1. family and parenting
2. babies and toddlers

4/13/2015
Newborn Transition
Postpartum Newborn Policies and the
Breastfeeding Relationship
Monicah Brumfield and Amanda Smith
OBJECTIVES
• Recognize postpartum newborn policies that
may delay or negatively impact the breastfeeding
relationship
• Discuss current recommendations for
transitional newborn care
• Create an effective plan for modifying hospital
policy for the best possible breastfeeding
outcome
Providing child birth and breastfeeding classes,
doula services, and private consultations to the
women of the Pinebelt and surrounding areas.
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4/13/2015
SMBBC
• 32 Births Attended
• 7 Childbirth/
Breastfeeding Classes
• 64 Breastfeeding
Consults
• 9 Mississippi Hospitals
• 1 Homebirth
7 Babies
3 Inductions
3 Natural Births
2 Medicated Births
3 Different Hospitals
Over 120 Months of
Breastfeeding
The newborn transition
A quick overview
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4/13/2015
Definition
• Transition is a process of physiologic change in
the newborn infant that begins in utero as the
child prepares for transition from intrauterine
placental support to extrauterine selfmaintenance
• The transition from fetus to newborn is a normal
physiologic and developmental process -- one
that has occurred since the beginning of the
human race.
Placental Circulation
• Exchanges O2 and CO2 by
simple diffusion
• Eliminates
li i
waste products
d
• Does the work of the lungs in
utero
Transition to extrauterine life begins
when the cord is CUT.
• Placenta no longer works as lungs
• Lungs begin to exchange gases
g and causes
• First breath inflates lungs
circulatory changes
• Lungs inflate – which thus results in newborn
circulation
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4/13/2015
Newborn Circulation
Umbilical cord is clamped
 Placenta is separated
 Three major shunts close

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

Circulatory Changes
Baby is no longer attached to mother/placenta
Lungs begin to function
First breath
Lung fluid cleared
Lungs fill with O2
Initiation of respiration
Physiologic Changes During Transition
•
•
•
•
•
•
Cardiovascular
Respiratory
Hematologic
Gastrointestinal
Renal
Immunologic
Assessment



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Vital Signs
Measurements
Gestational Age Assessment
Head to Toe Exam
Glucose/Feeding
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Temperature regulation
• normal ranges
97.7F - 98.6F
How long should it take to transition
from intrauterine life to extrauterine life?
A.) 1-2 hours
B.) 2-3 hours
C.)) 3-6 hours
h
D.) 6-12 hours
Common Newborn Procedures
Routine Practices
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4/13/2015
• Suctioning- Doctors usually use a
bulb syringe and suction the baby’s
mouth and nose as soon as the head
comes out. Baby nurses will
continue to suction baby, as they see
needed.
• Immediate Cord Clamping- In the
hospital, it’s standard to cut the
baby’s umbilical cord right away.
• Apgar scores- Caregivers will check
baby’s heart rate, respiratory effort
(is he breathing slowly and
irregularly or breathing well and
irregularly,
crying lustily), muscle tone, reflexes
and skin color. These are added up
to an Apgar score, which gives a
snapshot of the baby’s condition at 1
minute after birth and 5 minutes
after birth. Caregivers generally
don’t mention the scores to parents,
these are more for record-keeping.
• Vitamin K- Vitamin K is an
essential vitamin for blood
clotting. Compared to adults,
babies are born with lower
levels of vitamin K. So, they
are given a vitamin K shot or
prevent a
oral dose at birth to p
rare condition called vitamin K
deficiency bleeding.
• Eye ointment- an antibiotic
eye ointment is applied to
baby’s eyes. This is done
routinely in hospital births to
prevent an eye infection that
they can contract from mom’s
genital tract if she has
chlamydia or gonorrhea.
• PKU Screening- Certain
metabolic disorders are
routinely screened for at birth
through a heel stick blood
sample. These disorders have
devastating effects that are
best handled with earlyy
detection and treatment to
ensure the best possible
outcomes. This is the least
controversial newborn baby
care procedures.
• Hep B Vaccine- Hepatitis B is
a disease that is transmitted
via infected blood and sexual
intercourse, is given at birth in
the hope of catching as many
people as possible. It is not
q
for administration at
required
birth and may be given at any
time in childhood or
adulthood.
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4/13/2015
• Baby’s first bath- The baby is
usually taken to the newborn
nursery and given his or her
first bath.
• Height, Weight, Head
Circumference, and
T
Temperature
t
regulation.
l ti
• Hat, Shirt, Diaper, Footprints,
Bracelets, and Swaddle.
Separation Period
• Babies are routinely
passed straight to
the baby nurse
• Mom visits for
around thirty
minutes
• Then baby is taken
to the nursery for 24 hours
Yes, No, Maybe So….
What do you think?
Good for breastfeeding or maybe not?
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4/13/2015
Current Recommendations
AAP, WHO, ACOG
ACOG
• Delaying cord clamping for up to one minute can
allow for adequate iron absorption.
AAP
• Skin-to-skin contact will influence motor system
modulation of the newborn infant shortly after
delivery. Studies significantly support a transition
from the womb to the extrauterine environment.
Medical and nursing staff may be well advised to
provide this kind of care shortly after birth.
• Term newborns with no evidence of respiratory compromise
will be placed and remain in direct skin-to-skin contact with
their mothers immediately after delivery until the first feeding
is accomplished, unless medically contraindicated.
• The alert, healthy baby is capable of latching to a breast
without specific assistance within the first hour after birth.
Dry the baby, assign Apgar scores, provide identification
bracelets to mother and baby,
baby and perform initial physical
assessment while the newborn is with the mother. The mother
is an optimal heat source for the neonate. Normal newborn
care such as weighing, measuring, bathing, needle sticks,
vitamin K, and eye prophylaxis should not delay early
initiation of breastfeeding. Newborns affected by maternal
medication and exhausted mothers may require assistance for
effective latch-on and initiation of breastfeeding. Except
under special circumstances, the newborn should remain with
the mother throughout the recovery period.
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4/13/2015
WHO
Suction in newborns who start breathing on their own
• Routine nasal or oral suction should not be done for
babies born through clear amniotic fluid who start
breathing on their own after birth.
Cord clamping
• Late cord clamping (performed after one to three
minutes after birth) is recommended for all births
while initiating simultaneous essential newborn care.
Skin-to-skin contact in the first hour of life
• Newborns without complications should be kept in
skin-to-skin contact with their mothers during the
first hour after birth to prevent hypothermia and
promote breastfeeding.
Vitamin K prophylaxis
• All newborns should be given 1 mg of vitamin K
intramuscularly [IM] after birth [after the first hour
during which the infant should be in skin-to-skin
contact with the mother and breastfeeding should
be initiated].
Breastfeeding
• Initiate breastfeeding within the first hour after
birth
• Practice rooming-in
• Baby Friendly Initiative
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4/13/2015
So what do we want?
• What is the ideal newborn transition?
• How does this improve our breastfeeding
outcomes?
• What we are loving……
Time for Change
Creating an effective plan for
modifying the hospital routine
baby policies
• Talk to the moms
• Form a plan
• Know why
• Presenting the plan
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4/13/2015
Sources
Brodbibb, Wendy MBBS, IBCLC, PhD, FABM, Kruske, Sue RN, RM,
BHth Sc PhD, and Miller, Y BA (Psych) (Hons), PhD. (2013) BabyFriendly Hospital Accreditation, In-Hospital Care Practices, and
Breastfeeding. Pediatrics 131 (4): 685 -692
Lipka,
Li
k Diane
Di
RNC,
RNC BA and
d Marcia
M i K.
K S
Schulz
h l RNC
RNC, MS.
MS ((14 J
Jun 2012).
)
Wait for Eight: Improving Newborn Outcomes. Journal of Obstetric,
Gynocological, and Neonatal Nursing 41 (1): 46-47.
Rosenberg KD, Stull JD, Adler MR, Kasenhagen LJ. (2008). Impact of
Hospital Policies and Breastfeeding. Breastfeeding Medicine 3 (2):
110-116.
Graves, BW. (2013). Newborn Transition. J Midwifery Women’s
Health 58(6):662-70.
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