Wednesday, August 25, 2010

In the hospital: questioning routine interventions for your newborn

If you give birth in a hospital, your newborn baby will be subject to various interventions and medical procedures, many of which are viewed by new parents with awe, as though they were instilled by an infallible authority and therefore are unquestionable. That's how the hospital staff will try to present it, too, since they are officially representing the health care system and are supposed to promote its guidelines. However, after doing a bit of research, you will often be surprised to find what stands behind the routine practices of hospitals.

Let's take as an example the Hep B vaccine, which is routinely performed in all hospitals around here. Hepatitis B is a disease transmitted through blood or bodily fluids, and therefore can be passed from mother to child during birth. Many mothers are unaware carriers of the Hep B virus, which is why all newborn babies are vaccinated. Now, what interests me is why they don't check during pregnancy whether the mother is a carrier or not. Perhaps it's cheaper to just vaccinate, or perhaps the vaccine makers do all they can to perpetuate the recommendation for all-vaccination policy? I don't know.

There are many claims of adverse effects associated with the Hep B vaccine, most of which are shrugged off as mere coincidences not meriting serious research. It isn't in my power to check whether there is truth to said claims, but I don't believe it is healthful to bombard a new immune system with vaccination immediately following birth. It also happens that I was vaccinated against Hep B a few months before my first pregnancy, which was why we decided that in our case vaccinating our newborn would be largely pointless, and opted against it.

Please note I'm not making a blanket statement against all vaccinations/routine hospital practices. I simply believe parents would be wise to make informed choices, and deserve the opportunity to do so without pressure from the hospital staff. I also believe that when dealing with any anti-physiological interventions, our first question should be "Why?" as opposed to "Why not?"

Another common practice is giving a Vitamin K shot (which contains a mega dose of the vitamin) to all newborns, in order to prevent a rare and unpredictable condition that leads to problems with blood clotting and may cause permanent brain injury in babies. We didn't think much about the Vitamin K shot before Shira was born and allowed it to be administered, but now we are inclined to refuse that as well, because we learned that there are gentler, more physiological ways to reinforce a baby with Vitamin K, such as a Vitamin K-rich nutrition for the nursing mother, or a supplement taken by the mother or drops given to baby orally. Again, the risks associated with the shot are questionable, but there is another way – though no doubt, it's more hassle for the health care system to pursue reinforcing the nutrition of nursing mothers than to just give a shot and be done with it.

Around here, Hep B vaccination and Vitamin K shot are routine practices which will be performed without your knowledge or consent unless you explicitly state – and insist - that you are against them. To do that, it's important to make a decision before birth, and have at least one parent present at all neonatal check-ups. In our case it was my husband who accompanied our daughter to her initial check-ups after we all spent some time together in the delivery room.

I think it's very important, if at all possible, that your child is within sight of at least one parent at all times. Remember, the baby is your child, not hospital property. Hospital protocols are a very powerful thing; the whole business functions like a machine, and even if they aren't opposed to respecting your wishes, this notion might simply get lost in the process. Your best bet is to hover in the background and remind them which procedures you are interested or not interested in. 


PhDCow said...

Dear Anna,

I'm sure that hospitals vary in terms of their policies. When we completed our pre-admission paperwork for both of my children, there were several consent forms for us about Hep B, Vit K, circumcision (for my son), rooming in, etc.

I absolutely agree about being aware of every procedure or action during the hospital stay. If you're unable to do this, then your spouse needs to. When my oldest was born, I had an emergency c-section (dangerous, sudden pre-eclampsia) and I was in no condition to observe anything for several hours after the delivery. My husband was there, watching her first exam and asking questions.

Also, something to keep in mind about routine procedures. They're just that -- routine. Just as when we have a change in routine and it startles us, it's probably the same for the medical team.


Persuaded said...

Just after my oldest daughter Louisa was born, they trundled her off to the nursery. A few minutes later my mother and I went down to visit and found a doctor holding her upside down by one foot... supposedly as part of her newborn examination. yikes! Poor little thing was just screaming her heart out. Now, I don't think that experience permanently scarred her or anything, but I'm certain that it wasn't really necessary to hold her upside down! All that to say that your advice to hover around is extremely good advice indeed. I know that upon seeing me, the doctor immediately and very gently, put my daughter down.☺

LeAnna said...

We nixed the Hep B with our first, and will our 2nd, too. With our son we allowed the vitamin K shot, simply because we had him circumcised at 2 days of age. I always knew that circumcision in the Jewish community didn't take place until the 8th day (or 7th, one of those two) and that there is actual scientific evidence that the clotting agent needed to control blood loss isn't fully functioning until a child is a week old. Fascinated me! God is sovereign in all things. However, in the non Jewish community, we generally prefer to have it taken care of prior to going home. (Some do, some don't of course.)

Anyway, the hospital we had our son in was a small hospital and they were very good about honoring our wishes. We had a great nurse (which I thinks makes all the difference! I've already been praying for good ones this time) who was attentive and remembered all of my wishes.

The one thing I'd go back and do differently would have been to insist we go home after the circumcision. The head newborn nurse insisted we stay until my son had urinated after his circumcision. Even the Dr. who did the procedure told me she sends them home right after with no problem, but that head nurse was so dogmatic about it (and we being first time parents, of course listened) but we were there for HOURS, and she insisted on giving him some "sugar water" to help speed the process, blah blah blah. If that happens again I would put my foot down and say no thanks, we can monitor this at home.

That being said, I'm using a midwifery clinic (within a hospital) this time, and having a girl so I know I won't be faced with as many decisions.

Mrs David W said...

Good Day Anna,
Excellent post as per usual!
This is something I feel very very strongly about. It is so important to have a birth plan written out with your wishes so that nurses and doctors know what you wish for your child.
After my c-section due to my son being transverse (Sideways)
He was given Erythromycin... the eye drops given to babies. I had not written out my birth plan, so while I was in recovery it happened.
My son had a major, and I mean MAJOR allergic reaction to the drops. The poor little guys eyes were still swollen even four weeks later.
I realize of course that we can not truly tell until after if such a reaction will occur.
However,I question the necessity of the drops. Originally women with vaginal infections would cause the issue to be passed to baby's eyes in the birth canal. Today we test to make sure mom's do not have these issues. Also, in a c-section this is completely irrelevant as Baby does not pass through the birth canal.
Ok, strong feelings over with.
Thank you for reminding women to think think for themselves and be educated in what happens to our body through, during and after labor/pregnancy

Anonymous said...

Unfortunately, when I was pregnant with my first, I was very young and had no idea of what was going on, but my generalist knew I was a health careers student and advised me of everything every step of the way (since my dear husband had not a clue, nor did he care to hear the details). We were college students and our doctor knew we were paying cash, and knew we wanted only absolutely necessary procedures, and to be dismissed as soon as possible--this was a time when stays were longer. I had asked for an itemization of the bill so that I could tell what we received at the time.

When my second was born many years later, I was years into my career and was perfectly aware, although traumatized that the babe was taken to neo-natal intensive care right away due to lack of oxygen. So, I'd made it my business to see that no stint of hands-on care was stinted and the little one was with me as soon as possible.

Anonymous said...

Possibly hospitals were sued for complications in a baby because they did not do these things, and now they are covering themselves. That's how things like this usually get started.

Holding a baby upside-down? Aaak! How awful.

Most conscientious parents would make sure their baby got adequate vitamin K from various means like the ones you suggested, but the hospitals cannot assume that all parents will be so conscientious, so they go with that (that not all parents will know what to do or what to look for, or be conscientious).

All you can do is, like you say, hover in the background and remind.

I don't remember knowing about any of this stuff when I had my children, so I guess the hospitals just did what they did. I don't remember being asked about anything except circumcision. The big thing when I was having my babies was natural childbirth and refusing medication for pain and such.

may said...

Re the Hep B vaccination - I assume that they vaccinate the child because they then know it's done and the child is protected; better safe than sorry. If you are relying upon checks performed on the mother, then either you do them as late as possible (which may be difficult for other reasons) or you run the risk than in some cases the mother may become infected after the test was performed and then can pass it onto her child. Vaccinating the baby is in that sense safer since you address the potential harm directly and in most cases, the risks you face from vaccination are not as bad as the risks you face from the disease against which you are being vaccinated.

I presume that with the vitamin K shot the risks of relying upon compliant nutrition are similar. There will be people who say that they will follow the alternate route, and then don't or can't, or something gets missed. Again, a shot acts directly against the potential harm and it's easy to be sure that it's been done.

I also think that it is worth mentioning that public health initiatives are intended in part to deal with the consquences for the health of the public at large and as such tend not to discriminate between prudent parents and ones who are not. There will be parents whose behaviour is unsafe for all sorts of reasons. In the end, a general policy protects the many and, in particular, the vulnerable child.

That said, of course, there is no reason why a parent should not challenge the policy and consider whether there is an alternative route which offers the same protection for the child is available. One would hope and trust that a sensible medical practitioner would consider this alternative and reasonably advise the parents as to the safety of that option. (I can't imagine, for example, that anyone would query why you would refuse the Hep B vaccine for your baby given that you were vaccinated whilst pregnant, and will breastfeed).

But generally, and even where there is an alternative route available that will properly safeguard the child, I am much reassured that there is a general policy in place for those whose parents are neither prudent nor reasonable.

Mrs Anna T, I just wanted to add my very best wishes to you for your impending delivery. I look forward to seeing the pictures of your beautiful baby.

Harper said...

In the US women are often tested for Hep B as part of their routine annual physical. If the woman has not been tested recently when she falls pregnant, it is recommended that she be tested during pregnancy.

HOWEVER, regardless of the woman's test results, the baby is still given a Hep B shot at birth unless the parents sign a waiver. And most doctors will acknowledge that it really isn't necessary, but just a custom.

Crystal said...

I have never had anything but wonderful hospital experiences with wonderful thoughtful doctors at the birth AND throughout all my prenatal check-ups...with both of my boys' births. Your views of hospitals/doctors/health care saddens me if this is a reflection of the state of things in your country...from what I have gathered you seem to be bullied by medical professionals at every turn...if only everyone would educate themselves as you are doing then perhaps it would spark a country wide change in the way things are done? I just wanted to put my two cents in there that your experiences are NOT the least no here in the states.

Mrs. Anna T said...

Diane, I can't even imagine what purpose such a barbaric examination would serve. But that's a perfect example of how not everything they do in hospitals is in your best interest.

There's a law in our health care system saying that a baby born in a hospital must be examined by a doctor within 24 hours after birth. Within 24 hours means they don't "have" to whisk babies away shortly after birth, it's just more convenient for them. Check-ups, measurements and clean-ups can wait, but initial breastfeeding has a limited window of time after which baby falls sleepy.

Mrs. David W,

Re: birth plans - we came to the first hospital where I intended to give birth, with a clearly written and, in my opinion, entirely reasonable birth plan. They went through it point by point, telling us why this and that "can't be done because it's not our policy". For example I requested that no unnecessary people (such as medical students) be present in the delivery room. "Well, we can't promise you that", they said - it got me really incensed, because I did internship in a hospital myself and knew perfectly well patients need to be asked for their consent if we want to observe them (unless they are unconscious). Basically I was told that anything on my birth plan that doesn't agree with hospital policy is a waste of paper.

So, birth plans are all well and good but you still need to speak up and insist.

Mrs. Anna T said...

May, thank you for your well thought-out comment. I do realize that public health policies are designed in such a way that no one falls through the cracks. However it is very important that parents understand not all of it is necessarily optimal. It's important to understand that yes, there are mothers who use drugs and drink alcohol and carry STDs, and usually the doctors you meet in the hospital for the first and only time in your life won't bother finding out whether you are one of them or not. They won't check how health-conscious you are. It's YOUR job to do research and decide which procedures are necessary for you and your baby, and which aren't.

Crystal, you are very lucky. I wish more women could have your experience. It really is the people within the system who make all the difference. That's why so often you'll hear contradicting opinions about one hospital - someone was lucky to arrive while great doctors and nurses were in attendance, and someone was not.

Kristin Shoemaker said...

Very insightful post. In my state in the US it has become routine to take a blood sample for the state's DNA database. Of course, we can opt out (which my hubby and I plan to do for our child when he is born in October), but we will have to make sure it is in our medical records that we have refused the blood sample. Thankfully, it hasn't become law...yet.

Sheri said...

Hi, Anna, I just wanted you to know that I prayed for you and your precious baby today. I look forward to hearing another beautiful birth story! *Hugs to you precious friend!*

J in VA said...

In the US, the majority of moms are at least offered testing for their Hep B status with any prenatal lab work done so if they do that there is no question about their status. Babies get Hep from blood and body fluids, so if mom is neg, unless you are piercing or tattooing your baby right away :), Hep B is not an immediate concern.

For Vit K: vit K is made in the GI tract of the newborn. They must be eating in order to make it. If you are having a circ within a couple of days or had a traumatic birth (think bruising or head trauma that could lead to a hemmorhage) then Vit K in some form might be prudent. You can do oral drops but the recommendation is daily or weekly for 12 weeks. The injectable form is not the only way. At my hospital, the MD/CNM will refuse to do a circ before discharge if no Vit K is given.

God in His wisdom knew that by 8 days a baby eating well would have made enough Vit K to protect against blood clotting issues.

The best advice in all these situations is to have one parent (or a grandparent if Dad is not available) with the baby AT ALL TIMES.

Best wishes Anna!

J in VA

Jo said...

Interesting - I had none of these problems, any vaccinations had to be signed by me before proceeding so I was fully aware of what was going on - and this was 22 and 17 years ago. I think it varies between countries. My children never left my side without my permission.

monika said...

It's very interesting to read about the differences in another national health care system, from the perspective of a patient.
About the hep B shot: here in Sweden pregnant women are offered tests for rubella, syfilis, hep B, HIV and chlamydia. The new baby is only vaccinated if the mother actually has hep B.

Mrs. Anna T said...

Monika, your system sounds far better than ours. I've also heard that in Sweden and other Scandinavian countries keeping mama and baby together is the norm, not something a woman must make a special request for (a request which isn't always respected). No wonder your breastfeeding rates are higher than ours, too.

Anonymous said...


my babies were born in the u.s. and i experienced the same bullying as mrs. anna.

i know many other women who have experienced the same, right here in the u.s.

as a matter of fact, the more supposedly "advanced" a country is in medicine, the more they will bully a mother and make it seem like birthing a child is an unnatural thing.

mrs. anna is doing women a great service by making them think; reminding them to trust in God; and encouraging them to rely on the normal processes of reproduction which God created for us.

doctors in many, many countries have taken all that away from women. it's time to get it back!

Mrs. Anna T said...

Anon, just last night I watched "the business of being born" on YouTube and it looks like things in the US are even worse than in Israel. Our c-section rate, from what I know, hovers somewhere around 20% which is a huge number but still not as high as in the US. Yet. However unfortunately private midwifery is entirely the privilege of those who can afford it, because government funds hospitals entirely and at-home midwifes not at all - which means 99% of women birth in hospitals.

I had an OBGYN in a hospital deny to my face that pitocin causes unnaturally longer, stronger, more frequent and more PAINFUL contractions, while encouraging I must accept a pitocin i.v. I find it difficult to decide whether he was lying to me in order to manipulate me, or he was truly ignorant on the subject. Most likely the first. I don't know which would be worse though.

Lee Anne said...

Anna, this post could not have come at a better time! I am currently looking into this same topic and want to "delay" the Hep B shot and refuse the Vit K shot, and rather do the oral Vit K instead. What is not told to many parents is that one side effect of Vit K shot is jaundice, and it is more prevalent in babies with Rh factors. After talking to some mothers, it seems to me that they believe (or were told) that jaundice is pretty much a natural, expected part of childbirth. Hmmmm....

I am in the US and these 2 shots are routine hospital procedures. I am unsure about the level of resistance I will get from the hospitals if I refuse these shots, so I am taking your (and others') advice by making sure that whomever is with me during the birth (the daddy will be deployed in a war zone at the time, so other family members will have to assist me) will be my baby's "bodyguard" and be as fervently opposed to these invasive procedures as I am.

My husband thinks I am nuts because I am so opposed to these "routine" procedures, and he thinks that my paranoia of medical procedures blinds me to scientific facts. But when I show him "scientific facts," as well as parent testimonies, that prove these procedures do more harm than good to healthy babies of responsible parents, he turns a deaf ear because I don't wear a lab coat. Sigh. (Note: I do love and respect my husband very much; I only report this because it goes to show the two opposing beliefs on vacc's/shots can occur between both parents. Such a controversial issue!)

I learned in my psychology classes in college that people will do ANYTHING if it is ordered by someone in a lab coat, even if the person in the white coat orders the people to knowingly inflict pain upon another person for no apparent reason. We are not taught to question "authority," and I thank you Anna for being bold enough to publicly question this "authority!"

Anonymous said...

An alternative to the Vitamin K injection is to make sure that your newborn has unlimited access to your colostrum, which is extremely high in Vitamin K. Also, studies have shown that delayed cord clamping (waiting until the cord stops pulsating) allows between 20-50% of the baby's blood volume to flow into the body.

Best Wishes!