I am LOVING the changes that were implemented in the past year as we grow to becoming more Mother-Baby Friendly!
ALL babies go skin to skin from birth with mom at vaginal births, unless mom refuses to do it. Families are educated on this as a standard of care (prior to the birth), and I'd say that 95-99% of them agree with it and love it. I also educate families before the birth that baby stays skin to skin with mom for AT LEAST the first hour, or until after the first successful breastfeeding. Whichever one is longer. I go on to explain the benefits of the uninterrupted time of skin to skin from birth, and how it benefits both mom and baby. Dads do get a little upset because they either: want to hold their new baby too, or they want to know the baby's weight.
I also explain that knowing the baby's weight isn't the utmost important thing in this "Golden Hour", and point out that the rest of the family can wait to see/hold the baby until after that first hour -- because you as the new parents will NEVER get that first hour back again.
As for c-section births -- we are trying to get baby skin to skin with mom within the first five minutes of the birth. However, it's a different story in the OR. If mom is vomiting, shivering, or her arms are too weak (as is often the case with some of the spinal/epidural blocks), it's a safety issue over the skin to skin issue. In that case, we offer skin to skin with dad/significant other in the OR. Some dads/SO's love it, while others are just totally turned off by it. So, if mom/dad doesn't do skin to skin in the OR, I make sure that baby is skin to skin with mom in the PACU as soon as she gets there. (Medical stability of mom comes first, so sometimes it's delayed.) Breastfeeding attempts are made in the PACU as well. Not always as successful as with a vaginal birth, because of mom having to remain relatively flat after a spinal (risk of spinal headache if her HOB is elevated too soon).
Another change that we have implemented is that if your baby is going to the NICU, it is no longer an option to NOT choose to breastfeed/pump. You simply must start pumping for the colostrum for your baby's health and well-being. The NICU providers are insisting that all NICU babies get that colostrum/breastmilk for the health benefits. So far, moms are ok with this. This is where it gets sticky for me --- I don't feel that it should be forced on those who are adamant about not breastfeeding/pumping. But at the same time, I understand the health rationale for colostrum (at the very least), especially for the premature infants. Formula will never, ever take the place of the nutrients found only in mom's breastmilk. I do know that our NICU staff are excellent at providing the education to the parents about why colostrum/breastmilk is so important for their premature baby.
Anyway, we are on our way to truly becoming Mother-Baby Friendly!! YEAH!!!!
Showing posts with label mother-baby friendly. Show all posts
Showing posts with label mother-baby friendly. Show all posts
Monday, August 26, 2013
Wednesday, September 12, 2012
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.
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.
Sunday, September 02, 2012
Role transition
The more that I am in my clinical site, the more I am enjoying my role transition to midwife. I'm finding that I am liking my role as the nurse while at work, less and less. This only proves to me that I am -- without a doubt! -- in the right environment for midwifery at my clinical site! It also proves that yes, all of this struggle and huge student debts are worth it on my path towards midwifery. From the basic classes (theory, research, pathophysiology, etc) to the middle level courses (ante, intra, post/NB) to the advanced level courses.........and finally in my clinical site, where I am putting it all together!
I am incredibly grateful to be at my clinical site. These are fabulous co-workers and I can totally envision myself finding a permanent role at this site. God/goddess willing, of course!
My clinical site ~ women are treated as true partners in their care. Women are given choices, ALL of the choices, and are encouraged to ask questions, discuss their options with family/support persons, and then make their own choice as to what they would like their plan of care to be. Food and drink are highly encouraged in labor (yes, even with VBAC women!), ambulation and intermittent monitoring is the norm, and nursing care is superb. The hospital itself is a laid back, relaxed environment, where women and their families are treated well and with respect. No rigid rules and regulations for family, visitors, and times for visitation.
It's quite a shell shock to go from such a warm, loving, woman & family centered environment........to the rigid and often times noisy environment where I work.
I am incredibly grateful to be at my clinical site. These are fabulous co-workers and I can totally envision myself finding a permanent role at this site. God/goddess willing, of course!
My clinical site ~ women are treated as true partners in their care. Women are given choices, ALL of the choices, and are encouraged to ask questions, discuss their options with family/support persons, and then make their own choice as to what they would like their plan of care to be. Food and drink are highly encouraged in labor (yes, even with VBAC women!), ambulation and intermittent monitoring is the norm, and nursing care is superb. The hospital itself is a laid back, relaxed environment, where women and their families are treated well and with respect. No rigid rules and regulations for family, visitors, and times for visitation.
It's quite a shell shock to go from such a warm, loving, woman & family centered environment........to the rigid and often times noisy environment where I work.
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