• Rose Macomber

Informed Decision Making for Baby

You've spent your entire pregnancy preparing for baby's arrival: going to appointments, getting the nursery ready, picking out a name, thinking about every little detail to make sure they have a safe entry into this world. But are you prepared for the many decisions that come up in the minutes following birth?

When should you clamp the umbilical cord? What is so important about immediate skin-to-skin? What is this we keep hearing about Vitamin K? Why does my baby need (or not need) Erythromcyin eye ointment? Have recommendations changed on hatting after delivery?

There are so many things to consider and so little time following your birth to make these decisions. Let's break them down now.

Delayed Cord Clamping

We now know that there are clear, scientifically proven benefits to delayed cord clamping. If this is something you'd like, be sure to ask or confirm about the practice with your care provider during one of your prenatal visits.

Did you know that up to 1/3 of baby's blood volume can still be within the placenta immediately after birth?? Waiting to cut the cord can reduce the risk of anemia and improve overall early development outcomes. In cases such as preemies, delayed cord clamping can reduce death in at-risk infants. There *is* a slightly increased risk of jaundice with this practice, but there also may be other protective properties. Check out the blog post specifically on Delayed Cord Clamping for more in-depth information.

Immediate Skin-to-Skin

In recent years, skin-to-skin has become quite the headline, but what are the benefits? This practice can help release oxytocin, which helps to expel the placenta and prevent postpartum hemorrhaging. It also helps to regulate baby's breath and body temperature, and helps establish the first feeding and bonding.

If for any reason, you aren't able to practice skin-to-skin immediately following birth, it's not too late. This isn't an "all-or-nothing" thing, skin-to-skin at any time has benefits. It's not only for mom, either! Partners who practice skin-to-skin for 30 minutes on baby's first day benefit from their brain rewiring, likely to aid in them being more in tune with answering baby's needs. How neat!

Vitamin K

Vitamin K, Vitamin K, Vitamin K, but what IS it?? Do we need it? What does it do??

Babies do not begin producing Vitamin K until day 8. For most infants, this isn't a problem. However, with things like birth trauma, medical interventions, unexpected trauma, or even late vitamin K deficiency, bleeding can occur.

To prevent this bleeding, it has been routine to give all infants a Vitamin K shot at birth. Some parents opt out, feeling it is unnatural, unnecessary, or as potentially increasing risk of jaundice & leukemia (although there is not strong evidence to support this claim). Some other parents opt to try oral Vitamin K.

What's important to remember is that you have the choice and the right to either opt in or out. If this is something you'd like to learn more about, I recommend discussing any concerns with your doctor or future pediatrician, do research, and know your options.

Erythromycin Eye Ointment

Erythromycin is an eye ointment that is applied to newborns to prevent pinkeye in the first month of life. The most common cause of pinkeye in newborns is chlamydia. Although any number of bacteria can cause pinkeye, chlamydia is more serious and can lead to vision damage.

Some parents opt out of this, knowing they don't have chlamydia and they may feel the risks of antibiotics (even local) do not outweigh the risks. Other parents feel the sensation (blurring) can distress the baby and/or interfere with bonding.

Ultimately, this is your decision to make. Again, I would recommend speaking with your care giver about any concerns you may have, and remember that this is ultimately your choice to make.


As immediate skin-to-skin has become more typical, we've learned that for healthy-term infants, a hat is unnecessary for maintaining body temperature. We've also learned that a hat may actually interfere with bonding and feeding. Unless it's cool out or you have otherwise been instructed by your doctor, hatting a newborn at home is not necessary. It is important not to overheat baby, especially when sleeping, and a hat can contribute to overheating.

Using BRAINS to Make Decisions

If you read the previous blog post about using your BRAINS to make decisions, then you already know the process. If not, here's a quick overview of a process to follow when making decisions.

Benefits: Always ask about the benefits any given treatment or intervention has. Why should you consider this option? How will this help my baby?

Risks: Similar to above, you should know what the risks are with this treatment or intervention. Are there any reasons this might not be the best option for you and your family? What would happen if I opt out?

Alternatives: Are there any alternatives to this treatment or intervention? Is there anything we could try first?

Instincts: What do my instincts tell me? Don't underestimate your gut feeling - trust yourself and use your instincts to help you make this decision.

Nothing: What happens if we do nothing? What if we don't do as you advise? Here is where you weigh the risks of the treatment or intervention with the risks of doing nothing.

Space: You can ask your provider for space for you and your partner to make your decision. You have all of the information to make an informed decision, and it's totally acceptable to take a few minutes to talk it out with your partner or family if you need to.

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