Baby Friendly

Why do you need to get a weight in the first hour?

There was discussion about missing blood sugars if we do not know the weight. We have 90 minutes to have the baby in the nursery for a blood sugar.

Why does the baby need to be away from mom in order to check a glucose? And why does weight need to be known in order to check a glucose? Why can't you just go by symptoms or risk factors (e.g. mom has DM)?

Whoa! You have a long way to go to get to BF if this is your facility's culture. Ride the BFI listserv and start with the low hanging fruit. What's your treatment for the low blood glucose? It should be breastfeed. If you've moved the baby to the nursery to check the sugar, you then have to rush back to mom's bedside. Is your glucose machine bolted to the floor or wall? Take it to the LDR.

I think I am seeing what the problem is. We just started this BF project. We are trying to work out the kinks. One of the kinks is that when we were doing the breastfeeding and skin to skin after delivery, we would do the blood sugars in L/D. There were a few times that the blood sugars remained low and then we would get them to the nursery where they would care for the baby. L/D has been "written up" for bringing low blood sugar babies to the nursery, so now L/D is to take the baby to the Nursery by 90 minutes.

I see that there needs to be a change in culture. It is difficult for L/D RN's to care for the baby if there is a blood sugar issue in the fact that there usually is another pt to care for so time is of the essence.

What is your procedure? (recovery and transfer)

At our hospital, we have one or two nurses whose role is to transition and admit the newborns who are born on that shift. While the L&D nurse is recovering mom, the "admit nurse" is recovering baby. That nurse would be responsible for getting mom and baby breastfeeding and checking BG as necessary, not the labor nurse. After a few hours and both mom and baby are stable, they both report off to the couplet nurse.

Ishallis, I'm curious what your neonatal hypoglycemia policy is. Would you care to post the salient points here? For example, what are your criteria for doing a BG check, what are your cutoff values, and what is treatment, etc? I've found that many hospitals' hypoglycemia policies are a huge barrier to successful implementation of BFHI and breastfeeding.

Our policy/algorithm for LGA/SGA/GD babies is a blood glucose level within the first hour and a half...so weights can absolutely wait til after the first hour. We also do our checks in the room. It's a heel stick ran on an accucheck. No need for baby to go to the nursery for the poke.

Remember skin to skin will help regulate blood glucose levels. So if the baby as risk is stable, skin to skin is only going to help. If we need to do an accucheck earlier (baby is symptomatic) then we do it.

Any level above 25 for the first check is acceptable per or policy/algorithm. That's the low end though--so we want to feed that baby right away and recheck in an hour. If the first check is over 40 then it's a.c. checks.

I'm not an OB nurse, but my hospital is BF and I delivered my last son there. I also had gestational DM. They did a heel stick and used the same monitor that every other unit in the hospital uses for FSBGs. He didn't go to the nursery at all, except I sent him the second night in between breastfeeding him so I could get a good two-hour nap...I'm confused why the nursery is even needed for something like a BG? The audiologist brought her equipment right into our room for his hearing test; the lab tech did his heel stick for the newborn screening in our room; the pediatricians came to our room to check him over; they brought bath supplies so I could bathe him myself (after advising that I NOT do it the first day, b/c the research says that leaving the vernix on is beneficial for thermoregulation). The RN weighed him a while after he was born... I did skin-to-skin for a while and breastfed him, and did let the pediatricians check him while still in recovery. My husband had been holding him anyway so I could eat (I'd worked a shift the night before while in early labor and delivered him a few hours later, so I was tired and ravenous!) But I know for sure the weight was done after we got into the postpartum room, because the RN let my girls "help" weigh him and take his temp, and they didn't arrive at the hospital until I was in my postpartum room.

I don't know what the hypoglycemia protocol is; my son's was 40 so didn't need treatment. But I have a cousin whose baby had low BG and she was just encouraged to breastfeed. Her baby wasn't really interested though, so the RN gave her a little med cup of formula and taught her how to cup-feed it. The baby wasn't removed from their room for that either.

I do blood glucose checks while baby is skin-to-skin in mother's arms. If BG is low, protocol is to feed - and if babe is in arms, the kid is already in the restaurant. I check weight when mom wants to stretch her arms, go to the bathroom - this is usually in the first hour or two and after a feed or two. Weight can wait - we generally have 2 hours to do meds, baby measurements, etc. I will also give meds with baby in arms. I guess it's a different approach to the lists of tasks in the immediate postpartum. I keep mom and baby together as much as they want - and allow mom to tell me when she wants to let the baby go. Then I can do all the "stuff." Not sure why BG needs to be done in the nursery.... makes it hard to be baby friendly.

Thank you everyone for the insight. I am finding that our culture must change. One big protocol sounds pretty close all of yours. I will take all of the wealth of information back with me on monday..