Module 1: Newborn Nursery
Congratulations on your newborn! Once you’ve delivered, the healthcare team will take care of the medical needs of your baby while you recover and transition into your new role as a parent. Here’s what to expect while you’re in the hospital, and what decisions you’ll need to make.
Who Will See My Baby?
Pediatrician: We’ll do a full exam to make sure there’s no findings that need additional follow up and check on your newborn daily while they’re in the hospital.
Nursing: Nurses will be your most frequent companions! They’ll help you navigate feeding and swaddling, take vital signs, and carry out tests and screenings.
Lactation Consultant: These are an enormously helpful resource. They help with latch difficulties, proper positioning, increasing supply, pumping, and hand expression. If there’s trouble with feeding, they can identify a lip or tongue tie, high-arched palate, low tone, or other underlying reasons, so that you can discuss management with your PCP. You typically only see these consultants once or twice while admitted, so ask all your questions when you see them! Some Pediatricians are IBCLC-certified (the accrediting organization for lactation consultants), and can give continued assistance after leaving the hospital. If yours isn’t, there’s lots of IBCLCs in the community for a small fee (some insurances also cover a few sessions), so you can Google one near you if you’d like additional help after the hospital.
What Tests & Treatments Are Done In The Newborn Nursery?
Treatments: While you can decline these, I strongly recommend getting them, since they’re meant to help your child at their most vulnerable due to their weaker immune system.
Hepatitis B Vaccination: To keep your newborn safe from liver disease and liver cancer. It’s given within the first 24 hours, and again at 1-2 months and 6-18 months.
Erythromycin Ointment: To decrease risk of eye infection from Gonorrhea and Chlamydia, which can cause harmful changes in vision if left untreated.
Vitamin K Injection: Vitamin K is important for blood clotting. Newborns don’t start making adequate amounts until a few months of life, so this injection gives them extra stores to help avoid dangerous internal bleeding.
Screening:
Congenital Heart Screening: Identifies serious issues with heart anatomy and function. Our goal is to address these while you’re still in the nursery, where Cardiologists and Surgeons are readily accessible to discuss management.
Hearing Screening: Checks for hearing deficits and deafness. If your newborn fails the first time, don’t worry too much (this can happen if there’s fluid in the ear from delivery or too noisy of an environment during testing). They’ll have a repeat one within the first 3 months of life, and often, they’ll do just fine the second time around. If they fail again, they’re referred to the Ear, Nose, and Throat specialist for next steps.
Newborn Screening: A blood test that detects many common genetic disorders (like sickle cell disease and hypothyroidism). This is usually obtained through a foot prick, and results come within 1-2 weeks via mail. If abnormal, you’ll get sent to a specialist.
Jaundice: Tested for with a tool held above the skin (less accurate) or a blood draw (more accurate). It’s common for newborns to have mild to moderate jaundice, and it typically resolves in the first few days of life. However, in some infants, jaundice is more severe. We treat these cases with light therapy to prevent damage to the brain. See Module 4: Jaundice for more information.
Sugar Levels: If a mother has gestational diabetes or if their infant is large for their gestational age (e.g., much higher-than-expected weight for a typical 38-week old), the nursery will check sugar levels to make sure they don’t get too low. If they do, your newborn will receive sugar through an IV solution to help normalize levels.
What Decisions Will I Need To Make?
Breastfeeding: This is a decision you can always make later, though if you’re open to trying, it’s helpful to know earlier so that you can take advantage of lactation consultants.
Circumcision: If you have a boy, it helps to talk about this with your partner so you’re on the same wavelength! While there’s a slightly smaller risk of urinary tract infections (UTIs) with circumcisions, it’s not significant enough to firmly advocate for them. So, it’s more of a cultural and religious decision for your family. It’s ideal to make this decision while you’re in the hospital to ensure optimal insurance coverage, medical help in case of complications, and availability of someone able to circumcise (in some areas, this is the OB/GYN, while in others, it’s the Pediatrician, though a Pediatric Urologist is also qualified). This is usually a short, 15-20 minute procedure with local anesthesia to minimize discomfort. There are some exceptions where circumcisions can be done on an outpatient basis after delivery, so it’s not a necessity to choose then, though be aware that it can be more challenging to arrange.
Car Seat: You can’t leave the hospital without a car seat, so make sure to choose one before delivery and learn how to install it. It should be rear-facing for the first two years of life. If you’re having trouble installing it, Certified Inspection Sites can help verify that it’s done correctly. If your newborn is <37 weeks, there is often additional car seat testing in the hospital to ensure that oxygen levels will stay stable during longer trips.
Pediatrician: In the 3 months leading up to your delivery, I recommend finding a Pediatrician. There’s many factors to consider when making your choice. You can rely on advice from friends who trust their Pediatricians (this is a great way to start narrowing down options), though you should also think about what’s important to you. Are there Same-Day visits? Are they open late, so that you can take your child after your workday finishes and not have to take time off? Are you in alignment with their vaccine policy? If you’re a POC, is it important to you to have your Pediatrician be of a similar background to feel more understood in the struggles of parenting a child of color, as well as cultural practices that may differ from mainstream? A lot of offices now offer interviews or prenatal visits to see if they’re a good fit so take advantage of this if you can. It’s OK if you don’t connect with the style of one doctor to seek another. As with all relationships in life, sometimes they just aren’t meant to be, so make sure you find someone you feel comfortable asking questions to without judgement and that you’re able to trust. You’ll want to schedule the 1st newborn visit after you’ve delivered and while still in the hospital. Timing-wise, aim for about 2-3 days after expected discharge.
When Can My Baby And I Go Home?
It depends! If a vaginal delivery, it’s usually 1-2 days. If C-section, it’s often 3-5 days due to a longer recovery. Your newborn is typically admitted for 24-48 hours if no issues arise (in these cases, there should be follow up with the Pediatrician within 2-3 days). They may stay longer if there’s feeding issues, abnormalities on examination, prematurity, low sugar levels, high jaundice levels, or concerns about infection, though don’t fret! It’s a magical feeling when you go home with your new family, so it’s worth the wait to make sure everyone’s healthy before leaving the hospital.
