Babies Tale

Before leaving the subject of birth and going on to the newborn, we should discuss an important choice; the choice between natural childbirth and medicated childbirth. Your preparation and decision-making and the course of your labor will differ depending on what you prefer.

Having read the previous discussion of labor, you now have some sense of the physical and emotional events of normal spontaneous labor. It is concern about a tear or labor pain that influences many women to choose to use pain-relieving medication in labor.

The Use of Pain Medications or Anesthesia in Childbirth

Pain medication in childbirth has been used for centuries. Alcohol. Opium, and other drugs have been used, though how extensively is not known.

When using pain medications, you make a trade-off in return for relief of pain and tension and possible speeding up of labor, you accept the side effects on labor progress, your mental and physical well-being, or on your baby. You should balance the advantages and disadvantages as they apply in your situation before using or not using a particular medication.

What are the kinds of medications available, how do they work, and what are their risks and benefits? This section provides an overview that will assist you in discussing the subject with your doctor and making a decision on your preferences.

First of all, the choice of natural and medicated childbirth only exists as long as the labor remains normal. Some interventions are painful or stressful and increase the need for pain medications. If, however, you or your baby requires intervention [such as induction of labor, use of forceps, or cesarean section] for medical reasons, you will need pain medication.

Medication for Early Labor

Because the medications that provide the greatest pain relief also tend to interfere with early labor progress, they cannot be used too early, unless you want to stop labor. There are medications available if a very prolonged and exhausting pre-labor or early labor has caused excessive anxiety and worry. Sedatives or barbiturates [sleeping pills or medication] may help you rest. These are given in pill form or by injection, They may temporarily halt your labor while relaxing you or allowing you some sleep. These drugs reach your baby, who cannot easily excrete them, so it is important not to receive large doses. Because babies born with such drugs still in their bodies may have problems breathing or sucking, your doctor will probably only use small doses and will try to be sure that they have worn off before birth.

Tranquilizers are also used in long pre-labors to reduce muscle tension and anxiety. Some also help if you have severe nausea or vomiting. Depending on the drug chosen, you may feel dizzy and confused, your mouth could feel dry, and your blood pressure altered. These drugs also cross the placenta to the baby and may have effects on fetal heart rate, and newborn muscle tone, suckling and attentiveness.

Morphine, a narcotic, may be used in an attempt to stop a long, non-progressing labor. While it may cause you nausea, dizziness, and confusion, it may also do just what you need-put you to sleep and stop your labor temporarily. Narcotics can linger in the baby and can have some effects on behavior and breathing after birth. The greater the amount of the drug given the greater the effect on the baby.

Forceps deliveries are carried out after the first stage, when the cervix is fully dilated. Forceps are used if for some reason the baby’s head is not coming down the birth canal or if the baby is in distress and needs to be born rapidly. Premature babies may be delivered by forceps to spare their heads from being too compressed as they come through the birth canal. Forceps are also usually used to protect the baby’s head in a breech birth.

If your baby needs a forceps delivery, you will be asked to lie on your back and your legs will be put into stirrups. You will receive a local anesthetic. An episiotomy will be done to increase the vaginal opening. Forceps will be gently inserted around the baby’s head. Gentle pulling helps the head out. Once the head is born, the rest of the delivery occurs normally. If the baby’s head faces the wrong way, forceps may be used to rotate the baby’s head to help delivery.

Forceps deliveries are very safe and there is little chance of the baby being harmed in any way, although most will have marks on the head from the forceps for a few days after the birth. Forceps deliveries occur more often after a protracted labor where the mother becomes exhausted, where she has had an epidural and cannot feel to push with each contraction or where the baby’s head is large or in the wrong position.

Sometimes a vacuum extractor, also called a ventouse, is used instead of forceps. This is a cup placed on the baby’s head that is operated by a vacuum pump. It can be inserted before the cervix is fully dilated and is used, in conjunction with the mother’s pushing, to deliver the baby. A small circular mark where the cup was placed shows on the baby’s head for a few days after the delivery.

As the baby’s head emerges you will know. You will feel a stretching or burning sensation in your vagina. This is an exiting, intense time. You know the baby is almost here and may be tempted to push as hard as you can to get him out quickly. They could be a mistake, however, because a sudden push to make the baby come out too quickly and damage your perineum [causing tearing]. It is important for you not to push hard at this time. Let your uterus do the work alone. You should breathe rapidly and lightly [pant as animals do during birth]. So the baby can emerge gradually. Your doctor will give you instructions-and help the baby out slowly. You will soon be holding your baby in your arms.

After the head is born, the baby turns to one side and a shoulder and the whole body is born. And what a sense of relief you feel! Labor is over [or nearly so]. You have a baby. It may take a while for it all to sink in. In the meantime, you may be holding your baby and watching as a nurse or doctor examines him and cares foe him.

The Third Stage of Labor

Your job is not quite finished. The placenta still needs to be expelled. The third stage usually lasts from five to thirty minutes. The nurse or doctor will keep a hand on your abdomen to determine when the placenta separates from the wall of your uterus. Then you will be asked to push it out. You may feel some cramps, but there is usually slight discomfort.

The Fourth Stage of Labor

Immediately after birth, while your are holding and admiring your new baby, your doctor focuses on your well-being, The condition of your uterus and vagina is of major concern. It is important that your uterus remain contracted after birth, which keeps it from bleeding as much as when it is relaxed. Most women lose about one cup of blood at the time of birth. While this may seem like a lot. Remember that among the other many changes of pregnancy, your blood supply greatly increased. Thai excess blood is no longer needed, you will lose some of it at the time of birth and will continue to lose some over a period of several weeks [this discharge is called lochia]. Your doctor watches the amount of blood lost immediately after birth and, if necessary, takes measures to reduce this blood loss. These may include massaging your uterus vigorously, asking you to lightly stimulate your nipples, or giving you an injection of a medication [Methergine [methylergonovine] or pitocin [oxytocin]] that will cause your uterus to contract.

Your doctor will also check your vagina to see if you need any stitches. If an episiotomy was performed, you will definitely need stitches. Some tearing of the vagina or the perineum may also have occurred when the baby was born. Although the idea os tearing sounds rather unpleasant, be assured that the tears [or cuts] are usually not serious, and will usually heal rapidly. If necessary your doctor will begin stitching within a few minutes after birth. You will be given a local anesthetic for pain relief if you have not already had one.

At first sight, your newborn may not be quite what you had expected. For the first half minute or so, his skin might be bluish grey, and he may appear lifeless. That may be a shock if you are not expecting it, but this is the color of all babies in the uterus. As your baby begins breathing and more oxygen enters his body, his color will turn pinker or ruddier-first the head and body, then the arms and legs, and last the feet and hands.

Your baby will be soaking wet, streaked with blood, and smeared with vernix, a white sticky substance.. Some babies have a great deal of vernix all over their bodies, and some have only small amounts, only in the creases and folds. Vernix is almost like a hand cream, in that it protects the baby’s skin while he is floating in amniotic fluid.

His face may be swollen and he might have long fingernails. You may also be surprised by the size of your baby’s genitals. The size and color subside in a few days, when their genitals take on a more normal appearance.

Immediate Care

Even though most babies do not really need it, care-givers routinely suction babies noses and mouths very soon after birth to remove excess amniotic fluid and mucous. In fact, sometimes they begin suctioning when only the baby’s head is out. It is done with a rubber bulb syringe or with a little jar and tube called a mucous trap. The mucous trap is used if the baby’s airway seems to be very congested or if the baby was under stress during labor and breathing problems are anticipated at the time of birth.

Your baby’s umbilical cord will be clamped in two places close to his abdomen. Then the cord will be cut between the two clamps. Sometimes the father cuts the cord. Otherwise, the doctor does it. Even though there is a spurt of blood when the cord is cut, neither you or your baby will feel it at all, sense there are no nerves in the umbilical cord. Then your baby will be either be placed on your abdomen or taken to a special warm bed in the corner of the room for examination and other care. If he is placed on your abdomen, you will feel the warm, wet baby on your now soft belly. Many women find this a very pleasant sensation.

Your baby is dried off by rubbing briskly with soft towels to keep him from getting a chill [a major concern of your doctor]. Your baby will be wrapped in a warm blanket or two, and his head will be covered. In fact, it is a very good idea to have a warm little hat to place on the baby’s head as soon as possible after the birth because the baby’s head is such a large part of his body that a lot of heat can be lost through it.

In the last decade, doctors have seen considerable changes in the way childbirth is handled. More and more, mothers are able to choose their position during labor and delivery, and their wishes during the birth are given much higher profile. Hospitals may now offer birthing stools, water pools and other “natural childbirth” props. Birthing rooms in hospitals are more common. Home births may be marginally more common and accepted than they were a decade ago.

However, despite this progress, many women are still concerned that there is too much medical intervention in the process of childbirth. This is especially true for older mothers, who are considered to be at higher risk and are much more likely to receive medical intervention.

Home births are still very rare-planned home deliveries account for less than 1% of the total-and few doctors are happy about a first-time mother over 35 giving birth at home. Of course, the ultimate decision is yours, and you still have the option of a home birth if you want one, perhaps with the help of an independent midwife.

A first-time mother over 40 is likely to be offered an elective Cesarean, and this is especially true if she has had fertility problems. A high proportion of IVF babies are born by Cesarean section; first, because doctors do not want to put the baby at any risk, and second, because the whole pregnancy has become so medicalized that many mothers who could not conceive naturally doubt their ability to give birth naturally too.

This impression is backed up by a study of 195 women having their first baby over 35, compared with another 196 women in the same situation who had a history of infertility. The study showed that the women with no history of infertility were four times more likely to have a preterm delivery (less than 37 weeks), five times more likely to undergo a Cesarean section and significantly increased rates of vaginal-assisted delivery, chronic hypertension and fibroids compared with women having their first baby between the ages of 20 and 25. Those who had suffered from infertility had twice as many elective Cesareans as those in the other group, but otherwise there was no difference in outcome.

Unfortunately, in medical litigation cases, inaction can be seen to be negligent while intervention is not. So even if in a particular labor mother and baby’s chances would be best served by doing nothing, doctors may feel they have to intervene to protect themselves. When a mother is older and her baby is considered a precious baby, intervention is much more likely.

However, mothers who opt for a natural, and in particular, a home birth, do so largely because they believe it is safer:

“I had my third child at home at the age of 35. I believe that home birth is safer if there are no special risk factors, and the labor was far quicker and in every way better than the previous two. I believe that probably more babies die as a result of infections picked up in a hospital and mismanaged, extended and messed around-with labor in the hospital than would die at home in the rare event that something goes wrong. However, I do accept that at 35 with a first baby I would not have had the confidence to have a home birth, and if I had no children or had a history of infertility I would probably feel different too.”

Marianne, pregnant with her first baby at 39 after two years of infertility treatment, disagreed. “This might be my only baby. I’ll do whatever the doctors suggest. I’d like a natural birth, of course, but if things go wrong, if they suggest a Cesarean, I’ll go along with it.”

One childbirth-education teacher says that in her experience, older mothers generally feel positive about their labors. “I think they are more realistic than the younger mothers. They want a baby rather than a wonderful natural-childbirth experience.”

However, older mothers may have to stand their ground if they are under pressure to allow intervention in the childbirth process. And, like all mothers, they will have to make a choice. This means finding out what the options are and understanding what labor, both normal and with complications, involves.

As you enter the last three months of pregnancy, you may find yourself thinking more and more about the upcoming birth. Your large size and your baby’s movements are constant reminders that you will become a mother soon.

You may find yourself wanting to slow down a bit, preferring quiet evenings at home, slow walks, midday rests with your feet up, and a generally slower pace to your life. The twenty-four hour a day job of making a baby becomes tiring toward the end of pregnancy. When you add to that a job, child care, a social life, and the fact that you might be sleeping more lightly than usual, it is not surprising that you may want to simplify your life and take it easier from now until after your baby is born.

As you slow down and contemplate the upcoming birth and baby, you may be surprised to learn that your body has not slowed down at all. It is working at full speed, preparing for the birth. The baby is growing very rapidly, from about two to three pounds at the end of the twenty-eighth week to about six and a half to nine pounds at the end of the fortieth week. Many changes take place in your body to support such rapid growth. In this chapter we will examine these changes and the birth process itself. We will describe the newborn baby, what she looks like, what she can do, and her immediate care. In addition, we will discuss the first few weeks after birth-the immediate care of the mother and the emotional adjustments to new parenthood.

The Third Trimester

All your baby’s systems were formed in the first trimester. The organs and skeleton took shape and your baby took on a tiny but complete human form. During the second trimester, your baby began to move noticeably, gained the ability to see and hear, and began reacting to outside stimuli-that is, sounds outside your body, light and dark, and your eating and activity patterns. Your baby began turning somersaults, sucked his thumb, hiccupped perceptibly, and generally made you aware of his presence. The third trimester [the last three months od pregnancy] might be best thought of as a time when the final touches are put on your baby in his journey toward life outside your body.

Nutritional Requirements

As your baby grows in size her nutritional requirements increase. For example, she requires about one third more protein in these last months of pregnancy because every cell in the human body has protein as a primary ingredient and with each passing day she has more cells. In addition, because the bones are growing and becoming strong, the need for calcium, which is important to bone strength, increase by about two thirds during the last three months of pregnancy. The baby’s absorption of iron also dramatically increases.

As you can see, with these increased nutritional requirements, it is very desirable that you eat well o supply your baby’s nutritional needs as well as your own. It’s a good idea to reassess your nutritional intake during this last trimester, to see if you are getting the recommended foods in each of the food groups.

The death of a baby is a traumatic experience and one that hospital staff may find it difficult to deal with. They are geared up to deal with the joy of birth and not the tragedy of death. At the same time, doctors and nurses may be consumed with the aftermath of the delivery or in trying to save a baby’s life. They have little time for the mother and father, leaving both in a state of uncertainty:

“The delivery was awful and he was rushed off to the NICU [neonatal intensive care unit] the moment he was born. I remember they were all fussing around, giving me stitches and cleaning me up, but nobody mentioned the baby. I just assumed he was dead; at first I couldn’t believe it. I felt numb, and then I started crying. Nobody said anything to me and my husband went off to find someone who would tell him what was going on. Then they came to take me back to my room and I said, in tears, ‘I’m not going, I’m not going to the ward to see those mothers and babies.’ ‘Why not?’ they asked. ‘Because my baby’s dead!’ I bawled. At that there was a flurry, and someone came to say he wasn’t dead at all! He was in intensive care but they were sure he’d be all right, and I could go back and look at him later. It was, in fact, touch and go, but they didn’t say so at the time.”

If a woman is kept uninformed and uninvolved, the consequences can be quite tragic:

“It was obvious that something was wrong as soon as he was born. He was taken to the NICU immediately. There was some confusion over what different doctors said about whether he would live or not and that was hard, because I didn’t know whether there was hope. Meanwhile I was in the regular maternity ward with mothers and babies. I wasn’t with him when they disconnected the life-support system and let him die-there was no point in doing anything. If I had been more involved and helped by them, I think I would have chosen to be with him and to have held him when he died.”

There are probably many women who would have very similar feelings and reactions. Until very recently parents were not encouraged even to see their baby, who was whisked away as soon as it was confirmed that the baby was dead. Today, hospital staffs are increasingly aware that many parents want to see their baby, accept its death and have time to grieve. This applies even if the baby is born with a congenital abnormality. The imaginings of someone who has given birth to a baby with physical abnormalities are likely to be much worse than the reality; again, seeing, being with and holding the child can help parents accept the situation:

“They said the baby was deformed and [so] I didn’t want to see her. But my husband did, and he said, really it’s all right, she’s quite beautiful, you can look. They had wrapped her up so that her face and arms and tiny feet showed. She was very beautiful, and her face had a peaceful expression that made me immediately feel much better about her death.”

A mother whose baby has died can ask not to go to the postnatal ward, but to be given a room of her own or perhaps go to the general gynecological ward. Hormones can be given to suppress the milk supply, though this is less typical now because the drugs can have side effects. The mother may continue to produce milk for some days, to her great distress. The mother whose baby has died will have all the usual hormonal and emotional changes following a birth, but no baby; she is in a kind of emotional limbo, neither a mother nor not a mother.

If the baby has died because of some lack of intervention or action by medical staff, parents usually take out their anger on the hospital. This can make the situation worse immediately after the baby has died: “They should have figured out he was in distress. I can’t forgive them.” Anger is a normal part of the grieving process; being able to blame someone can help the situation seem more bearable for the parents in the short term. Most stillbirth or neonatal deaths, however, could not have been prevented, and blaming the hospital will not bring back a baby who has died.

How the hospital staff deals with a tragedy can make an enormous difference to the experience. If you have worries, it can help to talk to your team in advance about what you would like to happen in the event of the baby’s death, even if this sounds as if you are being unnecessarily morbid:

“I told them that if the baby was dead I didn’t want them to whisk her away. I would like to see and hold the baby right then and deal with my emotions then and there. They brushed this aside and said of course nothing will go wrong. In fact, my baby was born perfectly healthy. But I felt it was important for me to say what I wanted in case the unthinkable happened, so we knew where we stood and I wouldn’t be faced with half-truths or well-meaning attempts to protect me from reality.”

Women-and men-who have experienced a baby’s death are often told by doctors, hospital staff, relatives and friends to “forget about this experience-you’ll have another baby soon.” This is very distressing for the parents, who need to acknowledge the death and mourn the loss of their baby before going on to another pregnancy. Some hospitals will help the parents by encouraging them to see and hold the baby, perhaps taking a photograph they can keep, and discussing what sort of funeral arrangements should be made. Hospitals usually arrange for a cremation or burial free of charge, but some parents find they hastily go along with such arrangements and later are distressed because they did not attend a ceremony and because the baby is buried with others or in an unmarked grave.

You will also need to register the baby’s birth or death. You can ask that the baby’s name be recorded so that he or she can be acknowledged as your child, a real individual, and not just “a baby.” If you feel the hospital is not paying attention to your wishes, be firm and ask for what you want. Taking action in this positive way may help you feel a lot better about the experience when you look back on it and help you in the natural process of grieving. (See Further Reading, starting on page 165, for helpful books.)

Once your labor is well established, it is less likely that drugs can slow it for more than a short time. More effective pain relieving drugs may then be used. Also called analgesics [pain relieving drugs], they are given by injection under the skin, into the muscle, or into an intravenous line. Demerol [meperidine] is the narcotic analgesic most widely used in obstetrics. Its effects are similar to those of morphine and may be associated with a speeding up of labor in some circumstances. If anxiety, tension, and pain are great enough to actually slow labor, a narcotic or tranquilizer may reduce anxiety and allow labor to speed up again. These drugs reduce your pain, though you are still aware of the peaks of your contractions. They also help you sleep or relax between contractions. You may feel nauseated shortly after receiving them, and you may not like the dizzy, confused feeling. The pain relief lasts an hour or so, after which another dose may be given. The drug does accumulate in the baby’s body, however, and larger total doses may have more noticeable effects on your baby’s behavior. If your doctor sees that you will give birth when the narcotic effects on your baby will be at their greatest, she may give you [or your baby after birth] a drug called a narcotic antagonist, to reverse the effects of the narcotic.

Regional Anesthesia

Analgesia means relief of pain; anesthesia means loss of sensation. There are ways of injecting drugs in particular areas of the body to cause a loss of all sensation [numbness], in a limited area. Local anesthetic agents [like Novocain [procaine], used by your dentist] are used in this way. Agents like lidocaine and marcaine [bupivacaine] are used in obstetrics.

Depending on where they are injected, they cause varying amounts of pain relief. For example, a spinal or saddle block creates a rather large area of numbness. An injection of anesthetic is made in the lower part of the back, and the medicine enters the spinal fluid. The anesthetic is heavy and stays low in the spine. You might become numb from your ribs down to your toes [spinal block] or from your buttocks and lower part of the abdomen down your inner thighs [saddle block].the amount of numbness is determined by how low the injection is given and how low the drug remains in the body. You can have a “spinal headache” after a spinal anesthetic; this is very painful, can last for days, and usually requires that you lay down most of the time.

Epidural and caudal blocks differ from spinal blocks, since they are given with the same anesthetic agents but in slightly different places. The main difference is they are not given into the spinal fluid. The medicine is placed low in the back, just outside the canal where the spinal fluid is [therefore you will not get a spinal headache]. Although trickier to give than a spinal block, anesthesiologists prefer them for labor because they are not as likely to stop labor and the actual area of anesthesia can be better controlled [especially with the epidural].

The main difference between the caudal and the epidural is where they are given; the caudal is given at the top of the separation of your buttocks; the epidural, a few inches higher. As a result, the area of numbness with the epidural tends not to extend as far down into the birth canal and legs as with the caudal. You can push better and move your legs better with an epidural than a caudal.

Both spinals and epidurals are also used for cesarean births, allowing the mother to remain awake and alert to greet her baby.

Pain relief with these forms of anesthetic can be excellent; in fact, many women report total relief of pain. This welcome relief comes with no effects on your mental capacity. You do not become groggy or sleepy.

Because spinals can stop labor at a critical time, they tend to be used for very late labor and for cesarean births.

Forceps-assisted deliveries tend to be more common after regional anesthesia because women cannot push as well when anesthetized. Anesthesia can be “light or heavy”; women can push better [and feel more] if the anesthesia is light.

Another drawback to regional anesthesia is the possibility of a sudden drop in blood pressure soon after receiving the anesthetic. This sudden drop can temporarily reduce the oxygen available to the baby. Since this side effect is well known, measures are taken to prevent it [a large amount of intravenous fluid is given to rapidly increase blood volume which decreases the chance of low blood pressure] identify it as soon as it happens [blood pressure is checked constantly while the anesthetic takes effect] and treat it, if necessary with drugs to raise blood pressure.

Local Anesthesia

Three types of local anesthesia may be used for childbirth; the paracervical block, the pudendal block, and local infiltration of the perineum.

The paracervical block is given in the late first stage. Tow injections of local anesthetic drugs are made into the cervix and bring pain relief during contractions. Although this form of anesthesia rarely causes problems for the mother, it frequently causes sudden drops in fetal heart rate and noticeable effects on the baby’s muscle tone and reactivity after birth.

Although the amount of pain relief provided by a paracervical block is far less than with the regional blocks, a significant greater amount of anesthetic agent is used-thus, there are many more serious side effects. For this reason this form of block has been discontinued in many areas of the country.

The pudendal block causes anesthesia in the birth canal and is given in the second stage. Local anesthetic agents are injected into the vaginal wall. Again a larger amount of medication is used than for an epidural, but the incidence of drops in fetal heart rate appears not as serious as with the paracervical block. It can be used for forceps delivery or pain in the second stage. Most doctors give a pudendal block before an episiotomy is performed.

Local infiltration of the perineum consists of several injections to numb the area of skin and muscle between the vagina and the anus. It is most commonly used after natural childbirth if stitches are needed. It can also be given in the second stage after an episiotomy is performed. Side effects of a local block appear to be slight.

General Anesthesia

General anesthesia means a loss of consciousness along with pain relief. In other words, a woman is put to sleep and wakes up after the anesthetic has worn off. Nowadays, general anesthesia is uncommonly used-and is generally used for emergency situations.

General anesthetics are usually gases, which are inhaled. They cause a total loss of awareness. Nitrous oxide, trilene [trichloroethylene], and penthrane [methoxyflurane] are examples of such inhalation agents. Sometimes these are used along with sedatives that cause drowsiness. The sedatives might be injected into your vein.

One reason general anesthetics are used less often today is that they have profound side effects. The mother’s breathing may slow down or stop; her blood pressure could drop and cause her heart rate to change. General anesthetics may also stop contractions of the uterus and cause excessive bleeding after birth. The baby is also affected. Babies often have breathing difficulties, sucking difficulties, and poor muscle tone after general anesthesia have been used.

Besides the Apgar score, which is determined right after birth, a more thorough physical examination of the baby will be done a few hours later. The newborn exam is a thorough check of all the baby’s systems. A midwife, family physician, pediatrician, or nurse practitioner may carry out this exam. You may ask that it be done in your presence, so you can learn more about your baby, from head to toe, the examiner checks such things as the fontanels [”soft spots” at the top and back of the head]; the eyes, ears, nose, mouth, and throat; the ability to suck and swallow; the size of the head; the length and weight; the breathing pattern; the size of the liver and spleen; the heart tones and sounds of the lungs; the genitals; the hip joints; the overall appearance of the baby; and the baby’s reflexes. The baby’s ability to pas urine and move his bowels is also noted. Some babies are further assessed for their actual gestational age; there is a test called the Dubowitz examination that helps determine whether your baby was born early, on time, or late.

In the hospital, babies receive identification bracelets, sometimes on both wrist and ankle, and mothers receive a matching wrist bracelet; this is to prevent mixing up of babies in the nursery. Footprints and handprints are also taken immediately after the umbilical cord is cut, a sample of blood is taken from the cord, labeled and stored, in case it is needed later for blood typing or other laboratory tests. The baby’s temperature, feeding pattern, activity levels, breathing and heart rate patterns, and urination and bowel movement patterns are observed for the next several days. If at home, the parents make these observations after being instructed by their care-giver. In the hospital, nurses usually make these observations.

Within an hour or so after birth your baby will receive vitamin K to help prevent bleeding problems. Vitamin K helps in the clotting of blood; since babies do not have vitamin k in their systems for the first few days after birth, it is considered an important preventive treatment. Vitamin K can be given by injection in the thigh or by the mouth. At present, most doctors prefer to give it by injection.

Your baby will receive a number of laboratory tests. The skin is also examined for any marks or other important signs. A sample of blood is drawn from each newborn at least once within the first few days after birth. The one test given to all newborns is a test called phenylketonuria [PKU], PKU is a inherited disorder that can be very serious if not detected very soon after birth. A baby with PKU cannot properly process protein and needs a special diet that is low in phenylalanine, the component of protein that isn’t handled well. If PKU is detected and the baby receives this special diet, she will grow up normally, If it is not detected and treated, however, PKU can cause mental retardation. Because of the seriousness of PKU, all states and Canadian provinces require that all babies be tested for it. The same blood sample is checked for another condition, congenital hypothyroidism. Some people do not make enough thyroid hormones for normal development. If this condition is discovered early, a baby can be treated and grow up without any problems.

Blood is frequently drawn from newborns for other purposes. If your baby appears to be developing jaundice [indicated by yellowing of the skin and the whites of the eyes] your doctor may draw some blood to analyze its bilirubin. Bilirubin, a yellow substance, forms when red blood cells break down; the presence of excessive amounts gives a yellow tinge to the skin. If the bilirubin reaches a certain level, your doctor may feel it is appropriate to treat the baby to lessen the jaundice. While jaundice in a newborn is rarely a serious condition, it is important to keep track of bilirubin levels in jaundiced babies and to determine the cause. The usual treatment, phototherapy, involves keeping the baby in a brightly lit bassinet except for feedings. On rare occasions, a blood transfusion is done.

Blood glucose [a form of sugar] levels are also checked in some babies-those who are very large or very small, those whose mothers have diabetes, and those with other possible problems.