must allow nursery observation?

susancox · Nov 22, 2003

The physical and first bath can be done in the room. We don't do any "test" feeding with our premies but do have them eat sooner and start a BG protocol for all SGA babies. How early will you be? We only deliver 34 weeks and beyond, they have to go to another hopsital if they are less than 34 weeks so what we do may be different than for a baby less than 34 weeks. ????????

As far as insisting...I would ask to talk to the Neonatologist for the unit. Find out what he feels are policies that can not be adjusted for safety reasons and what he can do about things that don't endanger the baby. A lot can be done in the room as long as the baby doesn't have any respiratory distress signs, or is in need of an IV. What is the medical reason for the induction? The answer to that may help to clarify.

threesacharm · Nov 22, 2003

I am currently 34 weeks - with preterm labor at 32weeks 2cm 50%effaced with no change or further contractions since then.

Quite honestly asking these questions if I get to full term and baby is doing well. I completely understand the need for NICU or nursery care if I do have the baby in the next 3 weeks and would NOT even consider objecting to it.

Mostly I know nursing is hard work and don't want to be an awful patient and wanted thoughts if I am wrong wanting to disagree on these policies and if there was way to approach this at full term without becoming 'The really wacked out psyco patient in room 2 that makes the nurses miserable'. Besides this I am really really flexable and have no 'plans' or hopes about how my birthing experience would be as things are always different. (Well and epidural would be nice as after the first 2 being unmedicated has rid me of any desires to deal with pain are gone*chuckles*) Hope that clarifies :)

Speculating · Nov 22, 2003

Originally posted by threesacharm
Due to being high risk (had my 2nd child preterm) and for insurance reasons my choice of hospital has been limited to one. They have an incrediably good NICU and I have no quelms about delivering my baby there except one...they have a policy of removing the child to the nursery for observation about 1 hour after birth for an hour or two.

When I heard this I approched the childbirth instructor at one of my classes as the class is taught by a L&D nurse from the hospital I will be delivering at about the possiblity of the 'observation' being done in room as was done with my oldest and would of been done if second was full term (both born at different hospitals). She stated they would not allow this as they examined the baby during it's first bath (no I could not give the first bath) and put the baby under a warmer and even if I stated no artificial nipples they did give a very small amount of gloucose water to make sure everything inside was flowing smoothly! I kindly thanked her for the information and went on my way. Wasn't about to blow my top as I realize she isn't in charge of policy and answered my questions honestly.

Now a few weeks later I find myself seething more and more over what probably is a minor issue but feel it over rides my choice to have my child stay with me the entire time. I can't help but wonder after 2 children why I am not 'allowed' to bath my own child, where they 'have' to give gloucose water...as I don't see that working through 'all the piping' in one or 2 hours ...and i had no problems nursing my children or where a warmer is any warmer then my little one snuggled up to my own skin.

My first child I had with me the entire time and my 2nd did go to nicu for 2 days with no breathing assistance needed and I even gave her little tiny body the first bath.

Basically my question is barring any complications (believe me if there were any questions about her well being I would diffinately let them take my child) can I refuse to let them do this and insist the baby stay the same room as me? I hate to be a bad patient and totally understand this isn't the nurses fault but administrative policy. If I state I will absolutely not let them take the baby out of the room can they still do it? I am totally willing to let the nurses assist/observe my feeding, bathing, caring for my child. Just feel it should be Mom and Dad's choice if a baby goes to a nursery if it's doing well... am I wrong for thinking/considering these things?

sorry for the long post and any spelling errors. Any advice and thoughts on this matter is truely appriciated.

Threesacharm, I don't see anything wrong with your requests. As long as it's a good healthy birth, zero complications, and your baby has a good apgar then I don't see any medical reasons for your wants to be denied. Susancox gave you great advice talk to the neonatologist - may I also add if your able mention it to the MD/midwife while you're doing the deed. Forget their policies and procedures and let them know that you have your own policies and procedures. Just be firm when your asking just short of demanding and stand your ground this is a one time thing and great for bonding don't let them steal the moment if don't have too. If anyone knows of a medical reason to deny this young lady the joy of giving her baby's first bath please enlighten us. Threesacharm I wish you and your family well. You started this so know you must fill us in after the birth.

Mimi2RN, ASN, RN · Nov 22, 2003

Originally posted by threesacharm
Due to being high risk (had my 2nd child preterm) and for insurance reasons my choice of hospital has been limited to one. They have an incrediably good NICU and I have no quelms about delivering my baby there except one...they have a policy of removing the child to the nursery for observation about 1 hour after birth for an hour or two.

When I heard this I approched the childbirth instructor at one of my classes as the class is taught by a L&D nurse from the hospital I will be delivering at about the possiblity of the 'observation' being done in room as was done with my oldest and would of been done if second was full term (both born at different hospitals). She stated they would not allow this as they examined the baby during it's first bath (no I could not give the first bath) and put the baby under a warmer and even if I stated no artificial nipples they did give a very small amount of gloucose water to make sure everything inside was flowing smoothly! I kindly thanked her for the information and went on my way. Wasn't about to blow my top as I realize she isn't in charge of policy and answered my questions honestly.

Now a few weeks later I find myself seething more and more over what probably is a minor issue but feel it over rides my choice to have my child stay with me the entire time. I can't help but wonder after 2 children why I am not 'allowed' to bath my own child, where they 'have' to give gloucose water...as I don't see that working through 'all the piping' in one or 2 hours ...and i had no problems nursing my children or where a warmer is any warmer then my little one snuggled up to my own skin.

My first child I had with me the entire time and my 2nd did go to nicu for 2 days with no breathing assistance needed and I even gave her little tiny body the first bath.

Basically my question is barring any complications (believe me if there were any questions about her well being I would diffinately let them take my child) can I refuse to let them do this and insist the baby stay the same room as me? I hate to be a bad patient and totally understand this isn't the nurses fault but administrative policy. If I state I will absolutely not let them take the baby out of the room can they still do it? I am totally willing to let the nurses assist/observe my feeding, bathing, caring for my child. Just feel it should be Mom and Dad's choice if a baby goes to a nursery if it's doing well... am I wrong for thinking/considering these things?

Some of your requests are for standard care on many units. The problem to me is that the hospital does not do couplet care, and is not equipped or staffed to do so.

How to get around it? You can refuse the bath, and do it later on your own. Request warm bath blankets to bundle the baby afterwards.

There is no reason to give sugar water to a normal newborn, that is a very old policy, and maybe you could rock the boat. We give sterile water to bottle babies so they can swallow a few sips, which would cause less problems than pouring a little formula into a baby with a fistula or incomplete esophagus. That is not necessary with breast babies, as they usually get very little colostrum at the first feeding.

If you want the newborn assessment, meds, weight, etc. done in your room, it gets a little more complicated. It takes a nurse out of the nursery, who probably has other work to do, to monitor your baby. That is setting a precedent. Equipment would have to be taken to your room, and it would not go unnoticed by other patients on the floor. I think that battle would be much harder to win.

I agree, talk to the neonatologist. If you would let them take the baby to the nursery, and do their job, keep it for and hour and get it back to you, you may win on a couple of issues. You could initially ask for everything, and then back down,to the bath and no sugar water. Believe me, the baby does need to be monitored, but if it's fine and healthy, they may agree to let it go out early.

My son was able to bathe his second baby in the newborn nursery. He had told the nurse it was his second, and the nurse left him to it. The room arrangements, semi-private, with one sink and toilet for two moms, would make it difficult to do baths in with mom.

Good luck!

**canoehead, BSN, RN** · Nov 22, 2003

I think carrying a syringe and the erythromycin to the labor room is not too much to ask. If you are OK with not knowing the weight until the baby goes to the nursery then keep him/her at your side for as long as you like.

Remember that the final word on what they do to your baby is yours. If you want to do the bath it won't hurt the baby to be dirty for a few hours, if you want to breastfeed immediately go for it, and the glucose water is unnecessary if your baby is full term and healthy (older than 36 weeks).

Mimi2RN, ASN, RN · Nov 22, 2003

Originally posted by canoehead
I think carrying a syringe and the erythromycin to the labor room is not too much to ask. If you are OK with not knowing the weight until the baby goes to the nursery then keep him/her at your side for as long as you like.

Remember that the final word on what they do to your baby is yours. If you want to do the bath it won't hurt the baby to be dirty for a few hours, if you want to breastfeed immediately go for it, and the glucose water is unnecessary if your baby is full term and healthy (older than 36 weeks).

I think that she doesn't want the baby to leave her room at all. The meds wouldn't be bad, but pushing a scale around and sending a nursery nurse to her room to monitor the baby may be a little more complicated.

susancox · Nov 22, 2003

The L & D nurses get the Vik K and Erythromycin as a standard for every birth, to be given in the room after delivery, either by her or another L&D nurse, if we aren't real busy or another nurse has a not very active pt. The scale that sits in the hall is rolled to every single birth, except c/s's as there is one that stays in there. So bringing the scale in to weigh the baby in REALLY NOT a BIG DEAL. The other things to be done need nothing. Just because a baby is not quite term does not mean close observation by peds people is needed unless the baby is having problems (ie. tachypnic, tachycardic, flaring, febrile, etc.) The L& D nurse where I work does all the vitals, helps with breastfeeding and is in the room A LOT so the baby is pretty closly monitored. There is a lot to be done between the baby and the moms checks (q15 minute checks on mom x5--BP, uterus check, pain and bleeding to monitor.)We can get the couplet out to PP in about an hour and a half, maybe two hours- if we need to, or a little longer if it is quiet enough to do the bath there. So basically the L & D nurse has to be in your room a lot to care for you and so should be able to care for the baby as well. I suggest writing a birth plan ahead of time--there are web sites that will help you do that-- and bring it with you. Make sure the nurse reads it and if she says there are things that can't be done ask to talk to the charge nurse for any possible accomodations.

Good luck and congrats in advance!!

BETSRN · Nov 22, 2003

We push our scale into the room every time someone has their baby. All our babies are weighed in Mom's room (except section babies who come back to the nursery with Dad while we wait for Mom).

I say rock the boat a bit. Nothing that has to be done to that baby cannot be done with Mom at the bedside. The only way to effect change is to start asking for it.

As a nurse who works LDRP, you are NOT asking for anything outside the norm at all. maybe it's time that your facility come into the present.

mitchsmom · Nov 22, 2003

I'm not even a nurse yet but I agree with the above... after having my last 2 out of 3 babies in LDRP I couldn't imagine the old "observation" thing again. They rolled the scale into the LDRP rooms with #'s 2&3. The baby literally never left the room except for PKU/newborn screening and with #2 my husband went with him and with #3 I went. As a matter of fact, the nurse was concerned that it may be a pain to get a good hearing test so I nursed him and he was silent and it was super smooth, so it turned out easier and better for everyone!

I have a friend who went somewhere that she absolutely could not get around the observation rule & she was able to have her husband go with the baby so that he was never without mom or dad.

I'm a breastfeeding counselor, so needless to say hell would pretty much freeze over before my baby would get a bottle of glucose water without evidence-based reason.

Maybe you can nudge them into more mother-baby friendly routines. :) Best wishes.

NicuGal, MSN, RN · Nov 22, 2003

I have to put in a NICU perspective here...if you have a normal delivery with a baby that doesn't need to go to the nursery, then your requests aren't off the wall. If you have a preterm that has to go to the NICU for obs then it isn't going to happen the way you want. If the baby needs to be monitored, then the baby can't stay with you, a NICU doc can't stay there and the L/D nurses don't have a monitor, pulseox, etc to do it. Even in our normal nurseries, we do take the baby into the nursery for a short period of time to do our assessments and such. We don't routinely give glucose water...I didn't even know places still did that! If the baby were to have a low blood sugar it would get formula.

The only thing about talking to the neonatologist is that they usually have no say over normal newborn nursery...they only have say in the NICU. I would go to the unit manager or clinical nurse specialist to ask about this. If the baby is under the neo's care, then you go by the NICU standards, otherwise the floors have their own standards to go by.

Good luck and I hope you have a nice FT baby! :)

mitchsmom · Nov 22, 2003

I think she said she was talking about normal delivery, and that she knew if would be a different story if not.

Would it help to talk to the doctor? I always hear that the doc can write orders in your record to be followed?