At Cambridge Health Alliance, Delaying Baby’s Bath Improves Baby’s Health

Imagine you're a newborn, contentedly relaxing in a dark and warm place, bathed in amniotic fluid, when suddenly - BAM! - you're out in the world, surrounded by strange people, who are smiling and cooing at you but who are, nonetheless, very, very strange.

"It's the greatest adventure of their lives," says Cheryl McInerney, R.N., IBCLC, a lactation consultant at Cambridge Health Alliance. "And it's very stressful."

Now McInerney and CHA's Newborn Nursery Hospitalist Anita Gupta, M.D., IBCLC have helped introduce a new post-birth practice that not only has reduced the shock of childbirth for all involved but has reduced the rate of hypoglycemia (low blood sugar) in newborns by almost 50% since April 1, 2013.

The new step is relatively simple: Cambridge Health Alliance waits 12 hours after birth for the baby's first bath, choosing instead to place the newborn with mother, skin to skin, to ease the transition from womb to world.

Gupta says that certain newborns - those born to diabetic mothers, big babies over 8 pounds 13 ounces, and smaller-than-average babies - are at greater risk for hypoglycemia. Babies expend a lot of energy being born, and expending energy means burning sugar. 
Babies drop their blood sugar in the first two hours after birth and normally stabilize or increase it by six hours after birth.  For certain at-risk babies, the initial sugar drop can be dangerous. CHA is intent in removing as much stress out of the baby's first hours in the world to prevent the levels from dropping even further.

"We check blood sugar levels in the first hour after birth," says Gupta, "and then we continue to encourage babies to breast feed, after which we check their levels again."

But unlike the common practices performed in many hospital nurseries across the U.S., Cambridge Health Alliance performs all newborn tests and procedures in the mother's room. For instance, the state mandates that all newborns receive a shot of Vitamin K to assist blood in clotting and erythromycin eye ointment to prevent infection. At many hospitals, the baby is immediately brought to the nursery, tested, scrubbed, and brought back to the parents.

"Why?" says McInerney. "Why do we have to do all of this right away? Why not leave baby with mom?"

Gupta says there's no clinical reason to bathe babies immediately and remove the lotion-like fluid that has protected them from wrinkling as they lay immersed in amniotic fluid. The baby is merely dried at CHA to keep it warm, and flecks of substances may be removed from its hair; but Gupta and McInerney believe keeping the baby in close contact with the mother as opposed to separating them for bathing is the new best practice.  And their data backs them up.

The percentage of newborns experiencing hypoglycemia, which was 12.6% from December 2012 to March 2013, dropped to 6.5% from April to July 2013. "There were no other interventions aside from what we did with delaying the bath," Gupta says.  "The results were dramatic."

When the baby is eventually bathed, it's a joyful experience for all involved, McInerney says. The mother is rested; the baby has begun to get it bearings; even the caregivers aren't rushing to conduct a bathing before their shift ends. (CHA will not delay a bathing if the mother has hepatitis B or C, HIV, or MRSA; there's a threat that the virus could be transmitted to caregivers.)

Plus, keeping baby with mom right after birth allows breastfeeding to occur earlier. Under a Joint Commission National Quality Forum-endorsed voluntary practice standard, hospitals are encouraged to promote exclusive breastfeeding during the newborn's entire hospitalization. The Joint Commission notes, "Exclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG)."

A 2010 study by CHA's Dr. Melissa Bartick estimated that encouraging exclusive breastfeeding could lead to the reduction of 10 pediatric diseases, and save the U.S. healthcare system $13 billion a year.

"When we explain to moms, 'We're going to delay bathing your baby for 12 hours and here's the reasons why,' they really embrace it," McInerney says.

Gupta adds that the CHA team has presented their finding to other Massachusetts hospitals and they've also begun to embrace the new practice.

She adds, "It doesn't cost money. It saves money. It clearly improves clinical outcomes, and it's good for the patient - baby and mother.  What's not to like?"