Mother-Infant Coupling - page 4

I just became the assistant manager of a women's health care department. We just had consultants come in who have decided that our whole department needs to be changed around. We are a 200-bed... Read More

  1. by   SmilingBluEyes
    In the case of non private rooms, I can understand sending all other people home at 9 too. It would be NECESSARY in that case, or no one would ever rest. I would NOT want or appreciate a roommate's family hanging around all night either, while trying to rest. Lack of privacy is a HUGE customer issue I would think--- Not to mention, if they had all manner of visitors all day for BOTH patients, who would want to be up all night with a baby? In the case of YOUR hospital, having a night nursery may make sense, even though I think it's still a bad deal all-around. It does interfere with the mom taking charge of the baby's care and good breastfeeding practices early-on. It's far from an ideal mother-baby situation. But what can you do???? Thing concern me still regarding semi-private rooming.......

    I would think semi-private rooms in and of themselves, would be HIPAA violations, anyhow. I know when I was a surgical patient 2 mo ago my roommate was privvy to my situation as I was hers. This promises to become a huge issue, I think, as patients become increasingly aware of HIPAA laws and want to know why their privacy is NOT adequately protected. Thoughts?

    How many of you have semi-private rooms in OB? And what do YOU do to guard HIPPA-controlled information? It must be a tremendous challenge!
    Last edit by SmilingBluEyes on Apr 6, '04
  2. by   imenid37
    VW, your hospital sounds like the one i worked at back in the early 1990's in Baltimore. It is really difficult w/ room-mates in OB. I remember a non-English speaking pt. who wanted her boyfriend to spend the night. Her room-mate was mentally disabled (she could not care for baby on her own at all!). Well, because of the potential for the mentally challenged lady's privacy to be compromised, I told the boyfriend he had to go sleep elsewhere. He was nice enough to throw the chair at me and curse at me in his native language. We did have a nursery or babies could room in if mom wished. This often caused a conflict if one person had to hear the other pt's fussy baby all night, esp. if her baby was in NICU and couldn't come out even if she wanted him/her to. Putting well babies on PEDS was not an option. I am not sure if this was hospital policy or state infection control regs. I just think that different care options may need to be explored based on the physical facility, type of clientele, etc. One size doesn't fit all. We are a very diverse culture at the moment. In fact, I have had pt's in the past who had female family members doing most of the infant care for them and bringing in lots of foods, herbs, etc. for the mom. That also gets a little tight in a private room, really awful in a semi. it makes my blood boil to inflict a care delivery system on a staff and group of pt's just to save money and eliminate the jobs of some of those staff.
    Last edit by imenid37 on Apr 6, '04
  3. by   colleen10
    I just wanted to add that this discussion is really interesting to me, to see, I guess you would call it, 'regional' differences in the way couplets are managed.

    I finished my OB rotation at a very large women's hospital. On the Post Partum unit the nurse/couplet ratio was usually 1:5, 1:6. I believe the unit could hold about 25 couplets which it often came close to at any given moment. There was a large central nursery for the unit managed by one 'nursery nurse'. The nursery nurse was responsible for managing infants while they were in the nursery and to see that they received any vaccinations, treatments, feedings, blood tests, circumcisions, etc. while in the nursery. If she was overwhelmed then the other RN's assigned couplets would come in to help soothe a fussy baby or assist in a bottle feeding. At this hospital women, while encouraged to spend as much time and bond with baby, were not looked down upon if they wanted to give the baby back to the nursery to get some sleep and in fact, the infants were not allowed to room with mom during the night. In the evening all infants were taken back to the nursery to spend the night and were only released back to mom if they needed a feeding during the night.

    I have heard from instructors and other classmates that our ideas on birthing and women/infant care are a bit "backwater" as we don't have 'birthing centers' like they do on the West Coast and such a place really wouldn't fly here in the 'burgh. I think we only have one Mid Wife facility that is outside of a hospital enviroment. But, thought it was interesting to see the difference in view points none the less.
  4. by   SmilingBluEyes
    Glad I live on the West Coast then!
  5. by   colleen10
    Smiling Blu,

    You said it, you guys on the West Coast would probably think our practices "barbaric".

    One of my classmates wife had one child on the West Coast at a birthing center and one here in Pittsburgh. He said you could not imagine how different the two experiences were. He said that, at least in California, his wife had so much preparationa and input into her birthing plan. Here there was no such thing, they just had to do what the doctor said.
  6. by   SmilingBluEyes
    Quote from colleen10
    Smiling Blu,

    You said it, you guys on the West Coast would probably think our practices "barbaric".

    One of my classmates wife had one child on the West Coast at a birthing center and one here in Pittsburgh. He said you could not imagine how different the two experiences were. He said that, at least in California, his wife had so much preparationa and input into her birthing plan. Here there was no such thing, they just had to do what the doctor said.
    Barbaric? You are far from "barbarians" in my mind. Are these practices outdated and unpatient-friendly? Only in my opinion, yes. Oh----- Not that things are perfect here. Birth plans and certain demands (on both sides), can be as much a hindrance as a help, depending on how flexible DOCTOR, NURSE AND PATIENTS can be. And yes, all THREE need to be flexible for it to work. But LDRP should be standard of care everywhere, really; it's not that hard to do! You just have to get everyone on board. And being cross-trained makes a nurse MUCH more marketable than one who can ONLY do one area like, only labor, and newborn etc.
    Last edit by SmilingBluEyes on Apr 6, '04
  7. by   fergus51
    I think the fact that you say women "ARE NOT ALLOWED" to have their babies with them during the night is sad. Since when does a woman need hospital permission to have her own child with her? Very un-patient friendly... Heck, I probably would say barbaric and I am on the East Coast.
  8. by   ayndim
    Quote from fergus51
    I think the fact that you say women "ARE NOT ALLOWED" to have their babies with them during the night is sad. Since when does a woman need hospital permission to have her own child with her? Very un-patient friendly... Heck, I probably would say barbaric and I am on the East Coast.
    I agree. I probably would have gotten up and left the hospital if they had told me that. My first baby had to go to the nursery for a couple of hours (she had mecconuim (sp?), some minor respiratory problems and was having some low temp issues). I thought I would go mad. I actually ended up going in the nursery after about 30 mins and stayed until they let me take her back to my room. The only time my other two left my side was for weigh ins, hearing screeing and the first photo. I see nothing wrong with expecting the mom to care for her infant. Then again I am the type of patient who will get up and get her own ice, water and juice. I don't feel the time after birth is a medical problem so I see no reason why moms should be waited on hand and foot. I certainly never expected it. If the mom has some medical issues then obviously they should be cared for like any other patient. Otherwise, it is more like a very expensive hotel stay with medical help nearby if needed and the occasional medical exam.
  9. by   vwgirl
    Quote from ayndim
    I agree. I probably would have gotten up and left the hospital if they had told me that. My first baby had to go to the nursery for a couple of hours (she had mecconuim (sp?), some minor respiratory problems and was having some low temp issues). I thought I would go mad. I actually ended up going in the nursery after about 30 mins and stayed until they let me take her back to my room. The only time my other two left my side was for weigh ins, hearing screeing and the first photo. I see nothing wrong with expecting the mom to care for her infant. Then again I am the type of patient who will get up and get her own ice, water and juice. I don't feel the time after birth is a medical problem so I see no reason why moms should be waited on hand and foot. I certainly never expected it. If the mom has some medical issues then obviously they should be cared for like any other patient. Otherwise, it is more like a very expensive hotel stay with medical help nearby if needed and the occasional medical exam.
    I too, feel that an uncomplicated vaginal birth is NOT a medical problem. Yet, I have plenty of patients who will ring the call bell after an NSVD for me to "come hand me the baby from the crib" so they don't have to get out of bed, or hand them the ice water from the bedside table so than can have a drink! (I am NOT making this up!) :chuckle
  10. by   colleen10
    I also wonder if part of the 'patient unfriendly' practices we have here such as limited rooming in, etc. are caused by our high malpractice awards and rates, especially for OB/GYN. Seems we are loosing OB/GYN's left and right d/t the uncontrollable malpractice cases and awards.

    For instance, my one classmate who's wife gave birth at a birthing center on the west coast said that the staffs attitude was a very calm, natural one. She went in to be physically examined to see how she was progressing, was instructed to go do some shopping/walking around the mall and come back in 4 hours. She only had intermittent fetal monitoring throughout the labor and delivery (per her choice). Here in Pittsburgh she gave birth in a hospital and even though she asked in advance that she not have a fetal monitor and there were no medical reasons that she required one as soon as she was admitted they slapped a continuous monitor on her stating "hospital policy".
  11. by   RNKitty
    Quote from colleen10
    Here in Pittsburgh she gave birth in a hospital and even though she asked in advance that she not have a fetal monitor and there were no medical reasons that she required one as soon as she was admitted they slapped a continuous monitor on her stating "hospital policy".
    Even the birthing centers I have worked at require at least a 20-30 minute strip of continuous fetal monitoring to ensure reactivity of the fetus before they switch to auscultation. To come to a hospital and decline EFM at least for that small amount of time is unrealistic in this day and age of litigation. If they truly don't want ANY technology, they should deliver at home and not put the doctor's and nurses at risk for liability.
  12. by   fergus51
    Quote from colleen10
    I also wonder if part of the 'patient unfriendly' practices we have here such as limited rooming in, etc. are caused by our high malpractice awards and rates, especially for OB/GYN. Seems we are loosing OB/GYN's left and right d/t the uncontrollable malpractice cases and awards.

    For instance, my one classmate who's wife gave birth at a birthing center on the west coast said that the staffs attitude was a very calm, natural one. She went in to be physically examined to see how she was progressing, was instructed to go do some shopping/walking around the mall and come back in 4 hours. She only had intermittent fetal monitoring throughout the labor and delivery (per her choice). Here in Pittsburgh she gave birth in a hospital and even though she asked in advance that she not have a fetal monitor and there were no medical reasons that she required one as soon as she was admitted they slapped a continuous monitor on her stating "hospital policy".
    I completely agree that it is the perception of what will limit liability that regulates those types of practice. I went to a class a few years ago about legal issues in OB care. I was shocked to find out that EFM actually INCREASES lawsuit rates (mainly because of operators misinterpretting them) and that rooming in doesn't increase lawsuit rates at all. There is no medical reason to use EFM on a low risk woman (and no reason for those 20 minute strips we all do either as they have never been shown to improve outcomes) and no reason to limit rooming in for normal births.

    Unfortunately, most hospitals aren't interested in evidence based practice to do the best by their patients, they are interested in looking like they are doing the best for their patients.
  13. by   ayndim
    In the end the hospital can't force women to have EFM. Or force a mom to do anything else either. I hate it how they seem to make it sound like you have no choice. :angryfire I for one crossed out the consent for an episiotomy, for #2 and #3. My CNM rarely does them anyway and only for fetal distress (no the dr doesn't do them for assisted deliveries either). And as a multip who didn't have one the first time I knew that if there was fetal distress I would be able to push the baby out as fast as she could perform an episiotomy. My CNM actually told me that. My CNM was there when I crossed it off (she was there the whole time) and she didn't have a problem with that.

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