I figured that my current hospital where I work as a nurse was moving to be more "mother-baby" friendly. First it was the move to all mothers of well babies having in-room mother-baby care 24hrs/day. Then it was improving early breastfeeding rates. Then, improving skin to skin in the delivery room for vaginal births.
Now, we're going to start implementing (finally!) early (within 5 minutes of birth) skin to skin in the OR for c-section mothers. Whoa baby, I just cannot wait to see how well THAT will go over (or rather, won't go over so well) with the neonatalogists who attend every c-section birth. I brought up the fact that perhaps we don't need a neo at every c-section birth? After all, most of our scheduled c-sections are very atraumatic (normal, no labor, no anticipated problems with the baby) and the baby has no problems transitioning from the birth. Why have neo there for what is essentially a normal birth? The true reason why neo is there for every c-section is that it generates income/money as a NICU consult. There -- I said it --- it's financially driven, not evidence-based practice!
It is also going to be an expectation that EVERY mother will do skin to skin with her baby within the first hour, ideally, within the first five minutes after birth - unless she outright declines or has a true medical indication why. If it is not done, there will be a drop down selection list of acceptable reasons why she does not do skin to skin. Even formula feeding mothers will be expected to do skin to skin after birth (of course, unless they have a reason why they don't want to). I'm fine with skin to skin after birth -- for women who want to do it. I am not for the forcing of women to do skin to skin if they really do not want to do it. That is just ridiculous! Hell, it's downright assault if I place a baby skin to skin (after removing the woman's gown) without her permission to do so. I always ask if I may place the baby against her skin after the birth. With most of the women, I try to ask this before they give birth. There are certain cultures who will not touch the baby at all after birth, much less have the baby lie skin to skin against them. Then there are the teen mothers (and sometimes older mothers) who find the birth fluids "icky" and want the baby to be at least wiped down before holding him/her. My thoughts are this: not every woman is created equal, nor does every woman have the same beliefs or desires for their immediate birth experience. One size does not fit all here! I hate when my facility management decides to put everyone into this one size fits all box.
Oh, and it has been super stressed to us that all breastfeeding (healthy, term) babies MUST be at the breast before one hour. Seriously? Not every single baby wants to go to the breast within one hour of birth. We have mothers who receive narcotics during labor, epidurals during labor, stressful and prolonged labors, and then we have.......drumroll........dopey babies who want to sleep after birth. I am NOT forcing a baby to the breast. In fact, I teach new mothers to NOT force the baby to the breast. It's one thing to hold the baby skin to skin against your chest/breast. The baby may very well start to do the "head bob" thing and migrate down towards the nipple and latch himself on -- all on his own -- with little to no active encouragement. Or, the baby may need some time to recuperate from the birth, maybe a little stroking of the cheek with a finger or the nipple. The fact of the matter is, not all newborn babies will latch on to the breast within one hour of age. Some...just don't. It's really not a big deal, and it does not ruin the breastfeeding relationship if a latch does not happen within an hour. Once again, I find that the hospital is trying to put all mothers and babies into this one size fits all box. We have to look at each mother and baby as separate beings. They are not the same from room to room, day to day.
The good news is that formula will not longer be available for supplementation unless medically indicated, along with an MD prescription, for breastfeeding newborns. So many nurses (and new mothers) think that if they are breastfeeding, the baby isn't "getting enough milk" and start supplementing with formula, filling up their itty bitty stomachs. Also, nurses (and new parents) are feeding way too much formula to these newborn babies. We had quite the discussion at work a few weeks ago, and I was trying to educate my fellow nurses on the true size of a newborn's stomach. At birth: think almond sized. That's 5-10 cc, max. Not 1/2 to 1 ounce.
I predict lots of turmoil among the nursing staff (and the medical staff too) when these new changes are implemented. There are more changes coming, other than what I have discussed. Some good, some not so good, but all in the name of being more "mother-baby friendly". We shall see.
14 comments:
I don't know what state you're in, but neos here in Florida do NOT get paid to attend routine C/S births. The neos around here go to the deliveries as a courtesy to the hospital since moms like that little bit. And our neos are the biggest advocates for skin to skin and breastfeeding since in our population breastmilk means less NEC and other problems.
This is really good news. Makes me want to deliver where you're at! :)
I've been too shaky and weak after having some of my babies to hold them very well until an hour or so later. It's kinda of scary actually! I'd rather be able to pull myself together a little more and then bring on the nursing.
I love the reminder of how small a newborn's stomach is. I've only been able to breastfeed one of my kids and for only 4 months. There needs to be more high quality info. out there for those who have to do formula because it seems like we are left with nothing but dirty looks for not breastfeeding and we really need to know how to properly formula feed a tiny baby! I think I've made the mistake of not holding the baby up enough and practically drowning them with the bottle. Moms like me need info. and support too!
It's interesting to see what changes are taking place at your hospital.
I'm a NICU nurse at a HUGE NICU (over 100 beds)....and we would throw a fit if we had to go to every c-section. We only go for prematurity, meconium, bad tones, or anomaly. And the neonatologist isn't at most of those deliveries (only under 34 weeks, codes, and known anomalies)--the NNPs and RN handle them. RTs sometimes get called down to put a baby on CPAP or to to bring up a baby that we intubate.
Our NICU docs are also the ones that got the OBs to do delayed cord clamping--love it! They also have done a lot of education with OBs on the danger of inductions before 39 weeks. I love evidence-based practice!
Melissa
my son was born by scheduled c-section at 39 weeks. We were at a small hospital that does not even have neonatologists. However, even if they had been available, I would have been beyond angry had I had to pay for an NICU consult on a perfectly healthy baby! My first baby was a 29 weeker, so I love neos in their place, but at the birth of a healthy baby is NOT it!
Love to see motherbaby-friendly changes being implemented. Yes, every motherbaby is not the same and need not be forced into that Box of standards and protocols. Thanks for sharing and for advocating for Quality Care.
I had a neonatologist at my son's birth because he was the attending that night. There were so many people in there in the OR for his section (once I told them I was asthmatic) it was like a convention.
BTW my child was a large 41 weeker, so he really didn't need a neo, just needed to be unravelled from the rascally cord around his neck and left arm. Fine and dandy.
I was so out of it with relief that I don't even remember if he nursed in the first hour. I was so tired and it was around 3AM.
I cannot think of anything less "friendly" than being coerced into doing something one does not want to do.
Most of this "friendly" business is NCB nonsense. For those who want skin-to-skin, fine. For those who want to attempt breastfeeding immediately, fine. Insistence on no supplement can result in dehydrated babies [I've seen it; my granddaughter did not urinate for over 12 hours while both water and formula were withheld], but it makes no difference to the crunchy crowd.
Moderation in everything, I say, and common sense. Hospital stays are short nowadays; it would be much more productive if there was a system of community midwife visits at home for the first two weeks to sort out problems. I've seen lots of mothers who abandon breastfeeding almost immediately upon returning home because they had no support or assistance, etc.
I agree with pretty much everything except the supplementing. We have some moms that would not start or keep breastfeeding if they didn't have the option to supplement. We fully educate them on stomach size, supply/demand, counting diapers, etc...but some moms just want to know for sure how much their baby is getting and get very stressed if they can't. I feel some breastmilk is better than none, so if supplementing keeps them nursing, go for it. Sorry for the anonymous status, I just don't have any of the IDs.
We're starting skin to skin in the OR on Tuesday. I'm excited to see how it goes. My big concern is how cold it is in our PACU for those that don't recover in labor rooms even though we've asked to make it warmer in there. Most of our moms want to do skin to skin but I think its a cultural thing as most have had babies in other countries with midwives at home so it's expected they'd get to keep their babies.
"The true reason why neo is there for every c-section is that it generates income/money as a NICU consult. There -- I said it --- it's financially driven, not evidence-based practice!"
As an assistant nurse manager in the OR, I struggle with the financially driven decisions that Corporate makes (we are part of a big health system). Most of the time, these are non-healthcare professionals or those that have been out of a clinical setting for too long. It is scary to witness first hand the impact this makes on patient care. For now, my colleagues and I will keep fighting for our patients. But who knows how long we can keep this up!
As someone who works in a baby-friendly hospital, I encouraged you to think calmly and holistically about the new expectations. Imagine how other RNs feel when they hear that they will be expected to get a prescription for formula, while you think it's a great idea. Just like you, they are coming up with a million reasons it will be a problem. Encouraged STS and breastfeeding in the first hour can be lovely things and all you have to do is ask without pressure and document appropriately when the mother declines. All you have to do is get the baby to breast, and document that the baby attempted to latch but wasn't interested yet. At the breast doesn't have to mean latched and sucking! I think you'll find these changes make a big difference in a positive direction in terms of changing the culture, while retaining flexibility for individuals.
There are obviously good intentions behind these initiatives, but in practice I think Antigonos is right: moderation and good sense need to prevail. Formula use should not be restricted. By all means, provide info and advice when appropriate, but then treat women like intelligent adults and let them make their own decisions about feeding methods, including supplementation if that is what they prefer.
And as much as you are cynical about the profit motives of having a neonatologist routinely present at c-sections, I feel the same way about 24 hour rooming in being provided as a "service". Nonsense. It should be an option, when safe and appropriate for mom and baby, but it shouldn't be forced on everyone. There is so much evidence about the importance of adequate sleep in relation to mental health issues, and I can't think of a worse set up for PPD or postpartum psychosis than a sleep deprived woman being forced to stay awake all night after a long labor. Sending the baby to nursery so mom can sleep is sometimes the best thing for everyone.
I hope the hospitals that are outlawing formula supplementation are making electric breastpumps available for all their mothers, onsite breastfeeding classes,lactation clinics after discharge, and staffing a larger number of lactation consultants..otherwise this could get messy.
Here's a thought: what if just by making skin to skin the norm we start changing the visuals of childbirth and then that becomes the expectation.
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