Umbilical Cord Nonseverance and Adverse Neonatal Outcomes

Risks of Infectious Diseases in Newborns Exposed to Alternative Perinatal Practices

The purpose of this report is to educate providers about the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices. This report will provide information pediatricians may use to counsel families before birth and to appropriately evaluate and treat neonates who have been exposed to these practices.

The Term Newborn: Alternative Birth Practices, Refusal, and Therapeutic Hesitancy

The care of late preterm and term newborns delivered in hospital settings in the United States is largely standardized with many routine interventions and screenings that are evidence-based and serve to protect newborn's and the public's health. Refusals of various aspects of routine newborn care are uncommon but can be challenging for clinicians who care for newborns to navigate for many reasons. In this article, we describe the spectrum of refusal. We review suggested approaches that clinicians can take starting with increasing their own awareness of what specific components of newborn care are refused and why.

Alternative Birth Plans and Unintended Maternal and Neonatal Consequences: A Review of the Literature

Importance

Birth plans are an important part of childbirth preparation for many women.

Objective

The aim of this review was to discuss some common requests, specifically home birth, water birth, placentophagy, lotus birth, vaccination refusal, and vaginal seeding, including evidence-based recommendations, perceived benefits, and potential maternal and neonatal consequences.

Evidence Acquisition

A literature search for each topic was undertaken using PubMed and Web of Science. For the home birth section, the MeSH terms home AND birth OR childbirth AND outcomes OR complications OR recommendations OR guidelines were used. For the vaccination section, birth OR childbirth OR maternal AND vaccination refusal were searched. For the remainder of the sections, umbilical cord AND nonseverance OR placentophagy OR vaginal seeding OR lotus birth were searched. A total of 523 articles were identified. The abstracts were reviewed by 2 authors (J.R.W. and J.A.R.); 60 of these articles were selected and used for this review.

Results

Home birth is currently not recommended in the United States. Immersion in water for labor is acceptable, but delivery should not occur in water. Placentophagy and lotus birth should be discouraged because of risk of neonatal infection. Vaccines should be administered in accordance with national guidelines. Vaginal seeding should be discouraged until more is known about the practice.

Conclusions and Relevance

These evidence-based recommendations provide clear guidance for physicians so that the birthing experience can be enhanced for both mother and neonate without compromising safety.

Relevance Statement

This is an evidence-based literature review of alternative birth plans and recommendations for directive counseling.

Cutting Ties With an Old Friend: Omphalitis and Bacteremia With Umbilical Cord Nonseverance

Umbilical cord nonseverance (UCNS) is the practice of leaving the umbilical cord attached to the placenta after delivery. Limited case reports exist revealing adverse outcomes of UCNS. We report a case of neonatal omphalitis associated with Escherichia coli bacteremia and urinary tract infection after UCNS.

Neonatal Omphalitis After Lotus Birth

Lotus birth, or umbilical nonseverance, is the practice wherein the umbilical cord is not separated from the placenta after birth, but allowed instead to dry and fall off on its own. Lotus birth may result in neonatal omphalitis. This article describes the history and rationale for lotus birth as well as the etiology, incidence, clinical presentation, and management of neonatal omphalitis. Recommendations for educating families how to perform lotus birth safely are presented. Additionally, signs and symptoms that warrant newborn assessment and treatment are reviewed.