Mother-Infant Coupling

Specialties Ob/Gyn

Published

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?

I love Couplet care because it is a much more human way to treat patients. Also, I find in the hospitals that promote couplet care, the nurses seem to focus on what is best for the patient and NOT on what is most convenient for the managment/nursing staff in regards to staffing issues. I absolutely hate to rip a baby away from the breast before it is done with the first nursing so that I can transfer the patient within a timely 1-hour period. With LDRP/couplet care, the nursing staff can change, but the patient recieves better care.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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.

?

NEVER a complaint about lack of well baby nursery. And I mean NEVER. But then, they know ahead of time the expectations and realize THEY are the parents and need to assume care of THEIR babies. It's working just FINE where I work. MOST complaints we get stem from our LOUSY food, not nursing care or lack there of. Our couplet-nurse ration averages 3-4 couplets per nurse max. It works GREAT!

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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.

sounds like where I work.

Yanno, it always amazes me how controversial letting babies room in with their moms 24/7 becomes. WHY? What about moms who birth at home or at birthing centers? They seem to do fine. Seems to me, this should be standard of care EVERYWHERE, with the only acceptions being sick mom/baby,fresh from surgery or other medical conditions prohibiting such an arrangement. This is not that common since birth is essentially a HEALTHY event, not a medical one.

Up Vote Up Vote ×

My experience: roomed in with the first, baby NEVER left the sight of my dh or myself. I was all about being with my baby. I also was pretty much left alone because I was a nurse.

That was me though...I think if a hospital/birtcenter has a strict rooming in policy they should be able to supply a doula at a resonable fee (sliding scale - etc.) so that women who require more assistance for whatever reason - cultural, emotional economic - have access to personal support.

I bet the risk of post-partum depression, bonding issues and lack of breastfeeding would be addressed all at once. Hey and think of all the $$$ social services and insurance companies would save on prescription meds - dissolved marriages and relationships w/ s.o.'s-baby formula - the list could potenitaly go on and on and on.

just a thought.

kate-mom of 3

Up Vote Up Vote ×
What about moms who birth at home or at birthing centers? They seem to do fine. .

that was me with the last 2. I have a wonderful supportive dh ::and:: a close circle of friends who helped me with meals, my other kids etc. ::and:: a doula for a week postpartum.

In my experience many women who choose home birth/birthcenter with a midwife are a slim demographic. Primarily, white, educated (either formally or self), progressive thinking and/or deeply religious.

Most women who fly into the hospital for a "quick"" birth w/ no prenatal care do no fit into this catagory - therefore may *need* more support than women of the previously mentioned group.

Up Vote Up Vote ×
Specializes in OB.

The big problem I see in smaller facilities is that there is NO higher level nurseryor nursery staff of any kind for respite or "special cases". When a baby requires watching outside of the mother's room for whatever reason, one nurse must pass off her pp or labor patients to the other nurses to care for this infant. No on call staff either to pick up the slack.

Case in point - recently had an infant requiring bili lights. Simple procedure, can be set up and monitored in mother's room. However, this mother told me it made her very nervous (despite teaching and having had a previous infant on bili lights) and requested that the baby go to the nursery. Charge nurse stated no nurse available to staff nursery. As a result this mom, 1 day post op C/S sat up all night in a chair at the side of the isolette watching her infant, without sleep, despite everything I could do to persuade her otherwise. Literally would not even go to the bathroom unless I was in the room with the infant. I don't see any way to consider this decent patient treatment and with "complete rooming in" I was given no option.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Most women who fly into the hospital for a "quick"" birth w/ no prenatal care do no fit into this catagory - therefore may *need* more support than women of the previously mentioned group.

I hear what you are saying and consequently, in such cases, these parents *need* to learn to care for their babies as much as the other demographic you speak of. The short stay makes this even more crucial. I maintain, still, warehousing their healthy babies on the nursery is even MORE detrimental in their cases than anywhere else. They have to learn to care for them! We do not go home with them.

And, we have on-call staff for situations just like what baglady keeps mentioning. We do have an oncall signup and that way, there is an extra nurse available just in case there IS an admission to the special care nursery or a heavy floor to handle. Again, even in special care situations, the sooner parents become comfortable with the equipment around their babies and the tx we are giving them, the better. Bili light therapy IS considered "special care" and therefore, staffed to care for. These babies can/do go to our nursery at night so parents can sleep. Bili bank lights are noisy and very bright and I can see how people could NOT sleep with them going in their rooms.

It CAN work, I am telling you, if done right!

Up Vote Up Vote ×
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.

The law for my state is 8 well babies per nursery nurse. Baby number nine showed up when I had three hours left in my shift, and there was simply no one available, other than a tech, to come in and help me out. A tech is better than no tech, but with that many babies you really need another RN or LPN.

Up Vote Up Vote ×
My experience: roomed in with the first, baby NEVER left the sight of my dh or myself. I was all about being with my baby. I also was pretty much left alone because I was a nurse.

That was me though...I think if a hospital/birtcenter has a strict rooming in policy they should be able to supply a doula at a resonable fee (sliding scale - etc.) so that women who require more assistance for whatever reason - cultural, emotional economic - have access to personal support.

I bet the risk of post-partum depression, bonding issues and lack of breastfeeding would be addressed all at once. Hey and think of all the $$$ social services and insurance companies would save on prescription meds - dissolved marriages and relationships w/ s.o.'s-baby formula - the list could potenitaly go on and on and on.

just a thought.

kate-mom of 3

I forgot to mention that our facility does NOT encourage fathers/support people staying past 9 pm. I am more flexible than a lot of nurses; if the patient does not have a roommate and we are not busy I will let family members stay if the mom wants them to. Other nurses get on the intercom and kick everyone out at 9pm, no excuses! I don't think does anyone any good, but hey, I've only been there 4 years and she's been there 25, so what do I know anyway? :rolleyes:

Up Vote Up Vote ×
sounds like where I work.

Yanno, it always amazes me how controversial letting babies room in with their moms 24/7 becomes. WHY? What about moms who birth at home or at birthing centers? They seem to do fine. Seems to me, this should be standard of care EVERYWHERE, with the only acceptions being sick mom/baby,fresh from surgery or other medical conditions prohibiting such an arrangement. This is not that common since birth is essentially a HEALTHY event, not a medical one.

I couldn't agree more!

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
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. .

Hmmmm, what nursery fees? Here, they pay for the PKU draw , blood/lab draws,sugar testing, and basic admission to the hospital, only .The NURSERY "fees" start with admission to special care or they stay with the mom's hospital fees. Other than that, they are not paying "nursery" fees that I know of. Care fees are figured by acuity....and well babies are charged for higher acuity only in the 1st hour of life, when we are there recovering them after birth. :)

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I forgot to mention that our facility does NOT encourage fathers/support people staying past 9 pm. I am more flexible than a lot of nurses; if the patient does not have a roommate and we are not busy I will let family members stay if the mom wants them to. Other nurses get on the intercom and kick everyone out at 9pm, no excuses! I don't think does anyone any good, but hey, I've only been there 4 years and she's been there 25, so what do I know anyway? :rolleyes:

GOOD LORD WHY?????????????????????????????????? this is so outdated, it's not even funny. Lord, glad I don't work or would deliver there.

Up Vote Up Vote ×
+ Add a Comment