"Rooming in" on Mother/Baby - not one size fits all

Parakeeter · Mar 13, 2009

I work at the most productive "baby factory" in my state, we do somewhere around 3,000 deliveries a year and we have three separate postpartum floors. We encourage rooming in, but it's definitely not required - some of our moms don't have anyone at all staying with them, and I couldn't imagine just plunking a baby down in a mom's room while she's alone, exhausted and doped up on pain meds! When it's time for baby to eat that's one thing, and if mom needs help breastfeeding it's the nurse's job to stick around and help her, but if feeding's not an issue then it's off to the nursery for baby so mom can have a little time to recover.

We do couplet care, and always have one extra RN to be the "nursery nurse" for all the babies whose mothers are resting. It works well because during the day, the nursery nurse can help deal with peds and watch over the babies while the couplet nurse is getting her assessments done, and then at night the nursery nurse watches the many babies who come in for the night (we do have a high % of bottle-feeders) and helps the couplet nurse with PKU's, hearing screens, etc. I know in many hospitals it'd be a staffing issue to always keep a nursery nurse as a resource, but it saves the couplet nurse innumerable troubles and keeps the moms happy because they can keep or send baby to the nursery whenever they see fit. Press-Ganey tip, wink wink.

Equinox_93 · Mar 16, 2009

That must be nice to have the staffing to be able to take baby to mom for those moms who are breastfeeding and whose babies want to eat every 20min :) That's alot of back-and-forth for the staff LOL

I work at the most productive "baby factory" in my state, we do somewhere around 3,000 deliveries a year and we have three separate postpartum floors. We encourage rooming in, but it's definitely not required - some of our moms don't have anyone at all staying with them, and I couldn't imagine just plunking a baby down in a mom's room while she's alone, exhausted and doped up on pain meds! When it's time for baby to eat that's one thing, and if mom needs help breastfeeding it's the nurse's job to stick around and help her, but if feeding's not an issue then it's off to the nursery for baby so mom can have a little time to recover.
We do couplet care, and always have one extra RN to be the "nursery nurse" for all the babies whose mothers are resting. It works well because during the day, the nursery nurse can help deal with peds and watch over the babies while the couplet nurse is getting her assessments done, and then at night the nursery nurse watches the many babies who come in for the night (we do have a high % of bottle-feeders) and helps the couplet nurse with PKU's, hearing screens, etc. I know in many hospitals it'd be a staffing issue to always keep a nursery nurse as a resource, but it saves the couplet nurse innumerable troubles and keeps the moms happy because they can keep or send baby to the nursery whenever they see fit. Press-Ganey tip, wink wink.

SmilingBluEyes · Mar 16, 2009

Rooming-in is best under ideal circumstances. That said, provisions should always be made to help out with sick or tired moms so they can get rest. Allowing an adult overnight visitor is so helpful in this. I am sad there are still hospitals that have double rooms and disallow overnight visitors. In other places, staffing simply disallows well newborns to spend time in the nursery unless there is already a special care staff there to take care of them, or similar staffing matrix that allows this. In small community hospitals, you will be hard-pressed to be allowed to staff a well nursery just for convenience, sad but true!

I tell our new moms we will be happy to help out by watching newborns in our nursery if staffing allows---and it usually does. BUT I can't promise or guarantee this as we are simply not staffed to make such promises. It's usually much easier when there is a baby (or two) in the SCN so we can wheel a baby in for mom's sleep. We really do try to accomodate preferences; for sick moms, we simply do what we must to ensure their newborns are cared for so they can recover. Any place offering rooming-in really MUST allow overnight visitation, therefore, for moms who need help/sleep.

One more thing; there is a responsibility on their parts for their own recovery and learning. I always tell our moms to sleep when their babies do....even during the day. And if this means telling visitors they need rest, they must do so, or allow us to. 24-48 hours are not much time to allow for a mom to rest/recover and learn to feed and care for her new baby. Excessive and obtrusive visitors do not help this cause. Also nursing staff need to cluster cares so they are not in and out of the room constantly-----this allows tired parents much-needed rest.

lamazeteacher · Mar 17, 2009

I had been up for 48 hours solid. I had PIH and had been vomiting for hours upon hours - and then pushed for three hours until she was born. My husband had been by my side, awake, for the entire time. I was NOT alert at all - had a pounding headache, crying at intervals I was breastfeeding, so I was frequently trying to put her to the breast, but she was not interested in latching. When the nurse came to check on us, I was crying and told her I was afraid I wasn't doing a good job of caring for my baby, because I felt so exhausted and sick. She told me, "I can sympathize with you, but being that you had a lady partsl birth, and birth is a natural process, it's up to you guys to provide your daughter's care".
proceeded to hand her over to my husband, who walked with her for an hour or so in the room, and then I slipped into a fitful sleep despite her whimpering. I awakened at 3 am, and saw my husband asleep in the chair with the baby in his lap. I was concerned about the safety of this so I put her back in the bassinet (trailing blood as I got up) and rang for the nurse the one and only time I was there. She was friendly, but said unless I had changed my mind about breastfeeding, the baby had to stay with me.
I wasn't angry with anybody - the situation just really sucked and I wish I could have come up with a better plan.

You didn't need to come up with a plan, there is one in the P&P book that covers it much differently than the lazy, good for nothing friendly nurse did. The part of your post that I underlined and made bold, is a policy that would make any QA/QI committee blush and then come down harshly on the OB department!

You/your insurance company will be billed for newborn care that night, which includes nursing care; and so the provision of care is the hospital's responsibility. Please make a copy of your post and give it to your OB and the baby's doctor or your family physician.

When nurses disagree with newer (but this is at least 30 years old) procedures, like rooming in, they'll do inexcusable things to make it appear that it doesn't work. The ploy I hate most, is the one about not being able to have the baby in the nursery after being in mom's room, due to concerns about infection control. That's a crock! If you came in with or had your membranes rupture 24 hours before the baby's birth, maybe that would be plausible, - but then you'd be on antibiotics......so would the baby, and an "isolation" area would have to be provided in the nursery for your baby. However, even in the sleep deprived, physically challenged shape you and your husband were in, it was probasbly safer to keep your baby with you, as that nurse was dangerous!

Even the excuse that you were breastfeeding is faulty, as nurses are supposed to be assisting you with that, especially when it's the first time you've done that - even if you had classes. The allegation that only bottle fed babies belong in the nursery, is false.

This is a clear case of lazy nurses, disregarding their responsibilities, unless they had a newborn or three of them coding and being transferred to NICU or another higher level of care hospital, in the nursery. It doen't sound to me that you wanted rid of your baby to get some sleep, it's more like the staff lacked appreciation of the amount of sleep deprivation you had, and the extent of help you needed. Boooooooo!

When fresh parturients get OOB for the first time, a nurse must accompany her. That's an important policy that was shirked, and invites a write-up. You probably bled a lot because your uterus hadn't been massaged enough, and you needed to void. Please don't feel you lacked anything in your role. Those nurses were swinging it royally!

They (and you) were lucky that you didn't pass out........

Welcome to motherhood!! Crying is a reaction to the rapid decrease in your hormone level, after having your baby - totally a physical response. Enjoy it and don't let anyone discourage it. The relief after a good cry is terrific.:heartbeat

lamazeteacher · Mar 17, 2009

That must be nice to have the staffing to be able to take baby to mom for those moms who are breastfeeding and whose babies want to eat every 20min :) That's alot of back-and-forth for the staff LOL

That's what they're there for......... It's no laughing matter to have dangerous conditions such as there were for this family!

lamazeteacher · Mar 17, 2009

Rooming-in is best under ideal circumstances. That said, provisions should always be made to help out with sick or tired moms so they can get rest. Allowing an adult overnight visitor is so helpful in this. I am sad there are still hospitals that have double rooms and disallow overnight visitors. In other places, staffing simply disallows well newborns to spend time in the nursery unless there is already a special care staff there to take care of them, or similar staffing matrix that allows this. In small community hospitals, you will be hard-pressed to be allowed to staff a well nursery just for convenience, sad but true!
I tell our new moms we will be happy to help out by watching newborns in our nursery if staffing allows---and it usually does. BUT I can't promise or guarantee this as we are simply not staffed to make such promises. It's usually much easier when there is a baby (or two) in the SCN so we can wheel a baby in for mom's sleep. We really do try to accomodate preferences; for sick moms, we simply do what we must to ensure their newborns are cared for so they can recover. Any place offering rooming-in really MUST allow overnight visitation, therefore, for moms who need help/sleep.
One more thing; there is a responsibility on their parts for their own recovery and learning. I always tell our moms to sleep when their babies do....even during the day. And if this means telling visitors they need rest, they must do so, or allow us to. 24-48 hours are not much time to allow for a mom to rest/recover and learn to feed and care for her new baby. Excessive and obtrusive visitors do not help this cause. Also nursing staff need to cluster cares so they are not in and out of the room constantly-----this allows tired parents much-needed rest.

-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-

The things I highlighted and made bold in your post, are those unacceptable conditions that JACHO looks for. Hospitals with OB departments have plenty of notice that their nursery will need extra staffing. There was no "obtrusive" visitor making things difficult for the nurse - she wasn't there for that to be a problem - and the guy needed sleep!

The only time I kicked a visitor out, was when I came to take vitals and do a check on a new mom, asked the man sitting close to her face, on the bed if he was the baby's father. When the mom quickly said, "no" and sounded scared, I asked him to leave while I did the check, and she told me he was a weird distant cousin of the baby's father, who'd come up the back stairs earlier, but after the other visitors had gone. She thanked me for asking him to get out of her room.

I promptly called security, informed them of the situation and asked that they keep their TV monitors on those stairs. Luckily the baby was being bathed in the nursery, and wasn't in the room while he was there.....

lamazeteacher · Mar 17, 2009

There is no nursery where I work so we encourage someone to stay the night and help, it's all rooming in.

The administration of your facility needs to check on that........... Anyone giving nursing care in a facility must be licensed and covered by their insurance. It's the baby who rooms-in, not a visitor, even if it's the father of the baby. Look up the regulations in your state, and see if that's permissable. Then be part of the solution, making a policy that agrees with state regulations and take it to your department head, for consideration, rather than raising a ruckus about it.

SmilingBluEyes · Mar 17, 2009

Lamaze, what is ideal and what happens are often two different things. And we all know how management and administration get around JCAHO mandates when it serves them. The fact is, they refuse to staff for "what can happen" they only staff for the census we have now, and acuity of each patient. Rooming in/couplet care makes it necessary for nurses to care for several couplets at once without a nursery to send babies to just to sleep. That is just how it is. When we watch the babies, it's because we are tag-teaming for each other as staff members to make it happen. We are still considered responsible for both mom and baby, medically and staffing-wise, but that does not mean the baby is cared for in our nursery. It just cannot be promised unless there is a health issue for either mom or baby. It comes down to numbers and acuity. We write reports as charge nurses every shift discussing staffing and adequacy (or lack of) and rarely, do things really change. Couplet care and rooming-in are here to stay for well babies and moms.

SmilingBluEyes · Mar 17, 2009

I am betting those who say there is "no nursery" mean there is no well baby nursery, which indeed DOES meet federal and state requirements. As long as qualified staff and facilities are available to meet needs of changing medical conditions for patients, you are golden, if not fat-staffed.

Elvish, BSN, DNP, RN, NP · Mar 17, 2009

You know, most nights it's not that hard as a nurse to help moms with their babies, help them keep them in their rooms. True, I don't sit down a lot, but I didn't come to work to sit down. There are nights when I have 5 couplets and 2-3 have big issues but more often than not I can lend a hand.

I don't mind getting a fussy baby to settle (after all his needs are met, of course) while mom closes her eyes. More often than not, both are sound asleep by the time I leave and stay that way for a couple hours. I show new moms and dads how to settle their babies so that if I'm not there, they don't lose their minds with a screaming baby. I don't mind changing a diaper while I'm in there, after baby eats, while mom goes to pee, so they can all go back to bed. That's my job, you know?

I work at a big urban teaching hospital - every race, nationality, socioeconomic status, age - and believe it or not, rooming in works. Of course there are times when it's not appropriate - no way I'm going to force a 14yo who's been raped to keep her baby, or someone giving their baby up for adoption, or a mom that has labored for 48 hours and hemorrhages afterward to the tune of a 7/18 H&H, against their will. And sure, I've had a kid turn purple and had to bag him while he was in the NBN (and whispering a prayer of thanks that we caught it). But you know what? That is far from the norm, and most mothers and fathers enjoy keeping their babies. Our rooming in rate runs between about 60-90%, depending on what night it is.

lamazeteacher · Mar 17, 2009

I am planning on using the next city over's OB and hospital if I have another baby (although I hate to do that, cause I love my OB - but he only delivers at this hospital). I don't know exactly what could be done, but I know I could not go through that again. I was literally in such terrible shape it's a miracle I didn't drop my daughter.

Do you know the conditions at the hospital in the next city over? I'd check it out, before making definite plans to go there. You could be going "from the frying pan into the fire". It might be better to make an appointment to see the nurse manager of the OB department at the hospital where you had your first baby, discuss the negligent night duty staff and ask her to get back to you, or your OB about the positive changes she makes. There's a whole lot of training (and increased staffing, if that is a problem) to be done there, if the nurse you had isn't let go. I shudder to think what could have happened......... and still might, if something isn't done!

Since you and your OB have a good relationship, tell him what happened and what you did to improve things for other patients. He needs to be "part of the solution", too (which means he should not rage over there with an "off with your head attitude").

mommybess, BSN, RN · Mar 17, 2009

As so many others have said in their replies, you were jipped! Reading this makes me really angry and sad for you and all the others that are patient's of this nurse. Bottom line = lazy nurse! it is our jobs to take babies back and forth to the nursery in between breast feedings. Sure it's a lot of work but if mom needs rest that's part of my job to help the mom.

Mom's need sleep. Most arrive to PP sleep deprive unless they were a scheduled section. All mom's need to recover from giving birth, it doesn't matter what mode the baby arrived. All mom's need some level of education and assistance.

Ugh... I'm so sorry for your experience.