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Written by

Roxanne Albert, BSN, RNC-OB

Questions to Ask: Newborn Procedures

  • Birth, Birth Options
Newborn procedures are the assessments, tests, and common standard practices that are done within the first 24 hours from birth. There are quite a few things they offer/do for the baby after they’re born. Let’s break down those options and questions you can ask to help you better decide which of these options work best for you and your family!
Newborn procedures are the assessments, tests, and common standard practices that are done within the first 24 hours from birth. There are quite a few things they offer/do for the baby after they’re born. Let’s break down those options and questions you can ask to help you better decide which of these options work best for you and your family!

Skin to Skin

Newborn procedures: First is they offer skin-to-skin directly after birth and then encourage the baby to feed, whether that is breastmilk or formula. This is a great time for bonding between the baby and parents. Questions to ask to prepare for this period are:

  • Do you offer skin-to-skin directly after birth, including during a c-section?

  • Will my baby come directly to my chest or will someone put a towel down first, then place my baby on my chest? (and determine what YOUR preference is if it is different than the standard protocol)

  • What procedures will you do during this time?

  • In what scenarios could we expect to NOT receive skin to skin, and how long could we expect to wait before we are able to have skin to skin with our baby?

  • Decide how you plan to feed your baby:

    • Will you provide formula to me for the first feeding? (if formula feeding)

    • Will you be able to assist me in latching my baby if needed? Or provide donor breast milk if needed?

First Few Hours After Birth: Measurements and Medications

After around 1 hour of skin-to-skin and a good meal. If you have a vaginal delivery, they normally will get the birthing person out of bed to ambulate to the restroom to pee and get cleaned up at this time. If you have a c-section, it is likely you are still in recovery so they will offer to do the following procedure while your nurse changes your pad and cleans you up.

They will offer to do the measurements of the baby’s head, length, chest, and abdomen; weight; full head to toe assessment; and administer the medications.

The medications they offer are the first dose of the Hepatitis B Vaccine, Erythromycin eye ointment, and Vitamin K injection. You can learn more about the medications at Evidence Based Birth by clicking each medication.

Questions you can ask during this time or to prepare prior to are:

  • Can I be present as you do the weight, measurements, and medications? (if you want to be present, or delay if the family was separated during the delivery/postpartum)

  • Can you give the shots while I am skin-to-skin with my baby instead of on the warmer?

  • What are the medications and why do you give them? How would our care change if we did not get these medications?

  • What are the risks versus benefits for each medication, and why is it the recommendation to receive this medication at this time?

  • What options do I have for different medications? Some medications may have an oral option, can be delayed, or another option is to not receive it.

  • Telling them which medications you would not like that they routine give during this time as well.

Next 24 hours: Assessments and Vitals

Throughout the next 24 hours the baby will have assessments and vital signs at intervals determined by the hospital. The next big procedures are done around 24 hours. Some hospitals will offer a bath and hearing screen earlier or later than 24 hours, but I will bunch them all together here.

The procedures they do at 24 hours includes:

  • Newborn Metabolic screening

  • Bilirubin screening

  • Hearing screen

  • Bath

  • Congenital Heart Defect Screening

Newborn Metabolic Screening

Newborn Metabolic screen is where they prick baby’s heel and collect blood on a sample paper and send it to a lab run by the state to test for metabolic screening that could cause long term problems for the baby such as PKU and Cystic Fibrosis. 

Bilirubin Screening

Bilirubin Screening is done by using a tool to test the amount of bilirubin in the skin. Depending on the level they may need to do a blood test to get a more accurate reading before doing further interventions. Bilirubin is a byproduct of red blood cell breakdown that is broken down by our livers and then excreted out of our bodies. Baby’s liver are immature and they aren’t able to break it down as quickly as adults. If bilirubin levels get too high it can cause long-term issues for the baby. 

Hearing Screen

Hearing screen is done using two methods to identify babies that need further testing to determine if there is hearing loss. The two methods are Otoacoustic Emissions (OAE), and Auditory Brainstem Response (ABR). OAE is where they measure sound waves produced by the inner ear when sounds are emitted into the ear. ABR is where leads are attached to the baby and cups are put over the baby’s ears, the cups then emit clicking sounds and the leads measure the response of the baby. If the baby does not pass the hearing screening test this does not mean that the baby is deaf, but further testing is needed. 

Congenital Heart Defect Screening

Congenital Heart Defect Screening is when they place probes on the baby’s right hand and one of their feet that measures the oxygen in the blood. We want the two levels to be similar. If one is greatly different from the other this could indicate there is a congenital heart defect in place and further testing is necessary. 

Bath

Last, the bath is delayed as routine practice in a lot of hospitals now because studies show there are benefits to the baby and the bonding between the parents. WHO recommends it to be delayed till 24 hours but some hospitals will start offering it around 6 hours after delivery. 

Questions you can ask about these tests are:

  • Can the tests/screenings be done at the bedside, or can I be present while they are performed?

  • Can you let me know if you will need to draw the bilirubin lab prior to doing it so i can consent to it?

  • Can we delay the testing till I am done feeding the baby?

  • Can we be a part of the bath or perform the bath ourselves with you present? Or delay the bath till we get home to do it ourselves.

  •  Are all the tests mandatory? Can we decline any of them? What are the risks and benefits of declining them or delaying them till later?

Newborn procedures tend to be the one aspect of birth that we have the most control over. If we want our baby to receive a certain medication at this certain time, it can most likely be done in that way. It can be helpful to have an idea of what newborn procedures you want to do, and when you’d like them to be done. Some medications you can decline, some have other options available, including delaying, but it is best to have a conversation with your care team on what those options are to make your own informed decision.