Mother-Infant Coupling

[niquern]

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?

[tinnekke]

....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.

I feel your pain and also feel astonishment at those "convenience moms". I gave birth back in 2001, and the hospital where I had my son had all the rooms set up for couplets. They also have a class III NICU in its own area of the maternity floor. (Basically NICU is in a quiet area between L&D and Mother/Baby so that they don't have to be taken off the floor, just down the hall.) The NICU has its own area for moms so that they can stay in the hospital with their infants instead of having to leave to make room for healthy couplets. The Mother/Baby unit should rightly be called the family unit since they not only condone fathers staying the night, they outright encourage it. The Mother/Baby unit nursery is mostly for observation and doing infant care like baths and assessments, but moms are told to bring their infants down if they need a little time to themselves. I gave birth on a very busy weekend, (I labored in one of the OB examining rooms most of the night.) but you wouldn't have known it if you walked by the nursery. Other than a few under the warmers after a bath, there were no infants in the nursery. They were all in with their parents. Just about everyone there rooms in. Even I got to, and my son ended up being a c-section. I don't see why both the NICU and the observational nursery concepts couldn't be made to harmonize, especially if pregnant moms were given support during pregnancy to realize how good it is for them and their infants to room in after delivery. I loved it. It also gave my husband and I a perfect chance to get acquainted with our son's rhythms while we were in a place that was supportive and allowed us the opportunity to get rest if we needed it. (We never did, but it was nice knowing it was an option.) By the time we went home, we were already in synch with his sleep/wake schedule, and the sounds of his different cries were already firmly set in both our minds. I don't want to have any more childrem, but I do remember his earliest infancy very fondly. It was an incredible experience. :)