The recent discussions regarding first baths and cold babies prompt me to
share what we do at our facility. I'll try to be brief.
We are a level 1 nursery, meaning we typically have healthy moms and babies
that do not need special care. Virtually all of our babies go directly to
mom's chest as they are delivered, the cord is clamped and support person
or mom cuts the cord. Some docs wait until pulsation stops, others do not.
But only 1 rushes through this process and sometimes forgets and cuts the
cord himself (he's new, we're working on him).
At any rate, it is our policy that Dad or support person (or mom) is
offered/encouraged to do first bath. This bath is done AFTER parents have
had ample opportunity to hold, breastfeed, bond with baby and is according
to their time table, not ours. The baby's head is washed by the sink but
the "sponge" bath is done under the warmer at mom's bedside so that she is
involved. This is a part of our teaching, we talk the father through the
bath and discuss general baby care such as how often to bathe, the reason
for cord care, the importance of NOT scrubbing off the vernix. At least
this is my talk and that of many of the nurses on our staff. There are
always 1 or 2 who resist a new approach, but when the majority of the
nurses are doing it this way it's easier to influence change in the
holdouts.
When I am the nurse, every baby goes from the bath experience to mom's
breast or dad's arms (or chest, I like to show dads how they can experience
the same incredible bonding experience as mom does with breastfeeding). I
explain to the parents that baby's temp will typically drop after a bath
and the warmth of another person is far more effective in maintaining or
elevating a baby's temp than even the warmer. If the baby is not skin:skin
with one of the parents it is wrapped in at least 2 blankets and held
closely to an adults body, I never put them in an open crib or leave them
lying in the warmer and can honestly say I've never had a baby who's temp
was <97 at even 15 minutes after the bath. For any of you unaware, normal
temp is considered 97-99.
If we have a baby who is compromised in any way (ie: meconium aspiration,
resp distress, etc) it goes without saying that the bath is delayed until
baby is stable, and breastfeeding takes precedence over first bath.
As someone already mentioned, there is no problem with universal
precautions if the nurse keeps her hands off the baby or wears gloves on
those RARE occasions when it is NECESSARY to touch the baby. I constantly
remind parents that the baby is theirs, not ours, and to challenge any
nurse who tries to remove the baby from them for any reason.
Sorry for being so long with this.
Mary A. Banaszewski, RN, Lactation Specialist