There are, according to Dr. Celeste Phillips, 10 principles upon which FCMC is based:
- Pregnancy and childbirth as normal and healthy processes
- Personalized prenatal care
- Comprehensive perinatal education, with active input from the family
- Healthcare professionals assist the family in making decisions important to their care
- Mom's support system is actively involved in prenatal care, labor, birth, and infant care
- Support people present at Mom's discretion
- Labor and postpartum care provided in as much of the same space and by as many of the same people as possible
- Moms are encouraged to keep their babies in the room with them at all times if possible.
- The same nurse cares for Mom and baby as a couplet
- Parents included in as much of the sick newborn's care as possible.
Obviously, this is going to look different at every hospital, but for the most part, I have seen it work at mine. Our unit is not set up to have LDRP rooms; women give birth in Labor & Delivery, then are transferred to Mother/baby for the rest of their stay. As it is currently, a baby is brought to the nursery about an hour after birth (unless unstable, then brought sooner) for bath and assessment, then is back out to mom as soon as possible. If Mom requests, we can do the bath and assessment in the delivery or postpartum room; unfortunately, we are not currently staffed to do this for everyone, which I do not like.
In the mother/baby unit, we try to promote mother-baby togetherness pretty much from the start. As soon as we admit the mother, we let her know that we do encourage her to keep the baby with her as much as possible, and we encourage a support person to stay with her and help her. And of course, we nurses are there to help her with her baby as well.
Of course, there are times when Mom is physically unable to care for the baby - she is hemorrhaging, is just plain tired after laboring and then a c/s, is vomiting up her toenails (so to speak) or for infection control purposes - and we are able to work around that. We can bring a baby out to her for feeds, or we can feed the baby in the nursery with a cup or a bottle (Mom's choice) until she is feeling better. We also have occasions where a baby is up for adoption, or resulted as a product of the mother being raped - we go on a case-by-case basis. Some mothers want their babies with them, others do not. We certainly do not force anything on anyone. These situations are fortunately the exception rather than the rule.
It never ceases to amaze me how often rooming-in works, though. I have seen it work with moms of babies up for adoption, prisoners, single moms, married moms, moms of all nationalities, ages, socioeconomic strata, and personality. It never ceases to amaze me how often moms want to keep their babies with them; maybe it shouldn't, but it does. Even fresh c-section moms!
There are some things I do to help them out. If I'm in the room, I change diapers so Mom can pee or do whatever she has to do to take care of herself. I help settle fussy babies, so Mom can rest her eyes and arm, and often they are both sound asleep by the time I walk out of the room and they stay that way for a while. I show new parents how to swaddle and settle so that they don't lose their sanity with a screaming baby all night. I try to help Mom make sure she's got a good latch (if she's breastfeeding) and baby's getting enough to eat so he'll sleep between feeds. I try to cluster my care so that I don't have to wake the family up multiple times - sometimes if they're all sleeping when I walk in, I just leave a note on a paper towel in the baby's crib for Mom to call me when they all wake up so I can assess/medicate/whatever else. In the middle of the night, I don't knock before I open the door - again, wanting to preserve sleep! I tell Mom this when I start my shift at 7 pm and give her a chance to object, but most don't. Most thank me for not knocking every time I need to lay eyes on them. (That said, I would never ever take a baby out of the room without letting Mom or Dad know where and why.)
If Mom is at her breaking point and just needs a break from the baby - which many moms do at some point, whether in the hospital or at home - I let them know the nursery is there. I just tell them I need to know what to do about feedings: bring the baby back to feed, feed a bottle in the nursery, or cup feed in the nursery. All most moms ask is just for a few hours to take the proverbial edge off. Our hospital is fortunate to have a nursery staffed with two RNs so that this is an option. More often than not, though, with a little help, my moms keep their babies. I'm not a 'You-MUST-keep-your-baby' taskmaster, but sometimes all it takes is an extra pair of hands or a listening ear. Many a mom has spilled her guts about fears or frustrations or just the awesomeness of childbirth when I pull up a chair in her room at 2 am.
I really try to do my best to individualize my care. Some moms want me to leave them alone and let them do their thing. As long as she and baby are safe, fed, and ok, I'm fine with that. Others want more hands-on care. I'm fine with that too. Often first-time moms need so much cheerleading because we (I'm including myself in that category) are SO unsure about our abilities to parent. We are certain that we'll never figure out what's wrong with the baby when he cries, or that we'll never learn what sounds we can sleep through. I try to be that nurse that reminds them that for millennia, moms and dads have learned what their babies need, and so will this one that's in front of me. It's so easy as a nurse that swaddles a baby a hundred times a night to lose patience, and remember that this new daddy has never done it before and is afraid his baby will break if he wraps her too tight. But remember we must.
There are so many other issues that tie into FCMC - feeding baby, visiting hours, co-sleeping, psychosocial issues, infection control, and many others - that there's no way I can possibly do them justice in these few paragraphs. But I am interested in how your hospital handles FCMC, or what challenges you have had in your transition to FCMC, or anything else related to the topic.
Great FCMC resource:
http://www.pandf.com/index.html
