N E W B O R N  T O P I C S

WHAT TO CONSIDER WHEN CONSULTING PROSPECTIVE PEDIATRICIANS


As you meet various Doctors who may participate in the care of your newborn, obviously your own radar will help guide you towards a person whom you feel you can trust and communicate with. The Pediatric Care Provider (Pediatrician or Family Practice Doctor), will establish a time to see the baby for the first visit. Some providers will be comfortable with the first visit @ 7 days and others will insist on seeing the baby between day 1 and day 3 of life. When scheduling this visit it may be helpful for the Pediatrician to know that the Midwife is doing care and what this care includes. Following is a list of follow up care provided by me (The Certified Nurse Midwife) to your baby. This will help acquaint your Pediatric care provider with the Midwife’s care of the baby during the first week of life:

- Full Neonatal Exam @ birth (not including hearing test), including baby’s weight, measurements, heart auscultation
- Administration of Vitamin K and/or eye prophylaxis (erythromycin ointment), as needed
- Cord blood indices including Blood type and Rh, syphilis (state required) and bilirubin levels (direct and indirect)
- Breastfeeding assistance immediately postpartum
- Telephone call within 24 hours to assess baby’s adaptation to life, i.e. elimination patterns, feeding challenges and successes, cord care
- Home visit on day 3, including neonatal jaundice assessment and comparison with cord blood results, mother-baby interaction including observation of breastfeeding, umbilical cord care
- Home visit on day 7-10, including repeat weight of baby to ensure return to birthweight, assessment of breastfeeding, cord care, mother-baby interaction
- PKU can be done day 3 or day 7 by heel stick by me (the Pediatrician can do the PKU as well, either by heel stick or with a blood draw)

There are also concerns that you are going to want to address in order to determine if you have found a good match for your family. A few guidelines to use to try to get a glimpse of the provider’s underlying clinical philosophy may be of use to you. I have provided a few questions below whose answers may provide some insight. Some new parents feel as if they don’t know what to ask because there is so much and also because you are not yet directly involved in some of the decisions you will need to make about your baby, when she/he is born.

There are a few issues that will impact the first two weeks of your lives together.

To start, it is important to introduce the subject of neonatal jaundice. There are basically two types of jaundice that you should know about. The least common and most dangerous is called pathologic jaundice and is caused most often by ABO incompatibility (that is why I obtain the baby’s blood type from the cord blood, so that we can rule out pathologic jaundice). In 16 years of practice as a CNM, I have never seen a case. So it is quite rare. We won’t miss it though, since I have cord blood indices that can fill out the clinical picture. The second type is called physiologic jaundice. Approximately 50% of normal newborns have some jaundice caused by the immaturity of a newborn’s liver (physiologic). Sometimes even with normal jaundice, if it becomes too severe, intervention may be suggested to lower the bililrubin levels. Different providers intervene at different bilirubin levels. Some at 12mg/dl and others not until the bilirubin is over 20mg/dl(most common). Some Pediatricans don’t ever intervene, as long as it is physiologic. Intervention may include various methods of applying ultraviolet light to the baby to help reduce the bilirubin levels. This UV light can be administered in the hospital. There are also companies who rent a bilirubin vest or blanket that can be used at home for the same purpose, but your Doctor will need to write a prescription in order for the company to dispense the blankets for at-home treatment. In other words, your doctor must be in agreement with treating the baby out of hospital. It would be good to attempt to gauge who your care provider is with regards to physiologic jaundice, since having to admit your baby to the hospital after a birth at home will be tough. Most providers will give you their general feel of the situation with a simple question such as: What happens if my baby is jaundiced? If you sense that the provider would oblige you with the details, try to get a number value after which the baby would need hospitalization (above 20 is more reasonable than 12).

Another controversial issue for many prospective parents is the concern over childhood immunizations. Most Pediatricians will support a standard schedule of childhood vaccinations, beginning at around 2 months. For parents that believe in not immunizing, or for those who are questioning the decision, it would be good to attend Dr. Larry Palevsky’s talk at Realbirth and gain some insight from this Pediatrician and Nutritional immunologist. Most Pediatricians use Thimerosol free vaccines now. If trying to find out where your Pediatrician stands without putting them on the spot, you could simply explain that you are as yet undecided in terms of the controversy and ask if they would be supportive of you delaying the decision. This question will probably elicit the provider’s feelings on the subject.

Although this day in age it is rare that a Pediatrician does not verbally support the American Academy of Pediatrics recommendations to breastfeed for a year, it is wise to find out how devoted a practice is to your breastfeeding success. Sometimes a Pediatrician will suggest supplemental feedings of formula in the event of slow weight gain without first attempting to address breastfeeding challenges that if resolved could just as likely promote the desired weight gain. So find out what your pediatrician does in the event of a baby’s slow gain. Do they suggest that you work first with a lactation consultant?

There are many other concerns that you will have as a family such as the judicious use of antibiotics, how much someone dabbles in complementary medicine with sincerity, etc, but the above are concerns mostly that involve preventing unnecessary interruption to parent-infant bonding during the first week of life. Good Luck!