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Midwives/Vernix - Leaving it on for 24 hours

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We're giving birth with a midwife and are reading up as one would expect. A topic I keep coming across is the vernix. I understand that L&D nurses used to be instructed to immediately clean all the vernix off a newborn in order to stimulate a healthy temperature and breathing pattern and research is showing that that isn't essential for either of these reasons and that the vernix might actually be neutral or beneficial, not detrimental. Furthermore, immediate skin-to-skin is beneficial and the unnecessary practice of immediate cleaning of the vernix was keeping babies and mothers from skin-to-skin's beneficial effects. OK, so the baby doesn't need immediate cleaning and doing so keeps a baby from enjoying other things that actually are beneficial. I get that. Citing this evidence, many birth advocates and midwives now recommend not washing the baby for 24 hours, and only using plain water for the first week after that.

I'm having some trouble with this recommendation. 1) The vernix being beneficial or non-harmful doesn't necessarily mean it remains useful after birth. 2) The 24-hour recommendation presents new socio-cultural negatives which are not addressed. 3) Not needing to do an immediate cleaning for thermoregulation and breathing is not the same statement as saying babies should retain the vernix, much less that they should do so for 24 hours, so it is unclear where that recommendation came from. 4) I don't see how the blood, amniotic fluid, etc can be cleaned off without disturbing the vernix. 5) I haven't seen anything saying it is actually harmful or disadvantageous to wipe off the vernix, in part or in whole. 6) I've seen several recommendations to rub it in to the skin like a lotion, but no reference to how doing so would keep the baby from a plain water bath in the first 24 hours. 7) A waterbirth has a baby in water and I don't ever see any reference to that being a conflict for the desire to keep the vernix intact, so how can a plain water bath in the first 24 hours be harmful in a non-water birth? These are the thoughts I'm having regarding the recommendation.

I have a major emotional issue about normal newborn goopiness. I can suck it up and do 5-30 minutes of skin-to-skin on the chest because it provides such a positive benefit, but I'm going to be crawling and seeking a shower/bath for both of us by that point. With my first, I asked them to take and clean the baby and immediately return the baby for skin to skin. While I'm better informed now, the same practical problem remains. I want to do what is right for the baby, but I don't think I'm emotionally able to leave blood, amniotic fluid, etc in bits and pieces attached to vernix for over 24 hours, much less on the basis that it isn't necessary to immediately wipe it off. I am looking for some good, fact-based information to help guide me in making a reasonable cost-benefit analysis to figure out how much I will want/need to keep my queasiness in check for the sake of the baby. Can you help?

Answer
Hi, Louisa!
First of all, best of luck and congratulations on your upcoming birth.
Vernix is a goopy coating that protects the baby from becoming all pruney inside - being that it's floating in fluid all these months.
There are four reasons (that that come to mind) that it would be rubbed it off.
One - the baby is considered a biohazard (sorry!) until it has its first bath - because it's covered in bodily fluids. Therefore, for the hospital's sake, they bathe the baby.
Two - it is kind of goopy, and (understandably!) not everyone is comfortable with snuggling with it all over the place.
Three - rubbing the baby briskly helps stimulate it to take a breath - and in the process vernix gets mostly rubbed off.
And four - baby loses a ton of body heat in those first few moments from evaporation - fluid on the skin evaporates and draws heat out of the baby's body. So drying it off is imperative in those first few moments.
The benefit of leaving it on, for the moment, is that baby gets to go straight on your chest, and still has the lotion-y protection.
I would compromise bonding and squeamishness by having them hand you the baby directly, rub it briskly while it is on your chest, and within moments the baby will be nearly clean. Pop a hat on baby, cover both of you with a fresh soft blanket or three - and you get all the benefits.
You both get immediate skin to skin contact, baby gets appropriate stimulation to breath, baby gets cleaner and warmer, baby gets vernix rubbed into its skin (but mostly rubbed off), and you can kiss a soft clean face.

To answer a few specific points - cleaning the vernix off isn't what prevents the bonding - it's cleaning the baby across the room on a warmer instead of on your chest that prevents bonding. They can simply rub baby while it's on your chest - and problem solved.
I believe the reason for 24 hours is the same bonding issue - but again, wiping the baby clean while in your arms fixes that issue.
The reason for a plain water bath is that baby skin is so delicate, there's no reason to dry it out and treat it with soaps and lotions. They don't sweat much or play in the dirt - a simple water bath is really all they need. If you want a bit of Johnson and Johnson just for the yummy scent, I would just go really light on the soap. But really, water gets all the goop out if you rub gently and patiently.
Best of luck,
Sheva  

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Sheva

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I can answer questions about choosing a midwife, the different types of midwives, whether hiring a midwife is the right choice for you, history of midwifery, midwifery beliefs and practices, and where to find a good midwife. I can also answer questions about giving birth at home with a midwife.

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I am studying to be a midwife. I gave birth four times with midwives, two at home, and have experience with different types of midwives.

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