When the first contraction signals that your baby is on the way, the decisions you will have to make as a couple come thick and fast. Prior to that busy time, and while it's still just the two of you, you'll be gathering information and sharing your views on all kinds of topics from breast-feeding to sleeping arrangements. Along with learning the basics of baby care, answer these six questions together before B-day.
1. What should be in our birth plan and newborn-care plan?
A birth plan, written by you and your partner, describes how you want your labour and delivery to proceed -- insofar as you have control over these events. Your doctor, midwife or doula can explain which options are open to you and can help you prepare your plan. This is a good topic for your prenatal class, where other expectant parents as well as the instructor may have lots of ideas. The plan can be as simple or as detailed as you like. It should cover the medications you want or don't want, your preferences about moving around during labour, the roles your partner and support person will play and what medical intervention you would prefer.
A newborn-care plan should cover your wishes for how your infant will be treated while in the hospital, whether he will stay with you immediately after the birth and whether he'll be allowed sugar water while in the hospital nursery. Discuss your plans with your family physician or midwife and take into consideration your hospital's restrictions for birthing rooms. Even though you should be prepared to accept changes as you move through the experience, the process of working through these plans ahead of time make it much more likely that they'll occur as planned.
2. What do newborns look like?
It's not uncommon for parents to think their newborn baby looks perfect in every respect. Yet most newborns show obvious signs of the laborious journey through the birth canal. Typically, a baby born vaginally will have a large pointed head, puffy eyes and a flattened nose. She may have a full head of hair or she may be bald. She may be covered in a white, creamy protective coating, called vernix, and in fine body hair, called lanugo. Newborns often have swollen genitals and breasts. Their nipples may secrete a white or pink fluid, and girls may have some vaginal secretions. Babies born by caesarean section will look less the worse for wear.
You may wonder why every other baby in the hospital nursery is so odd looking compared to your little beauty. But chances are a few years down the road when you're looking at her birth photos, you'll be surprised to see how obvious are the marks of birthing to which you had previously been blind.
3. Should we bank the umbilical cord blood?
Because the umbilical cord blood contains a high concentration of stem cells (the basic units in the bone marrow responsible for producing all red cells, white cells and platelets), it provides a perfect match for a bone marrow transplant should the baby need it in the future. It is also more likely to provide a good match for siblings with a blood-related illness, such as childhood leukemia (one child in 1,000), or parents with another life-threatening disease. Also, because the stem cells have not yet built up antibodies, they are more compatible with a greater number of unrelated people in need of cell transplants.
However, the usefulness of cord blood is still under discussion in the medical community. Some recent studies, performed largely on related donors and recipients, have discovered that cord-blood transplants are less likely to "take" than bone-marrow transplants. Also, while both methods produce roughly the same survival rates in the long term, studies show cord-blood transplants result in more early deaths. But on the positive side, researchers have found using cord blood greatly reduces the risk of graft-versus-host disease (a potentially fatal complication, in which the donated tissue attacks the new host's body).
Once you've made the decision to collect your newborn's umbilical cord blood, you might consider either donating it to a public cord-blood bank or storing it for your child's or a family member's future use. The process of collecting the blood involves no risk or pain to mother or baby, since it's collected within 24 hours of the birth from the clamped umbilical cord that remains with the placenta. However, expectant parents who are interested in the options should obtain information and counselling early enough in the pregnancy to make arrangements for testing and for the collection and storage of the blood.
The procedure has been adopted in several centres in Canada and the United States. The Alberta Cord Blood Bank, associated with the University of Alberta in Edmonton, is a public resource that accepts cord-blood donations from hospitals across the country and makes it available to the general public. You can visit their website at www.acbb.ca or call 780-492-2673.
Other private programs for collecting and storing this blood have begun in Vancouver and Toronto, offering parents a once-in-a-lifetime opportunity to store the blood collected from their newborns for future use. Although Canadian health organizations have yet to form official policy on the collection of umbilical cord blood, other organizations around the world, such as the Royal College of Obstetricians and Gynecologists in the United Kingdom, warn that private cord-blood banks may be preying on parents' fears. But families with high incidence of diseases such as cancer may feel it is valuable insurance.
The Toronto Cord Blood Program (TCBP) at Mount Sinai Hospital (the phone number is 416-586-8818) accepts referrals from Ontario residents only. It operates on a cost-recovery basis charging fees to collect the cord blood ($600) and subsequent annual fees ($100) to store it. Your own hospital should be able to provide you with information about these programs or others that might become available in your area. Make sure to ask lots of questions and get information from a variety of sources. For example, according to the TCBP, blood can only be stored for 10 years with current technology, but Lifebank (a private cord-blood bank with offices in Vancouver and Toronto) stores cells for up to 15 years.
Either way, researchers believe the real potential of this procedure lies in the ability to use cord-blood cells in unrelated donor and recipient transplants. Depositing cord blood into a public bank allows further study, but using a private collector ensures the availability of the sample for future use by your family.
4. Diapers: Disposable or Cloth?
Fortunately, this is a decision that can be changed as easily asâ€¦a diaper.
• require less frequent changing
• "green bin" programs (now operating in some Canadian cities) collect soiled disposables to make into high-quality compost for parks and farms
• much cheaper (even with the cost of
• environmentally friendly
Other things to consider
• It's illegal to dispose of human feces in landfills, so discard any solid waste in the toilet before throwing the diaper out in the regular garbage.
• If your community has a cloth-diaper service, you can hire it to pick up, launder and deliver on a weekly basis.
• There's no reason why you can't use both: cloth at home; disposables away.
5. Should we have our newborn son circumcised?
Some choose to circumcise for religious reasons; others so that the boy's genitals will be the same as his father's. But the Canadian Paediatric Society states that there is no medical reason to circumcise a baby and several provinces no longer cover circumcision under their medical insurance plans.
Circumcisions are generally performed without anesthetic because there is no general or local anesthetic safe enough to give to newborns and because, up until recently, the medical profession believed that newborns didn't feel much pain or that they wouldn't remember pain. Using the data from three separate studies, researchers from The Hospital for Sick Children in Toronto analysed records on vaccinations given to 87 infants between the ages of four and six months. The results of the study, published in February 1997, found that male babies who had been circumcised reacted to the pain of the vaccination to a greater degree than did the female babies or the male babies who had not been circumcised. Another related study concluded with a recommendation that, during the circumcision procedure, a topical anesthetic be used to provide adequate pain control. Circumcision does pose some risks: infection, hemorrhaging and improper healing affect from two to 10 per cent of circumcised newborns.
6. What Maternity Leave and Parental Leave is available to us?
You will want to learn as much as you can about the options available in taking leave from work to care for your newborn. To find out which standards apply to you, you might check first with your employer's human resources department, then with the Ministry of Labour or its equivalent in your province or territory. Minimum provincial employment standards regarding leaves of absence and job protection vary from province to territory.
At the federal level, the government pays mothers on maternity leave through Employment Insurance. If a pregnant woman has been employed for at least
600 hours in the last 52 weeks before she gives birth, then she is entitled to 15 weeks of maternity leave (which includes a two-week unpaid waiting period). The benefits equal 55 per cent of the individual's earnings over a certain number of weeks up to a maximum of $413 per week in 2003.
Employment Insurance also entitles either parent (adoptive parents are included) to 35 weeks of paid parental leave. The parental leave benefits can be claimed by one parent or divided between them but it must be taken within one year of the child's birth or adoption.
Sickness benefits are also available for pregnant women unable to work due to a pregnancy-related or other health problem. These benefits, which are in addition to maternity and parental, can be claimed to a maximum of 15 weeks.
Information about these benefits is available at any Canada Employment Centre or Human Resources Development Canada office. Check the Government Blue Pages of your phone book.
Some family-friendly corporations or employers may offer benefits beyond the money and job protection offered by federal and provincial governments. You might be able to negotiate an extended leave with your employer to stretch your time at home with baby. One partner might be able to secure a leave of absence to start when the other's parental leave ends. Some couples save up vacation time and tack it on to their leave.
Excerpted and updated from Growing With Your Child, A Canadian Living Family Book (Ballantine, 1998), edited by Family editor Christine Langlois.