Info for New moms

When you look at the choices you have available at Providence ABC Unit you

should weigh the risks and benefits and then make a decision.  Because I

realize that statistically no matter which way you choose the odds are

everything will work out I am very flexible on all those choices.

Vit K- helps the baby clot off a bleed.  Babies are not born with Vit K it

is something we obtain naturally after birth.  Vit K helps prevent bleeds or

at least major bleeds.  Commonly people refer to circumcision as the major

risk of bleeding in which you need vit k.  I disagree.  Although bleeding

risk will be higher with circumcision if there is no vit k,,, usually that

is pretty containable.  My bigger concern is that you are squeezing the

babies head through a small space and there can be microtrauma that would

simply clot off with the benefit of Vit K.  The worst case scenerio of this

is an intracerebral bleed (into the brain) that could be disastrous.

Luckily I have not seen this yet and really dont want to see that.  I have

seen recently a large bleed between the scalp and the lining of the skull

which was a large bleed requiring an extended stay in the NICU and blood

transfusions.  More commonly is a cephalohematoma or a bleed between the

lining of the skull and the skull which at least is containable because its

a smaller tighter space rather than between loose skin of the scalp and the

skull.  But this last one I saw would have been prevented with vit k.  There

is another alternative to give vit K as drops but hard to find and not fast

enough to help prevent the bleed in the head.  When weighing your risks and

benefits the risk of the shot of vit K (which does not have thimerasol or

mercury) is the risk of a rare skin infection that is easily treated with

topical antibiotics and I have never seen  vs the risks of intracerebral

bleed which is equally rare but much more dangerous.  The usual concern for

new moms with the vit k shot is that it is a shot and it hurts.  I have

witnessed many of them that the baby didnt even notice it,,, must be that

they just got pushed through a small space and comparatively the shot was

nothing.

Antibiotic eye ointment- this is to prevent blindness from Chlamydia or

Gonorrhea.  Chances are you already know what your risks of those two

diseases are which are both sexually transmitted.  Things to consider with

it is that they say a large percentage of people with chlamydia are without

symptoms, coupling that with that the screen or test for it has as high as a

20% false negative rate ,,, meaning up to 20 percent of people with

Chlamydia can have a falsely negative test even though they have it.  So

unless you have only had one partner and your partner has only had one

partner your risk is not exactly zero.  It may be pretty close to that but

not zero.  So weighing your risks and benefits- risk of the erythromycin eye

ointment is a rare allergic reaction which would give a red eye for a couple

days and then go away, versus probably a rarer chance of blindness which of

course wont go away.

Hepatitis B vaccine-  this is given to newborns because when we used to

target just high risk groups ( people who had a lot of sex with different

people, IV drug users or health care workers) it did not really make a dent

in the amount of hepatitis B in the country since it was just the health

care workers that came in for their shots and they were the smaller chunk of

those at risk, so it was decided to give to newborns.  The other added

reason is there were some moms who did not get screened for hepatitis B and

they fell through the cracks.  I am pretty sure most of the midwives or OB

who deliver at Providence screen everyone which is standard.  This is a shot

you can choose to get later in life as it gets closer to those lifestyle

choices that would put one at risk.

Circumcision- This is not “medically necessary” but there are medical

advantages.  There is a decrease in infections, genital warts, cervical

cancer in the spouse , and penile cancer (which is very rare in either

category) with circumcision vs not.  There was a large study done to try to

prove with proper hygiene you could get the same lower incidence of the

above however that did not pan out , so even with those who were properly

instructed on proper hygiene  (which I hate to say will not be the majority

of the normal little boys) there was still a lower incidence of the above in

circumcision group vs no circumcision.  The other non medical considerations

would be if Dad is circumcised or not, or other siblings, or for that matter

the other little boys in the neighborhood that would be in the locker room

together.  Most commonly circumcisions are done in the hospital by the OB.

For those who want to wait another alternative is to have a Moyle - who is

one who performs a Bris- a Jewish ceremony around circumcisions at the home

at 8 days old,,, which they can do it with or without the ceremony.  I most

commonly refer people to Cantor Greenbaum who has done thousands of these.

His number at Beth Shalom Synagogue is (248) 547- 7970. His email is

perfectnow@excite.com  and his cell phone is 248-417-5632.

As a Family Physician I have seen probably around 20 complications of not getting

circumcised or adults who choose to get it done afterward because of some of

the problems listed above,,, compared to when I used to deliver babies I

have not had any serious complications of circumcisions and I have delivered

~600 babies in my career so there was a lot of circumcisions as well.

Feel free to click on the side bar to information from a conference I went to for common behavioral issues in children ages 0-5 

If you are looking for a good childrens song cd, a good friend of mine - Bruce Liles ( a psychologist who had worked in the Detroit schools) has an outstanding CD called "K is for Kids" .  He has other childrens songs , including ones in spanish, as well as some songs he wrote about social justice issues.  His website is www.bruceliles.com