10 Decision of Newborn Parents, Part 2

On Thursday, guest poster Christina began by sharing the first 5 decisions… today she continues on with 5 more decisions for parents of newborns.

Please note: We do our utmost to offer the best and most accurate information that we can, but we also encourage you to take the advice from our site as entertainment and informational purposes only and to always seek the advice of your trusted healthcare professional.

6. Newborn Heel Prick Metabolic Disorders Screen

Babies usually have a single heel prick to draw a drop or two of blood, which is put on filter paper and run through a tandem mass spectrometry test to screen for an average of 20+ inherited metabolic disorders, including PKU, cystic fibrosis & sickle-cell anemia.  Some states recommend two such tests- one immediately after birth and one just before hospital dismissal.

Why might I want this?

Many see the trade off of a single heel prick for the screening of so many diseases –many both potentially fatal AND treatable– as quite worthwhile.  If you know that any of the diseases tested for run in your family, this seems especially a wise choice. (However, different regions test for different diseases, so ask for a full list from your pediatrician or intended place of delivery.)

Why might I want to opt out?

All of the diseases screened for are very rare.  The blood screen’s rate of false positives is relatively high.  Thus many parents receive news their child needs further (more invasive) tests, may be advised to suspend breast-feeding in the meantime, and are understandably concerned, only to be told that the diagnosis was negative.  Additionally, some of the disorders have no treatment or cure, or have variations in forms which may require no intervention (despite showing up as “positive”).  For these reasons, some doctors such as Dr. Robert Mendelsohn (in his book How to Raise a Healthy Child in Spite of Your Doctor) recommend waiting for signs of a disease before testing or testing specifically for a disease that runs in your family, and certainly asking for further information and testing if a screen comes back positive.

Your options: Assent to the standard heel-prick screen as a precaution (see below for some steps to make it easier), test specifically for diseases for which your family has a history, or wait and see if any problems manifest, then pursue definitive testing.  If one disease in the screen comes back with a positive result, know that many of these are false positives:  continue breast-feeding, pursue further diagnostic testing, and try not to stress about it in the meantime.

**Please note that while the diseases are rare and the vast majority of kids will be fine with no screening, for the few that DO have a disease, an early detection often means the difference between life & death, or normal development & severe (often permanent) disability.  For many metabolic diseases, which can appear with no family history, the symptoms are subtle and likely to be overlooked until potentially irreversible damage has been done.  With this in mind, here are 4 steps you can take to make the screen easier & more accurate for your baby, if you choose to assent to it: 1. wait to do the test, ideally 3 days after birth, so metabolic factors have stabilized, 2. make sure baby is warm –especially warm baby’s foot in your hands for several minutes before prick to ensure that blood flows easily, 3. request that nurse hold baby’s foot until she stops kicking and only then prick, and 4. offer baby something to suck during prick (finger, binky, bottle or breast).

7. Vitamin K Injection

Vitamin K is a fat-soluble vitamin we get chiefly from bacteria in our gut (it’s also in leafy green veggies). It is crucial in blood clotting & bone health. Babies are born with lower clotting factors than adults, perhaps because their intestines lack the bacteria which provide most of ours. A Vitamin K deficiency can lead to “vitamin K deficiency bleeding“– severe internal bleeding.

Why might I want this?

Bleeding in infants due to vitamin K deficiency can be severe, leading to hospitalizations, blood transfusions, brain damage and death. While formula is enriched with Vit K, breast-milk tends to be lower in it. Intra-muscular injection (i.e. a shot) of Vitamin K is quite effective in preventing internal bleeding. There are several risk factors for VKDB, including: preterm delivery & difficulty feeding, low birth weight, delivery by forceps or vacuum extraction delivery, prenatal maternal use of certain medicines (including antibiotics, anticoagulants, & anticonvulsants), liver disease, extremely fast, or extremely prolonged labor, particularly during the pushing phase, and delivery by C-section.

Why might I want to opt out?

Many question whether God would design a faulty system– why would all babies be deficient in a vitamin that was also lacking in their natural food? Some feel that it’s preferable to instead supplement the breast-feeding mother’s diet with Vitamin K, both/either through a diet high in leafy greens & probiotics, or a supplement, rather than giving a newborn a painful injection. Colostrum, which precedes milk, is quite high in Vitamin K. An injection is an unnatural means of getting a vitamin that is usually absorbed through the gut wall, and, like all injections, provides an opportunity for contamination to be introduced, as well as potentially toxic preservatives. The amount of Vitamin K injected is also very high: 20,000 times the level present at birth. Lastly, high Vitamin K levels are a cause of jaundice in newborns.

Your options: Choose to have the injection as a precautionary measure, especially if your child had a traumatic birth, if your prenatal diet was low in Vitamin K, or if you took medications tending towards VKDB. Take a non-interventionist approach of a late-pregnancy diet high in leafy greens, delayed cord-clamping, and immediate breastfeeding. Or opt for the oral method of vitamin K supplementation.

Image by jonty.fisher

8. Sleeping Arrangements

Many hospitals now offer the option of “rooming-in,” in which baby & mother are kept together in one room, as well as the former model of nursery care, in which babies are tended by nurses in a separate room. Few hospitals recommend that the baby stay in the nursery throughout the day, though it is always an option if you need a break. Fathers are usually welcome to accompany the baby into the nursery during any screens or tests (and if they aren’t, they can insist upon it!).

Why might you prefer the nursery model?

Many moms (and their spouses!) are exhausted after delivery and will be facing months of sleepless nights tending a newborn. The chance to have someone else changing diapers and keeping an eye out for problems can be a welcome and unique break, especially if you deliver at a hospital friendly to breast-feeding who will bring your baby to you to be fed at the first sign of hunger.

Why might you prefer to “room-in”?

Some new moms don’t want their precious children away from them at any point, especially if their hospital tends to force standard procedures (injections, eye ointment, etc.) on newborns despite parental preferences, or if they are likely to give a hungry baby a pacifier or a bottle of formula. As newborns have very little stomachs (large as a thimble), ounces of formula really sabotage their metabolism & eagerness to nurse (in turn interfering with maternal milk production). Entire nursing relationships have been sabotaged by bottles given before hospital discharge.

Your options: Ask around and find out what hospital policy is regarding bringing babies to moms for feedings or giving them bottles– ask other patients and your doctor/midwife what this hospital’s reputation in this area is like. If it’s parental-preference friendly, you may want to take advantage of the nurses ability to watch over your child during the night (so you and Daddy can both sleep). If, however, the hospital nursery seems a risky place, keep baby with you, perhaps trading off with Daddy or another family member to tend to baby’s non-nutritive needs.

Note that you can begin one way and then switch as needed: I personally began with our daughter in our room, but when it became apparent that my husband & I were too tired after our 45-hour labor to adequately care for her, we gladly surrendered her to the nursery nurses, who faithfully brought her to me for feedings throughout the night and recorded her every diaper on her chart so I’d stay informed (Our hospital is stellar with respect to honoring parental wishes in all areas.).

9. Artificial Nipples (pacifiers or bottles)

Hospital nurses only have 2 arms, just like all of us, and tend to pacify crying babies with a pacifier rather than with cuddles. Some feel that sucking on a pacifier tires a baby out, decreasing their desire to eat. And some babies just plain old spit them out.

Why might you want to allow pacifiers?

Some babies like to suck. It’s a comfort thing– babies have been caught sucking fingers, thumbs, tongues, and hands in utero. As anyone who was a child-hood thumb-sucker knows, it’s hard to break those habits. Some parents would prefer that their baby’s “non-nutritive sucking” needs are met through a paci, which can be detached, washed, and eventually discarded instead of through a body part, which is always around (and often dirty).

Why might you want to avoid artificial nipples?

Some lactation experts warn of nipple confusion; with babies getting into poor latching habits after sucking on a paci or bottle (these require entirely different tongue positions). Many parents would prefer to allow their newborn to suck frequently at the breast, even if only for the first few days, to ensure a good milk supply, as well as to maximize skin-to-skin contact.

What are your options? Allow pacifier use, limit it to times when baby isn’t hungry or your breasts are sore from a feeding, or request that no artificial nipples be used at all. If your baby is too weak to nurse or has a poor latch, you can still use systems other than a bottle –such as a supplemental nursing system (with expressed breast milk or formula), finger-feeding, or a dropper. Here’s a handy trick: latches can usually be “re-set” by simply allowing a baby to suck a finger, which gets the tongue in the correct position for breast-feeding.

Image by [derekmswanson]

10. Time of Discharge

Most hospitals keep mom & baby for 24-48 hours after an uncomplicated vaginal delivery. For moms with c-sections, 3 days is the minimum, and for complicated births moms & babies may be kept any number of days.

Why might you want to stay the full recommended 2 days?

State laws were passed in the mid-1990s regarding postpartum “Length of stays” (LOS) out of concern for maternal & infant health. Many health problems (such as a retained placental fragment, for instance) take a few days after birth to manifest themselves. Additionally, many mothers will not be going home to much help, so the rest and care they receive immediately after birth in the hospital can be very welcome.

Why might you want to ask for an early discharge?

Plainly put, even the best hospitals are dirty places– they’re mainly for sick, germy people. In this sense, getting a newborn and recovering mom out of there doesn’t seem a bad idea. Some mothers also find sleeping difficult in a hospital bed, and being woken by nurses every few hours for vitals to be checked can be wearing. Some moms just recover faster in their own beds. Postpartum doulas– hired help specifically trained to care for newborns and their mamas– are far more available these days and can fill in the gap hospital nurses provide. Some midwives do house-calls, and many pediatricians or OBs will allow you to come in for a check-up 3 days post-partum, somewhat negating the need to spend all 48 hours under observation. Studies in California after the LOS laws were passed showed “a significant decline in neonatal readmissions [to hospitals] but not in 1-year mortality.”

Your options: Enjoy the full 2-day hospital stay, or ask for an early discharge if your delivery was uncomplicated and un-medicated, and follow up with a 3-day postpartum checkup for both mama & baby. Consider hiring a postpartum doula or having Grandma stay and care for you once home. You will likely need to get your OB/midwife and pediatrician to put a request for early discharge in writing, ideally in your birth plan.

For Parents of Little Boys: Circumcision

This is such a complicated issue (worthy of a post all its own) that I will only briefly touch on it. American doctors are split down the middle on recommending circumcision or not. The AAP’s official position states:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data arenot sufficient to recommend routine neonatal circumcision. Incircumstances in which there are potential benefits and risks,yet the procedure is not essential to the child’s current well-being,parents should determine what is in the best interest of the child.

Basically, it’s a preference issue. However, more boys are circumcised in the US than are not, often before leaving the hospital after birth.

Why might you want circumcision?

There do seem to be hygienic benefits to it: fewer yeast & urinary tract infections, lower cancer rates and drastically lower transmission rates of HIV, and STDs (even the female partners of circumcised men are slightly protected). There is a small percentage of men who require circumcision later in life for medical reasons, and circumcisions later in life are far more complicated than in an infant. Babies don’t remember the pain of surgery. Many Christians feel that if God commanded it for generations, it likely has some health benefit to it, just as the dietary laws do. When performed by a mohel (Jewish rabbi specializing in circumcision) on the 8th day, the procedure is very quick (under a minute), usually done in the comfort of your home with your son held in familiar arms and anesthetized in non-invasive ways such as sugar pacifiers, drops of wine, and topical anesthetic cream.

Why might you want to skip this elective surgery?

The hygienic benefits of circumcision can usually be overcome through personal hygiene and a monogamous lifestyle later in life. It’s a painful surgery, even if some form of anesthetic is used. In hospitals, it is probably terrifying for the baby, who is separated from his parents, strapped down, and in considerable pain for 10-20 minutes. As noted above, clotting factors are low in newborns and don’t rise until 5-7 days after birth, reaching their apex at 8 days after birth– surgery before then carries increased risk of hemorrhage. As some Christians have pointed out, modern hospital circumcision is quite different than the OT version in timing, method & environment.

Your options: Have the circumcision in the hospital before discharge (when it’s still covered by insurance), using one of the following methods decided on beforehand: the mogen clamp, the plastibell, or the Gomco clamp. Research each as well as the doctor who will perform the circumcision. Alternatively, wait until the 8th day (as is Jewish custom due to Genesis 17:9-14) for the surgery at the hospital, or hire a mohel to perform the surgery in your home or the hospital, usually using the Jewish shield technique. Or, skip the surgery altogether and add extra emphasis to your son’s personal hygiene.

(As a mom making this decision myself, I must say that, should we choose to circumcise our son, of all the methods the mohel-performed, Jewish shield technique seems the quickest, least painful, traumatic and risky; well worth the extra cost.)

Whew! That’s a lot to process! Better get started making those calls and writing that birth plan! :)

About Christina

Christina is a doula, a former teacher & choir director, a craftsy mostly-stay-at-home mom to E (4) & W (almost 2), nanny to L (2), foster mama to V (6) & A (3), and wife to Ryan. She is passionate about equipping moms to think critically in order to raise healthy children full of faith, music and imagination.

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Comments

  1. Circumcision shouldn’t even be on this list. The sooner we start looking at this as a NON-decision, the better for our baby boys. After all, would anyone feel the need to make a ‘decision’ about whether to cut off his healthy fingers? Of course not. The child’s foreskin deserves the same respect as any other part of his body. Bodily integrity is a human right that shouldn’t only be afforded to little girls.

    • Woah, woah woah to all those extremely impassioned on the topic of circumcision! I am not trying to argue one way or the other, as I fall pretty much straight down the middle on this one (if we choose to do this, it will be the “traditional” way on the 8th day, much the way Jews from Isaac to Jesus were circumcised– if you look into this, you will see that it is far less invasive, painful, and prone to complications than the more “modern” methods of surgery). However, for all who are Christians and reading this blog post, we should remember that God commanded this procedure as a sign of His covenant love and relationship with His chosen people (Israel) for thousands of years. Is it honestly in God’s character to demand that His people torture their baby boys and handicap them for life through an incredibly risky procedure? Remember, this is the same God whose Name is “”The LORD, the LORD, the compassionate and gracious God, slow to anger, abounding in love and faithfulness, maintaining love to thousands, and forgiving wickedness, rebellion and sin.” (Exodus 34:6) Other aspects of the Old Law, such as their dietary and ritual purity laws, are now known to be beneficial– is it such a stretch to believe that this command might be for an earthly benefit, too?

      On the flip side, Christians aren’t required to circumcise their sons — the New Covenant is one of heart-circumcision, not physical. And there’s nothing said in Scripture about the beloved of God before Abraham being circumcised– Adam sure wasn’t. Either way it seems quite possible to enjoy long life and a wonderful marriage relationship. I’m not a man, but from the limited interaction I’ve had with family members & my husband and close friends on the topic, it seems to me that most Christian guys are pretty happy the way their parents chose for them to be. And if they had a medical problem requiring later-life circumcision, that’s an option, too (more involved and painful than infant circumcision), but no one I know is really spending that much time wishing their parents had chosen differently on this one. That’s my take on it: do your research, choose wisely, but please, don’t demonize those who choose differently, especially when there are Scriptural reasons to lean either of both ways!

      • Michelle says:

        Hi Christina!
        I’m having trouble finding the reference that I am thinking of at the moment; I wish I could. The traditional Jewish circumcision is not the same as modern (even Jewish, mohel-performed) circumcision. Originally, a very small amount of foreskin was to be “clipped,” not completely removed as it is today. The complete removal was much later instituted by Rabbis who were likely trying to be “more” holy. So, yes, God did command circumcision to Abraham and his descendants, but I think it was very different from what is done today.
        On that note, I’m having a baby in a month and my husband is completely for circumcision and I am completely not (but we’re being surprised on the gender!). lol. One of our very rare strong disagreements. Let’s just hope for a girl, I guess! heh. :)

        Also, we loved this two-part series! Thanks. :)

        • Michelle says:

          I now see that lots of other people already commented and left references.
          oops. :) sorry!

  2. It amazes me that people complain about circumcision, with such low complication rates, but never make a peep about a woman’s decision to birth in a hospital, which carries a 30% chance of c-section. I think this has more to do with society (even Christians!) abandoning the Bible’s principles, and accepting the foolishness of the world.
    If you’re going to complain about circumcision, you should be complaining about birthing in a hospital a LOT more.

    • Laura: “It amazes me that people complain about circumcision, with such low complication rates”

      The complication rates are not low. More than 100 children die every year from the procedure. Every year, there are multiple wrongful injury lawsuits against the doctors that perform the procedure and the awards are often multiple millions of dollars. Many of the injuries/botches are not recognized until long after the statute of Limitations runs out (usually 3 years) so there are no lawsuits. Many parents don’t have the financial wherewithall to pursue these cases for their sons.

      “I think this has more to do with society (even Christians!) abandoning the Bible’s principles,”

      The New Testament speaks strongly against circumcision. During the time of Christ, the Jews were trying to put down the rising movement of Christianity and were trying to get non-Jews to join them but a requirement was that they had to submit to circumcision. Both Christ and the disciples spoke out strongly against it in many instances recorded in The New Testament.

      • No, there’s no argument against circumcision. There is argument against trying to find RIGHTEOUSNESS before God through circumcision as part of keeping the Old Testament Law, or through ANYTHING that was “Jesus-on-the-Cross” PLUS ___. No one here is claiming that Christian parents should circumcise their sons (or make their daughters obey the dietary Jewish laws, or as a family celebrate all the Jewish feasts) as a way to have a better standing/relationship before God. The NT is clear that that’s a form of works-righteousness that flies in the face of what the Cross proclaims: “you can’t get to Heaven on your own.”

        However, there is zilch, nada, nothing on whether or not Christian parents should be discouraged from maintaining an ancient Jewish practice due to health concerns… nor anything urging them to do it, either!

        We see the Apostle Paul circumcising one of his apprentices, Timothy (Acts 16:3), and not circumcising another, Titus (Gal 2:3-5). This had nothing to do with health, and everything to do with the Gospel. See a great little article on this here: http://www.desiringgod.org/resource-library/taste-see-articles/why-was-timothy-circumcised

    • That’s because circumcision doesn’t have a low complication rate. The complication rate for infant circumcision is very high. Additionally, 100% of circumcised (both male and female) have diminished sexual function. I am a homebirther and birthed my baby’s head into my own hands, at home but I would MUCH rather see women choose elective c-sections in the hospital than cut the gentials of their child. Genital cutting is WAY WORSE!!!!!!!!!!!!!!!! If you want to talk about The Bible, look at what it says about circumcision, a “yoke of slavery” and that we shouldn’t circumcise which puts faith int he flesh, but that we should live int he spirit and choose the freedom that Christ paid for.

      • Gretchen says:

        How do you know that they have diminshed sexual function? My husband is circumcised and her doesn’t seem to complain! Seriously??? how can you throw out 100%? NOTHING is ever 100%?

        • My husband and all of his friends that he’s asked agree with you, Gretchen.

        • Because circumcision removes tens of thousands of nerve endings from the male penis. Of course there is reduction in sensitivity…it’s a no brainer. You remove nerves = you remove sensation.

          Men circumcised as infants have nothing to compare themselves to. They have no idea what they COULD have had.

  3. Thanks so much for this series… helps us a lot as we prepare for our first little one to be born in just under 6 weeks. I am overwhelmed with all the decisions that need to be made, but look forward to going through this list with my husband. Thanks for laying things out so clearly. All of the comments have been helpful as well!

  4. I’m really enjoying this series of posts! Thank you for taking the effort to write them! I highly encourage you to really continue your deep research about circumcision. Many of the things you listed as being prevented are based on seriously flawed studies. If circumcision really protected against many of those diseases, then wouldn’t the rates in America be vastly lower? But they are not. We have rampant STDs, HIV/AIDS, and HPV. Hygiene is no more difficult for an intact man than for the average woman. We have lots of crevasses. ;) While it’s a matter of preference, why is it up to parents to decide what their son might prefer? If he grows up and is unhappy being cut, then he did not get his preference and he has no way of re-gaining what he lost (20,000+ fine touch nerve endings! the clitoris only has 8,000!). But if he grows up and is unhappy being intact, then he can choose of his own free will to have the procedure done (much like if I’m unhappy with my nose/boobs/chin, I can choose to fix it). He’ll be guarenteed some good drugs, a few days off work, fewer complications and he got the benefit of the freedom of choice. Foreskin is God-designed…perfect in it’s function, perfect in is placement. :)

  5. i almost refused the newborn heal prick for the reasons you mentioned… the diseases aren’t common, etc.

    boy, am i glad that we got it! our daughter ended up being diagnosed with congenital hypothyroidism. because it was caught within days of birth she has a great prognosis and is developing normally (she is now 5 months old), but if we hadn’t found out that early, she could have developed heart problems, mental retardation and grow issues.

    (and looking back on the comments, it looks like we’re not alone in this!)

    • Thanks for sharing! It’s good to have personal stories on both sides of these issues. I’m personally “with” you on this one, and don’t see much reason NOT to get a blood screen done. I do respect those that make an informed choice not to do it, though.

  6. I liked this series. We researched most of these issues with our first and went pretty naturally with her, but we did get the heel prick test on day 3 and 2 weeks. Our midwife did it. It was hard, but went smoothly. With our second, it was horribly traumatizing to both of us as her blood clotted so quickly (no vit. K shot) that she had to get poked over and over. It was a good 20 minutes of torture each time. Both my midwife and I were sweating. Ugh. I think I will still get it again just because it can mean life or death, but it is so hard to imagine!

    We struggled with the circumcision thing. I couldn’t imagine taking my gently birthed at home baby to get cut at that young stage of life. But we are Christians and if God says it is okay . . . I do think that there was not as much foreskin removed back in Bible times. We finally decided not to do it. It isn’t exactly encouraged in the New Testament and God DID create the foreskin after all. So, if we have any boys, we are choosing not to cut. I am relieved.

    Jenny, I am so sorry that your son went through that trauma and still suffers today. I will definitely re-look into the vitamin K shot. Thanks for sharing your story.

    • There’s a few good comments on here about tips for making the heel prick a bit easier– simple stuff like warming up the heel and keeping baby warm… Those are really helpful!

  7. Thought I’d add my 2 cents as well. :)

    As for the PKU/etc tests – this is NOT a ‘drop or two’ of blood. Having had it done with 3 of my 4 girls, some were done better than others, but it is/was a fairly thick, absorbent paper card with 2 circles (maybe the size of a dime?). The circles both need to be completely saturated (front and back). I remember breaking down in tears when some pediatric nurse had to work and work and work to get enough blood from my 5-day old baby’s heel. –She had laid her on her back and had her foot extended upward – no WONDER she couldn’t massage enough blood out!

    Also, as per my midwife’s information, the UN study that claimed reduced rates of HIV with circumcision are TERRIBLY suspect. I’ve never had to delve into this issue, but according to her, the study was a 6-month one and included adult-circumcised males. If I remember right, it can take anywhere from 6 months to several years for HIV to ‘show up’ on a test – how can the UN know what the rates are if the whole study only took 6 months?

    • Andrea Nagel says:

      Tis true, it can take several drops of blood to do the PKU but if done right it shouldn’t be aumatic. The heel needs to be warmed first so the blood flows well and the kind of lancet helps too. I have done many myself at work so I’ve learned a few tricks.

    • Another point about the HIV circumcision studies — these studies were done o men circumcised as adults, not as newborns. They only looked at the short term. The circumcised men had to abstain from sex during their recovery period which automatically make them less likely to contract HIV. There are zero studies done on infant circumcision showing that circumcision reduces the risk of HIV. Multiple studies on infant circumcision have shown that circumcision does NOT reduces the risk of HIV or any other STI. It’s false to claim that circumcising a baby will make him less likely to contract HIV, considering no study has ever proven this. If someone believes the flawed African trials, then it only makes a case for ADULT circumcision.

    • carolyns mom says:

      It is unfortunate that your practitioner wasn’t able to do it quickly – i have had it done 3 times- twice was fast and easy- and the other time was difficult- but since one of my kids was diagnosed with pku- 3 mins of uncomfort was worth it!

  8. Just wanted to add my experience… I had 2 homebirths so I didn’t have to deal with anyone pushing any of the procedures you mentioned. I still researched every one and wound up doing only the heel prick at the ped’s office. No eye goop, no vaccinations… Of course with home birth we waited to cut the cord, I nursed almost immediately and we co-slept (still do with my 2 year old). I did use a pacifier but not much and neither of my boys cared for it so we discarded they early on. My 2nd boy never had a bottle!! My 1st did but only after 5 months of exclusive BF… I also never circed my boys. We’re from Eastern Europe and boys are not circumsized there (unless you’re Jewish) so DH is intact and so are the boys.
    Congratulations on your beautiful baby boy!!

  9. Heather Benson says:

    Not to belabor the point but I am surprised the “heel prick” is even listed as a “decision” you need to make!

    • Well, parents do need to consider any procedure that is done to their child, and they do have to give their consent for it! :)

      Also, just as the test can be life-saving, it can also have adverse affects– like my friend whose child was falsely diagnosed with galactosemia, was told to stop breastfeeding, and then was unable to resume when later tests came back negative. So, parents need to know all the risks, what to watch for, and what ALL the options are– such as continuing to breast-feed until further testing is done…

      Personally, we have done the heel prick ourselves, and really appreciated the comments below giving tips for how to make it go a little easier (warming up the heel, holding the baby and/or nursing during the procedure, holding the foot below the heart level).

      • carolyns mom says:

        I was also told to stop breastfeeding- and so I pumped and then when i was able to resume breastfeeding i had a great stash AND was able to donate my breastmilk to another who was allergic to formula and whose mom was medically unable to breastfeed.

        Perhaps that should be in the article- perhaps you should ENCOURAGE it to be done and then remind people that there could be a false positive (although the rates are not that high) and to continue to pump even if they are told they cannot nurse- we’re talking within 24 hours for verification for most diseases – most mammas won’t lose their milk anyways.

      • After reading all these comments, I am stunned at the amount of negative feedback. So many are stuck on the same one or two issues. You were meaning to bring light to the newborn hospital procedures and I believe you delivered your opinions in a respectfully and relatively unbiased way.

        So thank you, I am a first time mother and 6 months along and I learnt what things to consider from reading your article. Am I going to only read your article and make my decisions, without researching further? Of course not. It’s seems as though, judging by some of the comments, people think mothers will end their research here!

        People should leave comments because they can be helpful but please be polite and respectful.

        I truly appreciated hearing something more about hospital procedures after birth. Thank you for your article, Christina.

        • Kayla, thanks for your balanced comment. I entirely agree- this should not be the end of your research! Christina’s desire was merely to bring light to some of these decisions and give parents some ideas of the different options and why a parent may choose this or that option. It is a starting place, not an ending place.

          I’m sure that you will learn much in your own research as you prepare for your upcoming baby (how exciting!). Glad you found the article helpful. :)

  10. Heather Benson says:

    On the “heel prick”- PLEASE do this!! They are some serious metabolic disease that are tested for that you want to find out sooner rather than later! It some of these disease by the time your child shows symptoms he may already have developmental delay.

  11. I would add two notes to this:

    On the heel prick:

    The heel prick is usually done twice. This is because the first prick, post-birth, is extremely inaccurate due to there being no metabolic products in the system. I believe that it can only pick up 7 or 28 disorders at the first screen, which is why the second screen is ordered (which can pick up all 28). A very valid option (and the one we chose) is to refuse the first test, and do the second test only, at about 3 days postpartum, so that the newborn is spared the pain of doing the test twice and only has to do the more accurate one.

    Additionally, we just did the heel prick with our baby, and our midwife did it so well that it was hardly noticeable to him. Here are the things she did: Make sure the baby is super-warm (this means holding the baby for at least 15-30 minutes beforehand), nursing while doing the test, and letting the heel bleed naturally rather than squeezing.

    On pacifiers:

    Another reason NOT to use artificial nipples is that fertility will return sooner, something that most women are not in favor of.

    Great article, thank you!!

    • That’s “7 of 28 disorders,” not “7 or 28 disorders.” Sorry!

    • All three of the midwives I had only did this on the third day. The last had me nurse the baby and she held its foot until it stopped kicking then did the heal prick. She claimed that this helped them not get so upset about it. (and she was only one of my three babies that didn’t have to get pricked twice to get enough blood for the test!)

    • Great tips on the heel prick! Thanks!!

  12. Given that the disorders the simple ‘heel prick’ tests for are life altering (ie. irreversible damage) and/or can lead to the death of a child…I can’t imagine choosing to wait to watch for signs – most people do not know they are carriers of disorders until AFTER their child has been diagnosed – I wouldn’t even know what signs to look for and by the time the signs are recognized it would likely be too late.

  13. This is so wonderful! We just, just found out we’re expecting – like I’m really not supposed to be telling anyone it’s that early – but I am already overwhelmed with all there is to learn and know. I am going to print this to refer back to.

    Thank you so much!!

  14. Thanks so much for these posts! We’re expecting our first baby in 4 weeks, and you have given me a non-biased perspective on these things I will need to consider (even though we live in England and things are done slightly different here).

  15. Love these posts! We opted out of just about everything as we are allowed in the state we live, but we could not opt out of the heel prick tests. We had a midwife, and she was still required by law to do that. I didn’t really mind doing that anyways. I nursed while they did that, no sugar water necessary :) Thanks again for all the informative posts!

  16. PLEASE do the heel pick!!!!! Please please!!!! My son has one of those very rare metabolic disorders!! It’s called MCAD and they just started testing for it in the 80′s therefore my husband and I had no idea we were carriers!! This very small test saved his life!!! Please don’t opt out!!! A lot of these disorders are newly found and the parents haven’t been tested and it could cause your child some serious medical problems if you don’t! Please heel pick!!!

  17. I really enjoyed the first part of this article and greatly appreciated the gentle tone and views on why someone might choose different options with each choice. I tweeted it on, and was looking forward to sharing the second half of the article as well. Unfortunately, I’m not sure that I feel comfortable doing that with the information given here on circumcision. I know that circumcision rates in various parts of the states are quite high, so yes, it’s still a relatively common procedure. However, the reasons for circumcision have largely been disproven http://www.nocircpa.org/4642.html. Also, the prepuce is an amazingly designed body part with many functions that are taken away with it’s removal http://www.drmomma.org/2009/09/functions-of-foreskin-purposes-of.html. I do not believe that God designed a throwaway body part.
    Circumcision has been shown to be a very traumatic surgery for infants and has many risks not mention in this article, including hemorrhaging leading to death http://www.circumstitions.com/Complic.html.
    I don’t write this to judge or besmirch any mothers who have tried to make a wise decision for their son and decided on the side of circumcision, but to simply encourage those who are facing the decision still to do thorough research.

    • Thanks for reading! I’m surprised that you feel that trying to present both sides of an issue every mom of boys will have to face is somehow the wrong approach. As with all of these procedures, my goal isn’t to tell parents which is the “right” decision one way or the other, but to say “hey! here’s the options, and here are all the reasons you might want each of them! Now you evaluate your circumstances and pick!” For sure, circumcision is one decision, but I don’t think it’s by any means one to be adamant on: other decisions have way more potential to affect life long-term, whether positively (hearing test, heel prick, for ex.), or negatively (Hep B shot, for ex.). People beloved by God have lived with or without circumcision for thousands of years. You say God doesn’t design throwaway body parts, but on the other hand, He doesn’t command generations of parents He loves to do something that is torturous and life-destroying for their boys!

      • Christina, I have no doubt that you’ve put forward the pros and cons as they were presented to you, I just don’t think that the pros are as pro as you think they are (the studies cited to get those results tend to be skewed or flawed) and the cons are more con than you think they are (the medical community tends to minimize them).

        As a pastor, I spent a lot of time researching the religious implications of circumcision (why would God command such a thing), and found, surprisingly, that he didn’t. BC, historical circumcision was characterized by either a small cut at the tip of the foreskin, or a slight stretching and removal of the “overhang”. The radical excision of the foreskin didn’t begin to happen until somewhere around 400 AD, because Jewish men were attempting to pass as gentiles in order to use Roman gymnasiums (where they had to be naked, and if they could pass, they obviously had a fair chunk of foreskin left). Radical, contemporary circumcision differs in process (the foreskin has to be skinned off of the full surface of the head of the penis – it is attached and non-retractable for several years after birth), and effect (the exposed head of the penis becomes keratinized, reducing sexual function – which was actually touted as a HUGE pro when introduced to Western modernity). Honestly, I was right with you up until I dug into the issue, but after seeing the depth of the suffering involved (studies on the brain activity of infants during circumcision were halted because they couldn’t be ethically completed based on intermediate evidence), the complications that can ensue, and the continually changing history of supposed benefits, I came to the firm belief that it IS a big deal, and definitely worth speaking out about.

        I don’t say any of this to come down on you at all. You’ve clearly worked hard to present a fair and unbiased point of view. You’ve done a great job. I really enjoyed the article. I just think that it’s a bigger deal than you think it is…

        My two cents anyway…

      • Christina, thank you for taking the time to read and reply. Until a few years ago, I thought much like you on the subject. Circumcision was something you could take or leave, and it was no big deal. Then I started learning about it. A common saying among “intactivists,” is “the more you learn the worse it is.” I’ve definitely found that to be true.
        Please believe that I’m not trying to attack you or your stance, but to, in grace, share something I’ve learned that I believe to be important. Sharing both sides of an issue is a good thing and often a beneficial thing, but I can no longer see a pro side to this particular issue. Everything I’ve learned about modern routine infant circumcision tells me that it is a very risky choice to make. Did you know that studies done on babies pain levels during the procedure show it to be so traumatic that many babies go into shock? Did you know that the surgery can negatively affect a boy’s nursing relationship or cause him to not feel safe with his mother? Did you know that over 100 boys in the U.S. die every year due to complications of the surgery?
        You mentioned long-term effects on life, but if you check out the list of complications that I linked to, you can see that there are from slight to serious issues that can arise from this surgery that affect penile function, urinary tract function, sexual function.
        Since the benefits often given for infant circumcision are either from iffy studies (HIV, STDs), or are so minimal with other more simple treatments (UTIs, yeast infections) it seems that the risk taken is not worth the slightly possible reward. (As for cancer prevention, the American Cancer society actually released a statement saying that they do not recommend infant circumcision as a preventative for penile cancer.) I just think that so many parents are told how great it is to do this, but are given no information on the risks or even the pain levels that their son will go through.
        As you mention God’s command to circumcise, I will say with Aaron (yes, my husband. NOT trying to gang up on you, he is just also passionate about the issue) that my best understanding of the biblical form of circumcision was different from what is done today, and did not involve cutting the prepuce away from the glans (did you know that until they begin to naturally separate [anywhere from age 2-10] the prepuce and glans are attached in a similar manner you nail is attached to the bed underneath?).
        Of course, I don’t think that one’s choice to circumcise or not, or one’s ownership of a foreskin or not, at all affects their standing with God. His beloved are his own regardless of the condition of their bodies.
        If you are interested in looking into the subject farther, the links I posted above all take you to excellent sites with good information on the topic.
        I know that discussing opposing sides of any parenting issue can be difficult and easily felt as a personal attack. Please know this is not my intention. I am very cautious when I choose to bring up this subject, because I would never want to hurt another mother. I have prayed my way through writing this comment asking for wisdom and words that would show love and grace to a sister in Christ. I truly hope that has come across.

        • Gretchen says:

          You say that “you” cannot see a beneficial side but what about everyone else? Are we not able to make up our own minds…I respect your opinion for your children and THANK GOD you can’t make the decision for mine. Although, my mind is not yet made up on whether or not to circumcise my boys, I have the right to make it. And, one wise man once told me that if you have to start a statement by saying, “Im not be judemental but…” thats at the very heart of what your being!!!

      • I have two points that I would like to make on God’s commandment for circumcision. I hope they both make it through moderation as it is starting to look like only pro-circumcision posts that reference God/Bible are making it through. I hope I am wrong about that.

        Any who, the circumcision that God commanded for Jewish people was not the same thing that “circumcision” is today. In Biblical times, they only cut the tip of the foreskin that extended beyond the glans. Now, we literally rip/scrape apart the foreskin that is fused the glans and cut the majority, if not all of the foreskin off. This is much more damaging and invasive. Here is more information about the change:

        http://www.jewishcircumcision.org/info.htm
        “4. Originally only the tip of the foreskin was cut, called milah. This practice lasted about 2000 years. During the Hellenistic period, many young Jews concealed their circumcision by drawing their foreskins forward. The rabbis of the time decided to change the requirements of the procedure so that a circumcised male could not possibly be altered to appear uncircumcised. This was the start of periah, removing the entire foreskin.”

      • The second point that I’d like to make about God’s commandment for circumcision is that The Bible does state that circumcision was a burden, not a benefit. Colossians 2:8-14, circumcision is referred to as being a requirement that was “against us” and “contrary to us” and that Jesus has “taken it out of the way, having nailed it to the cross”. The entire verse is quite clear and draws a hard line. As Christians, we have already been circumcised through Jesus’ own circumcision, with a circumcision made without hands. We are circumcised in the spirit, not the flesh. Circumcision in the Old Testament was a sign of what was to come, the sacrificial shedding of innocent blood. But that was not enough for salvation. The shedding of blood had to be coupled with the death of a willing and qualified victim, Jesus Christ the son of God. In Him, the law was fulfilled.

        As a Christian, I believe in choosing the freedom that Christ paid for and not casting doubt on the spiritual circumcision that He gave me by doing a second circumcision of the flesh on my son. There are many more Biblical references to this in The Bible and I think it’s important that this information have fair exposure. Scripture warns us not to put religious significance on circumcision of the flesh and is very clear that circumcision “means nothing”. And then to do what circumcision is today, a dramatically more invasive surgery that does harm our children? I can’t stand by silent.

      • God also commanded nations to kill nations. I think it’s important to keep Biblical commands in the context of which they were given. In the case of circumcision, that’s a Jewish covenant not commanded of any Christian.

  18. This is a good post. I have thought about these things but some of them are such hard decisions. Some of them are basically made for me because we don’t have many options where we live (eg. we are not circumsising if we have a boy, easy decision for me because we only have the hospital option where I live and that doesn’t interest me, we don’t have a hospital that respects parent’s wishes very well so rooming in, if I have to go to the hospital, is the only option that I want to use).

    Some of the decisions are so hard though, since there is always a second look at the issue. Always. A friend of mine recently had to have her preschooler circumsised because of an issue and so she says that next time she’d do it at birth. My midwife has had a client’s baby die from issues related to not getting the Vitamin K shot so she’s really uncomfortable with not doing it (although she would not do it if we asked I can tell it really bothers her) things like that.

  19. Hi,

    This was a beautifully written article. I would like to stress about the vitamin K issue. My son was born at home in a water tub. He had a beautiful gentle birth. He was only breastfed and we did do the delayed cord clamping. He had no birth trauma what so ever. He was not given vitamin K on the advice of the doctor who did the home birth. I was never given the whole facts and I should of been given the warning signs to look for. I don’t know why I did not research the vitamin K shot, but I totally trusted my doctor. My son ended up with a massive bleed on his brain due to Vitamin K Deficiency Bleed (VKDB). He had brain surgery and a 1% chance to live. It is a long story but I brought him to doctors with signs and symptoms of a VKD but no one connected the dots. His bleed was so bad that his brain was pushed past the midline causing global damage. My son went through such trauma and pain. He barely lived and was in pain for almost 2 years after the insult to his brain. Today he is 7 years old and happy but he is like a 3 month old. He cannot sit on his own or stand or walk or crawl. The boy was son would have been is forever gone. This has totally changed our lives. Your brain is such a crucial part of who you are. I am telling my story because I do not want this to happen to another family. Please think about the shot – it is just a vitamin. And as you mentioned breast milk is low in vitamin K. Most babies are fine without it but it is a huge chance to take. I do not believe that God caused this, I believe that when sin entered the world it created illnesses. Boy babies have a higher chance of this bleeding disorder. If you opt out – please watch your child very carefully for any signs of bleeding or bruising. My son was circumcised around 2 weeks old his bleed did not happen until he was 5 weeks old. It is called late-on set VKDB. I have also read studies that in some countries they tried just doing the vitamin k drops and not the shots and the incidents of VKDB went up. So please think about the importance of this shot. It is not rare when it happens to your child.

  20. I’ve enjoyed these two posts and even though my husband and I have opted out of many of these procedures for our first two children, it’s given me some things to think about for future babies. I will say, though, that I agree with Mary Mom about the metabolic screening test. Yes, these diseases are all very rare, but some babies do have them, and they are serious. Treatment (if available) should be started as soon as possible for a child with a metabolic disorder; sometimes by the time a disease is suspected, it’s too late. My son had two positive results for galactosemia and required further lab work to be done. Fortunately, they turned out to be false positives (likely due to the excessive heat that summer affecting the tests in the mail), but still. Babies are born with these diseases and they aren’t something to be taken lightly.

  21. This series was great. We actually turned down the vitamin k shot in the hospital, then when it came time to circumcise our son no doctor in town would do it because he hadn’t had his vitamin k shot. A doctor ended up having to order it from the hospital for our son later. I have mixed feelings about this and really wish we could have avoided it altogether, but since this is how things are where we live it looks like we will be doing the vitamin k shot with our next son just so we don’t run into the same issues.

  22. This series provides a nice road map for the many decisions parents must face at the birth of their child. I would like to say that the heel prick to screen for many conditions should, in my opinion, be done. It saved my grand daughter’s life. She was born without a thyroid gland and with this heel prick to test for congenital hypothyroidism her thyroid supplementation began within three days. Without the test in the nursery she would have suffered mental and cognitive retardation before symptoms would have been detectable. As a nurse, a mom, and grandmother I can’t stress enough the importance of this screening.

  23. I really enjoyed this series! So much good information!

    As a mom of a baby who has one of the disorders tested by the heel prick newborn screen, I would recommend it every time. My son has congenital hypothyroidism and while rare, it is very serious for newborns. Had we waited to have him tested until he showed symptoms, it would have been too late-thyroid hormone is necessary for brain and motor skills development and not having the hormone leads to serious irreversible delays in development. We are so thankful for this test!

  24. i had recently heard that as of 2009, the circ rate in the U.S. was down to 32%, partially due to many insurance carriers no longer covering the procedure.

  25. This series is so helpful to me! A lot to consider when we welcome our first child in May. Thanks for all the thought that went in to these posts.

    Random question… my family is planning a BIG family vacation to Vermont (we live in Texas) 4-5 weeks after my due date. We want to go and be team players but I am somewhat concerned with traveling so early after her birth. Do you have any tips? I need to call our pediatrician to see if it is safe to fly (my main concern is our little girls ears) so early. Do you have any thoughts? Should I not even be concerned?

    • Brittnie-
      I have traveled with both of mine that little. Nursing, pacifier or bottle(whichever is best for you) will help with her ears. Honestly I would worry about the germs. You will get lots of attention! Wear her covered if you can. The smaller they are the easier they are to travel with.

    • Brittnie, this is a good question – I’m due June 24 and my husband will be in a wedding in Napa Valley (other side of the state and requires a plane flight) on July 21… I’d really like to be able to go with him, as many old friends will be there and it will be a beautiful trip! But, we’re waiting to make arrangements until after the birth – partly because if the baby is overdue, we might be taking a two week old, not a four week old! Haha.

      I did some googling and it looked like most people didn’t see any issues with flying at that time… lots of anecdotes of people who did just fine with traveling with their very wee ones. It seems like nursing during flights (especially takeoff and landing) can help with air travel, popping ears, etc.

      Also, people recommended just allowing LOTS of extra time for travel. If you’ll be driving from the airport to the location, allow double the time because you’ll have to stop the car every time you feed. Allow extra time for getting to the airport, and for transporting all your stuff AND your baby… no more arriving at security an hour before the flight or anything like that!

      One other thought – I think if it were going to be winter, you might want to be a little more concerned… active flu season, cold temperatures, people indoors sneezing on baby, etc. However, since it will be summer, that probably won’t be *quite* such a big deal, especially if you wear the baby a lot to protect from too many germs, as the other commenter suggested.

      Congratulations! This will be our first too. :)

      • I would agree with all that’s been said above- we traveled with our daughter quite young, and nursing or giving a paci during take off and landing, as well as wearing her makes it the easiest time to travel! I’d just be cautious if it’s during flu season. I’d also take Vitamin D for both of your immune systems’ sake.

    • Jennifer says:

      We flew across country when our oldest wasn’t quite 1 month old, and it was during the Bird flu outbreak. Everything worked out fine. I nursed him pretty much the entire flight, and wore him when walking around. Since he was our 1st, I was totally exhausted, but our son was a great traveler! Just make sure you bring more diapers than you think you’ll need in your carrying and a change of clothes for the baby-you never know if there will be a delay! Good luck!