Mother-Infant Coupling

  1. 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 hospital in the inner city. Administration has decided recently to close our Level II NICU and change the unit into a mother-infant couplet unit with just an observation Nursery staffed with one RN. The problem that we are having is we are still delivering Level II NICU infants that have to be stablized and transferred out. So we haven't been able to implement the mother-infant coupling but the consultants want it done right now. I am just trying to get advice from other nurses if this is a good idea and how we could make this work. We deliver between 50-70 infants a month and half of them need intermediate care(ie. drug abusers, preemies, r/o sepsis etc). The consultants want us to crosstrain the L&D, Nursery and Post Partum staff to work all three units so that they can cut staff in half. I know that this will take months especially to crosstrain to L&D. Has anyone else had to go through these kinds of changes and how did it work?
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  2. 72 Comments

  3. by   cnsqdb
    Quote from niquern
    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 hospital in the inner city. Administration has decided recently to close our Level II NICU and change the unit into a mother-infant couplet unit with just an observation Nursery staffed with one RN. The problem that we are having is we are still delivering Level II NICU infants that have to be stablized and transferred out. So we haven't been able to implement the mother-infant coupling but the consultants want it done right now. I am just trying to get advice from other nurses if this is a good idea and how we could make this work. We deliver between 50-70 infants a month and half of them need intermediate care(ie. drug abusers, preemies, r/o sepsis etc). The consultants want us to crosstrain the L&D, Nursery and Post Partum staff to work all three units so that they can cut staff in half. I know that this will take months especially to crosstrain to L&D. Has anyone else had to go through these kinds of changes and how did it work?
    The Chief of staff should be able to manage the deliveries that come through. This means forwarding the potential preterm deliveries to an appropriate hospital prior to delivery. These problems are known prenatally and the delivery managed at anotherr hospital.
  4. by   SmilingBluEyes
    Quote from cnsqdb
    The Chief of staff should be able to manage the deliveries that come through. This means forwarding the potential preterm deliveries to an appropriate hospital prior to delivery. These problems are known prenatally and the delivery managed at anotherr hospital.

    These situations cannot be anticipated ahead of time always...what about "no docs cases" and other people who happen come to the ER in hard labor who are not stable enough to ship? We see "low risk" cases all the time who come in in preterm labor and if they are not stable, you cannot transfer them. And, what about babies you have to stabilize prior to transfer to a Higher-lever nursery for care?

    who handles this traffic?????? this needs to be handled very carefully if the transition will succeed and trouble not ensue. And it sure does NOT happen overnight , trust me! There will be a lot of resistance on the part of staff to crosstrain, not to mention the process of cutting staffing by 1/2. I would think it will be a tough row to hoe, really.
    Last edit by SmilingBluEyes on Apr 3, '04
  5. by   vwgirl
    ....are a nice concept, but only work with healthy infants and mothers that are willing to actually care for their babies, this includes during the night! When staffing is short on my unit, management likes to say, "Well, send the babies out to the mothers, let them take care of them." Needless to say, the mothers are NOT pleased when they are told, "I need you to keep for your baby for a while so I can treat this new baby/baby in respiratory distress/baby with an unstable blood sugar/baby who can't figure out how to eat/baby who need blood cultures drawn, etc." The moms expect to be able to drop their babies off at the nursery at 7pm and pick them up at 7am. And then management wonders why our "customer service" scores are dropping? (Like anyone really gives a ***** anyway.) Good luck, is all I can say.
  6. by   mandykatrn
    Quote from vwgirl
    The moms expect to be able to drop their babies off at the nursery at 7pm and pick them up at 7am. And then management wonders why our "customer service" scores are dropping?
    As a nurse on a mother/baby unit, I'm amused at the idea of mothers "dropping" off their babies at 7pm and picking them up at 7am. Are these healthy babies & moms? *WOW* There's NO WAY that would fly in my unit. Mothers are expected to care for their newborns with help from the nurses - not the other way around. :chuckle No way would we be able to take all the babies at night!

    It's interesting to hear how other units are set up though!
  7. by   seanymph
    I recently worked on a OB unit in CA where there was no established nursery. All babies from the time of delivery to the time of discharge were in mom's room (except C/S babies who went to a stabilizing room with the receivin nurse until mom was discharged to her room, this was basically the old nursery with 2 warmers, but no permanent nursery staff.). All postpartum rooms were private and accomadated an overnight helper for mom. All C?S patients were told that there babies would be rooming-in with them totally and they would have to have someone stay with them to help with the baby the first night. The nurses did help the patients, but it was known they were not available for full-time "babysitting". All sick or unstable babies were sent to their NICU. If for some reason the mom had to be placed on another floor, for cardiac monitoring, etc., then the baby was sent to the peds unit. This set-up worked great and their was never any complaints from parents about not being able to send the baby to the nursery for the night as they were all aware of the set-up ahead of time. I think this works great, especially for first time moms who should be taking care of the baby 24hrs while their is someone there to help them and reassure them.
  8. by   SmilingBluEyes
    we do couplet care and moms do NOT get to drop off their babies in the nursery all night. THEY are their mothers, THEY go home with them, not us. THEY have to learn to care for the babies and this is not done in a realistic way if babies spend all night in the nursery. Gee what will they do when they go home and there are no nurses at their beck and call to deal with whiney, hungry infants?

    Therefore, it behooves them to have their babies with them 24/7 unless they or the babies are sick or they are fresh from surgery. We don't have a wellbaby nursery, either. I don't believe in them. Glad I found a place that does not either. That is an old fashioned and outdated concept to me.
    Last edit by SmilingBluEyes on Apr 4, '04
  9. by   vwgirl
    I wholeheartedly believe moms need to take more repsonsibility in their babies' care, but the vast majority of them drop off the babies and say, " I want to sleep, you can bring him back in the morning." If the nurses try to tell them otherwise, we hear about it later on for not being "customer service oriented." I have worked in the nursery, by myself, with nine babies for 12 hours. I have to beg one of the floor nurses to come in to let me go pee. And by the time it gets to be hour #10 and those nine babies have been crying all night, I feel like a lousy nurse because all I want to do is give them back to their mothers and run screaming down the hall.
  10. by   imenid37
    [QUOTE=niquern]. So we haven't been able to implement the mother-infant coupling but the consultants want it done right now. I am just trying to get advice from other nurses if this is a good idea and how we could make this work.
    As someone who has been on the recieving end of what "consultants want", I think it will be a tough adjustment. I don't know where you are, but a nurse in my area can easily find another job and I am sure many of them will. I know you want the staff cut, but it won't be at your convenience. They will leave you high and dry at a most inopportune time because this kind of behavoiur on the part of admin. (I don't mean you-you're stuck in the middle) always results in a hostile response from the staff. Someone needs to speak up for your staff in a rational manner and advocate for the patients and nurses. Please try taking one or two open-minded staff members to admin. and formulate a time line to transition to your new care model. I think honesty (now I know hospital administrators are not known for their honesty) is paramount. The consultants are there to serve your facility, not the other way around. Personally, I think they are probably going to close your unit. Hospitlas often play these kinds of games before they do. Good luck. You are really gonna need it. I worked for a place prn that did this about 12 years ago. It didn't work. They had lost their ob/gyn residency program and I think it was thought ob was gonna close. Well, I heard they are looking for a manger for their well-baby nursery now. They had put the ob units together under one umbrella, but the tide has turned again. The staff was old, experienced, and highly resistant to any change. Too bad because at that particular hopsital, mother-baby probably would've worked fairly well. Isn't it amazing how facilities spend thousands of $ on consultants, but they rarely enlist the staff's input until after all knids of important decions have been made.
    Last edit by imenid37 on Apr 4, '04
  11. by   rUmad2
    I work in one of those "old-fashioned and outdated" facilities. Our moms are encouraged to keep their babies with them as much as possible but as a rule, most of them return to the nursery at night. Are your rooms arranged so nurses can be frequently checking the baby during the night without distrurbing the mother? I'm just wondering about those silent, unpredictable regurgs...Could you refer me to any articles with guidelines for this type of mom-baby care?
    Beth


    Quote from SmilingBluEyes
    we do couplet care and moms do NOT get to drop off their babies in the nursery all night. THEY are their mothers, THEY go home with them, not us. THEY have to learn to care for the babies and this is not done in a realistic way if babies spend all night in the nursery. Gee what will they do when they go home and there are no nurses at their beck and call to deal with whiney, hungry infants?

    Therefore, it behooves them to have their babies with them 24/7 unless they or the babies are sick or they are fresh from surgery. We don't have a wellbaby nursery, either. I don't believe in them. Glad I found a place that does not either. That is an old fashioned and outdated concept to me.
  12. by   bagladyrn
    As a traveler I've worked in probably every style of OB unit. From what I've seen, the "no nursery", babies room in 24/7 generally results in babies at the nurses station at 2 a.m. since no one is available to be in the nursery and mom insists on sleep for her and her s.o. (Tell them no and you have "customer service" complaints). When you get a baby that must be watched in the nursery but not sick enough to be shipped out, the rest of the unit must work short staffed for the rest of the night. What I see this as is a way for administration to save money and cut positions - they don't allow more staff on the floor just because you have the babies also, since "mom is doing the baby care".
    Nice concept in theory, but just never works out that smoothly. As others have said, you can definitely count on losing long term staff over this one - happens every place I've seen the transition - many times that's why I'm there as a traveler.
  13. by   vwgirl
    Quote from rUmad2
    I work in one of those "old-fashioned and outdated" facilities. Our moms are encouraged to keep their babies with them as much as possible but as a rule, most of them return to the nursery at night. Are your rooms arranged so nurses can be frequently checking the baby during the night without distrurbing the mother? I'm just wondering about those silent, unpredictable regurgs...Could you refer me to any articles with guidelines for this type of mom-baby care?
    Beth
    Actually, one of the biggest problems is that we can't escape from the nursery very often to go check on the babies that are out silently aspirating their own spit-up. One night I had nine babies to care for, by myself, and was called by L&D to came catch a new delivery. I told them I was the only one in the Nursery, none of the floor nurses could help because they were all busy; the house supervisor had to come sit with my nine babies while I attended the delivery. As far as having babies wind up at the nurses station so moms can sleep, this is ok until a call light goes off and then you have to wind up dragging the baby into the room to help the mom with whatever. If you have more than one baby at the desk, it gets really tricky.
  14. by   SmilingBluEyes
    There are plenty of articles supporting couplet care in AHWHONN's JOGYNN magazine and others. It does work.

    We do check on them frequently (about every 2 hours) w/o disturbing them, just looking in. I do all my vital sign checking etc, when babies are awake, encouraging parents to call me when infants awaken so I can weigh, do PKU, footprints without waking them up just for these things.

    Moms and dads are shown the warning signs and how to rescue any choking as well as bulb syringe use. Babies are sometimes brought out if they are extremely fussy and moms extremely exhausted, we try to help out. But when they are admitted, moms and dads are given a "welcome to the unit" information sheet, which they sign, and in there is a statement of our couplet care policy. They are encouraged to control visitors all day so when babies DO sleep, so do they. If they are shy about it, we are happy to help out here. We want them to rest as much as they would like to.

    Babies are in general to stay with their mom/dad 24/7 unless there is a specific reason they cannot (e.g. mom is sick, on magnesium sulfate, or baby is sick, or is recovering from surgery). We simply cannot promise anyone we can watch well babies all night long, as we have no wellbaby nursery. Well babies belong with their families, not staff.

    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.

    I hope this helps clear it up. It works well where I work, but then LDRP is NOT a new concept there, either, having been in place for some 14 years. I hope you can get it going there, too. It really IS great once all the staff and parents are on board with you! Good luck! I would not want to work any other way. It's great!

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