Delaying the First Bath
Catherine Coates, RN, BSN
Maternal Newborn Care University Hospital
Learning Objectives:
To learn about vernix caseosa and its functions
To learn about the practice of delaying newborn baths
To learn the benefits of delaying the bath
To learn how to support this best practice
Every generation has its own traditions on what newborn care immediately after birth.
Past traditions include:
Brief time with mother
Taken to the nursery for assessment and transitional cares
Glucose water fed by bottle
Bathed immediately after birth
Fathers involved in the “nursery” processes and mother stayed behind in
delivery room
Newer traditions
Focus on bonding and breastfeeding
Skin to skin contact with mother
Baby dried off to prevent heat loss but not cleaned
Initiating breastfeeding
What about the bath?
Delaying the bath of newborn babies
At University Hospital we are practicing the delaying of infant baths until after the first
24 hours. We have been doing this for almost a year. There are quite a few hospitals around
the country who have written this into their procedures as the best practice for encouraging
breastfeeding, skin to skin and bonding time. In fact, around the world this practice is being
used to maintain thermoregulation and decrease the risk of infection
World Health Organization (WHO):
“Thermal care is one of five ‘Best Practices’ for all newborns: (1) Keeping the newborn warm to
prevent hypothermia; (2) cord care; (3) eye care; (4) promotion of exclusive breastfeeding
within one hour; and (5) routine immunizations (WHO, 2003).”
SAVE THE CHILDREN:
Drying the newborn immediately after birth, skin-to-skin contact with the mother, wrapping the
infant with a dry cloth or towel, keeping the newborn’s head covered, and delayed bathing for
24 hours are essential care practices for keeping the newborn warm. Early skin-to-skin contact
with the mother also promotes bonding and facilitates the initiation of breastfeeding. These
strategies can be used effectively at home deliveries, as well as at facilities, and can improve
newborn health and survival. Since the highest period of risk for neonatal deaths is within the
first 24 hours, this indicator measures one of several thermal care practices that can improve
infant health outcomes and is directly related to achieving Millennium Development Goal #4 to
reduce infant and child mortality.
What took us so long to recognize that delaying bath is a good thing?
What ifs….
There are some maternal medical conditions like HIV, Hepatitis B and C where the best practice
is to bathe the baby.
An infant does not need to be deprived of the benefits of delaying bath because of
complications or conditions that necessitate transfer to the nursery or to the NBICU.
Staff may wonder or worry about the changes in work flow.
There also may be some families who choose to bath for whatever reasons. When all is said
and done, it is their birth experience, their baby and their choice.
Vernix Caseosa
Latin meaning:
Vernix means varnish
Caseosa means cheesy
Composition:
Sebum – the oily, waxy substance that gives us oily skin or oily hair and ear wax
Lipids
Water
Amino acids
Forms in the 3rd trimester
Stratum Corneum: the outer most layer of the epidermal layer of the skin providing the
barrier protection for skin. It consists of cells called corneocytes interlocked together
and embedded in highly hydrophobic lipid matrix – like bricks and mortar.
Functions of vernix
1. Hydrophobic barrier or waterproofing
a. Protective hydrophobic barrier
b. Protects against loss of fluids and electrolytes
c. Swallowed along with amniotic fluid and coats the digestive system
2. Facilitates passage through the birth canal
a. Protective bio-film
b. Minimizes friction of fetal parts during the birth process
3. Conserves heat
a. While not the primary function there is evidence
4. Moistures
a. The skin of a newborn changes in response to extrauterine life
i. Decrease in the pH of the skin as the acid mantle forms
ii. Decrease in surface hydration
b. When Vernix is left on the skin it helps retain some of the moisture
i. Skin is significantly more hydrated
ii. Less peeling and cracking
5. Anti infective
a. Vernix contains lysosomes, lactoferrin and other microbials that have antiinfective properties and linoleic acid which has anti-inflammatory properties
b. May serve as a physical barrier to bacteria, meconium and possibly infections
6. Antioxidant
7. Wound healing
Research is being done on the wound healing aspects of vernix
8. Skin Cleanser
Really.
So why are we so quick to bathe?
Benefits of delaying the bath thus leaving the vernix on
Protective properties of Vernix
The moisturizing and hydration factors
The anti-infective qualities
The antioxidant qualities
Decreasing cold stress
The thermal protection of the Vernix
Also heat is loss in process of bathing
Skin to skin
Reduces energy expenditure reserving energy for breastfeeding
Improves parental bonding
But wait there is more!
Vernix has a similar smell to colostrums
They have very similar properties
This means that leaving on the vernix may encourage breastfeeding
Recommendations for bathing
24 hours – after the vernix has absorbed into the skin
Save the Children – wait 24 hours
2012 AWOHNN poster presentation proposal: “Wait for Eight”
Or not at all
Where to begin
Good news! There are no related costs involved!
Educate nursing staff about delaying newborn baths, reasons for supporting the delay
and the benefits.
Teach parents/patient about the best practice of delaying newborn bath.
What do we teach our staff?
Exactly what we teach our parents
There is no hidden agenda
This is evidenced based practice
It is about doing what is best for the newborn
It is about providing quality patient care and an exceptional patient experience.
How do we teach our patients?
What do we say?
Use terms that they will understand
Scripted phrases
The results….
Conclusion: The birth experience is their birth experience. Their choices put into action. Let
us give them the best, updated information that we have to assist them in making the decisions
that are best for their new baby.
References
Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B. (2004). Host defense proteins
in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology,
191(6), 2090–2096.
Darmstadt, G. L., Bhutta, Z. A., Cousens, S., Adam, T., Walker, N., et al. (2005). Evidence-based,
cost-effective interventions: How many newborn babies can we save? Lancet, 365, 977–
988.
Gage, A., Ali, D., Suzuki, C. (2005). A Guide for Measuring and Evaluating Child Health
Programs, Chapel Hill, NC: MEASURE Evaluation. Retrieved from
https://www.cpc.unc.edu/measure/publications/ms-05-15
Lipka, D. V. and Schulz, M. K. (2012). Wait for eight: Improvement of newborn outcomes by the
implementation of newborn bath delay. Journal of Obstetric, Gynecologic, & Neonatal
Nursing, 41, S46–S47. doi: 10.1111/j.1552-6909.2012.01360_27.x
Lund, C. et al. (2001). Evidence Based Clinical Practice Guideline: Neonatal Skin Care.
Romano, Amy M. (2005). Research summaries of normal birth. Journal of Perinatal Education.
14(2), 2090-2096.
Save the Children. (2010). Report of a Technical Working Group Meeting on Newborn Health
Indicators.
Save the Children. (2004). Every newborn’s health: recommendations for care for all
newborns.
USAID/CORE Group. (2004). Maternal and newborn standards and indicators compendium.
Porter, R. H., Varendi, H., and Winberg, J.. (2010). Attractiveness of amniotic fluid odor:
Evidence of prenatal olfactory learning? DOI: 10.1111/j.1651-2227.
World Health Organization. (2003). Integrated management of pregnancy, childbirth, post
partum, and newborn care: A guide for essential care practice.