Mother-baby friendly status

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.