Having a baby can be overwhelming for any parent. But in "Eat, Sleep, Poop," Dr. Scott W. Cohen, a doctor and first-time father, offers a common sense guide to help answer parents' questions and guide them through that exciting first year.
Check out an excerpt of the book below, then head to the "GMA" Library for other great reads.
CHAPTER 1 - Prepare - Save the Date
The period before your first baby is born is one of the most exciting times in your life, but also one of the most anxiety-producing and nerve-racking. As anxious parents-to-be, we try to control a situation that is already out of our control, and we find it nearly impossible to focus on what is most important—looking forward to the baby's arrival. In this chapter I'm going to help you focus by offering Common Sense Parenting advice on preparing for your baby's arrival. Hopefully, you'll then be able to cut down the anxiety and concentrate on the excitement.
Here's what we'll focus on:
• What to buy
• How to choose a pediatrician
• Cord blood banking
• What to bring to the hospital
Nesting—What to Buy
If you're like most couples, as soon as you find out you're having a baby, you are immediately inundated with advice. Everyone with kids tells you what you absolutely must buy for the first year. Unfortunately, most first-time parents have trouble cutting anything from the list of "must have" baby items, which is why many end up with a bedroom like my friends'. I remember visiting them shortly after the birth of their first child. They took me on a tour of their new apartment, and when we walked into their bedroom, the three of us could barely squeeze in among all the baby paraphernalia. Along with their queen-sized bed, the room was cluttered with a crib, a co-sleeper, a sleep nest, and a bassinet, all of which they said they bought because everyone told them they absolutely had to have them. My friends worried that if they didn't buy everything everyone had recommended, they wouldn't be properly prepared and their child might suffer. As it turned out, their baby ended up sleeping in their bed with them for the first six months, leaving all of the baby contraptions unused. Now they look back and laugh. Like many other well-meaning first-time parents, my friends had allowed their anxiety to overwhelm them. I have to admit: I was also one of those anxiety-ridden first time dads who fell into the too-much-stuff trap. When my wife and I were preparing for the arrival of our child, it seemed like we were constantly buying new stuff for the baby. In every store we went to, the salesperson would tell us what we needed to buy and then point to a wall of infant items that appeared to reach to the sky. Even though many of the suggested articles seemed to perform the exact same function, we bought them anyway. Our baby's room soon became the most expensive room in the house.
So how can you prevent the too-much-stuff scenario? The following is a list of Newborn Must-Haves. The purpose of this list is not to tell you what kind of crib or bottle to buy, but to make sure that you remember to buy one. These items are the Common Sense Parenting essentials; anything you choose to add to the list is up to you. In the resources section at the end of the book you'll find a handy checklist that you can tear out or photocopy.
Newborn Must-Haves Checklist
___ Crib mattress
___ Mattress pad cover
___ Fitted sheet
Crib: You are soon going to realize that all your baby does is eat, sleep, and poop. And of the three, the one you'll yearn for the most is sleep. It goes without saying that your child needs a place to sleep, but there's no need to give her more than one place to do that. Decide where you would like your infant to sleep, and go with your decision. You may decide that you want to put her crib in your room because it will be easier for you to get to her in the middle of the night when she needs to be fed. You may want her right next to you in a co-sleeper (a small, portable crib that sits next to your bed). Or you may choose to have her sleep in her own room in her own crib from the start. I do feel that routine and repetition are very important, so the sooner you start the routine, the better. Ultimately, if the goal is to have her sleep in her crib and in her own room, the transition will be easiest on both you and her if you start in that location.
Common Sense Bottom Line Select an item for your baby to sleep in and go with it; she will not need three different places to sleep. The earlier she is in her own bed the better.
Mattress: I remember visiting a popular baby store when we were getting ready for our daughter. We were in the mattress aisle overwhelmed by the thirty mattresses leaning up against the wall ranging in price from eighty to eight hundred dollars. We called over a salesperson and asked, "Which mattress do you recommend?" He responded, "We tell our customers to ask their pediatrician." My wife whimsically smacked me on the arm and we started to laugh.
The salesperson asked, "What's so funny?" and I said, "I'm a pediatrician, but I don't remember a course in medical school entitled 'Sealy versus Serta.' "
We ended up basing our decision on common sense (no need to go overboard and buy the most expensive mattress) as well as my pediatric training (a firm mattress reduces the risk of SIDS).
Common Sense Bottom Line Choose a crib mattress that is firm, as it will reduce the risk of SIDS. As for organic versus nonorganic . . . I'll leave that up to you.
___ Car seat
___ Diaper bag
Car seats: Imagine four grown adults hovering around a plastic car seat staring blankly like a bunch of cavemen confronting a television for the first time. I used to say that you had to be a rocket scientist to figure out how to install a car seat until one of my patients, who worked for NASA, threw in the towel. And just like asking for directions, any father would rather spend eight hours trying to install this simple device than ask for help. When we went to buy our first car seat, the car we drove to the store wasn't the car we'd be installing the car seat in. So the staff couldn't help us with the installation. No problem, I thought. I'll just watch as the store manager gives me a quick demonstration and then I'll do it when I get home. After the half-hour demo, I was well-schooled in all the possible ins and outs, dos and don'ts of proper car seat installation. I felt like a pro. I got home, unpacked the box, and went to work. An hour later, after unproductively fiddling around with the thing, I was drenched in sweat. I pulled out the directions and tried to follow them. No luck. I called in the expert: my wife. She reread the instructions and relayed directions to me to no avail. I called the store, and after trying out a couple of their helpful tips, I got in the car, drove back to the store, and had the store manager install the car seat for me. Note to self: when you buy a car seat, drive to the store in the car into which you'll install the car seat.
Common Sense Bottom Line Unless one or both of you is an engineer or car mechanic, go to a car seat installation center at your local police station, fire department, car dealership, or baby supply store and have a pro do it. Then drive home with a smile on your face knowing your child will be sitting safely in a properly installed car seat.
Diaper bag: In the diaper bag make sure to have diapers, wipes, diaper cream, plastic bags for dirty diapers, a changing pad, and a change of clothes. I also recommend that you keep a little bin full of the same supplies on every floor or in every major room of your house so that you can quickly tend to a dirty diaper.
___ Swaddling blanket
Clothing: You are going to buy and receive lots of "cute" outfits for your newborn. These are more for you than for your baby. My daughter had a bigger wardrobe before she was born than I've ever had in my life. She had so many dresses with layers of lace I remember asking my wife how many balls she was planning to attend in the first year of her life. Remember, you are going to be hungry and sleep deprived, and all you'll want to do is change that diaper and go back to sleep. Going through layers of clothing will not help your stress level, so keep it simple.
Common Sense Bottom Line I recommend investing in lots of onesies. My daughter wore them almost exclusively for the first four months. These all-in-one garments are inexpensive, easy to wash, save time for you, are comfortable for your baby . . . and cute!
___ Changing table with a pad/soft rug or mat
___ Gauze/baby wipes
___ Diaper cream
Diapers: You are going to go through so many diapers that you may start having dreams about them. Disposable diapers are inexpensive and simple to use. I recommend buying them in bulk. Some infants go through ten to twelve diapers per day. If you want to go green, you can choose cloth diapers. Keep in mind, however, that while you won't be filling up a landfill with disposable diapers, the overall effect on the environment may be no different if you take into account how much water is involved in washing reusable diapers. The new cloth diapers come with waterproof diaper covers that clip or Velcro close for quick, easy use. Diaper wipes: While some hospitals recommend using small square gauze pads and water as diaper wipes, I think this is a challenging test for new parents. Try and scrape off tarry newborn poop with a tiny gauze pad! I have seen parents use a whole stack for one diaper change. Yes, your child's skin is sensitive; and yes, we do want to decrease the risk of an allergic reaction. But baby wipes are safe and very effective. Choose a wipe that doesn't have a lot of extra additives or fragrances, as this will decrease the risk of irritating your newborn's skin.
Diaper creams: These are used to treat or prevent diaper rash, which every baby will get at some point—even if you are the parent of the year and change every diaper immediately. Diaper creams create a barrier to protect the irritated skin from being re-irritated by the baby's poop and pee, thus allowing the skin to heal. The thicker the cream the better. I recommend using it when you notice a rash rather than as a preventative measure. Why put it on if it's not necessary?
Note: Doctors no longer recommend using talc powders because they can be dangerous for babies to inhale.
___ Infant bathing basin
___ Baby soap and moisturizer
___ Nail file/clippers
Bathing basin: It is very difficult to hold a newborn in a sitting position while you bathe her, especially when she doesn't yet have good head and neck control. I recommend a bathing basin in which your child can lie down. This type of basin has a sling that goes over it like a tight hammock, so the baby lies in the sling and the water seeps through into the basin. This is helpful because your child is not sitting directly in the water, which reduces the risk of drowning.
Baby lotions: Just like baby wipes, baby lotions, shampoos, and soaps are safe. Parents have been using them for decades. You do not have to use them if you do not want to, but they smell good and are safe. Deciding whether to use organic or nonorganic products is a matter of personal preference. In the end, my wife and I used what our parents used on us as babies—good ol' Johnson and Johnson.
Nail files: It seems every newborn has nails like Freddy Krueger, and you'll be surprised at how often they scratch themselves. (Fortunately, a child's facial scratches will heal without scarring, so no need to worry.) Nail files tend to work better than clippers because you don't have to worry about clipping your child's cuticle, which can be painful and bleed. If you do nick her by accident, just place a little Neosporin on the cut and it should heal fine. Some nails even peel off. I recommend nail care while your child is sleeping. A moving target is always more difficult.
___ Infant and children's acetaminophen (Tylenol)
___ Children's diphenhydramine (Benadryl)
___ Electrolyte replacement fluid (Pedialyte)
___ Antigas/colic remedies (Mylicon, Gripe water, Hyland's Colic Tabs)
___ Insect repellant
Medications: I recommend stocking up on essential medications. This will save you a trip in the middle of the night when your child is sick and needs them. I have included a dosing sheet (see page 266) for your convenience, but you should consult with your doctor before using any medication. Some of these medications have a shelf life of up to one year, but check their expiration date prior to using.
• Infant Tylenol Concentrated Drops (generic: acetaminophen) will be helpful if your child has a fever or is in pain. • Children's Benadryl (generic: diphenhydramine) is helpful for allergic reactions. • An electrolyte replacement fluid such as Pedialyte can be used to rehydrate after a vomiting or diarrheal illness. • Colic and gas remedies are not medically proven but are safe and may be helpful. Half of my patients say they are great, while the other half find them useless. Mylicon drops are like Gas-X for babies. Gripe water and Hyland's Colic Tabs are homeopathic mixtures that may be soothing to your child's stomach. Chamomile tea is also a good remedy to try. These remedies can be found at most supermarkets or drugstores and come with a dropper. You can give these to your child several times a day. Follow the package directions for dosing frequency.
Sunscreen lotion: This can be used before six months of age, but it is best to keep your infant out of direct sunlight for the first couple of months. If you do go out in the sun, use a sunscreen with an SPF of at least 30 (most children's sunscreen lotions have at least SPF 50), and apply early and often.
Common Sense Bottom Line Stock your medicine chest with medications for common baby ailments so you'll have them available before you need them.
___ Digital thermometer (rectal and axillary/underarm)
___ Bulb syringe
___ Saline nasal spray
___ Gum/tooth cleansers
___ Hand sanitizer
Thermometers: Do not buy an expensive, fancy thermometer. (If you get one as a gift, return it for a nice credit at the store.) Ear and temporal artery thermometers are expensive but inaccurate. Invest in an inexpensive digital rectal thermometer. These thermometers are accurate and easy to use, and display results in eight to twenty seconds. The accuracy of the thermometer is very important. This is because the difference between 100.3 and 100.4 degrees Fahrenheit in a child under two months of age may be the difference between seeing your doctor in the office or going immediately to the hospital for a battery of unpleasant tests. With infants under two months old, always use a rectal thermometer, as they are the most accurate. Once your child is over two months of age, you can use an axillary (underarm) thermometer. Oral thermometers can be used when your child is five years old.
Pacifiers: I am often asked whether or not to give a baby a pacifier, and, if so, what type. In general, I feel if you can find a way to soothe your child without one, a pacifier is one less thing you'll have to wean them off of in the future. On the other hand, if a pacifier soothes your child, and it gets you a couple of extra hours of sleep or quiet time, then it is probably worthwhile. Although I would not introduce one for this purpose alone, pacifier use while sleeping may decrease the risk of SIDS because it keeps the baby in a more aroused state. So, if she is already using a pacifier, think of it as an added bonus, and don't worry: Just because your infant uses a pacifier doesn't mean she'll still need it when she's three. As for choosing a pacifier: don't waste your money on fancy ones. Your baby won't care if she's sucking on a freebie from the hospital or a hundred-dollar Swarovski crystal model. And when it comes to the touted orthodontic pacifiers, keep in mind that pacifier use does not affect permanent dentition or negatively affect the palate unless used after the age of three.
Common Sense Bottom Line If you can find a way to soothe your baby without a pacifier, you'll have one less thing to wean her off. If you do introduce one, inexpensive is just as good as fancy.
Bulb syringe: In general, newborns sound congested. On top of that, they are going to get a lot of colds in the first few years of life. Since there is no medication that has been proven to successfully relieve cold symptoms in children under the age of four, you may turn to saline drops and bulb suction. However, even if your child sounds like Darth Vader, try to resist the urge to use the suction too often.
Common Sense Bottom Line If you see something in your infant's nose and that something is bothering her, suck it out with a bulb syringe. Otherwise leave it alone. Every time you stick the syringe in her nose, it will irritate the inside lining, causing more swelling and congestion. If it is not bothering her, don't let it bother you.
Hand sanitizer: If you are going to be Type A about anything, then be neurotic about hand washing. Fever and illness will stop both you and your baby in your tracks, so it's not a bad idea to carry hand sanitizer in case there isn't a sink available to wash your hands. Keep anyone overtly sick or coughing and sneezing away from your baby. School-age children, especially toddlers, who are sticking their hands in their mouth or nose, are always brewing something. They don't need to be kissing your newborn.
___ Bottles (4 ounces)
___ Nipples (level one)
___ Breast pump
___ Freezer bags
___ Nursing pads
___ Nursing bra
Bottles and Nipples: Most infants take 2 to 4 ounces every 2 to 4 hours for the first 2 to 4 months of their life. Do not invest in a lot of larger bottles initially; you won't need them. And there's no need to go crazy buying a bunch of different bottle nipples. If milk comes out of the nipple and your child gets it, that's all that matters. Start with a level-one nipple because it mimics the flow of breast milk the best. As your child gets older or if you notice she is getting frustrated with the slow flow, then increase to a faster-flow nipple. My daughter was still happily using a level-one nipple at one year of age. As for sterilization: you may want to sterilize or boil bottles and nipples in hot water prior to the first time you use them, but after that you can safely hand wash them with soap and water or throw them in the dishwasher. You do not have to sterilize bottles or boil them in hot water after each use. After all, do you know of a breast that is sterile? Be realistic . . . but if you want to sterilize, be my guest. Breast pumps: Breast pumps range in price from a couple hundred dollars for the electric kind to less expensive hand pumps. Hospital-grade electric pumps, which are the fastest, may cost as much as four hundred dollars to rent for five months. Consider your time. In the middle of the night when you want to go back to sleep you probably want a fast pump. Although hospital-grade may not be necessary, a hand pump may be tediously slow.
What's Up Doc?— How to Choose a PediatricianOnce you know your due date, it's not too early to start shopping around for a pediatrician. Choosing the right one can be a daunting task. Whoever you select will be the person overseeing the health of your pride and joy for the first twenty-one years of her life. Here are some tips to help you pick the right person for the job.
Where to Start
If you are new to your area, call your local hospital and speak to the nurse in charge of the pediatric ward or the newborn nursery, and ask which pediatricians she recommends. The charge nurse sees these doctors every day and knows how they interact with their patients and the hospital staff. They know who is cranky before their first cup of coffee and who is always smiling. You could also visit a local chat room for new moms. I have found that parents will gladly spread the news, both good and bad, on doctors in the area.
If you know the area, ask friends, family, or your own doctors— especially your obstetrician—for a recommendation. This is one time when lots of outside advice is welcome. Consider the personalities and expectations of the people giving you suggested names. The more you have in common with these folks, the more likely the pediatrician they recommend will be a good match.
Once you have a list of prospective pediatricians, visit their offices and meet with them. Many pediatricians do prenatal interviews. This is a chance for you to get to know the doctor and his philosophies, as well as take a look at the office. Some doctors will meet with you privately, one on one, while others do a more informal group session with several sets of parents. I am a fan of group sessions because they allow you to hear the concerns of other parents as well as questions you may not have thought to ask.
Just as you would never buy a car without doing your homework and test driving it first, you should not only speak to potential doctors but also be knowledgeable about their practices. Remember, this will be a long relationship and you want it to be as comfortable a fit as possible. So consider the following factors.
Inquire as to how far in advance the doctor is booked. This will give you an idea of how hard it may be to get an appointment. The number of doctors in an office, as well as the number of exam rooms, will help you figure out how long you might be stuck in a busy waiting area. There should be at least two exam rooms per doctor. How large is the waiting area? This is where you are going to spend most of your time with your anxious child and other noisy little ones. A waiting room that is large and fun may offset the wait time, compared to a small crowded waiting area. A smaller office, on the other hand, may have a more personal feel.
A young doctor may be more up-to-date on current procedures and treatment options than an older doctor, but will not have the same amount of practical experience. The key is not how old the doctor is, but his willingness to ask for help when it is needed and refer to a specialist if required. You might consider a younger doctor if you want your child to have the same physician throughout childhood, since an older doctor may retire before your child is grown.
Some parents think a girl should have a female doctor and a boy a male doctor. Although this may be true for older children and teenagers who have a hand in picking a new doctor, your pediatrician's gender should not matter if your child has been with that doctor since birth. Your child will grow up with her doctor and her trust in that person will grow as well. What's most important is that you choose someone with whom you feel comfortable.
Common Sense Bottom Line Don't worry about choosing a male doctor for your baby boy or a female doctor for your baby girl; go with the person you feel most comfortable with. Patient-doctor trust will deepen with time.
Board Certification You should make sure that your pediatrician is board certified. You can easily find out by asking the doctor or looking on his business card for the initials F.A.A.P., which stands for Fellow of the American Academy of Pediatrics. You can also go to the American Board of Pediatrics website at www.abp.org. Board certification means that your doctor has kept up to date with the field and taken a test to prove it. Pediatricians need to recertify every ten years by written examination.
Availability Most doctors have standard nine-to-five hours Monday through Friday, but it is important to know whether your prospective pediatrician has office hours on weekends or in the evening, which may save you a trip to the emergency room or urgent care. Most doctors will make themselves available by phone, and many are accessible via e-mail. Ask your physician if he is available by phone or e-mail and how quickly he is able to respond. Also inquire as to the availability of nurses or other support staff for phone consultation.
If there are multiple doctors in a practice, ask if your child will always see her primary physician, or if she will often be seen by others in the practice. Some practices share patients and you see whoever is available, while in other practices you almost always see one doctor. I believe that seeing one primary doctor ensures continuity of care. However, you may need to see other doctors in an emergency or when your child is sick.
Who Is On Call After Hours?
Many practices alternate being on call (answering patient questions after hours) with the other doctors in the office, while some practices share this responsibility with other groups. As a result, you may not know the person to whom you are speaking, and he may not practice medicine in the exact same manner as your doctor. Some offices utilize nursing triage companies that follow a standard protocol book. This tends to be less personal, and studies have shown that more families are sent to the emergency department as a result.
Vaccines, antibiotics, and alternative therapies such as homeopathic or holistic medicine are all issues that may be important to you, so try to find a doctor with a similar philosophy. Some physicians require vaccines be given at the recommended age, while others may allow you to spread them out. Some may offer homeopathic remedies prior to starting antibiotics. Having a similar philosophy about these issues will make office visits more productive. However, it is a good idea that both you and your doctor are open to discussing options and concerns that may veer from a particular medical philosophy.
This may be the most important factor to consider when choosing a pediatrician. Not only do you want your child's doctor to be well-trained and medically knowledgeable, but since your son or daughter will be spending the next eighteen to twenty-one years visiting this person, you'll want to make sure that those visits will be pleasant, relaxed, and educational. Some parents choose pediatricians who can just tell them what is wrong and how to fix it; it doesn't matter to them if their doctor has a personality. But you want to feel that you can talk openly with your child's physician about the health issues that concern you. You should feel comfortable speaking with your pediatrician, and hopefully, when your child is older, she will feel comfortable confiding in that person as well.
Some offices have an in-office lab that can save trips to a local hospital or lab for blood work. If your pediatrician does not have a lab, she may have nurses who are trained to draw blood, which can then be sent off to the lab without you having to make a separate trip. Another service that can be very helpful is an informational website containing handouts on pertinent topics. Your doctor's website can assure you that you're getting information you can trust rather than trying to weed through a Google search.
If the office staff is not friendly and helpful, it can undercut any positive feelings you have for your pediatrician. Receptionists answer the phone when you want to make an appointment for your sick child. The billing staff are the folks you'll speak with if you cannot make a payment or are confused about a specific charge. And the nurses will be giving your child her shots and answering medical questions on the phone. The more comfortable your child feels with the nurses on staff, the more relaxed she will feel during her office visit.
While your infant will not be as aware of the office environment as an older child, as she grows she will appreciate the kid friendliness of the pediatrician's office. Many children refer to their doctor's office as the "shot place," but the more comfortable and fun the office is, the less anxious your child will feel. You may want to ask if there are separate entrances and waiting areas for sick and well visits, so that your healthy newborn isn't sitting next to a toddler who is coughing and sneezing. How close and easy it is to park is also an important consideration when transporting your infant back and forth to the doctors.
It is incumbent upon you, the patient, to discuss your financial responsibility with a potential doctor's office. Find out what insurances the doctor accepts and if he is in your insurance's network. If your pediatrician does not take your insurance, you are considered out of network and you may have to pay in full at the time of each visit. Your newborn is on either Mom's or Dad's insurance policy for only thirty days after delivery. Make sure you call your insurance company to place your child permanently on your plan or their own plan within those thirty days. This will ensure that your child is covered without the need for underwriting. And also make sure to verify her benefits so you are not surprised when the bill comes.
It is important that your doctor has admitting privileges at the hospital at which you are delivering because he can see his patients there and write orders on how to treat them. He will be able to see your baby every day and is responsible for writing orders and discharging your newborn. If your child has to be hospitalized later in life, your pediatrician can take care of her in the hospital with which he is affiliated. If your pediatrician does not have privileges at the hospital where you are delivering, ask the hospital or your obstetrician whom he recommends to see your child in the interim.
As a child, I always dreaded waiting in the cold exam room for a half hour, naked except for that strange paper gown that never seemed to fit. You may think that a doctor who sees his patients on time is unheard of, but it's not inappropriate to ask about a pediatrician's punctuality. Doctors expect you to show up on time, so it is okay to expect the same from them (with a little leeway for emergencies).
How to Use the Following Checklist
Now that you know what to look for in a pediatric practice, use the following checklist when you speak to a prospective doctor on the phone or at a prenatal visit. Before you speak with him, sit down at home and rate the following categories from 1 (not important) to 5 (very important). Make a copy of your rated form for each pediatrician you are planning to visit. Write the doctor's name on the top of the page and take it with you to your meeting. As you learn about the office, place a check mark on the line to the left of the rating scale if the office fits that particular criterion. When you get home, look at your check marks and see if they correspond to characteristics that you feel are most important. If so, you have found your match. If not, keep searching.
Daddy vs. Doctor—Choosing a Pediatrician
During my wife's pregnancy, friends and relatives told her, "You're so lucky to have a pediatrician at home! You don't have to go through the search for a good one." But I knew that it's not the standard procedure for a physician to treat his own child, that it would be too difficult to separate my emotional attachment from what might be medically best for her. Still, I had to admit that it was going to be hard for me to relinquish control to another doctor, especially when it came to my own child. I planned to have my medical kit by the bedside so I could exam our daughter immediately after delivery.
When we started the process of selecting a pediatrician, we had the following requirements: My wife wanted someone who was warm and receptive. As a first-time parent, she didn't want to feel uncomfortable asking "stupid questions." Even though I'm a pediatrician, I wanted someone who could give my wife and me a perspective different from my own, which tends toward the more relaxed end of the scale. That way we could both rest reassured that Aubrey was getting the very best attention.
Equally as important to us was the doctor's medical training. We were thrilled to find someone who had trained at a children's hospital. In the unfortunate event of having a baby who was seriously ill, we wanted someone who had extensive experience in managing all types of scenarios.
We also wanted someone who had enough time to sit and talk with us and not make us feel that we were being rushed through appointments. And we decided that we wanted someone who was young enough so that Aubrey could have the same doctor throughout her childhood.
We chose a young, female pediatrician whose warm personality and medical expertise was just what the doctor and his wife ordered.
After Aubrey was born, the stethoscope that I had packed in my duffel bag and brought along to the delivery room was never unpacked. I had no urge to examine her, nor did I think of her as my patient. I trusted the qualified person we had chosen as our daughter's doctor. As for me, I needed—and wanted—to focus on what was most important: being Aubrey's daddy.
What's in the Fridge?— Umbilical Cord Blood Banking
Another decision you'll be confronted with prior to delivery is whether or not to bank your child's umbilical cord blood. You are going to be inundated with mailings and brochures from companies that will offer to store the cord for a "nominal" fee. One father even asked me if he could just keep his baby's umbilical cord in his own refrigerator at home. Obviously, this is not recommended, but we should discuss the reasons why you may want to bank your child's umbilical cord blood.
The idea behind cord blood banking is to keep your newborn's healthy stem cells in case they're needed later for transplantation— that is, to replace bad cells, such as cancer cells. Although this idea may seem cut and dry, there is more to the story. Cord blood bank brochures list hundreds of illnesses for which this procedure can be curative, and yet there is the slimmest of chances that you will be able to use the banked stem cells for your child. Let me explain why.
When a child develops a malignancy such as leukemia, or a rare metabolic or autoimmune disorder, doctors usually look to irradiate the bad cells and replace them with healthy new stem cells. These stem cells can be from bone marrow or cord blood. These stem cells are often acquired from an allogenec donor— that is, from another individual. It is important that the donor's stem cells are as close a match to the recipient's as possible to minimize the potentially fatal risk of the recipient rejecting the donor's cells. Since a perfect match is your best bet for a successful transplant, it makes sense to use your own stem cells. Sounds simple, right? It's not. In fact, if your child came down with an illness such as leukemia, and you had saved her cord blood, the stem cells from that cord blood likely would not be used, because, most often, the condition already existed in the infant's cord blood. So the doctor would need to look for an outside donor for the stem cell transplant.
There is the possibility that with new technological advances there will be more applications for the use of cord blood. For example, using it to generate new organs or tissues. Extensive research is currently looking into the benefits of cord blood used in this way.
At the moment, however, cord blood banking is a double-edged sword. If you bank your child's cord blood and never use it, you have wasted money but possibly gained peace of mind. If you do not bank your child's blood and could have used it, you might regret it. So how should you decide what to do?
My wife is someone who loves insurance policies. We joke that if a salesperson came to our door and offered us insurance in case of the one-in-a-million chance of being struck by lightning, she would buy it. Still, when we were pregnant we were offered cord blood banking for a much-discounted rate and chose not to do so. My wife and I reasoned that, unlike most insurance, we were not likely to be able to use it in the future. We also felt that the cord blood banking companies were preying on our fears at a vulnerable time.
So, while the chances are that your child will not be able to use her own cord blood in the future, there are a few situations in which you might consider utilizing a cord blood bank:
1. If you have a family member with a known genetic or malignant medical condition that could potentially benefit from cord blood transplantation.
2. If you are someone who is going to stay up at night worrying about the slim possibility of your child being affected by an illness that may benefit from transplanting her own stem cells—and money is not an issue. If you fit into either of these categories and choose to use a private cord blood bank, make sure the company has an institutional review-board-approved protocol with signed informed consent, and that it complies with national accreditation standards developed by the Foundation for Accreditation of Cellular Therapy (FACT), the U.S. Food and Drug Administration (FDA), and the Federal Trade Commission (FTC), as well as similar state agencies. You should also know that there are two types of cord blood banks: private and public. Private banks are private companies that you pay to bank your child's cord blood for the sole use by your child or someone you designate it to. These banks charge a collection fee as well as a monthly or yearly holding fee. Public banks, on the other hand, bank cord blood for anyone's use, free of charge. This is similar to a blood bank. A donation to a public cord bank is a gift of life to someone who can really use it.
Common Sense Bottom Line
Cord blood banking companies are asking you to buy insurance that you will likely not need. The chances of your child needing her own cord blood stem cells range from one in one thousand to one in two hundred thousand.* And there is no evidence of the safety of such stem cell transplantations. My recommendation is that you decline the offer to store your child's cord blood in a private bank unless you fall into one of the two categories listed above. If you want your baby's stem cells to potentially help someone else, store them in a public bank.
It's Time!—The Hospital and What to BringNow that you've used your Common Sense Parenting smarts to get ready for the big day, think about the hospital where your newborn will arrive. Does your pediatrician have privileges at the hospital you've chosen? Does your hospital have a neonatal intensive care unit and pediatricians on staff who are available in case of emergency? These are some of the questions my wife and I had before our daughter was born. We didn't want to be in a situation where we had to be transported to another hospital for a specialist, rather than having everything at our disposal under one roof. Luckily, both our obstetrician and pediatrician had privileges at a hospital that fit these requirements, which alleviated a lot of our anxiety.
Whatever questions you might have at this point, the more you have answered prior to delivery the more empowered and less anxious you will feel. So make a list of questions that are still of concern to you, and find out the answers. As you look forward to B-day, here are my suggestions for making sure you're ready:
• Take an infant CPR class. You should be able to find one at your local hospital. When you know what to do in case of an emergency, you'll feel more confident and empowered.
• Take a tour of the hospital. Be familiar with the labor and delivery rooms and where you are supposed to check in. Visit the newborn nursery, the rooms where you are going to stay, and where your baby is going to be taken for testing after delivery.
• Do a mock run. Drive from your home to the hospital along the route you plan on taking and know alternate routes in case of traffic or an emergency. Walk the exact route you plan on taking from the parking lot to the admission station. If possible, fill out a preadmit form so that you do not have to fill out paperwork when you are admitted. This is the last thing you want to be doing when you are in labor.
• Pack your bags and place them in the car ahead of time. Think of your hospital stay as a mini vacation. If you have trouble sleeping in another bed without your favorite pillow or blanket, bring it. You are going to be at the hospital up to two days for a vaginal delivery and up to four days for a cesarean section. Pack accordingly. To your surprise, you may even have several hours of downtime during labor. If you enjoy listening to music on your iPod, browsing the Internet on your laptop, or reading a magazine, then pack them. Don't forget your toiletry bag, several changes of clothes and pajamas, as well as comfortable shoes or slippers. Bring an outfit and blanket that you want to put your child in for the ride home. Ask what the hospital supplies; many hospitals have diapers, onesies, swaddling blankets, hats, shampoo, soap, digital thermometers, bulb suction, and a plastic bathing basin that they will give to you to keep. Don't forget your camera and video camera. Charge the batteries and bring extra ones. This moment only happens once, and you don't want to miss it.
• Make sure your car seat is properly installed. You won't be allowed to leave the hospital without it.
• And finally . . . relax. Enjoy the anticipation! You're about to have a baby!
*AAP Policy Statement, "Cord Blood Banking for Potential Future Transplantation,"
Pediatrics 119, no. 1 (January 2007): 165–70.