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11 Medical Decisions to Make for Your Baby Before Delivery

You've educated yourself about pregnancy and made choices for your labor and delivery, but are you prepared to make medical decisions for your baby? #NewBorn #MedicalDecisionsForNewBornBaby #Baby #MondayMorningMomsChildCare #MondayMorningMoms #ChildCare Photo Credit: Jessica Byrum/Stocksy

In my experience as a doctor, I've realized that many new parents don't realize that in the first few hours of their baby's life, they'll need to make at least 11 (yes, 11!) medical decisions for their tiny new person. After hours of labor, that probably sounds like the last thing you want to do, which is why it's important to plan ahead as much as possible and discuss any questions you have with your doctor.

Think about the issues below, read through my recommendations as a pediatrician and a mom, and include your preferences in your birth plan.

1. Delayed cord clamping. Usually the umbilical cord is clamped immediately, but waiting just 30 to 60 seconds after birth to clamp the cord allows the placenta to give a few more pulses of blood to the baby (hence the term "delayed cord clamping"). This extra blood from the placenta can be as much as 30 to 40 percent of your baby's total blood volume. And all that extra blood can prevent anemia in the first six months of life. Studies also show that toddlers whose umbilical cords were cut after one to three minutes may be less likely to have delayed motor skills than children whose cords were cut immediately. In 2016 the American College of Obstetricians and Gynecologists (ACOG) officially recommended delayed cord clamping for all infants.

2. Cord blood banking. Cord blood banking is exactly what it sounds like — "banking" the extra blood in your baby's umbilical cord after it's cut in a registry or bank for future use (for example, to treat certain illnesses). It's become more popular in recent years, though it can be costly, depending on whether you opt for a private or public bank. Private banks may set you back anywhere from $1,000 to $2,500 for the initial collection, plus annual storage fees, whereas public banks are free. However, both storage options have pros and cons. The most notable difference between the two is that with private banks, you retain all control over your cord blood and can make all the decisions about it; however, it can be quite costly. Public banks are free, but you're donating your cord blood, meaning that anyone who needs it can use it (it may also be used for medical research).

3. Skin-to-skin newborn care. Do you want to hold your baby skin-to-skin right after delivery, even if you have a C-section? More and more hospitals allow newborns to spend the first few minutes of life skin-to-skin with their mother. This means that we place the baby, unwrapped, on mom's bare chest, between her breasts. We usually put a warmed blanket over the baby. The nurse or pediatrician can evaluate the baby right on mom's chest, if necessary. Routine infant care, such as antibiotic eye ointment, vitamin K, weight, measurements, footprints, bath, and full medical assessment can be delayed until after infant is breastfed, parents have bonded with the baby, and mom is ready to rest.

4. Antibiotic eye ointment. Newborns usually get an antibiotic eye ointment called ilotycin squirted into their eyes in the first few minute of life. Most states mandate this prophylactic treatment of newborn eye infections, although parents do have the right to decline the medication. The purpose is to kill bacteria — most often from STDs — that can cause blindness, and the risks and side effects of the treatment are essentially zero. Additionally, the antibiotics do kill common bacteria from the anus and genital area that can be passed during vaginal delivery. That said, many moms feel their risk of carrying STD-related bacteria is essentially zero and some opt out of the eye ointment.

5. Vitamin K injection. Shortly after your baby is born she will receive an injection of vitamin K in her thigh to prevent bleeding. Without vitamin K, about 2 percent of infants will develop hemorrhagic disease of the newborn, or vitamin K deficient bleeding (VKDB). Although it's usually okay to delay vitamin K until baby and parents are done bonding, it's not a good idea to decline vitamin K all together, as vitamin K deficient bleeding can be dangerous to newborns.

6. Bathing. Babies are born covered in vernix, a waxy white substance that looks something like cream cheese. Some hospitals will immediately bathe babies to remove the vernix, though it's becoming more common for hospitals to delay baby's first bath. Some parents want to do their baby's first bath themselves, often with their own special soap. This is completely fine, but you'll want to note it in your birth plan; otherwise, there's a chance a nurse will do it for you at the hospital.

7. Breastfeeding. Is breast really best? Is bottle-feeding okay? This is one of those subjects everyone (and I do mean everyone) will have a strong opinion about. The reality is, only you know if breastfeeding is best for you and your baby.

8. Pacifiers. Who knew that pacifiers could be so controversial? Many breastfeeding advocates discourage pacifier use until breastfeeding is well established, but there is also evidence that pacifier use can reduce the incidence of Sudden Infant Death Syndrome (SIDS). Other people think a pacifier habit is better than a thumb-sucking habit and give their baby a pacifier right away. Many people find pacifiers are essential for parental sanity — how else can you help a well-cared-for baby stop crying? Whatever your pacifier preference, be sure to note it in your birth plan or the nursery nurses may give your baby a pacifier without asking.

9. Circumcision. The U.S. circumcision rate fell to 58.3 percent in 2010 (down from around 64 percent in 1979) meaning that nearly half of US baby boys were not circumcised. Worldwide, about half of men are circumcised, although the popularity of this procedure is falling, especially in Europe and the Western United States. Don't worry: No one will circumcise your son without your permission (and a signed consent form). But this a procedure you'll definitely want to make an informed decision about before you go into labor.

10. Hepatitis vaccine. Babies usually receive their first hepatitis B vaccine in the hospital. This is just the first of a long series of vaccines that are recommended during childhood, and while the American Academy of Pediatrics' (AAP) previous recommendations included an option for delaying the first dose vaccine until baby's first well-visit, they've since updated their policy.  Now, the AAP recommends that all newborns receive this vaccine within 24 hours of being born. To get all your questions about vaccines answered, talk to your pediatrician before your baby is born. Yes, you can schedule a visit while you are pregnant! Which brings me to #11...

11. Pick a pediatrician. If you deliver your baby in a hospital and have not yet chosen a pediatrician, the hospital will usually assign a pediatrician to see your baby. It's a better idea to pick your own pediatrician and have them see your newborn in the hospital. Schedule a visit to meet with each of the pediatricians you are considering while you are still pregnant. You'll thank yourself later when you know you've found the right doctor for you and baby.

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