Booby Traps Series: “I used to ‘forget’ to cut the cord.” Why hospitals should delay newborn procedures until after the first feeding.

This is the 20th post in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

Keeping mothers and babies together as much as possible right after birth has long been recognized as important for breastfeeding.  But for years the standard practice has been to remove the baby from the mother’s arms in order to perform a variety of newborn procedures, including weighing and measuring, eye prophylaxis, bathing, and needle sticks.

This tradition of yanking the baby away can be so strong that a nurse midwife once told me she resorted to a kind of guerrilla move to keep moms and babies together:  “When I delivered at hospitals where I knew they liked to separate the mom and baby right after the birth,” she said, “I’d just ‘forget’ to cut the cord for as long as I could.”

Sadly, mothers’ reported experiences bear this out.  In the 2006 Listening to Mothers survey, 66% of mothers reported not having their babies in their arms in the first hour.

When it comes to the timing of newborn procedures, delay is a good thing.  According to Linda Smith in The Impact of Birthing Practices on Breastfeeding, the evidence supporting continuous contact between moms and babies after birth is “overwhelmingly strong.”  This uninterrupted contact allows the natural, programmed behaviors of the infant – including instinctual breastfeeding behaviors – to unfold.  Research has shown that during this sensitive period, separation of the baby from the mother disrupt babies’ instinct to crawl and attach to the breast.   Bathing is particularly disruptive to breastfeeding, since some of breastfeeding at this stage is based on smell.  Linda Smith concludes, “Separating the baby for any reason other than resuscitation is unjustified and harmful.”

It’s not just breastfeeding advocates who believe that delay is best.  The 2005 the American Academy of Pediatrics statement, “Breastfeeding and the Use of Human Milk,” instructs providers to:

Dry the infant, assign Apgar scores, and perform the initial physical assessment while the infant is with the mother. The mother is an optimal heat source for the infant. Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. Infants affected by maternal medications may require assistance for effective latch-on. Except under unusual circumstances, the newborn infant should remain with the mother throughout the recovery period. [my emphasis added]

What can you do if you’re expecting a baby and are concerned that your baby might be taken away for these newborn procedures?

One thing you can do is include this statement in your birth plan:  “I would like all newborn procedures, including weighing, measuring, bathing, needle-sticks, and eye prophylaxis,* delayed until after the first feeding.  After the feeding, I would like these procedures done with the baby lying on me or being held by me.”

If you think you’ll need some justification for this change in procedure at your hospital, you could cite the AAP policy above.  And if you really need to push for this, you can give your providers a copy of the AAP’s model hospital breastfeeding policy, which states the same thing.

For the one in three babies who are born by cesarean section, this kind of delay may not be feasible, but I’m holding out hope that one day all healthy babies born by cesarean will have the chance at some skin-to-skin time and even the opportunity to feed immediately after birth.  It is certainly worth discussing your desires with your providers and requesting that you get skin-to-skin contact with your baby as early and as much as you are physically capable of having.

Did you have newborn procedures delayed until after the first feeding?  Did you have to fight for this?

*Modify based on the procedures you’re planning to have done.



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21 Responses to Booby Traps Series: “I used to ‘forget’ to cut the cord.” Why hospitals should delay newborn procedures until after the first feeding.

  1. June says:

    I didn’t even see my baby for the first hour. I had a natural birth in a hospital (something I had to fight hard for) and after labor, while I was too exhausted to think clearly…my husban took photos of our daughter to show me her face…while she just lay on the table for no apparent reason. And then a soon as she was handed to me, the nurses invited the entire family into the room to meet the baby. I seriously wish I would have spoken up but I didn’t even think about it until significantly later. Homebirth next time…no doubt.

  2. beth says:

    with my daughter i did not get this crucial first hour. the nurse grabbed her almost right away because she was grunting instead of crying. i kept asking for her back, but the nurse held on to her, looking in her eyes and rocking her. the midwife didn’t say anything at all, which kind of made me frustrated. my husband was also asking why i couldn’t hold my daughter. once my daughter started crying the nurse handed her back. by then she was bathed and no where close to wanting to breastfeed. breastfeeding never ended up working out either, i just pumped until she was six months old and quit.

    with my son, the nurse tried to take her away but the midwife waved at her hands and said “no.” the nurse tried again to grab my son, in spite of acknowledging the direction from the midwife. then the midwife started to stand up, leaned across my son and i, and she firmly said “NO! what is wrong? look at him, he’s fine! just give him time to warm up.” it was so wonderful having her advocate for me, and it allowed my husband to know it was okay to stand between me and the nurse, that he wasn’t getting in the way. i was able to hold my little man for at least an hour and he wanted to eat pretty much right away. it made me feel so happy and empowered to be able to bond. i immediately knew breastfeeding was actually going to work this time around and was determined to make it happen. i’ve made it to seven months now with him, and haven’t quit yet.

  3. Emily says:

    Good info to have. Moms should also know that by Federal Law, if they tell(not request) the care provider and/or hospital not to do something, like take the baby away, cut the cord, anything actually and it’s done, the hospital has violated their patient rights. Parents have the legal right to say No to anything. It’s called “Informed Consent/Refusal”. This applies to c-sec moms too. They can tell the Dr. that they are enacting their right to Informed Consent/Refusal and that the baby is to be placed on their chest right after birth and that the staff is not to do anything to the baby until they say to and the staff can not do anything. The parents have the power, we are just sadly under informed(I speak from experience with my first child). Having it written in their birth plan is the first step after finding out their rights. After that, they need to make sure everyone gets a copy of the plan, including any family/friends who will be there for the birth so they can back the parents up. Also, they should not sign the part of the hospital paper work that basicly says the staff can do any procedure they deem necessary(most of these turn out to be unneeded interventions that only benefit the staff). Put a big black X through it and write in “Per Federal Law: I am enacting my right to Informed Consent/Refusal for both mysefl and my infant child for all procedures regardless of how routine the are deemed to be.” “Procedure” includes bath, bottle, cord cutting, etc.

  4. Mags says:

    We delayed as much as we could with my dd. Though we had a few fights about natural birth, including delaying the cutting of the cord. They took her away from me and said they needed to “resuscitate my baby”. Thank God I educated myself or that would have freaked me out. They brought her right back to me…my DH had to stop them from doing all kinds of things we didn’t want done at all let alone before she was on me.

    With my son, we changed practices and it was an incredible difference. My son was put right on my chest and nursed right away. Lots of magic both days.

  5. Tracy CB says:

    My daughter was born via scheduled cesarean (complete placenta previa, so we had lots of time to shift gears from home birth to hospital birth plan) and although the hospital we birthed at was rather conservative, I was able to have my baby skin to skin almost immediately. Some staff were hesitant, and it was all new, so we “negotiated” to skin to skin after the one minute Apgar. She crawled to the breast and latched on, among other amazing feats, while the team closed. She stayed on my chest/in my arms, totally naked and perfect for the next 2 hours throughout closing, transfer to recovery and then recovery itself. Finally, after nursing up a storm and getting ready to leave recovery, I agreed to a couple of procedures: weighing and measuring. We declined other interventions at the time (no need for eye ointment; delayed vitamin K and then the staff forgot about it so we ended up doing oral with my homebirth midwife who continued to do the postpartum home visits). We unfortunately did have to cut the cord right away. My surgeon loved the idea of the “slow cesarean” and was good with delaying cord clamping, too, but my placenta was also anterior so had to be cut through to get to her. This, unfortunately, made going slow or delaying cord clamping too unsafe. We never did bathe her in the hospital. In fact, I think it was a week later at home until she got a full sponge bath! She never left our sight in the <48 hours we were there. We deferred metabolic and hearing screening until we got home, so she just never left our room nor our arms.

    All that was done at a hospital more known for interventions and not being very mother-baby friendly, so with good helping of knowledge and perseverance, I think even cesarean moms might be able to get some of these things accomplished. Granted, we had a lot of prep and negotiation time. I think it's good for every mom to contemplate what she wants/needs in case of cesarean (yes, current rates are too high but even if you go for WHO 10-15% or Ina May stats of 1%, there is always the chance that a cesarean may be required) and to be prepared for that so she negotiates it early if she wishes and definitely that she/partner/support fight for it if that time should come.

    I certainly didn't get the home birth I desired, but we had an absolutely beautiful and empowering cesarean birth…something I truly didn't even think was possible! We were so happy to have had all the things we did get and extremely happy to know that we apparently really touched a lot of people at the hospital and staff were starting to encourage similar practices with more and more cesarean births. We started something and that really makes me beam!

  6. VandyB says:

    At my son’s natural birth in a hospital, my midwife intentionally did not cut the cord for quite a while. As the hospital nurse repeatedly tried to take my baby boy, my midwife just kept repeating, “Sorry, he is still attached.” It was a nice way to let me hold him for longer without having to argue with the nurse. I did not understand until much later that this is her subtle way of trying to change the culture at the hospital.

  7. Nicole says:

    As a labor and delivery nurse and mama to a 6 month old little boy who I delivered at the hospital where I work, I can see both sides of this. My little guy had meconium in his fluid so after just a quick visit with me (the midwife actually had me reach down to bring him up onto my tummy), he went to the warmer to be suctioned and was promptly returned to me within minutes. Despite this short separation, he latched right on and has been nursing great ever since. However, since having my son, I find myself being more of the advocate for moms who want their babies skin to skin right away. Unfortunately, management has set a policy that newborn cares must be completed within the first hour of birth and mother/baby couplets are passed of to postpartum nurses (who have 2-3 other couplets) within just a few hours of delivery. It is frustrating to me as a nurse, that I have to rush to do a million things in sometimes as little as 2 hours. Especially when you have been working hard with a family and it was a long delivery; it makes me feel like I don’t even have time to share in the family’s joy. There are plenty of other things that can be done during that first hour that don’t include separating mom and baby.

    On the other hand, it is important to remember that many hospital deliveries are higher risk because of medical problems (eg: diabetes, pre-eclampsia…), inductions (whether they be medical or elective,)and pain meds/epidurals during labor. Low risk women have the ability in many states to deliver either in free standing birth centers or at home, but higher risk women and their babies need medical involvement. These are babies who may often need some help at birth. Having just renewed my Neonatal Resuscitation Certification, I am reminded of just how quickly interventions need to happen for these babies who are not vigorous at birth. If a baby is not vigorous, interventions need to happen within 30 seconds. The definition of vigorous is a heart rate above 100, good muscle tone and good respiratory effort (baby has to at least be trying to breath).

    That said, I would be happy to leave healthy, vigorous babies with mamas as long as possible before doing any of the routine cares. As I said before, there are plenty of other things that need to be done in that first hour that don’t involve baby. Please try to remember as you deliver in a hospital, that the vast majority (there’s always some oddball in every group, so I can’t say all) of us went into the medical/nursing fields because we want to HELP, not hurt. None of us go to work with the intent to undermine a patient’s birth plan. Please also remember, that we are charged with a great responsibility…your life and your baby’s life and yes, moms and babies do still die in labor/delivery. There is no greater trauma to a healthcare provider than to lose a patient. Yes, birth is a natural process, but things can and do go wrong sometimes. I have seen babies who look fantastic on their fetal monitor strips come out looking lifeless and vice versa (babies who you anticipate will have trouble come out screaming and wriggling). Yes, you have the right to informed consent/refusal, but if your decision could be harmful to your baby (which is probably less than 0.1% of the time), we as healthcare providers have to step in and do what is necessary for your baby.

    The intention of my post is not to tell anyone what they should/shouldn’t do with their birth, it is simply some information that you may not have heard or considered before. I became a labor and delivery nurse because I love helping moms and dads meet their new babies and learn how to take care of them. Now that I am a mom, it has changed my perspective in many ways. I would like to take this information to my manager and see if there is a way we can delay baby cares and extend recovery times after delivery to better accommodate our patients’ wishes. It saddens me that I hear so many negative comments from people about their nurses, I try to change that every time I walk through our unit’s doors!

    • Kate says:

      Nicole, in light of your recent training you may be interested in reading Mercer et al’s work on the fetal to neonatal transition, the blood volume theory, nuchal cords and cord clamping.

      In the final minutes of birth, the tight squeeze plus cord compression can result in a lack of venous return to the fetus and hypovolemia at birth – as you wrote, this can happen quickly in a baby that had otherwise good heart tones during the labour.
      The current training in neonatal care is still to sever the neonate before placental transfusion can re-perfuse the infant back to a normal state and continue with the transition.
      While we have now discovered the circulation is more important in adult CPR, we are yet to respond appropriately to the physiology of the birth process for babies that require the cord intact.
      Is it customary to leave the flat, pale infant intact for the first 30secs while drying, warming and other stimulation is attempted, or is the cord clamped immediately?

      • Nicole says:

        Cord clamping is left up to the doctors/midwives and I don’t know that I have ever seen a doctor delay cord clamping. I do hear a lot of negative comments about delaying cord clamping. I’ll admit, I have been guilty of this myself. I actually hadn’t heard of the research you mention, but it does make sense. Do you have a link to his research or the name of the article so that I might share it with my unit?

  8. Nicole says:

    I also wish more nurses understood that it is far easier to assist a baby with breastfeeding when they are interested than it is an hour later when they are starting to hit that sleepy phase. So if they are looking to simply save time, letting baby nurse first thing saves time right after delivery and throughout the hospital stay since babies nurse better when they can do it early.

  9. EmilyN says:

    I really appreciate this article. As a labor and delivery nurse, I always discuss the recovery period with my patients long before we get there and address their questions about what they can expect. I always let them know (that as long as everything is normal) to expect to hold their babies for the majority of the first two hours. I am able to assign Apgars, take vital signs, give infant meds, take blood sugars (if necessary) while the infant is skin to skin. I usually take the infant’s measurements after the first feeding, and return the infant to skin to skin contact immediately after. The bath and footprints happen at the very end of the recovery period, when mom is getting cleaned up before her transfer to the post-partum unit.
    I want to encourage all the moms out there to be vocal about your plans for your birth, to discuss these things with your nurse at the beginning of your labor and especially with your physician or midwife before you come to the hospital.
    As a nurse, I care so much about my laboring patients, and it can be really frustrating when a patient arrives at the hospital already on the offense, planning to fight with everyone trying to care for her, and viewing me as the enemy of her desired birth. I always want to give my patients the experience they desire as long as I can do so safely. Often, nurses are caught between the physician’s orders, the hospital’s policies, the charge nurse’s expectations and the patient’s desires. I think that sometimes patients don’t realize how much their nurses are fighting for them behind the scenes.

  10. MzB says:

    Ladies, thank you for sharing the nurse’s perspective. I promise to remember that nurses are there to help! (but I’m also going in with a doula on one side and a clear birth plan on the other! :). )

  11. Rachael says:

    I’m due in July and will be having a csection. I plan to have my attorney write out my birth plan to assure it goes the way I want it to go. I want the baby given to me ASAP, delay cord clamping, no eye ointment, no hepB, and no vitK. I also would like to take my placenta home. And I dont plan on baby getting any hospital baths. ;)

  12. Allison says:

    With my last child I had to have a complicated c-section that made it necessary that my child was separated from me during the almost hour long procedure to close up my abdomen, so after they allowed us a few minutes of her on my chest, they had my husband take his shirt off and provide the skin on skin contact with her until I was available. As soon as I was wheeled into my hospital room the nurse took her from my husband and put her on my chest and immediately started guiding me through beginning breastfeeding. They never removed her from our room, and only asked if we wanted them to take her from the room once, if we didn’t want to witness them performing the heel stick test.

    This was a huge difference from years before when my first son was born also by c-section. They barely let me get a look at him before whisking him away to the nursery where they bottle fed him while I was left alone in a ‘recovery’ area. He was not brought to us until a while after I had been taken back to our hospital room. They were more concerned with trying to get me out of bed and walking despite me telling them I could not feel my legs yet because the epidural had not worn off yet than helping me nurse him. He was mostly kept in the nursery and when he was hungry they would wheel him in already squalling and push him on the other side of the room from my bed and leave. I couldn’t get out of bed on my own to get him and my husband slept like the dead, even with the screaming baby and me yelling to him, he didn’t wake up and the nurses would ignore me ringing the call button for half an hour. By the time I would finally get him to breast we were both hysterical and worn out. I asked for help knowing that we were having latch issues and the nurse glanced over and said it looked like we were doing fine, to just keep trying. That was the only advice we received the entire time we were in the hospital. I never was able to breastfeed him properly and quit after 2 weeks because he was severely dehydrated and I was unable to get any assistance. The experience was so miserable that I didn’t even bother to try nursing my second son.

    I can’t help thinking I was cheated by the hospital staff of not just a wonderful bonding experience with them, but also the chance to do what was best for them.

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