Medications and vaccines

Immediately after giving birth, routine care for newborns includes a few different treatments. It can be really helpful to know more about these recommendations ahead of time!

An antibiotic eye ointment, called erythromycin, is a clear gel that is gently squeezed into each eyelid. It looks greasy, but should not cause your baby any discomfort. It helps to protect against an eye infection called neonatal conjunctivitis that can be caused by many different bacteria present in the vagina, or rarely in amniotic fluid. Neonatal conjunctivitis can cause serious complications like blindness and requires IV antibiotics for treatment. In some states, you may not be able to sign refusal for this medication, it is mandated by law. 

Vitamin K is a small injection of — you guessed it — Vitamin K. Vitamin K is essential for forming blood clots. After infancy, our bodies develop bacteria in the gut that make Vitamin K for us. But when they’re born babies don’t have this in their bodies yet. The shot gives them protection against bleeding while they develop their own gut bacteria to take over the job of making the vitamin for them. 

Not having enough vitamin K can cause bleeding issues that range from minor — like a little extra bleeding after getting a shot — to a severe condition called Vitamin K Deficiency Bleeding, which can be fatal. Many parents are curious about using oral Vitamin K as an alternative to the shot. This is an option, but because Vitamin K in this form is processed through the digestive system (instead of going directly into the muscle and being absorbed into the bloodstream with the shot), oral doses have to be given weekly and are less effective than a one-time injection of the vitamin. Therefore, they are not typically offered or recommended. 

Hepatitis B is the only vaccine recommended for newborns. It is part of a 3 dose series, which is continued at your well-baby visits. If you have tested positive for Hepatitis B during pregnancy, the routine for your baby’s care will be slightly different.

Hearing, hearts, and jaundice

Some routine testing, like a hearing screen, cardiac screening, or bilirubin scan, are brief and non-invasive. Checking your baby’s hearing, pulse oximetry, and their jaundice level are all things you can expect before going home. If there are any red flags on those tests, your pediatric provider will discuss your options and next steps (which are often just re-checking the tests at a later hour or day). 

You might wonder why it’s so important to do these tests in the first days of your baby’s life. Let’s break it down. 

Hearing test 

A hearing test is important because even a newborn baby is already learning language. If their hearing is impaired (even in just one ear) knowing and addressing it early on can make a big difference for your baby’s language development. 

Oxygen levels

A pulse oximetry test of your baby’s oxygen level in different parts of the body — usually done by putting a sticker with a red light on your baby’s hand and foot. This test can help to catch worrying heart problems that happen in about 1 in 1,000 babies and might otherwise go unnoticed. 

Jaundice screening 

Jaundice screenings, often also done with a special light placed on your baby’s skin, make sure that bilirubin levels aren’t getting too high. Sometimes instead of a skin sensor, this is checked using a blood test, collected along with the blood sample discussed below. High bilirubin levels can cause problems like lethargy, poor feeding, and in some rare extreme cases, brain damage.

Newborn screening

Newborn screening is another test that is typically done after your baby is 24 hours old. It involves a small blood sample. You might picture having your blood drawn in your arm as an adult, but this test requires a very small sample and it can be tricky to find a tiny newborn vein. So most of the time, a heelstick is used. Your baby will have their foot warmed and then a small prick is made in their heel. Some babies barely notice, others might cry. Blood is collected onto a paper form, which is sent to your state’s processing lab by the hospital. 

But why?

The biggest question is, what are they screening my baby for? And that’s a great question! The answer varies because testing is a little bit different in each state. In general, the test covers multiple conditions that a baby can be born with and are impossible to see on a physical exam. Most of these conditions have treatments that are important to start early in life, so testing is essential.

It can be helpful to check what the testing requirements and suggestions are in your area, and discuss any particular concerns you have with your pediatric provider — such as a family history of a metabolic disorder. You can look up what your state tests for here if that information isn’t provided by your hospital. If you give birth outside of a hospital, it’s recommended that you have newborn screening done between 24 and 48 hours of life. This can typically be done by your home birth or birth center provider, or at a lab. 

Reviewed by the Ovia Health Clinical Team

Read more

• Recommended immunization schedule for baby’s first year
• Baby check-ups

Hand expression

Even if you don’t want to collect and store colostrum, learning how to hand express colostrum at the end of pregnancy is so valuable. It is much easier to learn a skill when you’re well rested and have some privacy than when it’s an immediate or urgent need just after giving birth. 

Your body starts to produce colostrum as early as 20 weeks. Some people find they leak small amounts of it or that their bra is stuck to their nipples at the end of the day. If you’re interested in collecting and saving colostrum during pregnancy, experts generally recommend waiting until 37 weeks. Your OB provider can help you create a timeline that works for you!

Hand expression can take some practice to master, and you may find that each breast needs a slightly different touch or technique. We love this short video that shows some different ways to express those precious drops. The best way to save colostrum is in very small syringes that are about 1-3 mLs in size. You can label and freeze the syringes until you’re ready to thaw and use them.  

Who does it help?

Colostrum collection can benefit many parents. Those who have experienced low supply or who have risk factors for low supply may want extra colostrum on hand to avoid excessive newborn weight loss or reduce the risk of jaundice. 

Those with gestational diabetes or who take beta blockers may want to collect colostrum to use in case of low or unstable blood sugar instead of using formula. 

Parents of multiples, babies who have IUGR, and babies with diagnosed genetic or physical differences may also benefit from having extra colostrum saved. There are a variety of reasons why it can come in handy. Talk to your provider or a lactation professional about the pros and cons. 

For some people, hand expression causes temporary but uncomfortable cramping, so it’s always a good idea to check in with your OB provider beforehand to see if there are any activities you should avoid that may cause contractions. Again, it’s generally recommended to wait until 37 weeks to try hand expression or colostrum collection.

Helpful tips

The best time to practice hand expression or collect colostrum is when you’re relaxed and not in a rush. Often people find that being warm and post shower/bath is a great time. Some gentle breast massage can help warm things up as you get started. Once a day is generally enough for practice until you get the hang of it. You may consider expressing more than once a day if you are actively collecting and storing. Keep in mind that at first, you may see just a hint of clear wetness or nothing at all.

If you’re collecting colostrum you’ll want to:

• Wash hands and have clean spoons, container/syringe ready
• Express for few minutes on each side collecting drops (aim for 10 drops and measure how much this is to make future collection easier, for example 10-15 drops might equal 1 mL)
• Date and store your colostrum in the freezer

Now that you have a little bit more information about hand expression and colostrum harvesting, you can make an informed decision about what is right for you!

Read more

All about colostrum

Breastfeeding basics

• First breath: When Baby cries for the first time, they is also taking in their first breath. A doctor or nurse will suction around the mouth and nose so that there is no respiratory obstruction.
• Skin-to-skin contact: After birth, Baby will be placed on your body and covered with a blanket to get warm and start bonding! These sweet snuggles will help your little one regulate their body temperature and promote breastfeeding success. However, if they is born prematurely or in respiratory distress, they will be rushed to the NICU to be examined further.
• Physical evaluation: One minute and five minutes after birth, a nurse will give Baby an Apgar score, which assesses activity, appearance, reflexes, respiration, and circulation. If there are no red flags, they will soon also be weighed and measured.
• Cutting the cord: Shortly after birth, it’s time to cut the umbilical cord. The American College of Obstetricians and Gynecologists recommends delaying cord-clamping for at least 30 to 60 seconds after birth, and some families prefer to wait even longer – until after the cord has stopped pulsing – which is sometimes as much as three minutes. If that’s something you’re interested in, it can be helpful to talk to your healthcare provider about it ahead of time. Cord cutting is often done by the baby’s parent (if that’s something you’re interested in) once the healthcare provider has clamped it in two places. And cord blood may be taken if your healthcare provider needs it for further testing or if you have chosen to donate it to a blood bank.
• Vitamin K shot and antibiotics: An injection of vitamin K assists with blood clotting to prevent excessive bleeding, especially in the brain, and a nurse will also likely give Baby antibiotic eye drops to prevent eye infection. These steps do not need to happen immediately after birth, and they can take place after Baby has been snuggling with you for some time. 
• Baby’s first outfit: After the initial testing, they will get a diaper, beanie, and blanket – they’s ready to be held, breastfeed, and loved!

Reviewed by the Ovia Health Clinical Team

Read more

• Apgar score: what it is and how to interpret it
• Feeding your newborn: baby’s got to eat

Sources

• “Apgar score.” MedlinePlus. U.S. National Library of Medicine, 5/3/2016. Web.
• “What happens straight after birth.” NHSDirect Wales. NHSDirect Wales, n.d. Web.

What is whooping cough?

Whooping cough (pertussis) is a dangerous and very contagious respiratory infection. Infants—and especially newborns—are at the greatest risk of serious complications from whooping cough.

According to the Mayo Clinic, whooping cough is characterized by a “severe hacking cough followed by a high-pitched intake of breath that sounds like ‘whoop.'”

There are two types of whooping cough vaccines: DTaP, and Tdap. Children under age 7 receive the DTaP vaccine series, which helps build the body’s immunity against whooping cough. Adults and children 11 and older receive Tdap, which is a booster immunization, about every ten years.

Babies aren’t able to receive the DTaP vaccine until they are 2 months old, which makes it so important for your baby’s loved ones to stay up to date with their own Tdap boosters.

“Cocooning” your baby

In order to keep your little one safe from whooping cough infection, you’ll want to create a “circle of protection” around them. This is known as cocooning, and it starts even before a baby is born.

The CDC recommends that pregnant people receive a Tdap booster each pregnancy, “ideally between 27 and 36 weeks gestation.” The CDC recommends getting the Tdap booster no matter when your last one was because once your immune system builds antibodies against whooping cough, these antibodies will be passed on and provide your baby with some immunity as well. 

It’s recommended that people who don’t receive a Tdap booster during pregnancy do so immediately after giving birth, although this will not protect a baby directly.

In addition to pregnant people, it’s recommended that anyone who will be spending a lot of time with your baby is up to date with their whooping cough vaccinations or boosters. If they are not up to date, they should get their shot at least 2 weeks prior to being around the baby in order to build up sufficient immunity and protection.

Because whooping cough infections are often so much milder in adults, many may not even know they have whooping cough when coming into contact with your baby. If you haven’t already, it’s a good idea to speak with your family, friends, and anybody else who will be spending time with your baby about whether they need a Tdap booster.

More questions about whooping cough? Your healthcare provider or baby’s pediatric provider are great resources for more information about protecting your baby from whooping cough.

Reviewed by the Ovia Health Clinical Team

Read more

• Quiz: How can I tell if my newborn has a cold?
• What vaccines can I get during pregnancy?

Sources

• “Vaccines for Family and Caregivers”, Centers for Disease Control and Prevention, CDC. Reviewed Dec 5, 2019. Accessed at: https://www.cdc.gov/vaccines/pregnancy/family-caregivers.html#:~:text=Preteens%2C%20teens%2C%20and%20adults%20who,need%20to%20get%20vaccinated%20again
• “New Parents and Grandparents—Which Vaccines Do You Need?”, Cedars-Sinai Staff, Cedars-Sinai. Oct 21, 2018. Accessed at: https://www.cedars-sinai.org/blog/vaccines-new-parents-and-grandparents-protect-newborn.html
• “Whooping Cough”, Mayo Clinic Staff. The Mayo Clinic. Oct 9, 2019. Accessed at: https://www.mayoclinic.org/diseases-conditions/whooping-cough/symptoms-causes/syc-20378973#:~:text=Whooping%20cough%20(pertussis)%20is%20a,was%20considered%20a%20childhood%20disease.

Boston NAPS, LLCPrivate nursing company and team of qualified Registered Nurses

Usually, the first sign of jaundice is the yellowing of the skin, which may be noted on the baby’s face, and then moves to the trunk, arms, and legs if the bilirubin level continues to increase. You may also notice yellowing in the whites of the eyes. Here are some facts about jaundice for you to be aware of as you prepare for your new baby.

Most cases of jaundice are not harmful, are caught early, and are easily treated. If left untreated, a very high level of bilirubin can damage the brain. However, the condition is almost always diagnosed and treated before the levels become high enough to cause this damage. The American Academy of Pediatrics (AAP) recommends that all infants born in the hospital be screened for jaundice and its risk factors, in addition to having a bilirubin level drawn prior to being discharged home if indicated. The AAP also recommends that newborns have a follow-up appointment with a healthcare provider/pediatrician 3-5 days after birth, where the baby can then be screened again for jaundice and its risk factors.  This screening process allows for early detection of jaundice and thus, early treatment.

To determine if treatment is needed for your baby’s jaundice, the healthcare provider will look at your baby’s bilirubin level, how fast the level is rising, whether or not the baby was born early, and how old the baby is.  Treatment includes increasing feeds to encourage an increase in bowel movements to help excrete the bilirubin in the stools, usually with breastfeeding and sometimes supplementing with formula. Sometimes, in addition to increasing feeds the baby is placed under lights called phototherapy that help to break down the bilirubin levels in the skin.

Always contact your healthcare provider or pediatrician if you are concerned about jaundice once you are home from the hospital. All babies should be seen by a healthcare provider in the first 5 days of life to check for jaundice. If your baby as a high fever, is feeding poorly, is not making enough wet and dirty diapers, or if the coloring of the skin is darkening or spreading down the body to the legs.

About the author:
Boston NAPS, LLC is a Boston-based, private nursing company and team of qualified Registered Nurses that specializes in providing nursing care to expecting, new, and experienced parents and families. Boston NAPS services include prenatal, postpartum, lactation, and newborn support and education to families throughout Massachusetts. All services are offered in the privacy and comfort of your home, with some services also offered in a group setting. For more information about Boston NAPS, please visit their website at www.BostonNAPS.com.

Sources

• American Academy of Pediatrics Clinical Practice Guideline “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation” Pediatrics. Vol. 114 No 1, July 2014

Breastfeeding

Whether they’re bigger, sore, itchy, leaky, or just different, breasts change over the course of pregnancy as the body’s natural way of preparing to produce milk and breastfeed Baby. When pregnant, your breasts produce the first milk, a thick, rich substance known as colostrum. Colostrum helps build up Baby‘s immune system and even helps them take their first poop! Colostrum will be replaced by thinner, more typical breast milk within a week of Baby‘s birth. This mature breast milk contains the right amounts of water, protein, and fat to help Baby grow big and strong and can also help protect them against many illnesses and challenges, including:

• Asthma
• Diarrhea
• Ear infections

Breastfeeding may also help prevent long-term disorders like diabetes, Crohn’s, and obesity, as well as Sudden Infant Death Syndrome (SIDS).

The American Academy of Pediatrics recommends breastfeeding for at least 2 years or as long as mutually desired. There is no set timetable for when you should stop – it all depends on how comfortable you and Baby are.

Breast pumps

For those who still want their baby to drink their breast milk but do not wish to directly breastfeed or are having difficulty, there is always the option to use a breast pump to store nutrient-rich milk and feed it through a bottle. For many parents, a mix of pumping and direct breastfeeding is ideal for work flexibility and other periods of separation from Baby. It is also possible to feed baby pumped milk and only pumped milk. Exclusively pumping for Baby is a unique journey with so much to offer and explore!

Formulas

In the U.S., formula ingredients are strictly regulated. Any FDA-approved formula contains just what your baby needs to grow and thrive. The best formula is the one your baby digests well and takes easily! Some parents do want to read the ingredients and choose a formula that aligns with their values, and some babies will need support to find a tolerable formula for them. 

Formula can come ready to feed (which is sterile and recommended for at-risk babies and all newborns) or powdered. Always make sure to follow the instructions on your formula fully to maximize safety. Formula should never be made at home, as it is likely to be missing key nutrients, and formula purchased internationally should be used with extreme caution. Counterfeit formula is a concern, as well as no notification practices for any recalled international brands.

Formula can always be used in addition to breastmilk when needed or desired, and combination feeding is a very popular choice. Read more about that here.

Read more

• Breastfeeding: everything you need to know
• Your guide to breast pumps

Sources

• C M Dogaru, D Nyffenegger, A M Pescatore, B D Spycher, C E Kuehni. “Breastfeeding and childhood asthma: systematic review and meta-analysis.” American Journal of Epidemiology. 179(10): 1153-1167.doi: 10.1093/aje/kwu072. Web. 4/11/2014.
• FR Hauck, J MD Thompson, K O Tanabe, R Y Moon, M M Vennemann. “Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis.” Pediatrics. doi: 10.1542/peds.2010-3000. Web. 6/13/2011.
• AI Edelman. “Breastfeeding and the Use of Human Milk.” Pediatrics. Vol. 129 No. 3. Web. 3/1/2012.
• “What are the benefits of breastfeeding?” Eunice Kennedy Shriver National Institute of Child Health and Human Development. Eunice Kennedy Shriver National Institute of Child Health and Human Development, 12/9/2013. Web.
• Liesbeth Duijts, MD, PhD, Vincent W. V. Jaddoe, MD, PhD, Albert Hofman, MD, PhD, Henriëtte A. Moll, MD, PhDb. “Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy.” Pediatrics. American Academy of Pediatrics, 6/21/2010. Web.
• “Infant formula: Your questions answered.” Mayo Clinic. Mayo Clinic, 1/19/2013. Web.

Devised by Dr. Virginia Apgar in 1952, the Apgar score is a number from 1-10 that indicates how healthy a newborn is at birth, based on five categories; Appearance, Pulse rate, Grimace (reflex), Activity, and Respiratory effort. A score of 7 or above is considered normal, while 4 to 6 is low, and 3 or below is critically low. The test is most frequently done at one and five minutes after birth, but may be performed again if the score is below 7 at the one or five minute intervals. A low score may mean that the baby requires medical attention, but does not necessarily indicate long-term problems.

Each of the five categories of the Apgar test is graded from 0-2, with 0 the lowest and 2 the highest. The scores from each of the five categories are added together to come up with the overall Apgar score.

“A”ppearance

The “Appearance” portion measures oxygen flow across the body – a baby who is not getting enough may have a blue tint. A score of ‘0’ will be given to those who are blue in the body and extremities, while a ‘1’ will be given to those who are blue just in the extremities. Babies whose bodies and extremities are totally pink and healthy will be given a ‘2’.

“P”ulse rate

The “Pulse” section measures the heart rate to make sure that a newborn’s heart is functioning as it should. Babies with absent pulse rates get a score of ‘0’, while those whose pulse rates exist but are below 100 are given a ‘1’, and those with a pulse of over 100 get a ‘2’.

“G”rimace (reflex)

This measures the baby’s reflexes – how they respond to stimulation. A baby geting a ‘0’ will not respond to stimulation. A baby who gets a ‘1’ will make some slight reaction, and a baby getting a ‘2’ will cry or pull away when stimulated.

“A”ctivity

The “Activity” portion scores baby on how well they are moving around. A baby who displays little activity will get a ‘0’. A baby with a ‘1’ will show some flexion, while a baby who gets a ‘2’ will display flexed arms and legs, and resist extension.

“R”espiratory effort

This section measures the amount of effort a baby is able to put toward breathing. A baby who displays no signs of breathing will get a ‘0’. Weak or inconsistent gasping gets a ‘1’, and a strong cry will get a ‘2’.

What happens if the score is low?

Oftentimes, a baby with a total score below ‘7’ may be in need of some extra medical attention, but this is not always the case – your healthcare provider will be able to give you a clear assessment of your baby’s health regardless of the Apgar score. The Apgar score is among the best-known neonatal tests in the United States, but it is not universal. Your healthcare provider may have a different rubric that they use to score Baby‘s health, even if you are in the US.

Reviewed by Dr. Jamie Lo

Read more

• Baby’s first minutes

Sources

• “Apgar score.” U.S National Library of Medicine. MedlinePlus, 11/20/2014. Web.

Does putting a pair of headphones on your pregnant belly playing classical music produce a baby genius? Every parent wants their child to be at the top of the class, and it’s never too early to start stimulating and interacting with your little one. Here are some ways to keep infants engaged once they’re born:

• Use auditory stimulation: Talk to Baby, imitate their sounds, and play music so they is used to a wide range of noises.
• Show colorful images: Infants are best able to see images in black and white as their retinas develop, so exposing them to brightly colored objects or images will begin training them to interpret intensities of different colors.
• Find toys with a variety of textures: Let your baby learn smooth vs. rough, soft vs. hard, and other contrasts by holding or touching different types of (safe) objects.
• Encourage movement: It’s easy to keep your infant in a playpen rather than following them around the room, but crawling and walking as early as possible improves vision and balance. When Baby is old enough, place them on their belly to prompt them to move around.

The bottom line

The research is slim on precisely which techniques are the most effective for educating your little genius, so it doesn’t hurt to experiment! Babies don’t necessarily have a huge propensity for advanced mathematics or postmodern literary criticism at such a young age, so try to keep it simple.

Read more

• Best books to read to your baby
• Talking to your baby

Sources

• Heather Haring, OTR/L. “What’s so important about crawling?” MedCentral. OhioHealth, 4/1/2009. Web.
• Jay L. Hoecker, M.D. “Is it OK to play Baby Einstein DVDs for my 6-month-old? Can this kind of programming promote a child’s development?” Mayo Clinic. Mayo Clinic, 4/12/2014. Web.