Although still uncommon, the rate of home births has increased during the past several years…
In a new policy statement, “Planned Home Birth,” in the May 2013 Pediatrics (published online April 29), the American Academy of Pediatrics (AAP) makes recommendations for the care of infants born in a home setting. Regardless of the circumstances of the birth, including location, every newborn infant deserves health care that adheres to AAP standards. The AAP concurs with the recent statement from the American College of Obstetricians and Gynecologists (ACOG) that the safest setting for a child’s birth is a hospital or birthing center, but recognizes that women and their families may desire a home birth for a variety of reasons.
Pediatricians should advise parents who are planning a home birth that AAP and ACOG recommend only midwives who are certified by the American Midwifery Certification Board.
There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant.
All medical equipment, and the telephone, should be tested before thedelivery, and the weather should be monitored.
A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.
AAP guidelines include warming, a detailed physical exam, monitoring of temperature, heart and respiratory rates, eye prophylaxis, vitamin K administration, hepatitis B immunization, feeding assessment, hyperbilirubinemia screening and other newborn screening tests.
If warranted, infants may also require monitoring for group B streptococcal disease and glucose screening. Comprehensive documentation and follow-up with the child’s primary health care provider is essential.
Going home with a newborn in your arms means the beginning of a whole new life for you and your family. Managing the differences between expectations and reality—especially in terms of feeding your baby—can go a long way toward making it not just a smooth transition, but also a time of joy. To help moms prepare Petite Pediatrics is offering prenatal lactation consults for expecting moms.
Kathy Klammer is a nurse who is an International Board Certified Lactation Consultant (IBCLC) who has many years of experience working with breastfeeding moms. She provides Lactation Services and is available for home or office visits within the first few weeks of life, but is also available prenatally for expectant mothers who are anxious about breastfeeding or have specific concerns such as reduction and other breast surgeries as well as illnesses or medications that could affect the breastfeeding relationship. This provides a unique opportunity to discuss concerns, teaching of latch-on techniques and suggestions on how to get off to a good start in the early weeks.
To help prepare you for feeding your newborn, here is some helpful information about breastfeeding and formula feeding.
You’ve probably heard it before: “Breast is best.” But is it really?
Yes, from both a nutritional and infection prevention standpoint. Breast milk is currently unrivaled as the ideal food for infants. The infection fighting antibodies it contains just can’t be bottled in even the most expensive of commercial formulas, and breast milk has been shown to reduce a newborn’s chance of developing everything from ear infections, allergies, vomiting, and diarrhea to pneumonia, meningitis, and potentially even sudden infant death syndrome.
True, breastfeeding is “natural.” But that doesn’t mean that getting started with breastfeeding is easy. Those first couple of weeks can be challenging, because in reality, there is usually a period of self-education and on-the-breast training. We recommend taking it step by step, keeping a few precautions in mind, and being patient as you and your baby learn how to do it. Remember, millions of women have successfully breastfed their babies; you can do it, too.
Here are some tips for breastfeeding success:
If all goes well with the birth of your baby and you’re both doing well after delivery, start breastfeeding as soon as possible—right there in the hospital.
Ask for help – Lactation nurses can assist with techniques to help mom and baby get started in the right direction.
Focus on getting the process of “latching” (how your baby attaches to your breast) down pat. First, make yourself comfortable; use pillows for support and put anything you might need during breastfeeding within easy reach. Then get your baby interested in breast milk by rubbing a few drops around your nipple. If baby doesn’t respond, try stroking around his mouth to stimulate what’s known as the “rooting reflex.” If he still doesn’t open wide enough, gently press down on the chin.
Don’t settle for “almost on”: Improper latching on can quickly result in sore breasts and a frustrated (and still hungry) baby. Keep repositioning until baby’s tongue is under the nipple, so he can draw the nipple and the darker-colored area around the nipple (called the areola) into his mouth. This will make breastfeeding success more likely for you both.
So if breastfeeding is so beneficial, is formula even acceptable for feeding your newborn? The answer is yes. In fact, most parents will use formula at some point during their child’s first year. And while formula can’t exactly match the nutritional makeup of breast milk and doesn’t contain the added benefit of infection-fighting antibodies, it nevertheless serves a very valuable purpose for those who are not able or choose not to breastfeed.
There are three basic types of formula—those based on cow milk, those based on soy, and those that are “specialized,” “hypoallergenic,” or “elemental” (which means the formula’s components are broken down for easier digestion). Most babies do fine with the first two types, but some babies may need an elemental formula if they have difficulty digesting the other types.
There is much to consider with baby formula. For starters, here are some tips for making sure your baby gets what she needs from her formula:
Formulas are iron fortified because iron is a critical part of a healthy baby diet. Some people mistakenly assume that iron causes stomach pain or constipation in infants. In fact, babies only absorb a small percentage of the iron in their food, and most babies tolerate iron-enriched formulas without a problem. If you have concerns about this, talk with your pediatrician.
Consider how often you intend to use formula for feeding before buying a certain type. Also factor in whether you want to pay for the added convenience of ready-to-feed, or if using powdered formula on the road, or at home, better suits your needs and your budget.
Stock up so you don’t run out. Before you do this, however, make sure your baby is happy with the formula you’ve chosen. Check the expiration dates, too; you don’t want to buy more than you can use before that date.
It’s worth mentioning that about 10 percent of babies are lactose- or soy-intolerant, a condition called milk soy protein intolerance (MSPI). These babies tend to start fussing soon after eating, spit up, become gassy, or have problems with constipation or diarrhea. If your baby reacts this way to eating formula, talk with your pediatrician.