On my unit, babies are taken to the nursery along with their mothers for the
newborn checks by the pediatricians. Sometimes they come at 8 a.m. and
sometimes it's 10:30. We don't get the mothers or the babies until we see
the whites of the pediatrician's eyes. Mothers are ushered out as soon as
they've asked whatever questions they wanted to, and one of us finishes
dressing the baby while the next mother and baby are ushered in. We don't
have more than one mother (and father/signif. other, if present) in at a
time, to protect confidentiality. We are not concerned that a baby who
overhears the doc examining the next baby, will reveal privileged
information.
Of course, if the mother prefers to dress her baby herself, she takes it
with her. But if it's breakfast time, she goes into the dining room and
starts eating before we bring the baby out to her.
We do take the babies out without the mothers for blood tests in the early
morning, or anytime, really, like if we have to do a bilirubin or a glucose
check at an odd time. I say 'we' but I don't do it myself. Normally the
lab comes and takes the specimen, but since I do blood tests in the out-pt.
clinic I just offer to do them when I am working on the ward as well. I do
them while babies are nursing and it works wonderfully. The lab techs
object that they must stand in awkward positions to take tests while babies
are nursing, and many of them prefer not to have mother looking on while
they stick the babies. If they went to the mothers' rooms, they could let
the babies lie at the breast, and adjust the height of the bed to protect
their own backs. Instead, a staff person is in the nursery for the baby,
and administers sugar water (16% glucose is what we use) to the baby orally
by syringe. Terrifically efficient use of maternity staff time! Mothers
are not given a choice about this; babies are fetched and brought back and
no explanation is routinely given nor consent for the glucose solution
obtained. That's just not how we do things here. It took me about 10 years
to get used to never asking permission for anything but now it seems almost
normal to me, though it still doesn't seem right! (Because it isn't right,
actually...)
A typical newborn exam by one of our more experienced pediatricians takes
about 150 seconds. The new residents take 15-20 minutes but only learn 1/10
as much about the baby's health in that time compared to our old pros.
There are a couple of docs who manage to use the exam to connect with the
baby and the parents, and teach the parents a lot about the baby in an
empowering way to boot, even while spending less than 5 minutes per baby.
These folks are a joy to behold. Most just do the exam on auto pilot and
afterwards we can be reasonably sure the baby doesn't have a major heart
defect, hip dysplasia, or any gross neurological disorders.
Since obstetricians can't tell time at all, we are just grateful that they
only make rounds on the mothers whose births involved one of them. We are
also glad that they do not expect us to bring the mothers to them, lay them
on an exam table and undress them - they go into the mothers' rooms all by
themselves, whenever they get around to dropping in, and they don't mind a
bit if the baby is with her.
and that's IT from me, until mid-August.
Rachel Myr
Kristiansand, Norway
soon to be sailing toward the Swedish w. coast!!
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