Mother-Infant Coupling

Specialties Ob/Gyn

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I just became the assistant manager of a women's health care department. We just had consultants come in who have decided that our whole department needs to be changed around. We are a 200-bed hospital in the inner city. Administration has decided recently to close our Level II NICU and change the unit into a mother-infant couplet unit with just an observation Nursery staffed with one RN. The problem that we are having is we are still delivering Level II NICU infants that have to be stablized and transferred out. So we haven't been able to implement the mother-infant coupling but the consultants want it done right now. I am just trying to get advice from other nurses if this is a good idea and how we could make this work. We deliver between 50-70 infants a month and half of them need intermediate care(ie. drug abusers, preemies, r/o sepsis etc). The consultants want us to crosstrain the L&D, Nursery and Post Partum staff to work all three units so that they can cut staff in half. I know that this will take months especially to crosstrain to L&D. Has anyone else had to go through these kinds of changes and how did it work?

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

There are plenty of articles supporting couplet care in AHWHONN's JOGYNN magazine and others. It does work.

We do check on them frequently (about every 2 hours) w/o disturbing them, just looking in. I do all my vital sign checking etc, when babies are awake, encouraging parents to call me when infants awaken so I can weigh, do PKU, footprints without waking them up just for these things.

Moms and dads are shown the warning signs and how to rescue any choking as well as bulb syringe use. Babies are sometimes brought out if they are extremely fussy and moms extremely exhausted, we try to help out. But when they are admitted, moms and dads are given a "welcome to the unit" information sheet, which they sign, and in there is a statement of our couplet care policy. They are encouraged to control visitors all day so when babies DO sleep, so do they. If they are shy about it, we are happy to help out here. We want them to rest as much as they would like to.

Babies are in general to stay with their mom/dad 24/7 unless there is a specific reason they cannot (e.g. mom is sick, on magnesium sulfate, or baby is sick, or is recovering from surgery). We simply cannot promise anyone we can watch well babies all night long, as we have no wellbaby nursery. Well babies belong with their families, not staff.

Breastfeeding and bonding are better supported when babies stay with their moms, not with nursery staff. Moms need to learn pretty darn quickly how to respond to various infant cues for feeding, attention, diapering, etc and can hardly do this with the baby in the nursery half the time. And if/when we do have sick infants in the nursery, yes, the nursery nurse CAN watch the well ones, but NOT all night. Again, this does nothing to foster bonding and learning infant care on the parts of the parents/caregivers. When we have kept babies in the past in the nursery all night and the first thing in the morning, the ped's demand to know WHY ------even THEY don't like it. It's unrealistic to think you can just send off your baby to be "watched" all night and succeed at all at breastfeeding or learning to care for him/her while you in the hospital. Our rooms are designed privately and are generous in size, so fathers/others are ENCOURAGED to spend the night, helping mom out and bonding with their babies as well. Since more than 90% of the moms we admit request breastfeeding, it behooves them to have the baby with them all the time so they can learn this in the short time they are with us.

I hope this helps clear it up. It works well where I work, but then LDRP is NOT a new concept there, either, having been in place for some 14 years. I hope you can get it going there, too. It really IS great once all the staff and parents are on board with you! Good luck! I would not want to work any other way. It's great!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Actually, one of the biggest problems is that we can't escape from the nursery very often to go check on the babies that are out silently aspirating their own spit-up. One night I had nine babies to care for, by myself, and was called by L&D to came catch a new delivery. I told them I was the only one in the Nursery, none of the floor nurses could help because they were all busy; the house supervisor had to come sit with my nine babies while I attended the delivery. As far as having babies wind up at the nurses station so moms can sleep, this is ok until a call light goes off and then you have to wind up dragging the baby into the room to help the mom with whatever. If you have more than one baby at the desk, it gets really tricky. :rolleyes:

WOW sounds pretty dangerous tome---- NINE babies? How does ONE nurse care for NINE babies, even if they ARE 'well"? Hey, you definately need more staffing or to stop wellbaby nursery staffing. You know, parents CAN (AND MUST) be taught to watch for spitting up/aspiration, and they are where I work. After all, they go home with their babies, not us, and they can just as well aspirate at home as they might in their 24 short hours in the hospital with US! Empowering parents to know what to watch for and how to help is the best way to go and this is not done if the kids are in the nursery more than 1/2 of the hospital stay.

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I love mother-baby. It works well at my current facility. The problem is, there is not always a one-size fits all approach to care delivery that works. What would be a "special care" baby at one facility (ie. a drug addicted 35 weeker) is a regular kid at another. The REAL issue that the poster brought up is that the facility wants to cut the staff and the consulting company sees this care delivery model as a way to do it. It has nothing to do w/ offerring enhanced pt. care. If this facility has a lot of high risk full-term (for lack of a better description) babies, then mother-baby might work w/ a max of 2 to 3 couplets to offer safe appropriate supervision to these pt's. Also, even w/ a very co-operative staff, the learning curve to convert from a traditional care delivery model to mother-baby can be many months, so that must be taken into consideration. This, however, is not the idea it seems as that probably would only deliver quality pt. care, not save $.

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At the facility I spoke of earlier we did not keep babies at the nurses' station at any time because all our staff was either too busy with their mother/baby patients or with the labor patients any there was no telling when the charge nurse would be called away from the desk. Any babies that were too sick to stay in the mom's room was sent to the Peds unit where they had there NICU and a stepdown nursery.

Never had any problems or complaints.

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I wholeheartedly believe moms need to take more repsonsibility in their babies' care, but the vast majority of them drop off the babies and say, " I want to sleep, you can bring him back in the morning." If the nurses try to tell them otherwise, we hear about it later on for not being "customer service oriented." I have worked in the nursery, by myself, with nine babies for 12 hours. I have to beg one of the floor nurses to come in to let me go pee. And by the time it gets to be hour #10 and those nine babies have been crying all night, I feel like a lousy nurse because all I want to do is give them back to their mothers and run screaming down the hall. :o

not a nurse yet just responding with an experience. my friend just had her baby 2 weeks ago and had an emergency c-section (placental abruption) anyway she was in the hospital for 5 days and it is a family centered birth hospital so mom and baby (and dad if he wants) stay in one room. well th probelm with this type of family center is that visitors came all day and evening to visit and my friend didn't get a lot of rest (they had been trying for 10 yrs to get pregnant so the baby was an EVENT!) anyway they ended up getting so worn out from not sleeping enough that they finally asked to send the baby into the nursery the last 2 nights. Now i know that they should have spoken up and put a no visitor sign out or told the nurse no visitors, but they "didn't want to be rude", not to mention that the phone kept ringing. I feel for the nurses in that nursery because they are busy with infants who are having problems and all it takes to overwhelm them is 3-4 moms needing "a break" and the nursery is going bananas from feeding, changing, vitals etc.... I know because my baby was born there and spent the first 5 days in the nursery because she wasn't holding her temperature and they suspected an infection because of her wet lungs. those nurses,students, aides and docs never sat down! the idea of cutting staff because mother and baby will room together might work a lot of the time but what are you going to do when a few moms want a break and send the babies to the nursery? If the hospital says the patient is always right then they need to staff the hospital in a way that peoples wishes can be realisitically met.

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....are a nice concept, but only work with healthy infants and mothers that are willing to actually care for their babies, this includes during the night! When staffing is short on my unit, management likes to say, "Well, send the babies out to the mothers, let them take care of them." Needless to say, the mothers are NOT pleased when they are told, "I need you to keep for your baby for a while so I can treat this new baby/baby in respiratory distress/baby with an unstable blood sugar/baby who can't figure out how to eat/baby who need blood cultures drawn, etc." The moms expect to be able to drop their babies off at the nursery at 7pm and pick them up at 7am. And then management wonders why our "customer service" scores are dropping? (Like anyone really gives a ***** anyway.) Good luck, is all I can say.

UMMM, willing to care for their infants??? They have no choice. That is their baby, like it or not, our mothers get no choice.

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I also worked at a hospital in which administration came in and decided to have consultants come in and teach me how to be a 'real' family centered nurse. I found this to be an insult because, as far as I was concerned, I had already been doing 'real' family centered nursing. I am all for the concept of family centered nursing, and encouraging parents to be proactive in the care of their newborn, but I also feel we should be treating the pts as individuals and be able to center our nursing care based on the individual needs of the pt and her infant. So, if that means I have a mom that wants her infant to room in with her, hey, that's great, I'm all for it, but on the other hand, if I have a mom exhausted and wants me to keep the infant in the nursery all night for feeds, or even out on demand, I respect that also. Goodness was that ever a runon:) !

Sorry, back to the consultants, anyway, Iit seemed like the consultants wanted us to treat all pts alike regardless of their situations. The hospital is very culturally diverse, and what a disservice to the pts to try to treat them by a script written by a consultant.

I left the job a year ago tomorrow, and I miss the pt care and my coworkers terribly. However, I have stayed close with all of my friends, and it doesn't sound like things are getting better with the 'new & improved' consultant method, as a matter of fact, I have had people tell me to be glad I left when I did.

I hope to go back to Mother/Baby nursing someday, but right now, I will continue to get my 'baby-fill' working in a pediatric office.

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Specializes in ER, PED'S, NICU, CLINICAL M., ONCO..

:rotfl: Although we are from different health care systems, as I could see, on the Maternal-Child area we've got more similarities than differences.

I work in a small hundred-bed private-hospital, alternating the NICU with the Mother-Infant coupling. Our NICU is so small that we integrate all the labels in one. Sometimes it happens to have it close during few hours because there are no babies in it. Very rare but sometimes it happens.

The Chief of the staff is very reluctant of forwarding any complicated delivery. We've some unfortunate complications with fatal end, because we were not ready to afford them.

As I know, the complexity of the area was a growing process that began without inpatients of peds, and accepting only those deliveries with a very healthy prenatal antecedents. That process grew until interchanging surgeons and other specialists from the main public and private Hospitals of BSAS City. The second floor of the building has changed from an Adult-Med-Surge-Unite to a Mother-Infant Coupling Unite. Nothing was done from Night to Morning. Every change takes time.

Nowadays we deliver similar ciphers of infants, still more than 70 monthly.

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Specializes in ER.

I find it hard to justify to parents why they are paying hundreds of dollars in nursery fees, and yet they are the ones taking care of the baby. They do need to learn, but learning occurs better with rest. It's reasonable to assume that a woman up all night innlabor, and her family, are not going to be ready to care for a baby until they nap, and will not wake to baby cries when they are overtired.

I saw where one nurse was taking care of 9 babies. Isn't there a law for daycare centers that forbids more than 4-5 preschool children to each caregiver? Although that law doesn't officially apply to the hospital I am sure nursing staff could look it up to justify minimum staffing for hospitals.

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Specializes in OB, newborn, gyne.

I believe "Guidelines for Perinatal" states a ratio of 6:1 for well-baby:nurse. From the units that are completely "mother-baby" I have a question, please. What are your patient satisfaction comments? I do believe the key here is not only educating staff to the changed expectations, but educating the community and clients.

Earlier, I referred to the unexpected, silent regurg of the infant. I agree parents should be taught appropriate use of the bulb syringe, but what if both are asleep? What is the liability regarding an infant aspirating in a mother's room when everyone is asleep? Granted, an infant can aspirate in an attended nursery, but which would be worse in the eyes of a jury who sees it as the hospital's number one responsiblity to keep infants safe?

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Our mother baby couplets always had high satisfaction ratings because they knew ahead of time what to expect. They can sleep when the baby sleeps (which is about 70% of the time!) and they don't have to be away from their new bundle of joy. This does mean they have to take some responsibility for limiting visitors during the day by telling the nurse or putting up a sign or something. Being a parent means making choices, and entertaining visitors for 12 hours straight and getting worn out is not in their best interest.

As far as aspiration for a rooming in baby.... I just don't see how far we are supposed to go in the name of limiting liability. The idea that they shouldn't have their own babies with them because we are afraid to get sued seems silly to me. I have never worked in a hospital with a wellbaby nursery and have never heard of a lawsuit over this type of thing.

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Our ratio is one RN to 4 babies. Our hospital does rooming in, and nobody has complained. They know this coming in, and the majority like it. If they are too weak, or on Mag, yes, the baby is in nursery. Remember, most of our vag deliveries go home in 24 hours, so one night isn't going to give them THAT much rest. They may also have a person spend the night, so they can help with the baby.

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