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Natural Birth
Working on Birth Plan. Wondering what your thoughts are on these items?
So, I've been working on my birth plan and most of it I have done quite a bit of reading about to know what I want. But the items about baby care, I'm not sure on, so I figured I would see what you all have read on this.. Thanks for the input! 
P.S. Also I am using the birth plan creator from here is anyone is interested: https://pregnancyandbaby.sheknows.com/pregnancy/baby/Birth-plan-creator-241.htm
-Please delay eye medication for the baby until we are well past the initial bonding period (a couple hours after the birth).
-If available, would prefer erythromycin eye treatment or other antibiotic eye drops instead of silver nitrate.
-I would like to waive the administration of eye antibiotics.
-I would prefer to have Vitamin K administered orally.
-I would like to waive the administration of routine Vitamin K, unless medically indicated.
-I would like to defer the PKU screening.
-I would like to defer the following vaccinations:
This discussion has been closed.
Re: Working on Birth Plan. Wondering what your thoughts are on these items?
Not sure if this is helpful, but here's what we're doing
- We're not doing any eye cream at all. Depending on your state, you may have to write up some sort of religious exemption.
- Find out what the hospital's policy is on oral Vit K. I've heard conflicting things about this. You may end up needing to administer it yourself if you decide it's medically necessary. I need to order some & find out the proper dosage...we're going to have to do it ourselves.
- The PKU screening at is pretty quick & painless...but it's good to know the results of it. This isn't something I'm going to mess with.
I would forgo the eye "goo" unless you have a known vag infection, or are high risk for one. I would probably get it if you have GBS, just in case.
I'm cool with Vit K shots....is it bad that I'm a nurse and didn't know it comes in oral? I work in the ER.
PKU is a quick and easy heel prick. The baby will be more pissed that his/her foot is being held still. I used to do these a lot when I was a pedi phlebotomist. It's about 6 drops of blood (literally....one in each circle). Also, the PKU covers a lot of fatal conditions - mostly metabolic. Most states mandate it, and honestly, I don't really see a good reason to want to skip it. The things it detects are rare, but they are treatable if found. If you don't detect them and your baby has one, they can be fatal (some of them). This test has to be done between 24 and 72 hrs of life. It's kinda time sensitive so you won't have much say in the timing. My son was getting bili tests every 4 hours, so they just did it when he got one of his other zillion heel pricks.
Do you want to skip the antibiotics and vitamin K? I wouldn't even leave the door open for "medically neccesary" if you really want to skip them, frankly. You can get oral vitamin K online if you go that route, I think you have to administer them at one day, one week and one month or so? And I think Hepititis B is the only vaccine routinely administered at birth.
This is what mine says:
"After baby is born:
?Skin-to-skin contact immediately
? No procedures done unless my husband or I have given explicit permission
? The baby is to stay with me or my husband at all times
? If there is a need for medical attention, we would prefer to deal with attending physicians - no residents/students, please
? Please do not give the baby sugar water, formula or pacifiers without our permission
? No Hepatitis B shot
? No antibiotic eye drops
we're all sorts of paranoid bc DS had a suspected infection after he was born, and we were bullied into all sorts of things (instead of waiting a few hours and trying less invasive measures first), so that's why the emphasis on leaving us alone is there. I agree with the pp about the PKU test - it's legit and screens for complications. hth
DS2 - Oct 2010 (my VBAC baby!)
I've heard from my midwives and ped. that oral Vit K is not as effective... if you DO need it (i.e. there is trauma to LO's head or you get him circ'ed) I'd def have the shot to be more effective.
I don't think silver nitrate is allowed anymore...
I don't know if this covers post care, but do you have delay cord cutting until it's done pulsing?
Also, delaying any kind of bath or wiping off the vernix?
Also, I would delay EVERYTHING until after the initial bonding period, not just the eye ointment.
Oh, one more - do you care if they routinely administer pitocin for the delivery of the placenta? You might want to ask if you can have an hour or so on your own to deliver it before they give it to you.
It's a little repetitive and confusing to me. Are you declining the Vit K and eye ointment or delaying them? Either way, just say so. You really only need one sentence for each.
Ditto pp on the PKU- why would you want to decline it? Sure, no one wants to see their baby's heel pricked, but IMO the risks of not testing far outweigh the temporary discomfort. I would ask that a heel warmer be used to make it easier, not decline the screening outright.
This is actually the opposite. I will come back later when I'm not at work and post a peer reviewed research study from Cochrane in which they looked at this. The findings were that the level of Vitamin K in the system was identical in those who received the shot versus those who received the oral. Because Vitamin K is produced by and absorbed by the intestines, they are now conducting research to determine if the absorption rate of oral is higher b/c it is in a form that the body is more likely to recognize and the receptors of the gut can pick it up. Obviously, no findings yet, but it would make sense given what we know medically about vitamin K.
In several countries (including Canada) the oral is preferred over injection in hospital settings. I think you can't go wrong either way. Our midwife is giving us a script for the oral that we will fill a few days ahead of time and administer ourselves at our homebirth. My birth plan in case of transfer states that the oral pre-filled script should be used.
I actually finished my patients early, so here we go:
https://www2.cochrane.org/reviews/en/ab002776.html
"
Main results
Two eligible randomized trials, each comparing a single dose of intramuscular vitamin K with placebo or nothing, assessed effect on clinical bleeding. One dose of vitamin K reduced clinical bleeding at 1-7 days, including bleeding after circumcision, and improved biochemical indices of coagulation status. Eleven additional eligible randomized trials compared either a single oral dose of vitamin K with placebo or nothing, a single oral with a single intramuscular dose of vitamin K, or three oral doses with a single intramuscular dose. None of these trials assessed clinical bleeding. Oral vitamin K improved biochemical indices of coagulation status at 1-7 days. There was no evidence of a difference between the oral and intramuscular route in effects on biochemical indices of coagulation status. A single oral compared with a single intramuscular dose resulted in lower plasma vitamin K levels at two weeks and one month, whereas a 3-dose oral schedule resulted in higher plasma vitamin K levels at two weeks and at two months than did a single intramuscular dose."
Note here that the single dose of either had the same rate, but the oral declined long term. However, oral is always recommended for the 3 doses, not a single dose. And when given in the proper 3 doses, it was actually more effective than the single injection. So moral of the story - if you chose to go oral, don't skip doses - do all three!
Another thing I learned that I had heard the opposite of -- people all tell me that breast fed babies had a decreased need for prophylactic Vitamin K, but again, the opposite is true. B/c most formulas are over-fortified with Vitamin K, breast fed babies are actually the ones most at risk and in need of it prophylactically. Stocking up on your Vitamin K veggies pre-natal does not help - it has not been shown to build up in breast milk. So you will still need to stock up on Vitamin K rich foods after birth, but you won't get any added protection to baby by eating these things the weeks prior to birth.
These are things that surprised me, so I thought I'd share.
my hosp used erythomicin I believe and was like 30min after birth cos she had problem latching on. and with that she could still see my clearly eyes open. So its ok if they give to LO right away depends on what type.
Vit K shot was given 1-2 hrs after birth. And PKU Screening was done the next day. I allowed hep B vaccicantion, i debated a lot even in hosp but decided to give her the next day. My ped told me if delayed for weeks would throww off her vaccination schdule and I really dont do well with calendars and scheduling for her so decided next day and stick with his program. shes fine ever since. And also after birth all that really matters is LO.
http://www.jakeala.etsy.com
I don't have the journal articles I used to do my research, but here's what we did:
No eye ointment (didn't feel it was necessary)
Did 1/2 normal dose of VitK (read that there isn't much evidence for the current dose and it is a pretty high dose). I don't think hospitals will circumcise without VitK. We didn't circ, so this wasn't an issue. I probably would have had them administer it orally if that was available.
Didn't do PKU at hospital. I can't remember if we did this at his 2wk appt or not. I think we did. We're not in a high risk category for PKU. (after reading other's comments, I'm wondering if we did this at his first pedi appt. I don't think he had any heel sticks in the hospital but I really can't remember. I can't imagine we would have declined it totally.)
Didn't do any vaccinations at the hospital. Started the Hep B series at 1yo. Did all other vaccinations on pedis schedule.