in your eyes does not necessarily seem that gentle. This is why some parents choose to delay the newborn screening; give baby some time to adjust to the new world!

Standard Procedure For The Mother:

Oxytocin Injection

Standard practice is to have active management of third stage of birth (delivery of the placenta). This means that instead of waiting for mom’s natural hormones to trigger the uterus to clamp down to stop bleeding and birth the placenta, your doctor or midwife will be actively involved. Unless you decline it, immediately after the birth of your baby, you will receive an injection of artificial oxytocin in your leg. They will also encourage you to push out your placenta while applying traction to the cord within minutes of birthing your baby. You can read the official guidelines in the Third Stage of Labour document, which actually lists physiological (no active management with oxytocin) third stage as a reasonable option, and notes that this can take up to an hour. The document also lists some of the risks of actively managing the third stage.

Why do some women decline active management of third stage?

An actively managed placental birth might be the best option for most women, discusses how, if you have had medical interventions during birth, you likely will want your third stage to be managed. However, if you have had a normal, physiological birth, your body has natural systems in place to facilitate the safe birthing of the placenta. This same article discusses the ideal criteria for natural, safe birthing of your placenta without medical intervention. Another article I encourage women to read is the 30-minute third stage by Gloria Lemay.

Please make sure to discuss these typical procedures with whomever you have chosen to attend your birth ahead of time. Ask informed consent questions so you can decide what feels right for you and your baby.

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  4 comments for “Standard Procedures In The Seconds After Birth – did you know about these?

  1. May 29, 2013 at 2:25 pm

    Yuk!!!! I have learned much more than I want to know. :-)

  2. May 29, 2013 at 1:49 pm

    Awesome resource. Thanks Jess! We declined all but the PKU!

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