A few observations on cord clamping, jaundice, and infant imprisonment
This is not the story of my daughter's birth. To understand that story, you must have a child of your own. One moment, there are x people in the room. The next moment, there are x+1 people in the room, the +1 being an amphibious creature that just fell out of the rain spout and suddenly is yours. Nothing could have prepared me for that surprise, and it gave me a fit of laughter.
But back to the topic at hand, a few observations. First, when is the best time to cut the umbilical cord? After reading quite a bit about this (here's my favorite source of sources), I don't have an extremely strong opinion. I appreciate that the doctor gave me the freedom to decide when to cut. I waited about a minute. One possible reason to not wait too long is that getting too much blood into the baby can contribute to jaundice. More on that in a moment.
Within 24 hours after the birth, various doctors and nurses had poked and prodded and measured our baby several times. The data was good, and our baby was doing great. 'Let's go home today,' we said. 'Not so fast,' they said. 'Your baby is our patient. We won't discharge her for at least another day.'
And that was that. Our baby was quite literally imprisoned in Magee Womens Hospital in Pittsburgh for the next 24+ hours. If we had tried to simply walk out with our baby, a security alarm would have gone off, the doors would have all locked, and we would have been treated as criminals, just like Douglas Kennedy.
The imprisonment of my baby angered me quite a lot. To be fair, our prison was not as uncomfortable as some other prisons, but a prison is a prison. We all would have been happier and less stressed out if we at least had the option to go back to our comfortable home. I dream of living in a free country someday.
Freedom is a rather lofty and abstract goal. Returning to earth, let's keep talking about the medical system. Before releasing us from prison, the doctors required us to schedule an appointment with a pediatrician for the very next day. Baby's bilirubin levels were slightly high, around 12 mg/dl. Doctors worry about bilirubin because of some association (correlation, not necessarily causation) between bilirubin and a potentially severe form of brain damage called Kernicterus.
But Kernicterus is extremely rare; according to this article, perhaps only about 5 in 100000 babies were afflicted even before doctors started paying attention to the connection to bilirubin. To put this in perspective, the chance that your baby will die in its first year from all causes combined is something like 680 in 100000 (i.e., 6.8 out of 1000).
By the fourth daily test (our third post-hospital visit to the doctor), our baby's bilirubin had stabilized at about 16 mg/dl, making her slightly jaundiced. Jaundice is common, or even normal: 60% of full term babies are said to have jaundice. Given this prevalence, common sense might hint that there is some neonatal benefit in having a slight bilirubin excess. Indeed, bilirubin has recently been demonstrated to have extreme antioxidative effects. I concur with this guy's suggestion that otherwise-healthy babies should not receive special attention before the bilirubin level crosses about 25 mg/dl. By contrast, the American Academy of Pediatrics starts shitting its pants about possible lawsuits at about 17 mg/dl (see figure 2), which happens for about 5% of babies.
These experiences -- the imprisonment and the excessive monitoring and testing -- point to at least one sad truth: The medical system has become too concerned with minimizing the risk of extremely rare worst-case scenarios. That might sound weird -- how can someone be too concerned? The problem is that life is not black and white. People are alive in varying degrees. The person is more alive who is more engaged with his family, more energized to follow her curiosity, and more free to make his own decisions. The hyperactivity of the medical system is a tax in every sense -- on family time, energy, and finances. When doctors becomes too concerned about unlikely bad events, it is in these subtle ways that the medical system quite literally subtracts from our lives.
But back to the topic at hand, a few observations. First, when is the best time to cut the umbilical cord? After reading quite a bit about this (here's my favorite source of sources), I don't have an extremely strong opinion. I appreciate that the doctor gave me the freedom to decide when to cut. I waited about a minute. One possible reason to not wait too long is that getting too much blood into the baby can contribute to jaundice. More on that in a moment.
Within 24 hours after the birth, various doctors and nurses had poked and prodded and measured our baby several times. The data was good, and our baby was doing great. 'Let's go home today,' we said. 'Not so fast,' they said. 'Your baby is our patient. We won't discharge her for at least another day.'
And that was that. Our baby was quite literally imprisoned in Magee Womens Hospital in Pittsburgh for the next 24+ hours. If we had tried to simply walk out with our baby, a security alarm would have gone off, the doors would have all locked, and we would have been treated as criminals, just like Douglas Kennedy.
The imprisonment of my baby angered me quite a lot. To be fair, our prison was not as uncomfortable as some other prisons, but a prison is a prison. We all would have been happier and less stressed out if we at least had the option to go back to our comfortable home. I dream of living in a free country someday.
Freedom is a rather lofty and abstract goal. Returning to earth, let's keep talking about the medical system. Before releasing us from prison, the doctors required us to schedule an appointment with a pediatrician for the very next day. Baby's bilirubin levels were slightly high, around 12 mg/dl. Doctors worry about bilirubin because of some association (correlation, not necessarily causation) between bilirubin and a potentially severe form of brain damage called Kernicterus.
But Kernicterus is extremely rare; according to this article, perhaps only about 5 in 100000 babies were afflicted even before doctors started paying attention to the connection to bilirubin. To put this in perspective, the chance that your baby will die in its first year from all causes combined is something like 680 in 100000 (i.e., 6.8 out of 1000).
By the fourth daily test (our third post-hospital visit to the doctor), our baby's bilirubin had stabilized at about 16 mg/dl, making her slightly jaundiced. Jaundice is common, or even normal: 60% of full term babies are said to have jaundice. Given this prevalence, common sense might hint that there is some neonatal benefit in having a slight bilirubin excess. Indeed, bilirubin has recently been demonstrated to have extreme antioxidative effects. I concur with this guy's suggestion that otherwise-healthy babies should not receive special attention before the bilirubin level crosses about 25 mg/dl. By contrast, the American Academy of Pediatrics starts shitting its pants about possible lawsuits at about 17 mg/dl (see figure 2), which happens for about 5% of babies.
These experiences -- the imprisonment and the excessive monitoring and testing -- point to at least one sad truth: The medical system has become too concerned with minimizing the risk of extremely rare worst-case scenarios. That might sound weird -- how can someone be too concerned? The problem is that life is not black and white. People are alive in varying degrees. The person is more alive who is more engaged with his family, more energized to follow her curiosity, and more free to make his own decisions. The hyperactivity of the medical system is a tax in every sense -- on family time, energy, and finances. When doctors becomes too concerned about unlikely bad events, it is in these subtle ways that the medical system quite literally subtracts from our lives.
posted by My Freakwentness at 5:50 PM
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