Help Becoming Baby Friendly

klone, MSN, RN · Mar 4, 2013

Do you encourage rooming in?

What are your policies on hypoglycemia?

Do you give out any kind of gift bags?

RN_BSN09, RN · Mar 4, 2013

Our unit is baby friendly, and we have the same nurse care for both mom and baby (3 to 4 couplets per nurse). We have a transition nursery for immediately after the birth which is staffed with one RN... after bath and initial meds, baby is then sent to stay in mom's room. We also have a separate postpartum nursery that is either staffed with an RN or CA. The nursery RN/CA assists the floor nurses if needed with assessments, bottle feedings, phototherapy babies, and labs, but are not assigned any patients. They also do circs. We are trying to do most everything in the mom's room at the bedside, but the nursery is there if mom wants to sleep and not have all the lights turned on for assessments, and for complications such as phototherapy.

Not sure if that helps, but that's how our unit runs. :)

debsgreys · Mar 4, 2013

No gift bags anymore. Yes we do encourage rooming in.for hypoglcemia we want mom to breastfeed if BS is still low, mostly I see formula is given.I think it depends on the RN working on how it is given. Sounds like it works well RNBSN09 where you work.

It does help, that is what I love about this site!

uRNmyway, ASN, RN · Mar 6, 2013

Where I worked mother-baby, all baby-friendly facilities, here is what I typically saw:

-Immediate skin-to-skin contact. If mom had complications or was a fresh C-section, they would make dad take off his shirt and put baby on him.

-Encourage breast feeding during first 30-60 minutes of life.

-Baby in room with mom at all times unless complications.

-Rooming in, absolutely. We might take the baby at the nurses station during the night for an hour or two if they were criers and mom was exhausted, but that's it. There was no such thing as a well-baby nursery.

-Even if low BS, we put to breast. We might manually express and cup feed, but absolutely prioritize breast milk. If we had to supplement with formula even once we had to fill out these long forms explaining why, with parent signature for authorization and all. We would also encourage manual/pump expression between feeds to have extra on hand to supplement if needed.

-Formula was kept in a locked cabinet, like narcotics basically lol. We did not provide formula except for the little ones in the intermediate care nursery.

-All nurses had to take a 3-4 day orientation on breast feeding. You also had the option to take a more advanced training if you wanted it. I never got to since I was agency.

-Most of the mother-baby departments I worked on had LPN/RN teams, with ONE CNA for the floor. Each team (night shift) had 5-6 couplets. That way, if there was a difficult feed to assist, the RN would assist while the LPN attended to the other patients. If anything happened, the LPN would just go get the RN out of the room.

PinkNBlue, BSN, RN · Mar 6, 2013

We're working on becoming baby friendly ourselves and have implemented some changes on our unit. For starters, we no longer give away formula gift bags. Many do ask for them (if they've had a baby with us before and received it last time) and we explain that because we're baby friendly and encourage breastfeeding, we no longer have them.

We encourage rooming in and really, it is the responsibility of the nurse admitting the patient to our floor that they let the mother know we do rooming in with our babies. Of course we will not refuse a baby in our well baby nursery but we will make sure to explain the reasoning behind rooming in and the benefits, especially breastfeeding mothers. Unfortunately a lot of nurses still have the mentality of bringing the baby to the nursery for the night because "mom is tired". Yes, that's true but education is necessary so that the patient can make an informed decision. Do not just offer to take the infant (unless it's a safety issue, of course).

For hypoglycemia, we have a algorithm we follow... if it's below 40, immediately to breast or if bottle feeding, formula. Then recheck 1 hour after.

We do put baby to breast/ skin to skin after lady partsl delivery and do attempt to do so after a c section in recovery (or at the very least, bring baby to recovery to feed).

We do couplet care and are responsible for our assessments on mom and on baby. We also take gyne surgical patients so I know exactly how you feel regarding time. And the limited hours with the LC's. I work the 3-11:30pm shift so we never have LC's with us.

debsgreys · Mar 7, 2013

thanks for all the info. We have have a similar algorithm for hypoglcemia. last few months I have seen most of our moms do skin to skin following a C/S, in the RR. pinknblue how many couplets do you care for?? A big part of becoming baby friendly is getting the Dr.s' and residents on board with the education prenately, thats instead of asking are you going to breast or bottle and giving the proper info on breastfdg. For years I feel so much is loss thru moms knowing very little prior to delivery and we are expected to perform miracles in 2 days.

The education for the entire staff including the Docs is Best Fed Beginnings.

PinkNBlue, BSN, RN · Mar 8, 2013

We usually have 4 couplets.

debsgreys · Mar 8, 2013

pinknblue, sorry to keep asking you questions LOL Does your unit staff all RN's? or do you have CNA or techs?? I spoke to my manager this week about my reaching out for advice on baby friendly, esp. staffing. We have a Best Practice commitee that meets next week and I am trying to bring some info with me.

PinkNBlue, BSN, RN · Mar 8, 2013

pinknblue sorry to keep asking you questions LOL Does your unit staff all RN's? or do you have CNA or techs?? I spoke to my manager this week about my reaching out for advice on baby friendly, esp. staffing. We have a Best Practice commitee that meets next week and I am trying to bring some info with me.[/quote']
I don't mind questions at all! We do have techs but rarely have enough. They do vitals at the beginning of each shift and then help wherever needed. It's most helpful to have them help with getting up our patients for the first time for safety reasons.

debsgreys · Mar 8, 2013

Thanks again, we have no CNA or techs, when we did couplets average was 4 and an ante or gyne. Many times no lunch or 10 mins. Our policy on M/B units is hourly vs with assessment x 4 and with d/c and admissions, phew! we even have to escort mom and baby out to car many times.

uRNmyway, ASN, RN · Mar 8, 2013

Thanks again we have no CNA or techs, when we did couplets average was 4 and an ante or gyne. Many times no lunch or 10 mins. Our policy on M/B units is hourly vs with assessment x 4 and with d/c and admissions, phew! we even have to escort mom and baby out to car many times.[/quote']
Geez, hourly VS? Like, the whole PP phase? Id love to see data that supports the necessity for hourly vitals if you've had normal VS for 12 hours, normal bleeding, appropriate weight loss, normal urine output, good feeds, etc.