Lamaze International's Sixth Healthy Birth Practice - Keep Mother and Baby Together, It's Best for Mother, Baby, and Breastfeeding recognizes the evidenced-based practice of immediate skin-to-skin for the new dyad after birth. Both newborns and their parents receive benefits from spending the immediate postpartum time together.

Babies benefit from skin-to-skin

Babies benefit from being placed directly on the birth parent's chest after birth and remaining there. This placement helps stabilize respiration and heart rate, lowers stress hormones and supports breastfeeding initiation. Additionally, thermoregulation occurs more effectively and blood glucose levels are able to reach normal levels and be maintained there more easily.

Parents benefit from skin-to-skin

The birthing parent benefits by being able to initiate and support early breastfeeding, and having the release of oxytocin postpartum helps the uterus to contract and minimize postpartum bleeding. There is also the significant impact on bonding that occurs for both the baby and the birthing parent. Additionally, it is recognized that the non-birthing parent also benefits from skin-to-skin time in the early days.

Hypoglycemic newborns

There are certain circumstances that may necessitate close monitoring of the newborn's blood glucose levels and puts the babies more at risk for hypoglycemia. Large or small for gestational age babies (LGA or SGA) are more likely to be hypoglycemic as well as late-term premature babies or those born to an obese parent. If the pregnant person had Type 1 or 2 diabetes or was diagnosed with gestational diabetes during pregnancy, the baby's blood glucose will also require vigilance to ensure a stable transition after birth.

If the newborn's blood glucose levels indicate the need for additional support to stabilize after a breastfeeding session fails to do so, it is often recommended that the baby be removed to the special care nursery or neonatal intensive care unit for further monitoring and treatment, including the admission of formula or even intravenous fluids. This may mean that the birthing parent joins their baby in a hospital unit that does not support privacy, new parent comfort or recovery. At times, the new parent may not be able to accompany their baby right away but must wait until their own physical condition stabilizes post birth.

This separation and treatment can be stressful to both the newborn and the parents, detrimental to early bonding and interfere with initiating breastfeeding and exclusive breastfeeding after hospital discharge. There are also increased costs when babies need to be admitted to the NICU that could be avoided by stabilizing blood sugars while the baby remains in-room with the parents.

An alternative to the NICU

A study published in Krager Biomedicine Hub, Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia, indicates that newborns who need additional glucose supplementation are able to achieve stable blood glucose levels with the administration of oral dextrose gel during feeds. This reduces the need for the baby to be transferred to the NICU for dextrose. The glucose gel helps keep at-risk babies with their parents and supports early breastfeeding, bonding, and dyad stabilization.

How was the study conducted

This randomized, double-blind, placebo-controlled study looked at 230 newborns who required treatment for hypoglycemia. 115 hypoglycemic infants were given up to three doses of 40% dextrose gel administered buccally (to the cheek) over a 48 hour period in addition to breastfeeding, drinking expressed breastmilk or formula. The other 115 study participants were just breastfed or provided expressed breastmilk or formula. If the baby's blood glucose level did not stabilize and they needed to be transferred to the NICU for IV dextrose, this was considered a "treatment failure".

Please click on the above image to see a video of the placement of the dextrose gel in the buccal cavity an infant.

Study results

The number of infants requiring transfer to the NICU for IV dextrose therapy significantly decreased with the implementation of the new protocol for administering dextrose gel along with feedings to hypoglycemic infants. 26% of infants with the oral dextrose gel needed a transfer for IV dextrose and 42% of infants without the dextrose gel required a transfer. The exclusive breastfeeding rates at hospital discharge improved after the introduction of the dextrose gel protocol.

The infants who were most likely to "fail" the oral dextrose gel therapy and require a NICU admit and IV dextrose therapy were LGA, more likely to have been born by cesarean section and had overall lower blood glucose levels.

Conclusion

Persistent low blood sugar can be a dangerous condition for a newborn and require treatment to prevent additional and more severe complications. Keeping a parent-baby dyad together is good for both babies and parents, reducing stress, increasing exclusive breastfeeding, stabilizing newborn temperatures, heart rates, and respiratory rates. The ability to stabilize blood glucose levels in hypoglycemia newborns with the administration of oral dextrose to the baby, while keeping parents and babies together and promoting birth recovery can improve outcomes such as higher exclusive breastfeeding rates at discharge and reduced costs with fewer NICU admits.

What can a birth professional do

Childbirth educators, doulas, and others can share this study with students and clients. Families can learn that during the newborn transition and the first hours of postpartum recovery, if their baby should be diagnosed with hypoglycemia, this protocol might keep parent and baby together, stabilize newborn glucose levels and prevent a costly and stressful NICU admission. They can discuss this protocol with their health care providers to see if it is an option for their families if needed. Additionally, I do share that there may be benefits to expressing, collecting and storing colostrum prior to birth to have on hand as well should their baby require treatment for low blood sugar. They can also inquire prenatally if their baby may benefit from having this on hand, especially if they have been diagnosed with gestational diabetes. Take a look at the study yourself and consider this when covering these topics with the families you work with. There is also a consumer friendly press release that covers this information as well.

References

Rawat, M., Chandrasekharan, P., Turkovich, S., Barclay, N., Perry, K., Schroeder, E., ... & Lakshminrusimha, S. (2016). Oral Dextrose Gel Reduces the Need for Intravenous Dextrose Therapy in Neonatal Hypoglycemia.Biomedicine Hub, 1(3), 1-9.

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