I like this subject line, and the thread is fascinating.  I honestly had no
idea there were still hospitals practicing in the way described by Phyllis
Adamson.  Shows how sheltered I am!  WHO has published a document about 10
years ago called 'Care in normal childbirth' and there it is stated in no
uncertain terms that there is no need to separate healthy mothers and babies
at any time, and many good reasons to take great pains to keep them
together.

I'm going to read Phyllis' post to my colleagues some day when we all need a
good belly laugh.  They will not believe it is for real; that's how far it
is from our world.

The main things that strike me about the elaborate 'observation' rituals
outlined here, are that they double the number of staff employed in this
area - one for mother, one for baby.  Of course, when the two are separated,
both are at increased risk: baby for hypothermia and hypoglycemia, and
mother for hemorrhage in the short term, and unknown effects for both in the
long term, such as altered stress hormone secretion, not to mention the
obvious danger for breastfeeding failure.  But it is macabre that the very
intervention - separation, ostensibly for intensive observation - is what
causes the need for such observation.  We wouldn't have a snowball's chance
of covering all the bases if we separated them because there aren't that
many of us on the job at once.  In these cost-conscious times I am surprised
some number cruncher hasn't figured out that it's wasteful to split up a
unit and observe them as separate entities.

Also, what about the innate risk of getting babies mixed up?  This kind of
shell game with mothers and newborns is downright SCARY.

Here, in a normal birth, still nearly 80% of births here, the baby is born
with mother, her chosen companions, a midwife and a maternity aide in
attendance.  The midwife does the Apgar determination and looks the baby
over rather cursorily, suctioning (and we still use DeLee suction devices!!)
if she considers it necessary.  Third stage is conducted actively, with use
of oxytocics and cord traction as routine measures.  Once in a blue moon a
mother requests no oxytocics, and some midwives are more conservative about
giving them as well.  Suturing, if necessary, is done.  Babies are weighed
and measured after 2 hours unless there is a really good reason to do so
before.  At that time we take their temperature, and if the baby is bloody
or messy, it will be quickly washed with a washcloth or under the shower
head over the baby bath, as we have stopped routinely bathing the babies in
the labor suite.  All the immediate care, which consists of expectant,
attentive observation, tapering gradually off to coming into the room every
now and then to see how all are doing by the end of the 2 hours, is done by
the midwife and the aide, with baby on mother's belly or chest.  At two
hours, mother's blood pressure is measured.  Her fundus will have been
palpated several times already.  She has a chance to empty her bladder and
is strongly encouraged to try.  She may shower.  There are no doctors
around, unless the mother or baby is having difficulty.  The newborn exam is
done on morning rounds by a pediatrician, after baby is 24 hours old, to
avoid overdiagnosis of heart murmurs.  We have IM vitamin K as standard
care, given shortly after birth, and no eye prophylaxis at all.

Obviously if the mother is hemorrhaging, or baby not breathing, we don't
just twiddle our thumbs for two hours, but if mother and baby are stable, we
just treat them like mammals and leave them pretty much alone, while staying
available to help get BF started if need be.  You can see pretty much
everything you need to see if you can view the soles of the baby's feet
while suturing, for example.  Unless the room is very noisy, you can hear
whatever sounds baby is making too.  This thread has made me see how
minimalistic our approach is, which is a good thing because I was starting
to think we are doing WAY too much to them by even moving them arbitrarily
after two hours, or actively trying to get baby to take breast in mouth.
Everything is relative.  I still favor waiting for baby to take the
initiative to latching on, but I think I will stop whining about it for a
while.

Rachel Myr
Kristiansand, Norway

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html