Mother-Infant Coupling

colleen10 · Apr 8, 2004

I also wonder if part of the 'patient unfriendly' practices we have here such as limited rooming in, etc. are caused by our high malpractice awards and rates, especially for OB/GYN. Seems we are loosing OB/GYN's left and right d/t the uncontrollable malpractice cases and awards.

For instance, my one classmate who's wife gave birth at a birthing center on the west coast said that the staffs attitude was a very calm, natural one. She went in to be physically examined to see how she was progressing, was instructed to go do some shopping/walking around the mall and come back in 4 hours. She only had intermittent fetal monitoring throughout the labor and delivery (per her choice). Here in Pittsburgh she gave birth in a hospital and even though she asked in advance that she not have a fetal monitor and there were no medical reasons that she required one as soon as she was admitted they slapped a continuous monitor on her stating "hospital policy".

RNKitty · Apr 8, 2004

Here in Pittsburgh she gave birth in a hospital and even though she asked in advance that she not have a fetal monitor and there were no medical reasons that she required one as soon as she was admitted they slapped a continuous monitor on her stating "hospital policy".

Even the birthing centers I have worked at require at least a 20-30 minute strip of continuous fetal monitoring to ensure reactivity of the fetus before they switch to auscultation. To come to a hospital and decline EFM at least for that small amount of time is unrealistic in this day and age of litigation. If they truly don't want ANY technology, they should deliver at home and not put the doctor's and nurses at risk for liability.

fergus51 · Apr 8, 2004

I also wonder if part of the 'patient unfriendly' practices we have here such as limited rooming in, etc. are caused by our high malpractice awards and rates, especially for OB/GYN. Seems we are loosing OB/GYN's left and right d/t the uncontrollable malpractice cases and awards.
For instance, my one classmate who's wife gave birth at a birthing center on the west coast said that the staffs attitude was a very calm, natural one. She went in to be physically examined to see how she was progressing, was instructed to go do some shopping/walking around the mall and come back in 4 hours. She only had intermittent fetal monitoring throughout the labor and delivery (per her choice). Here in Pittsburgh she gave birth in a hospital and even though she asked in advance that she not have a fetal monitor and there were no medical reasons that she required one as soon as she was admitted they slapped a continuous monitor on her stating "hospital policy".

I completely agree that it is the perception of what will limit liability that regulates those types of practice. I went to a class a few years ago about legal issues in OB care. I was shocked to find out that EFM actually INCREASES lawsuit rates (mainly because of operators misinterpretting them) and that rooming in doesn't increase lawsuit rates at all. There is no medical reason to use EFM on a low risk woman (and no reason for those 20 minute strips we all do either as they have never been shown to improve outcomes) and no reason to limit rooming in for normal births.

Unfortunately, most hospitals aren't interested in evidence based practice to do the best by their patients, they are interested in looking like they are doing the best for their patients.

ayndim · Apr 9, 2004

In the end the hospital can't force women to have EFM. Or force a mom to do anything else either. I hate it how they seem to make it sound like you have no choice. :angryfire I for one crossed out the consent for an episiotomy, for #2 and #3. My CNM rarely does them anyway and only for fetal distress (no the dr doesn't do them for assisted deliveries either). And as a multip who didn't have one the first time I knew that if there was fetal distress I would be able to push the baby out as fast as she could perform an episiotomy. My CNM actually told me that. My CNM was there when I crossed it off (she was there the whole time) and she didn't have a problem with that.

nekhismom · Apr 9, 2004

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.

SBE, I respectfully disagree here, although I do agree with most of your points throughout this discussion. First let me say that I have never been completely comfortable with mother/baby, and I LIKE the nursery.

From a mom's point of view, the nursery was a LIFE saver for me when Nekhi was born. I tried to rest, but was so wound up that I could not sleep. I was breastfeeding, or trying at least. Nekhi tried to nurse for over 2 hours straight, and I was in serious pain, and he was hungry and frustrated. The lactation nurse was unable to help us. Nekhi just kept wailing. So the nursery nurse suggested feeding Nekhi 5 cc's of formula and taking him to the nursery until he woke up again so that me & dh could rest. I unhappily agreed. But I DESPERATELY needed the rest. Breastfeeding in the hospital was H*ll. I had inverted nipples, and they cracked and bled. I got some nipple shields and nipple shells, and that helped a bit. But it was a rough go of things. However, I did end up successfully breastfeeding for 22 months.

Therefore, in my experience, the nursery HELPED with my bonding to my son ( I was so frustrated with myself and my son by the time they came to get him) and with my breastfeeding.

I don't think that parents should be able to "drop the baby off" for the entire night though. But I DO think it should be an option so that an exhausted mom can get some rest. I mean, if you've ever seen a labor, you know it's called LABOR for a reason.

My facility DOES have a nsy, and I am very thankful for it.

fergus51 · Apr 9, 2004

Do you think you wouldn't have slept if the nursery nurse had given your child the formula and he fell asleep in your room? I guess I don't understand what difference it makes where he sleeps.

Just an observation, but I think you actually agree with Deb. She's said before there are circumstances that warrant having a baby out so mom can rest, just that it shouldn't be the routine and it shouldn't be all night. That seems to be your view as well.

nekhismom · Apr 9, 2004

Do you think you wouldn't have slept if the nursery nurse had given your child the formula and he fell asleep in your room? I guess I don't understand what difference it makes where he sleeps.
Just an observation, but I think you actually agree with Deb. She's said before there are circumstances that warrant having a baby out so mom can rest, just that it shouldn't be the routine and it shouldn't be all night. That seems to be your view as well.

I guess so. The point was, I needed a break from having Nekhi in the room. Just a small one. I was a frustrated new mom. I was sick of his wails. I just needed a minute, ya know?? I mean, I hadn't slept well the night before, I had stadol and an epidural during labor, and felt like a truck had ran over me. I just needed to sleep. And removing Nekhi from my room helped a great deal. I know that in today's hospital environment, many women receive meds, and could probably benefit from a rest period.

I think we still need the choice. I mean, we all know some moms would take advantage of the nsy and drop the baby off for the entire night just because it was there. But some moms truly just need a couple of hours to rest. Now, if all moms were given a few hours to rest after delivery, not immediately, but say 3-4 hours after delivery.....get say 3 hours of uninterrupted sleep. I think THAT would be a tremendous help, would allow the mom to recover a bit, and would generally help the situation. I would think mother/baby would be a better idea if that were an option. however, due to the fact that babies are born 24/7, the nsy would have to be open 24/7, and that's another issue.

Just my opinion, of course. But I don't like mom/baby, and I'm glad we had a nsy where I delivered, and I'm glad we have one where I work. Now, if we only had CNM's, THEN we'd be talkin!

SmilingBluEyes · Apr 9, 2004

Do you think you wouldn't have slept if the nursery nurse had given your child the formula and he fell asleep in your room? I guess I don't understand what difference it makes where he sleeps.
Just an observation, but I think you actually agree with Deb. She's said before there are circumstances that warrant having a baby out so mom can rest, just that it shouldn't be the routine and it shouldn't be all night. That seems to be your view as well.

thank you. I was going to make that point but you did it for me.

I never said a baby SHOULD NEVER COME OUT OF A MOM's ROOM. But I took exception to babies spending entire nights in a nursery. I still do.

Breastfeeding problems are NOT solved by baby spending 8 or more hours in a nursery. What do these moms think their babies are eating while they slumber? IF they think we would STARVE them so they can sleep? Think again, not on my shift. But I have actually had them send out to the nursery, requesting they stay ALL NIGHT but NO BOTTLES or CUPS OF FORMULA. I don't think so. You bet the kid will get formula IF mom refuses to nurse for resting purposes, and I will tell her so.

I can tell ya stories about breastfeeding and exhaustion; I was discharged home w/o my premature son (6 weeks early) and made trips to the hospital (3 blocks away) to breastfeed him at night in the SCN, until a room became available for me to stay in on the floor, 3 days later. I used to fall asleep in the rocker in the SCN, mesmermized by the blue glow of the bili lights, I was so exhausted. I had been in labor 2 days myself after being hospitalized for over a week to try and STOP labor. I know about the exhaustion in being a new mom. But you know, You do what you have to, to make it work. It never occured to me to do anything less and I was not even a nurse back then.

I am amazed by how many "breastfeeding" moms want their cake and eat it, too. I guess it's immaturity. I think in such cases, it's likely the minute they go home, the bottles will come out anyhow. THAT is what I mean by NOT having infants in a nursery ----NOT for HOURS on end when they should be breastfeeding or bonding. Special circumstances CAN exist and we do our best to accomodate these but RARE is the baby who is out all night unless it's a special case (like DHS, etc.)

SmilingBluEyes · Apr 9, 2004

however, due to the fact that babies are born 24/7, the nsy would have to be open 24/7, and that's another issue.
Just my opinion, of course. !

Yes I would agree except how do you staff for this? This is the big problem, the crux of the matter, you might say. Answer is, they DO NOT.

fergus51 · Apr 9, 2004

Oh I hate theat Deb!!! No cups, no bottles, no formula, no soothers, and I want to sleep for the next 8 hours.... Ummmm no. Complete stupidity as far as I am concerned. We will not starve an infant and that doesn't help breastfeeding! You don't want to get me started on the moms who won't let their 34 weeker under triple photo have a soother/cup/bottle either......UGH.

Working the NICU has made me more accepting about rooming in. I think about women who complain about needing 8 hours of uninterrupted sleep and want to say "Do you know what our NICU moms would give if they could have their baby in the room with them?". Yes, you need sleep, and you should take every opportunity to sleep and I will help anytime I can with that by settling your baby if you're having trouble, but no I won't wheel it out and starve it for 8 hours. Most babies sleep for a good 4 hours after delivery and their first feed. And they sleep 70-80% of their time. There is no reason to have a baby in the nursery ALL night.

RNmommy · Apr 9, 2004

Honestly, I am stunned that there are still facilities that do not do couplet care. At our hospital, we are stunned when visitors ask where the nursery is so that they can stare at the babies. Umm, they're with thier mothers. We have separate L&D and Postpartum, not LDRP. However, all of our rooms are private and equipped with a cot for dad or SO to sleep on. We RARELY have a pt spend the night alone (maybe a P2-3+ every now and then). We do have a WBN staffed by one RN. We use the WBN for admitting CS babies, administering hearing screenings, assisting the lab with blood draws (PKUs are performed in the room by a lab tech), warming cold babies, administering some phototherapy (most babies with no other problems will receive phototherapy in their rooms), circumcisions and babysitting while mom takes a shower or a short nap. We also have a level II NICU. In CA we are bound by state mandated RN:PT ratios. In WBN it is 1:8. NICU 1:2 and mother/baby 1:4 couplets.

Upon admission parents are instructed on bulb syringe use. Rarely we have a parent call out bc the baby is aspirating and they can't handle it. Our BF rate is 99% and our parents tend to be educated, upper middle class. During the night shift, we give priority for babysitting to fresh c/s moms but even then we send the babies back out for breastfeeding. Our lacation policy is air tight. We are NEVER allowed to give BF babies artificial nipples or formula unless the parents specifically request it. We can only suggest supplements for medically necessary reasons. BTW, our customer service ratings are through the roof. We accommodate alsmost every request. But then again, I'm in CA, and moms at our hospital just dont ask for their baby to be sent away for 12 hours. I seriously think that if this happened, we would consider a social services consult for impaired attachment.

I also could not imagine giving birth at some of the hospitals you describe.

nekhismom · Apr 10, 2004

thank you. I was going to make that point but you did it for me.
I never said a baby SHOULD NEVER COME OUT OF A MOM's ROOM. But I took exception to babies spending entire nights in a nursery. I still do.
Breastfeeding problems are NOT solved by baby spending 8 or more hours in a nursery. What do these moms think their babies are eating while they slumber? IF they think we would STARVE them so they can sleep? Think again, not on my shift. But I have actually had them send out to the nursery, requesting they stay ALL NIGHT but NO BOTTLES or CUPS OF FORMULA. I don't think so. You bet the kid will get formula IF mom refuses to nurse for resting purposes, and I will tell her so.
I can tell ya stories about breastfeeding and exhaustion; I was discharged home w/o my premature son (6 weeks early) and made trips to the hospital (3 blocks away) to breastfeed him at night in the SCN, until a room became available for me to stay in on the floor, 3 days later. I used to fall asleep in the rocker in the SCN, mesmermized by the blue glow of the bili lights, I was so exhausted. I had been in labor 2 days myself after being hospitalized for over a week to try and STOP labor. I know about the exhaustion in being a new mom. But you know, You do what you have to, to make it work. It never occured to me to do anything less and I was not even a nurse back then.
I am amazed by how many "breastfeeding" moms want their cake and eat it, too. I guess it's immaturity. I think in such cases, it's likely the minute they go home, the bottles will come out anyhow. THAT is what I mean by NOT having infants in a nursery ----NOT for HOURS on end when they should be breastfeeding or bonding. Special circumstances CAN exist and we do our best to accomodate these but RARE is the baby who is out all night unless it's a special case (like DHS, etc.)

Deb,

Of course, you're right. I completely understand what you are saying, and I do think I agree with you overall. I just LIKE having a WBN available. I TOTALLY agree about not having a baby in the nsy all night. I just think that having the option for a few hours, even one or two hours, is a tremendous help. I felt like the time I had in the hospital (48 hrs) was the only chance I had to try to rest a bit before I went home. And I was right! When I got home, it was just me. My husband was away 4 nights a week, and I had no family in the area. SInce you are an AF wife, I'm sure you can relate. I just felt like the WBN was a HUGE commodity to me.

But, it shouldn't be an all night thing. I guess I just worded it wrong.

And you're right, most bf'ing moms don't do well after they leave. Some do succeed, but many who don't have enough help in the hospital don't continue at home. No arguing that point here.