Mother-Infant Coupling

CoffeeRTC, BSN, RN · Apr 10, 2004

Collen10..I think my mother works at the same Pittsburgh hospital you was talking about??? As an LPN she is sometimes floated to that floor to help in that nursery when it gets busy. I just delivered at Shadyside Hosp (I don't think they really have a well baby nursery?) and had the baby with me at all times. (the nurse took her for a few hrs to do test and "kept her so I could get some sleep"..I didn't ask her to but it was nice :) )

Anyhow..we we just talking about rooming in and she said the same... at night the nursery is FULL of babies and that this "women's" hospital encourages this. Odd...this facility is supposed to be the cutting edge of nursing care?

Shotzie · Apr 10, 2004

I started my nursing career out on a womens care wing of a large city hospital. They had started "rooming in" as it was called them, about 18 mos before I went to work there and had done the staffing changes and facilities changes to accomodate it.

I was like all the other nurses and just like SmilingBlueEyes and Fergus in my opinion of moms who wanted to farm out their babies at night. I was probably even more sure that babies belong with their moms all night long --no exceptions--after I had my first child...the birth was easy, my husband stayed with me and my mom was in and out of the room the full 48 hours I was there...really now!...if I could keep my baby with me without a problem then why can't those other moms!!??

Several years later I had another child. I had had the flu for 8 days before I went into labor. I was weak and still coughing. The labor did not progress and I had to have Pit started...I swear that is the drug from H*LL created by some psychotic sadistic male researcher to make women suffer as much as possible...The anesthesiologist that was on would not do an epidural because I had had severe sciatica during the pregnancy and had resultant numbness in my left leg. They gave me stadol and then tried demerol. My pain was lessened very slightly but I added vomiting and repeated retching to the joy of labor. To make a long story short, it ended up being a forceps delivery and I sufferred (and I do mean sufferred!) a 4th degree tear.

I delivered in the mid morning and my baby stayed with me and my husband the whole day. I was still coughing all the time and was too exhausted to be able to do much more that peer happily at him while his daddy held him. I nursed him during the day and we did just fine.

But night time was a whole other story. My mother had died 6 months before and my husband had to stay home with our other child. I was alone, exhausted, not able to move very well because of the tear, I still had a foley in place and still had complete numbness in my leg. I asked to have the baby kept in the nursery and given formula so I could rest. I was told in no uncertain terms it would not be done. I was told "it's your baby, you have to care for it". I tried to reason from a nurses standpoint, I stated why I felt like I couldn't manage him alone on that night and assurred them that I would not have any problems bonding or breastfeeding...I loved my child and I knew I could breastfeed from previous experience but I just needed sleep. The staff was rather nasty about it and I kept my baby with me all night. I couldn't change his diaper and I couldn't manage him well enough to position him for breastfeeding. The morning staff found him sleeping on my chest because I couldn't get him back into the bassinett and me crying.

When the doc made her rounds that morning I was still crying. My husband had not yet arrived and I felt so alone and so overwhelmed I could not see how I was going to be able to care for this baby and myself. The doc was furious and she got the nurse manager in the room to discuss what had been done (or not done) the night before. I cried even harder and only the arrival of my husband with roses in his hand stopped me.

In this case, keeping the baby with me worsened every problem I had. I left that hospital and that experience with a much softer view of what is right and what is wrong. I was much more willing to keep the babies in the nursery from then on, especially if mom was having to leave to go home to a couple of small ones already at home. I didn't let myself be snowed by a mom who only wanted to pass on her responsibility. But I did learn to spend a little time finding out how the labor went and what else the mom had going on at that time before I stuffed rooming in down her throat.

...and by the way, I never had any problem breastfeeding my child not did I have any problem bonding...once I was rested, of course!

MarnnaRN · Apr 10, 2004

I am all for coupling, but what about the mom who was in labor fo 20 hours, and hadn't slept for a day and a half, delivers late, (9:30p.m.) and baby still needs bath, picture, hearing test and assessment? I didn't get to the post partum room til midnight. I had her with me before that, while I was stitched and whatever else went on. That was me, and the nurses, ever so graciously kept my baby for 3 hours, from midnight til 3 a.m., so I could get a couple hours sleep. I took her back at 3, fed her, and they took her for 2 more hours for me. BTW: we went home when her 24 hours were up.

fergus51 · Apr 10, 2004

I think you guys are missing the point. No one, not me, not Deb, no one I have talked to thinks that all babies must room in 24 hours a day no exceptions. The problem is that some women seem to think that the baby should be in the nursery all night (without feeding often) when they have had a normal labor and delivery. They also seem to think that the only way to sleep is with the baby out of the room (I have had women ask me to take the baby out so that they could sleep when the baby was out like a light!). That just isn't the case. For a normal healthy birth, there are few reasons to have a baby in the nursery all night if at all.

camay1221_RN · Apr 10, 2004

I didn't find that I slept as well with the baby in the room. I was more than happy to have my kids out on demand for feeds, but the time between, I was able to sleep better knowing they were behind the locked door of the nursery. It also was a great comfort to me that the people carrying for my kids in the nursery were my co-workers that I trusted 100%.

mandykatrn · Apr 11, 2004

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?

OMG - what hospital is this? At least please identify the state you're located in, because I don't want to chance getting near that hospital with a ten-foot pole, and I'm betting many others wouldn't either!

mandykatrn · Apr 11, 2004

OMG - what hospital is this? At least please identify the state you're located in, because I don't want to chance getting near that hospital with a ten-foot pole, and I'm betting many others wouldn't either!

Sorry, just saw your reply about the rooms being semi-private. But still, this hospital sure sounds less than desirable to deliver at. JMHO

mitchsmom · Apr 12, 2004

Are yall Pittsburghers talking about Magee Women's?

I delivered my first baby there in 1997 and he stayed with me the whole time except for an initial "observation" time and then when he went for PKU - otherwise he was with me the whole time. (My next two were delivered in a small town Florida hospital with LDRP's and no mandatory "observation" times, etc. These days I would not chose a hospital if they had mandatory times to keep the (healthy) baby away from me.)

Also, I got curious about birthing centers in Pittsburgh and I found a link to one here, attended by 4 CNM's!:

http://www.midwifecenter.org/

Also for those of you who keep the babies in the nursery and send them back when they need breastfeeding, how does your nursery determine they when need to feed? Since crying is a late indicator of hunger, and you may have several babies keeping you busy, do you just do certain time intervals or ??? I guess part of what I'm getting at is that babies usually show subtle signs of being ready to nurse that don't always happen on a schedule, and it just seems like it would be easier for mom to cue in on these than a busy nursery. Plus, I think I've repeatedly seen it quoted that breastfeeding moms actually ended up with more rest when rooming in anyway. She and baby get "in sync" more quickly this way, and are likewise further "out of sync" with the nursery option (and thereby the whole process keeps them up longer, getting less rest afterall). An example of this scenario is described on p. 50 of Dr. Jack Newman's Ultimate Breastfeeding Book of Answers, but is too long to write out here! :)

I think it's a sticky situation about doing things that mom might not like. I mean, patients probably don't like to ambulate after surgery but it's best... seems like there are some things that are similar in L&D??

For those of you who think more things should be done evidence-based, how do you not go insane from the frustration? I just went as a labor coach for my best friend the other day, and have just been really frustrated ever since. It makes me wonder how I will deal with it on a day to day basis (although I guess I'll have a little more control with my own patients than I did as labor coach. As labor coach I kept mostly quiet as I did not want to step on anyone's toes... also a difficult balancing act between self, patient, and staff - I just pretty much let her and staff do what they wanted and I just helped her out around the room, etc.)

karenmcd · Apr 12, 2004

One consultant...too many. A mother baby unit only works if it is strictly adhered to. Staff and families need to be aware of what is acceptable. I work in a well nursery and level 2 nursery. We go between each depending on our assignment. The unit is "supposed to be" a mother baby unit but mothers constantly send babies to the nursery at night. One question for you....how can you accept one baby and not another's??? In reality no baby can be turned down at the nursery door. What ends up happening is that even though you call it mother baby it doesn't happen that way. I wish you could get a different consultant but I bet no matter what information you present you will be forced into this. I strongly reject the idea of only one RN. That is not acceptable because as you stated you will still be responsible for the stabilization of infants prior to transport.....what if there are 2 requiring transport???? Even the best trained L&D nurse will not be much help in this area. If you do it....in writing a plan must be in place with specific information on which circumstances allows a baby to go to the nursery and who watches over the babies when the one and only RN needs to eat, go to the bathroom or has to handle a sick baby. Keeping in mind that unlicensed assistive personel no matter how good they are...can never equal an RN.

colleen10 · Apr 12, 2004

Mitchsmom,

I had an opportunity to tour and meet with one of the CNM at the Mid Wife Center. It was an incredible experience to see their facility and talk to them about their birthing ideaology and patient care. It was such a positive experience. Wish in Pittsburgh that we had more birth options such as their facility but it seems that more CNM are being pushed out. They created their own center because their CNM practice at AGH was discontinued d/t increased prices, etc. Glad they fought the good fight to create their center.

mitchsmom · Apr 14, 2004

Mitchsmom,
I had an opportunity to tour and meet with one of the CNM at the Mid Wife Center. It was an incredible experience to see their facility and talk to them about their birthing ideaology and patient care. It was such a positive experience. Wish in Pittsburgh that we had more birth options such as their facility but it seems that more CNM are being pushed out. They created their own center because their CNM practice at AGH was discontinued d/t increased prices, etc. Glad they fought the good fight to create their center.

Yes, I hope they have a thriving practice and can stay in business! Do they deliver at the center and at the hospital or just at the center?

colleen10 · Apr 14, 2004

They deliver at both the mid wife center and at the hospital. However, the mid wife center does not offer epidurals because there is no anastesh. on site.

They have three birthing rooms that you can see on their website. It's a very "homey" feel. There is a kitchen down the hall from the birthing rooms so that family and friends can stay at the center while mom is laboring and have a place to meet and eat or cook food if they want.

They have a couple exam rooms and do all kinds of woman care. They also have a classroom/learning center in the basement for education.

They haven't done too many births at the center yet because they have been having problems getting accepted by insurance companies. Not because they are risky or anything but because when they were in the process of organizing the center they didn't realize how long it would take for insurance to accept them.