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

Specialties Ob/Gyn

Published

When I gave birth to my daughter, 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 had wonderful Labor/Delivery nurses. They got me through the labor from hell. However, once we got to the PP room, and my beauftiful, wonderfully alert and crying-her-heart-out baby girl was placed with us, the nightmare began. I don't blame the nurses per se, but it was a scary situation. I was NOT alert at all - had a pounding headache, crying at intervals for no real reason (maybe the mag sulfate I'd been given combined with sleep depriation?) 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".

I understood what she was saying, and 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.

Needless to say, I had a harrowing night. my Husband tried to help, but he was absolutely exhausted and truthfully handles sleepnessness much worse than I did. I remember pinching myself to try to stay awake so I could comfort the baby.

When the doctor rounded the next morning, I begged to go home. I knew I would get more help at home (because other non-sleep deprived family would be there to help me). He agreed and sent me home.

I'm just wondering what the policy is on this type situation in other institutions. I was breastfeeding, and went on to breastfeed for a long, long time - but honestly, my baby was in jeopardy that first night that she was in our room. Certainly I'm not the only mother who has delivered after days of being awake. I just wondered how other places handle this, or if it's the same.

I wasn't angry with anybody - the situation just really sucked and I wish I could have come up with a better plan.

:twocents:

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

It's also not a laughing matter to have a newborn prevented from eating when they need to eat, regardless of mama's circumstance. If Mom had a hard labor/birth and wasn't able to breastfeed when baby needed to eat- then the compromise needs to be made to either use formula or keep mom up long enough to pump enough to last through some decent sleep. The situation here was described as a mother who intended to breastfeed- you can't just have mom crash/sleep and not make arrangements for baby to eat as needed. And most newborns seem to want to eat OFTEN- so that doesn't really give mom a chance to sleep even if the nursing staff CAN bring baby in at first signs of hunger. Again- Mom's condition doesn't change baby's needs. I'm certainly NOT advocating just leaving Mom in a dangerous situation- but I AM saying that baby has needs too.

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.

Um- when Dad stays overnight after a birth- it would be *parenting* care- which is his right and responsibility as the child's parent.

Specializes in Labor and Delivery.

I'm sorry but as soon as she said the dad was asleep with baby on his lap while she was asleep there should have been some intervention. What if he had moved and the baby would have fell on the floor? Obviously the couple was to exhausted to care for the baby at that time. I feel the Nurse could have asked mom if she would like to pump so that the baby could be fed and the couple could get some rest. Rooming in is wonderful, but it shouldn't be forced. What if mom was bleeding/ still on mag/ pca pump etc., what provisions do they have in that instance??? There must have been SOME way for the baby to be looked after for a period of time for them to get some rest.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

We make provisions for sick moms by changing assignments in order for those moms to have more intensive nursing care. But we can't go changing assignments for routine well nursery care all night long. The numbers don't allow for it. And I agree if a baby is found in an unsafe position/place then intervention is definitely warranted. We encourage sleepy parents to place newborns in cribs when they get tired and the babies are asleep. If a kid is screaming his lungs out, we will go in and try to help. We aren't mean after all. But they will have to manage at home without nurses, and that is a fact.

Specializes in Emergency Dept. Trauma. Pediatrics.

After reading some of the things in this thread I am so grateful that I had such a great support system when it came to the care of my babies at the hospital. Can say differently as far as delivery, but the postpartum care me and my children got was wonderful. I know I am a good mom, I know if anything I push my body to far sometimes when I should be resting after births or surgeries, I am perfectly capable of taking care of all 4 of my kids and go to school with no help from friends or family or even spouse for half the year when my husband has to go work out of state. As supermom as I try to be, even I have to give in to help at times and I am so thankful that I had a postpartum staff of nurses that were so wonderful and helpful and looked out for the best interests of everything. I roomed in with all of my 4 children, and breastfed them as well and if I needed a shower or rest I was allowed that. After all, even though it's what my body was made for, my body had just gone through a pretty traumatic experience. I feel so bad for any of the woman here that were not given that same treatment :(

I'm sorry but as soon as she said the dad was asleep with baby on his lap while she was asleep there should have been some intervention. What if he had moved and the baby would have fell on the floor? Obviously the couple was to exhausted to care for the baby at that time. I feel the Nurse could have asked mom if she would like to pump so that the baby could be fed and the couple could get some rest. Rooming in is wonderful, but it shouldn't be forced. What if mom was bleeding/ still on mag/ pca pump etc., what provisions do they have in that instance??? There must have been SOME way for the baby to be looked after for a period of time for them to get some rest.

I am absolutely not suggesting that rooming in be forced. I AM saying that baby has needs that do not change just because mom is too exhausted to care for them. If Mom wants to breastfeed but is too exhausted to care for her baby- she needs to either change her mind about breastfeeding or have someone assigned to the room by the hospital for constant care- or, as I said before and you say in this post- stay up long enough to pump enough for baby while she sleeps. However, pumping before milk is established isn't going to get her much, and pumping colostrum wastes alot of it IMO because it's so thick and sticky and ends up not coming completely out of the container. It also risks nipple confusion by feeding baby from a bottle before baby learns to suck well from the breast (as it is much harder to suckle effectively from a breast than it is a bottle.) Also- do you really think a 15-20 min nap is going to cut it as far as mom being exhausted and baby being out of the room only that long until baby wants to eat again? I don't. I think in those cases that having a CNA assigned to the mom's room should be mandatory. In addition to CNA training- they can be trained by the hospital to care safely for the newborn in that circumstance.

What do you think happens when the family gets home? Parents are frequently too exhausted to take care of their children safely until the kids end up sleeping through the night (or- for some of us- not until they hit the preteen sleep-till-noon stage). How ever do they make it? The only practical solution I can see in this case is for Mom to change her mind on breastfeeding to get some sleep OR for the hospital to provide an in-room sitter for safety (I'd say a CNA would be preferrable to a volunteer given the liability issues). If Dad is that tired too then yes- he won't be much help (but it's still parenting care he provides, not nursing care- as I was clarifying in response to the other post.)

Specializes in OB, HH, ADMIN, IC, ED, QI.
:twocents:

It's also not a laughing matter to have a newborn prevented from eating when they need to eat, regardless of mama's circumstance. If Mom had a hard labor/birth and wasn't able to breastfeed when baby needed to eat- then the compromise needs to be made to either use formula or keep mom up long enough to pump enough to last through some decent sleep. The situation here was described as a mother who intended to breastfeed- you can't just have mom crash/sleep and not make arrangements for baby to eat as needed. And most newborns seem to want to eat OFTEN- so that doesn't really give mom a chance to sleep even if the nursing staff CAN bring baby in at first signs of hunger. Again- Mom's condition doesn't change baby's needs. I'm certainly NOT advocating just leaving Mom in a dangerous situation- but I AM saying that baby has needs too.

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Newborns are also tired after wandering into this world, too and hearing things so much more amplified than when they were inside the uterus. Often their crying is fretful, and a being held, rocking motions, and a pacifier will suffice (unless they're the type who spit that out). Usually first milk (senior moment, can't think of its name) is not pumpable, as its quantity is less than milk later, stimulated by suckling). :yawn:

The most sensitive set-up I've ever seen, was at Kaiser Permanente hospitals' OB units, designed by an architect who deserved a medal for it. First of all, the hallway where visitors came to see new moms, was a covered OUTDOOR one. No cross contamination by visitors, and the whole family could come. It was secure. The babies were placed in "drawers" (literally) after they'd stabilized, which were at the level of most hospital beds, next to mom. When mom got tired, she'd slide the "drawer" through to the 4 bed/"drawer" nursery (which prevented overcrowding nurseries) where a nurse was stationed at all times. It was actually then nearly in the nursing station, in a "pod" arrangement. Some idiot redesigned those hospitals without that, to the detriment of all. The loss of shangri-la.......:(

Specializes in Community, OB, Nursery.
Newborns are also tired after wandering into this world, too and hearing things so much more amplified than when they were inside the uterus. Often their crying is fretful, and a being held, rocking motions, and a pacifier will suffice (unless they're the type who spit that out). Usually first milk (senior moment, can't think of its name) is not pumpable, as its quantity is less than milk later, stimulated by suckling). :yawn:

A couple things to add here:

1) Baby-friendly hospitals discourage the use of pacifiers, and my hospital will not provide them to new parents. I personally don't care if parents start their babies on pacifiers - I did w/ mine on day 2. However, the fact remains that when baby is rooting and looking for something to suck on, it is going to be far easier to latch baby on then than later when s/he is screaming and frantic. Within the first hour or so is the best time to do this.

2) I disagree with colostrum not being pumpable. It is individual, of course, but most moms can at least get a couple mls if they're full- or near-term. However, pumped breastmilk in a cup (people are so afraid of nipple confusion) is not going to satisfy a baby's desire to suck, even if it fills his tummy.

3) If there is a support person there, s/he can do the holding/rocking etc just as well as I can. That is part of being a parent.

4) It's really not hard in most situations to get mom in a side-lying position to nurse so she can rest and baby can eat. He gets close to mom, he gets to suck, she gets to rest, everybody wins.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
A couple things to add here:

1) Baby-friendly hospitals discourage the use of pacifiers, and my hospital will not provide them to new parents. I personally don't care if parents start their babies on pacifiers - I did w/ mine on day 2. However, the fact remains that when baby is rooting and looking for something to suck on, it is going to be far easier to latch baby on then than later when s/he is screaming and frantic. Within the first hour or so is the best time to do this.

2) I disagree with colostrum not being pumpable. It is individual, of course, but most moms can at least get a couple mls if they're full- or near-term. However, pumped breastmilk in a cup (people are so afraid of nipple confusion) is not going to satisfy a baby's desire to suck, even if it fills his tummy.

3) If there is a support person there, s/he can do the holding/rocking etc just as well as I can. That is part of being a parent.

4) It's really not hard in most situations to get mom in a side-lying position to nurse so she can rest and baby can eat. He gets close to mom, he gets to suck, she gets to rest, everybody wins.

What she said. Much better than I said anything here.

Specializes in Emergency Dept. Trauma. Pediatrics.

One of my favorite things about breastfeeding was being able to lay on my side, hook baby on and both of us go back to sleep. I would wake back up and put my boob back and all was well. At the hospital though they didn't allow this, they had a rule that you couldn't sleep with the baby in the bed as well. i know Co Sleeping is very controversial but it worked for me and all my babies and they are all well rounded independent sleepers now. I couldn't stand NOT having my small baby sleeping with me. I am a very light sleeper though and it was never a problem.

My children when I was in the hospital would only eat probably every 1.5-2.5 hours. A lot of times if they started fussing we would just wrap them tight and give the binky and they would drift right back to sleep. I think I had pretty easy newborns though, my youngest did not cry once when she was born and after birth she just laid there in her bundle staring around for hours before dozing off without a peep. The nurses said it they never seen anything like it LOL.

Specializes in Psych, Med/Surg, LTC.

Neither hospital I delivered at allowed co-sleeping, either. One did not have a well baby nursery, and the other did not take breastfed babies at night. My baby just wanted to be held, he did not need the breast, but since he was breastfed, he wasn't allowed in the nursery. :rolleyes: I understand they were busy and didn't want to keep bringing him out to feed every 1-2 hours. 1-2 hour stretches of sleep would have been nice, though, instead of NONE. There seemed to be plenty of time for nurses to check on us to make sure we weren't sleeping in the bed while nursing, though. :chuckle Of course, co-sleeping wasn't allowed. I was so happy to get home so we could go to bed and nurse/sleep together. We still do it 15 months later. :D

Specializes in Community, OB, Nursery.

Hey Gooey - come have your next baby at my hospital. I don't care if people co-sleep. I just ask them to let me know if they are so that we can do it safely in the hospital beds. Most people welcome that. My babies are safe, my moms are happier, and everybody sleeps better.

It drives me crazy - so many other cultures co-sleep and mom and baby are not separated much at all. And here we expect babies to go straight from warm, yummy, feelgood womb to a plastic box, and be happy about it. :confused:

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