Mother-Infant Coupling - page 5

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   nekhismom
    Quote from SmilingBluEyes
    Breastfeeding and bonding are better supported when babies stay with their moms, not with nursery staff. Moms need to learn pretty darn quickly how to respond to various infant cues for feeding, attention, diapering, etc and can hardly do this with the baby in the nursery half the time. And if/when we do have sick infants in the nursery, yes, the nursery nurse CAN watch the well ones, but NOT all night. Again, this does nothing to foster bonding and learning infant care on the parts of the parents/caregivers. When we have kept babies in the past in the nursery all night and the first thing in the morning, the ped's demand to know WHY ------even THEY don't like it. It's unrealistic to think you can just send off your baby to be "watched" all night and succeed at all at breastfeeding or learning to care for him/her while you in the hospital. Our rooms are designed privately and are generous in size, so fathers/others are ENCOURAGED to spend the night, helping mom out and bonding with their babies as well. Since more than 90% of the moms we admit request breastfeeding, it behooves them to have the baby with them all the time so they can learn this in the short time they are with us.
    SBE, I respectfully disagree here, although I do agree with most of your points throughout this discussion. First let me say that I have never been completely comfortable with mother/baby, and I LIKE the nursery.

    From a mom's point of view, the nursery was a LIFE saver for me when Nekhi was born. I tried to rest, but was so wound up that I could not sleep. I was breastfeeding, or trying at least. Nekhi tried to nurse for over 2 hours straight, and I was in serious pain, and he was hungry and frustrated. The lactation nurse was unable to help us. Nekhi just kept wailing. So the nursery nurse suggested feeding Nekhi 5 cc's of formula and taking him to the nursery until he woke up again so that me & dh could rest. I unhappily agreed. But I DESPERATELY needed the rest. Breastfeeding in the hospital was H*ll. I had inverted nipples, and they cracked and bled. I got some nipple shields and nipple shells, and that helped a bit. But it was a rough go of things. However, I did end up successfully breastfeeding for 22 months.

    Therefore, in my experience, the nursery HELPED with my bonding to my son ( I was so frustrated with myself and my son by the time they came to get him) and with my breastfeeding.

    I don't think that parents should be able to "drop the baby off" for the entire night though. But I DO think it should be an option so that an exhausted mom can get some rest. I mean, if you've ever seen a labor, you know it's called LABOR for a reason.

    My facility DOES have a nsy, and I am very thankful for it.
  2. by   fergus51
    Do you think you wouldn't have slept if the nursery nurse had given your child the formula and he fell asleep in your room? I guess I don't understand what difference it makes where he sleeps.

    Just an observation, but I think you actually agree with Deb. She's said before there are circumstances that warrant having a baby out so mom can rest, just that it shouldn't be the routine and it shouldn't be all night. That seems to be your view as well.
  3. by   nekhismom
    Quote from fergus51
    Do you think you wouldn't have slept if the nursery nurse had given your child the formula and he fell asleep in your room? I guess I don't understand what difference it makes where he sleeps.

    Just an observation, but I think you actually agree with Deb. She's said before there are circumstances that warrant having a baby out so mom can rest, just that it shouldn't be the routine and it shouldn't be all night. That seems to be your view as well.
    I guess so. The point was, I needed a break from having Nekhi in the room. Just a small one. I was a frustrated new mom. I was sick of his wails. I just needed a minute, ya know?? I mean, I hadn't slept well the night before, I had stadol and an epidural during labor, and felt like a truck had ran over me. I just needed to sleep. And removing Nekhi from my room helped a great deal. I know that in today's hospital environment, many women receive meds, and could probably benefit from a rest period.

    I think we still need the choice. I mean, we all know some moms would take advantage of the nsy and drop the baby off for the entire night just because it was there. But some moms truly just need a couple of hours to rest. Now, if all moms were given a few hours to rest after delivery, not immediately, but say 3-4 hours after delivery.....get say 3 hours of uninterrupted sleep. I think THAT would be a tremendous help, would allow the mom to recover a bit, and would generally help the situation. I would think mother/baby would be a better idea if that were an option. however, due to the fact that babies are born 24/7, the nsy would have to be open 24/7, and that's another issue.

    Just my opinion, of course. But I don't like mom/baby, and I'm glad we had a nsy where I delivered, and I'm glad we have one where I work. Now, if we only had CNM's, THEN we'd be talkin!
  4. by   SmilingBluEyes
    Quote from fergus51
    Do you think you wouldn't have slept if the nursery nurse had given your child the formula and he fell asleep in your room? I guess I don't understand what difference it makes where he sleeps.

    Just an observation, but I think you actually agree with Deb. She's said before there are circumstances that warrant having a baby out so mom can rest, just that it shouldn't be the routine and it shouldn't be all night. That seems to be your view as well.
    thank you. I was going to make that point but you did it for me.


    I never said a baby SHOULD NEVER COME OUT OF A MOM's ROOM. But I took exception to babies spending entire nights in a nursery. I still do.

    Breastfeeding problems are NOT solved by baby spending 8 or more hours in a nursery. What do these moms think their babies are eating while they slumber? IF they think we would STARVE them so they can sleep? Think again, not on my shift. But I have actually had them send out to the nursery, requesting they stay ALL NIGHT but NO BOTTLES or CUPS OF FORMULA. I don't think so. You bet the kid will get formula IF mom refuses to nurse for resting purposes, and I will tell her so.

    I can tell ya stories about breastfeeding and exhaustion; I was discharged home w/o my premature son (6 weeks early) and made trips to the hospital (3 blocks away) to breastfeed him at night in the SCN, until a room became available for me to stay in on the floor, 3 days later. I used to fall asleep in the rocker in the SCN, mesmermized by the blue glow of the bili lights, I was so exhausted. I had been in labor 2 days myself after being hospitalized for over a week to try and STOP labor. I know about the exhaustion in being a new mom. But you know, You do what you have to, to make it work. It never occured to me to do anything less and I was not even a nurse back then.

    I am amazed by how many "breastfeeding" moms want their cake and eat it, too. I guess it's immaturity. I think in such cases, it's likely the minute they go home, the bottles will come out anyhow. THAT is what I mean by NOT having infants in a nursery ----NOT for HOURS on end when they should be breastfeeding or bonding. Special circumstances CAN exist and we do our best to accomodate these but RARE is the baby who is out all night unless it's a special case (like DHS, etc.)
    Last edit by SmilingBluEyes on Apr 9, '04
  5. by   SmilingBluEyes
    Quote from nekhismom
    however, due to the fact that babies are born 24/7, the nsy would have to be open 24/7, and that's another issue.

    Just my opinion, of course. !
    Yes I would agree except how do you staff for this? This is the big problem, the crux of the matter, you might say. Answer is, they DO NOT.
  6. by   fergus51
    Oh I hate theat Deb!!! No cups, no bottles, no formula, no soothers, and I want to sleep for the next 8 hours.... Ummmm no. Complete stupidity as far as I am concerned. We will not starve an infant and that doesn't help breastfeeding! You don't want to get me started on the moms who won't let their 34 weeker under triple photo have a soother/cup/bottle either......UGH.

    Working the NICU has made me more accepting about rooming in. I think about women who complain about needing 8 hours of uninterrupted sleep and want to say "Do you know what our NICU moms would give if they could have their baby in the room with them?". Yes, you need sleep, and you should take every opportunity to sleep and I will help anytime I can with that by settling your baby if you're having trouble, but no I won't wheel it out and starve it for 8 hours. Most babies sleep for a good 4 hours after delivery and their first feed. And they sleep 70-80% of their time. There is no reason to have a baby in the nursery ALL night.
  7. by   RNmommy
    Honestly, I am stunned that there are still facilities that do not do couplet care. At our hospital, we are stunned when visitors ask where the nursery is so that they can stare at the babies. Umm, they're with thier mothers. We have separate L&D and Postpartum, not LDRP. However, all of our rooms are private and equipped with a cot for dad or SO to sleep on. We RARELY have a pt spend the night alone (maybe a P2-3+ every now and then). We do have a WBN staffed by one RN. We use the WBN for admitting CS babies, administering hearing screenings, assisting the lab with blood draws (PKUs are performed in the room by a lab tech), warming cold babies, administering some phototherapy (most babies with no other problems will receive phototherapy in their rooms), circumcisions and babysitting while mom takes a shower or a short nap. We also have a level II NICU. In CA we are bound by state mandated RN:PT ratios. In WBN it is 1:8. NICU 1:2 and mother/baby 1:4 couplets.

    Upon admission parents are instructed on bulb syringe use. Rarely we have a parent call out bc the baby is aspirating and they can't handle it. Our BF rate is 99% and our parents tend to be educated, upper middle class. During the night shift, we give priority for babysitting to fresh c/s moms but even then we send the babies back out for breastfeeding. Our lacation policy is air tight. We are NEVER allowed to give BF babies artificial nipples or formula unless the parents specifically request it. We can only suggest supplements for medically necessary reasons. BTW, our customer service ratings are through the roof. We accommodate alsmost every request. But then again, I'm in CA, and moms at our hospital just dont ask for their baby to be sent away for 12 hours. I seriously think that if this happened, we would consider a social services consult for impaired attachment.

    I also could not imagine giving birth at some of the hospitals you describe.
  8. by   nekhismom
    Quote from SmilingBluEyes
    thank you. I was going to make that point but you did it for me.


    I never said a baby SHOULD NEVER COME OUT OF A MOM's ROOM. But I took exception to babies spending entire nights in a nursery. I still do.

    Breastfeeding problems are NOT solved by baby spending 8 or more hours in a nursery. What do these moms think their babies are eating while they slumber? IF they think we would STARVE them so they can sleep? Think again, not on my shift. But I have actually had them send out to the nursery, requesting they stay ALL NIGHT but NO BOTTLES or CUPS OF FORMULA. I don't think so. You bet the kid will get formula IF mom refuses to nurse for resting purposes, and I will tell her so.

    I can tell ya stories about breastfeeding and exhaustion; I was discharged home w/o my premature son (6 weeks early) and made trips to the hospital (3 blocks away) to breastfeed him at night in the SCN, until a room became available for me to stay in on the floor, 3 days later. I used to fall asleep in the rocker in the SCN, mesmermized by the blue glow of the bili lights, I was so exhausted. I had been in labor 2 days myself after being hospitalized for over a week to try and STOP labor. I know about the exhaustion in being a new mom. But you know, You do what you have to, to make it work. It never occured to me to do anything less and I was not even a nurse back then.

    I am amazed by how many "breastfeeding" moms want their cake and eat it, too. I guess it's immaturity. I think in such cases, it's likely the minute they go home, the bottles will come out anyhow. THAT is what I mean by NOT having infants in a nursery ----NOT for HOURS on end when they should be breastfeeding or bonding. Special circumstances CAN exist and we do our best to accomodate these but RARE is the baby who is out all night unless it's a special case (like DHS, etc.)
    Deb,
    Of course, you're right. I completely understand what you are saying, and I do think I agree with you overall. I just LIKE having a WBN available. I TOTALLY agree about not having a baby in the nsy all night. I just think that having the option for a few hours, even one or two hours, is a tremendous help. I felt like the time I had in the hospital (48 hrs) was the only chance I had to try to rest a bit before I went home. And I was right! When I got home, it was just me. My husband was away 4 nights a week, and I had no family in the area. SInce you are an AF wife, I'm sure you can relate. I just felt like the WBN was a HUGE commodity to me.

    But, it shouldn't be an all night thing. I guess I just worded it wrong.

    And you're right, most bf'ing moms don't do well after they leave. Some do succeed, but many who don't have enough help in the hospital don't continue at home. No arguing that point here.
  9. by   CoffeeRTC
    Collen10..I think my mother works at the same Pittsburgh hospital you was talking about??? As an LPN she is sometimes floated to that floor to help in that nursery when it gets busy. I just delivered at Shadyside Hosp (I don't think they really have a well baby nursery?) and had the baby with me at all times. (the nurse took her for a few hrs to do test and "kept her so I could get some sleep"..I didn't ask her to but it was nice )

    Anyhow..we we just talking about rooming in and she said the same... at night the nursery is FULL of babies and that this "women's" hospital encourages this. Odd...this facility is supposed to be the cutting edge of nursing care?
  10. by   Shotzie
    I started my nursing career out on a womens care wing of a large city hospital. They had started "rooming in" as it was called them, about 18 mos before I went to work there and had done the staffing changes and facilities changes to accomodate it.

    I was like all the other nurses and just like SmilingBlueEyes and Fergus in my opinion of moms who wanted to farm out their babies at night. I was probably even more sure that babies belong with their moms all night long --no exceptions--after I had my first child...the birth was easy, my husband stayed with me and my mom was in and out of the room the full 48 hours I was there...really now!...if I could keep my baby with me without a problem then why can't those other moms!!??

    Several years later I had another child. I had had the flu for 8 days before I went into labor. I was weak and still coughing. The labor did not progress and I had to have Pit started...I swear that is the drug from H*LL created by some psychotic sadistic male researcher to make women suffer as much as possible...The anesthesiologist that was on would not do an epidural because I had had severe sciatica during the pregnancy and had resultant numbness in my left leg. They gave me stadol and then tried demerol. My pain was lessened very slightly but I added vomiting and repeated retching to the joy of labor. To make a long story short, it ended up being a forceps delivery and I sufferred (and I do mean sufferred!) a 4th degree tear.

    I delivered in the mid morning and my baby stayed with me and my husband the whole day. I was still coughing all the time and was too exhausted to be able to do much more that peer happily at him while his daddy held him. I nursed him during the day and we did just fine.

    But night time was a whole other story. My mother had died 6 months before and my husband had to stay home with our other child. I was alone, exhausted, not able to move very well because of the tear, I still had a foley in place and still had complete numbness in my leg. I asked to have the baby kept in the nursery and given formula so I could rest. I was told in no uncertain terms it would not be done. I was told "it's your baby, you have to care for it". I tried to reason from a nurses standpoint, I stated why I felt like I couldn't manage him alone on that night and assurred them that I would not have any problems bonding or breastfeeding...I loved my child and I knew I could breastfeed from previous experience but I just needed sleep. The staff was rather nasty about it and I kept my baby with me all night. I couldn't change his diaper and I couldn't manage him well enough to position him for breastfeeding. The morning staff found him sleeping on my chest because I couldn't get him back into the bassinett and me crying.

    When the doc made her rounds that morning I was still crying. My husband had not yet arrived and I felt so alone and so overwhelmed I could not see how I was going to be able to care for this baby and myself. The doc was furious and she got the nurse manager in the room to discuss what had been done (or not done) the night before. I cried even harder and only the arrival of my husband with roses in his hand stopped me.

    In this case, keeping the baby with me worsened every problem I had. I left that hospital and that experience with a much softer view of what is right and what is wrong. I was much more willing to keep the babies in the nursery from then on, especially if mom was having to leave to go home to a couple of small ones already at home. I didn't let myself be snowed by a mom who only wanted to pass on her responsibility. But I did learn to spend a little time finding out how the labor went and what else the mom had going on at that time before I stuffed rooming in down her throat.
    ...and by the way, I never had any problem breastfeeding my child not did I have any problem bonding...once I was rested, of course!
  11. by   MarnnaRN
    I am all for coupling, but what about the mom who was in labor fo 20 hours, and hadn't slept for a day and a half, delivers late, (9:30p.m.) and baby still needs bath, picture, hearing test and assessment? I didn't get to the post partum room til midnight. I had her with me before that, while I was stitched and whatever else went on. That was me, and the nurses, ever so graciously kept my baby for 3 hours, from midnight til 3 a.m., so I could get a couple hours sleep. I took her back at 3, fed her, and they took her for 2 more hours for me. BTW: we went home when her 24 hours were up.
  12. by   fergus51
    I think you guys are missing the point. No one, not me, not Deb, no one I have talked to thinks that all babies must room in 24 hours a day no exceptions. The problem is that some women seem to think that the baby should be in the nursery all night (without feeding often) when they have had a normal labor and delivery. They also seem to think that the only way to sleep is with the baby out of the room (I have had women ask me to take the baby out so that they could sleep when the baby was out like a light!). That just isn't the case. For a normal healthy birth, there are few reasons to have a baby in the nursery all night if at all.
  13. by   camay1221_RN
    I didn't find that I slept as well with the baby in the room. I was more than happy to have my kids out on demand for feeds, but the time between, I was able to sleep better knowing they were behind the locked door of the nursery. It also was a great comfort to me that the people carrying for my kids in the nursery were my co-workers that I trusted 100%.

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