Hospital Policy re: parents not allowed NB procedure?

Jolie, BSN · Jul 19, 2007

I am interested if anyone has any info on how legal this is. Are some hospitals different in regards to who can be with baby during NB screen and circ? Is there some legal right parents have to be with baby during these procedures?
THanks,
a hopeful L&D nurse to be

The "legal right" is called parenthood. Other than cases where a child is in imminent danger, hospital personnel have no legal standing to separate a parent from a child. If the parents wish to be present for a circumcision, newborn screening, physical exam, first bath, etc., they have every right to be, and it is unwise legally and ethically to try to do otherwise. Strong-arm tactics such as telling parents that they "can't" be present for certain procedures are counter-productive, instill mistrust in parents, and have no place in the maternal-child setting. If a physician is unwilling to do a circumcision with the parents present, then let him or her explain the rationale to the parents. My guess is that they will end up refusing the procedure or seeking out a physician who is willing to respect their wishes. There is no reason for a nurse to ban parents from blood draws, physical assessments, baths, etc. These are great teaching opportunities, and most parents are interested only in protecting and comforting their new babies.

It is the nurse's responsibility to explain these procedures to the parents, describing what they are likely to see and hear, and let them know what expectations the hospital staff has for the parents' behavior during the procedure, such as focusing their attention on identifying and comforting their child, not touching sterile equipment, not taking photos, etc.

The only patient I have ever known who up and left the mother-baby unit AMA did so when she was told that her healthy, stable 4-hour old baby HAD to go to the nursery WITHOUT her. I didn't blame her for leaving. She was an experienced NICU nurse, and there was no nurse or physician in that unit more cabable of caring for her son than she was.

SmilingBluEyes · Jul 19, 2007

Jolie said it well. They have the right to refuse any and all "procedures" anytime they choose, once educated as to the benefits of such. There are very few things parents refuse that are REALLY a problem, after all. As Jolie said, also, no need to exclude parents from observing and /or participating in most procedures done. Including them increases trust and improves the working relationship between parents and staff.

In other words, it has a lot to do with how we treat them and approach these things. But they have the right to refuse pretty much anything they want to as parents.

TiffyRN, BSN, PhD · Jul 19, 2007

I ask parents if they want to be present if I need to do a heelstick or reinsert an OG or NG. Most stick around for OG placements, just look away, as for the heelsticks it really is highly individual. If the infant needs something more invasive like an IV start or art stick I will ask them to leave and I've never had a parent protest.

For circs in the NICU strangely enough they are done in the room with many other babies and often other visitors though the presence of the particular infant's parents is discouraged as it would probably be traumatic for them. Most circs are done early in the morning before visitors generally arrive and many during shift change when visitors are not allowed.

I've never heard of a parent insisting on attending a circ though I could understand that. I have a feeling the docs would be totally against it and I would leave it to them to hash it out with the parent. Since most of our circs are done by a Pedi that just does that, he is not the infant's permanent Pedi then I think he would just refuse and tell the parents they can have the circ done by the infant's permanent Pedi once discharged. Is that rude? Yea, but this guy is a real piece of work (very good with circs though, the infants rarely cry during the procedure).

Oh, and I work NICU, not General Nursery, it that makes a difference.

nicunana · Jul 19, 2007

I have never had a parent request to be present for a routine circ. However, I have arranged for the whole family to be present at a Briss (done by a rabbi) in our rooming in room. It was an important and joyful part of their religion, and also signified that the baby was at last stable enough for this procedure.

fergus51 · Jul 19, 2007

It's up to the parents and up to the provider. Parents have every right to be present and providers have every right to get someone else if they feel uncomfortable doing it in the parents' presence.

Only once have I refused to perform a task with the parents present. It was an IV start and they wanted to videotape me doing it. I wouldn't do that. I needed to concentrate on the baby and the task at hand, not the parents. They were a bizarre couple though, this was just the first taste of it.

mer_RN · Jul 19, 2007

i agree with everyone else that it is the parents right to watch whatever they want. however many of them want to watch the circ and VIDEOTAPE! it. who in the world wants to sit around and watch the kids circ on tape? many of the ob's feel the parents just want to use it to sue them or whatever if the circ looks "ugly" a few years down the road. who knows. i think most parents just want to watch the bath etc. so they can learn everything they can whille there is someone there to teach them.

Elvish, BSN, DNP, RN, NP · Jul 19, 2007

i agree with everyone else that it is the parents right to watch whatever they want. however many of them want to watch the circ and VIDEOTAPE! it. who in the world wants to sit around and watch the kids circ on tape? many of the ob's feel the parents just want to use it to sue them or whatever if the circ looks "ugly" a few years down the road. who knows. i think most parents just want to watch the bath etc. so they can learn everything they can whille there is someone there to teach them.

Videotaping a circ is just ridiculous, IMO. I'm not for circing anyway (OT, I know) but if I were I'm not about to video anyone cutting any part of my child's body. I can't imagine anyone wanting to. And any parent who wants to do it for the reason listed above needs to rethink having it done period. JMHO.

fergus51 · Jul 19, 2007

I think a lot of families want to videotape for future litigation. I really do and I will not consent to having myself videotaped when I get that vibe.

It's the reason some hospitals won't allow videotaping at all anymore which is a real shame.

Kundera · Jul 19, 2007

I attended my younger son's circ. I wanted to be with him. I held my pinkie in his mouth for him to suck during the procedure. The midwife had no problem with my being there.

And for the record, I would never circ a son of mine again! :nono:

crissrn27, RN · Jul 19, 2007

Ok, so the place I am leaving kind of "strong-arms" parents about not being able to come in the nursery. They only allow parents in if their babies are sick and on a NICU bed. Otherwise, nurses say that it is against policy to allow parents in for bath, NB screen, etc. Then they say they can't let babies go out to the "clean" pp rooms with their babies, because they are "contaminated" with blood/fluids. So the babies have to go to the nursery when mom is moved, at 1 hour pp. Baby has to be at least 2 hours old, temp above 98 before bath, then rewarm baby to temp around 98.5. before going back out to mom, around 3-4 hours total, sometimes more. Haven't ever had a mom that refused to give their baby up, but I was just waiting for it. If more moms would say no, then "policy" would have to change. Anyway, I give up, I'm moving on, lol.

babyktchr, BSN, RN · Jul 19, 2007

We don't advocate parents to watch circ's, and do have a few that ask. We do try to use the nursery is a "clean" area rationale, but ultimately the physicians say they don't want the parents watching. There ratioanale is that it is a surgical procedure and if it were taking place in the OR, they wouldn't be allowed to watch then, so why now? I have known a doc to refuse to do a circ because of a parents wish to watch and didn't back down. They ended up having to take their baby to a urologist for the circ...don't know if they watched then or not. I don't know which hill to stand on here really, because both postions are valid. I prefer parents NOT to be present during a circ. JMO.

We don't "like" parents to come when we do hearing screens, but don't refuse them, and we do baths if the room if asked.