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Pregnant? 12 Medical Decisions You Need to Make Before the Contractions Start



Kathleen M. Berchelmann, MD - published on 11/18/14

If you don't make them yourself, someone else will be making them for you.

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? In the first few hours of your baby’s life you will need to make many medical decisions for your tiny new person, or someone else will make them for you. I’ve attended deliveries for more than a decade at five different hospitals, and it’s shocking how few mothers are able to make educated decisions on these issues under the stress of delivery. So take a few minutes to think through these, and include your preferences in your birth plan.

1. Delayed cord clamping: Usually the umbilical cord is clamped within one minute of a baby’s birth, but it seems that waiting just 1-3 minutes after birth to clamp the cord allows the placenta to give a few more pulses of blood to the baby. During the birth process the blood vessels in the placenta constrict, pushing blood towards the baby. This extra blood from the placenta can be as much as 30-40% of the baby’s total blood volume. And all that extra blood can prevent anemia in the first six months of life. Waiting these extra few minutes before clamping the cord is referred to as “delayed cord clamping.” If you don’t request delayed cord clamping, it might not happen. Be sure to read up on the risks and benefits before you write your birth plan.

2. Cord blood banking: Umbilical cord blood donation and banking is an especially important topic for Catholic parents, as these stem cells are changing the face of embryonic stem cell research. With time, we hope there will be no need for a debate regarding stem cells from leftover embryos created by IVF. Instead, we will be able to use stem cells from donated or banked newborn umbilical cords. As technology changes, the utility of cord blood and umbilical cord tissue is rapidly increasing. 

3. You have a choice of either donating your baby’s cord blood to a public registry or privately banking his/her umbilical cord blood and tissue. Be sure to educate yourself about cord blood registries vs. banks. If you do nothing, your baby’s umbilical cord will go in the trash. Of note, it is possible to practice delayed cord blood clamping (as above) and still collect cord blood for donation or banking.    

4. 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? You need to be clear about this in your birth plan. Some hospitals, especially those that have the BestFed Beginnings program, allow healthy 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.

5. 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 that can cause blindness. But most of these bacteria are from STDs, and many moms feel their risk of carrying such bacteria is essentially zero, and they wish to avoid giving their newborn an unnecessary medication. The risks and side effects of the treatment are essentially zero, also, and the antibiotics do kill common bacteria from the anus and genital area that can be passed during vaginal delivery.

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