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?
Relax, we’ve got everything taken care of. More than anything, we want you to know that you can focus on loving and bonding with your newborn while we attend to your baby’s medical needs.
To select me as your pediatrician, you must first have met with us in clinic to establish care - this is known as a “meet and greet” appointment, is offered at no charge, and must be scheduled well in advance of your delivery. If you have not already done so, call us as soon as possible because there may be a waiting list.
If you have already established care with us, here’s the next step:
Simply let the the hospital staff know you have established care with us — no further action is necessary on your part. Typically the hospital staff there will manage your care and inform us when you are ready for discharge to arrange for followup. Dr. Meri currently maintains privileges at Emanuel Hospital so if you are her patient and she is available she will come to the hospital to examine your newborn within 24 hours of birth. Routine care includes Hepatitis B vaccine, Vitamin K shot, and antibacterial eye ointment, and these may happen before your first visit with me. To learn more, see below.
Birthing center or home births
Please call us as soon as possible after your baby is born to allow enough time to schedule a visit. We prefer to see your baby within 24 hours of age, so have your midwife call us right away to give us the head’s up and pass on any relevant information about the birth. If it is in the middle of the night, but the baby is healthy, you can leave a message with our paging service (503-963-6173) and ask them not to relay it to us until the morning, or just page us in the morning.
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.
The Hepatitis B Vaccine. The Hepatitis B virus is transmitted by blood, by sex, or through childbirth when mothers are carriers. When transmitted during childbirth, the resulting disease in newborns is so severe, that 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 women are generally tested for it during pregnancy. If your test came back negative, your baby's risk is very 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, many parents with normal Hepatitis B tests have chosen to postpone the vaccine until a later date. This is generally safe as long as you are not high risk. Do not delay this vaccine if: positive, high risk or unknown Hepatitis B status of the mother, or close family contact (caregiver) with Hepatitis B.
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 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.
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.
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 strongly recommend meeting with a lactation specialist to make sure it all goes smoothly. Yes, it costs money and can be a hurdle for some families. But also consider: it is cheaper than formula, is more natural, and the peace of mind you will get from it as you spend years of your life breastfeeding is priceless. Meg Stalnaker is wonderful, though there are many great lactation specialists in Portland. 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.
After birth (within 24 hours)
Newborn visit (day 3-5 of age, home visits encouraged)