What (natural) choices/options do I have with a hospital birth?

[JustSomeChickVee]

Originally Posted by z2akids I'm sorry if I wasn't clear. My comment was related to the pp who said that it's better to wait 1-2 weeks to do the PKU test. Whether a mom's breastmilk is in has nothing to do with the PKU test. If baby doesn't have the necessary enzyme, they don't have it. Colostrum, breastmilk or formula won't change that inborn deficiency. If baby has PKU it is imperative to find out asap so that they can receive a diet that won't cause them to have brain damage. There are definitely special formulas that baby could take that would prevent permanent mental retardation and waiting a couple of weeks to get tested means a few weeks without the proper diet while permanent damage is taking place. Unfortunately, there are websites out there spouting misinformation and leaving the impression that the heel stick used in the NBS test is the equivalent of torture. I know not everyone feels the same way I do, but I would much prefer my 24 hour old baby have a couple of minutes of discomfort to make sure that he doesn't wind up with brain damage or dead due to a treatable inborn error in metabolism.

This. my son slept through his heel stick, he didn't budge at all.

[bluedaisyma]

I wasn't saying breast milk would change the test, I was saying that bc one of things they test for is if the baby can tolerate breastmilk (I am not wording that correctly), it is inaccurate to test it before the milk is in.

From a board-certified Ped at St. Johns (he basically states what I have been told and is in the literature to an extent) that the reason they do it in the hospital is bc they can't guarantee parents will get it done at a 2 week "re-check" so they go ahead and do it while they have the babies there. I don't have the insert, but it clearly states that not all the things it tests for are accurate or valid before 1-2 wks (as a disclaimer), however, I have never (and this is back when I did the PKU's immediately) had a doc mention that they should get a re-check to be most accurate.

For most babies, checking a PKU within the first 48 hours is too soon for the very reasons you stated in your question. However, because of the high sensitivity of the PKU test, there are some babies with PKU who will have a positive test within 48 hours. Most states feel it is best to test everyone before they leave the hospital because unfortunately not all babies get their two week checkup. Since it is impossible to predict who will get their PKU recheck at two weeks and who won't make it to the doctor, the states choose to test everyone. There are some states that will allow the parents to waive the PKU test in the hospital. Therefore, parents should inquire about this option. But be sure to get the test done within two weeks of age and preferably on the fourth or fifth day of life.

[z2akids]

Originally Posted by bluedaisyma I wasn't saying breast milk would change the test, I was saying that bc one of things they test for is if the baby can tolerate breastmilk (I am not wording that correctly), it is inaccurate to test it before the milk is in. From a board-certified Ped at St. Johns (he basically states what I have been told and is in the literature to an extent) that the reason they do it in the hospital is bc they can't guarantee parents will get it done at a 2 week "re-check" so they go ahead and do it while they have the babies there. I don't have the insert, but it clearly states that not all the things it tests for are accurate or valid before 1-2 wks (as a disclaimer), however, I have never (and this is back when I did the PKU's immediately) had a doc mention that they should get a re-check to be most accurate. For most babies, checking a PKU within the first 48 hours is too soon for the very reasons you stated in your question. However, because of the high sensitivity of the PKU test, there are some babies with PKU who will have a positive test within 48 hours. Most states feel it is best to test everyone before they leave the hospital because unfortunately not all babies get their two week checkup. Since it is impossible to predict who will get their PKU recheck at two weeks and who won't make it to the doctor, the states choose to test everyone. There are some states that will allow the parents to waive the PKU test in the hospital. Therefore, parents should inquire about this option. But be sure to get the test done within two weeks of age and preferably on the fourth or fifth day of life.

Just in case you simply forgot to add it, I found the cite to your quote:

Ask the Expert on iVillage would not be on my lists of citations for any paper I had to write. His explanation spends a lot of time discussing the difference between sensitivity and specificity and none explaining why he disagrees with the AAP and March of Dimes (just to name 2) on testing past 24 hours. And, not a cite to back up his opinion.

Whether or not mom's milk is in, baby's physiology is already fixed. If baby is missing enzymes (or other necessities) to digest milk proteins, then that lack will show up in baby's blood. There is no need to actually consume breastmilk to know if the enzymes exists.

[dealdoll]

Originally Posted by bluedaisyma Oh at my last birth, which was at a hospital, they were awesome. they gave me the placenta to take home, they didn't do anything for the 1st 3 hrs (like, I said to them, "you can come weigh the baby now "), we left same day, they didn't do any pokes, prods or tests besides the hearing test which they did in our room...I only had monitoring more than I would have liked (but still not a lot) bc I had a huge bleed when I went into labor. Oh and I can't have homebirths anymore bc of my kidney disease (well I can, but I risk stroke ) but I would have a homebirth with a MW or unassisted if I could!

Really encouraging that you had such a great hospital experience. It's exactly what I'd want !

[hohaas]

For me, id really like to have another waterbirth but the hosp I'm going to this time doesn't do them but the dr is for laboring in the tub. I'm trying to get the ok from the unit but they haven't gotten back w/ me yet (I've called and emailed). I think every mom has the right to refuse or consent to anything. I know I don't plan on wearing the gown and getting continuous monitoring. I'm gonna eat when I feel like it and may even refuse an IV.

[OneFishTwoFish]

I hope you're able to swing getting the midwife to deliver you at home! If you can't, can you perhaps at least leave the hospital early so they aren't checking your stitches every few hours?

I had my first birth in a big hospital. Everything had to be by the book and I HATED it. So when I had my second son (we had moved anyway) I did a ton of research on the local hospitals and asked on MDC for recommendations. I ended up with a WONDERFUL midwife group and had my son in a super supportive hospital. He was born naturally in the water and I wouldn't change a thing about the entire experience.

I hope you can find something that works for you!

[PinkLemonade7503]

Start asking a few questions at each visit. Some of these things might not be a big deal, and others you might have to fight for. The ones that are no big deal you can leave off of the birth plan.

Then, I would keep your birth plan as short and sweet as possible. I think you have a better chance of getting five things, then twenty.

For instance, a lot of hospitals have monitors that don't need for you to be tethered to the bed. Or they might say, we just need twenty minutes of monitoring per hour. You will probably have to compromise a bit, but you can still have a great experience!

[bcb1961]

Originally Posted by z2akids Just in case you simply forgot to add it, I found the cite to your quote: Ask the Expert on iVillage would not be on my lists of citations for any paper I had to write. His explanation spends a lot of time discussing the difference between sensitivity and specificity and none explaining why he disagrees with the AAP and March of Dimes (just to name 2) on testing past 24 hours. And, not a cite to back up his opinion. Whether or not mom's milk is in, baby's physiology is already fixed. If baby is missing enzymes (or other necessities) to digest milk proteins, then that lack will show up in baby's blood. There is no need to actually consume breastmilk to know if the enzymes exists.

No. The test doesn't look for the enzyme itself. It looks at the ratio of amino acids that have been metabolized. This is the same way that many many tests work. For example, drug tests. They don't look for the drug, they look for the metabolites of the drug that the body would produce after consumption.