Having your Baby

First of all, congratulations! This is an exciting time, and we’re thrilled to be here to support you through this process. What do you need to know about having your baby? 

First, to select one of us as your pediatrician, you must first establish care with us unless you already have an older sibling who comes here, and there is usually a waiting list for new patients - apply here as soon as possible if you are interested. (Siblings of current patients can bypass this process.) For new applicants we advise having a backup pediatrician selected because we do have more requests to join our practice than there is space available.

If you have already established care with us, here’s the next step:

An important note on collaborating care with outpatient midwives. Many outpatient midwives offer newborn care for up to the first 2 months of age. This continuity of care is wonderful. However, please do not use these visits as a replacement for your visits with us, but rather in collaboration with our visits. Why? Quite simply because we would like to be there with you from the start, getting to know you and your newborn, and planning for your child’s long term health care choices. If something comes up where your child needs more advanced pediatric medical attention, we can only provide that assistance if we have already established care, so it is important to do so as soon as possible. If cost is a limiting factor, just let us know. Typically, your midwives can alternate visits with us to offset this cost if necessary.

Preventive measures for newborns

There are three preventive measures routinely given to newborns. Knowing what these are can help you make an informed decision.

1. The Hepatitis B Vaccine. The Hepatitis B virus is transmitted by blood, by sex, and through childbirth when mothers are carriers. But what a lot of people don’t know is that children can catch it silently through environmental exposure, mostly from parents, and this transmission is believed to be responsible for a large number of unsuspecting adults found to have chronic Hep B infection without any risk factors. Childhood infections, though they may initially be silent, tend to lead to more chronic and devastating disease than adult infections. This is why the vaccine is given to all newborns to protect them from any potential transmission at birth. Many mothers do not know they are carriers, so pregnant women are usually tested for it. If your test came back negative, your baby's risk is low. Of course the test is not 100% accurate, which is why the recommendation is for all babies to get the vaccine. But no intervention is without potential risks, either, so even though there are no known worrisome reactions, some vaccinated parents with normal Hep B tests have chosen to postpone the vaccine until a later date. This is generally safe as long as both parents are vaccinated and Hep B negative. Do not delay this vaccine if: positive, high risk or unknown Hep B status of the mother, or close family contact (caregiver) with Hep B. 

2. The vitamin K shot. After birth some babies have too little vitamin K to clot effectively, and can suffer severe hemorrhaging. This can be prevented with a single injection of the vitamin, it is safe, highly effective and we strongly recommend it. Is it traumatic to the baby? Minimally — the needle poke is quite brief and it’s nothing compared to childbirth! While it can be administered orally, it is not as effective.

3. The antibacterial eye ointment. Prior to this, the number one cause of blindness in the newborn period was eye infection from chlamydia or gonorrhea contracted through childbirth. These bacteria are more common than you might think because women can be silent carriers. Nowadays, most women are tested during pregnancy. If you are negative, the chance of an eye infection in your newborn is very low. It’s not zero, though — tests are never 100%, and there are other bacteria that can cause eye infections, too. Fortunately, it's not an oral antibiotic, it's more like putting ointment on a wound. Some people may tell you not to do it because it interferes with bonding due to blurring the infants vision. This is not true - infants can’t see a thing when they're born, so blurring their vision is not possible. However, it is an intervention, and no intervention is without risk. The medicine can (rarely) irritate their eyes, and can reduce some of the healthy bacteria that they get from the vaginal canal, though it will quickly be repopulated. These risks are very minor compared to blindness, but blindness is extremely rare when your tests are negative, so just think about which risk you are most comfortable with. Whenever you’re not sure what you prefer, it’s usually good practice to follow the standard of care, which in this case is to do the ointment. And if you opt out, let’s watch your infant closely to make sure there are no signs of eye infection developing, so we can treat at the first sign.

Breastfeeding

Out of everything, this is one of the most important measures to help your newborn thrive. There are many resources to help ensure successful breastfeeding. If this is your first baby, we recommend meeting with a lactation specialist to help it go more smoothly. Yes, it costs money and can be a hurdle for some families, but then again it is cheaper than formula, and being able to actually enjoy nursing pain free is priceless. Two of our favorites are Meg Stalnaker and Doris Onnis. There are also many other good options at Legacy and Providence lactation clinics. We especially recommend meeting with lactation if you have any conditions that put you at high-risk for lactation difficulties: flat or inverted nipples, minimal or no change in breast size during pregnancy, history of irregular menstrual cycles, history of breast reduction or augmentation, hormone imbalances, twin pregnancy, complicated birth and/or c-section, history of depression, or a baby with medical problems to name a few.

For breastfeeding resources, try these out:

• La Leche League > Number one resource for lactation.

• Breastfeeding, Inc. > Dr. Jack Newman's site

• Can I breastfeed if…? > Handy answers to common questions.

• Medication use during breastfeeding > Good resource

House call and follow-up care

After your newborn visit, if all goes well we'd like to see you again around day 3-5 of life, and for this visit we offer a house call at no additional charge. That way, you can just stay at home and focus on bonding with your newborn. (Note: if you live more than about 10 minutes from our clinic, we need to block out more time from our schedule, so there is a $50 charge for driving time.)

Next, you'll come in for your first clinic visit at 2 weeks of age. We recommend always scheduling your next well visit each time you see us so you'll never have to worry about when you need to come in next. For your reference, our schedule of routine well checks can be found on the right side of this page and in more detail in our preventive care schedule.

Healthy Schedule

• After birth (within 24 hours)

• Newborn visit (day 3-5 of age, home visits encouraged)

• 2 weeks

• 2 months

• 4 months

• 6 months

• 9 months

• 12 months

• 15 months

• 18 months

• 24 months

• 30 months

• Yearly thereafter