Evelyn writes:

Our hospital is considering going to a more "family centered" care with
Mother/Baby couplets for one  nurse to care for both the mother and baby.
This will also mean a much smaller nursery and rooming in for most
situations.  The staff is rather resistant at this time, and we are looking
for hospitals that have made this transition and are doing well with it.  If
anyone would like to share any tips for this transition I would love to hear
from you.  Did you find it required more staff than the more traditional
model?  What about the situations where the mother wants to "sleep" at night
and send her baby back to the nursery?


Evelyn,  I applaud your hospital for wanting to move into couplet care.
Although they may not be ready to work towards Baby Friendly, in my
experience mother/baby care is an important step in that direction.  

Many of the hospitals in my area are changing over to couplet care.  At
first, the staff is resistant.  They are threatened in many ways.  First,
they need to be cross-trained.  This means that nursery nurses have to be
willing to learn how to care for mommies and postpartum nurses have to learn
how to care for babies.  For nurses who are comfortable in their own arena,
this may not be a pleasant change.  Second, some nurses, especially nursery
nurses, may be fearing for their jobs as the hospital downsizes (and
hopefully eliminates the need for) the well-baby nursery.  There tends to be
some attrition and staff turnover through this process.  The nurses that can
adapt, do, and eventually come to see the value of mother-baby care.  Those
who cannot or will not adapt, may choose to or may have to find another
place to work.

As for the mothers, at first there may be an uproar from them as well.  If
they have previously had a baby at your facility (or at another hospital
without couplet care), they may complain loudly about being tired and
wanting the baby to spend the night in the nursery.  Often, they will
complain to their doctors about this.  It is important to get your OBs on
board about the change so that they can support the idea.  Unfortunately, in
an effort to please (or coddle) their patients, they may tell them to insist
that the baby be taken to the nursery at night.  This is counterproductive
to your efforts.  It is also important that the nurses be trained to "speak
with one voice".  One of the greatest barriers to good breastfeeding support
in a hospital is the mixed messages that women get from the nursing (and OB)
staff.  If the nurses can be taught how to support mother-baby care, they
can and will consistently pass this message on to the patients.  

The messages need to be:

"Your baby wants to be close to you."
"If you keep the baby with you, you will be able to immediately respond to
his needs."
"When your new baby wakes up, he is ready to eat right then.  Having him in
your room means that he will not have to cry to get fed.  Crying is a late
sign of hunger for babies."
"You may have your husband or someone else stay overnight in your room.
This support person can help you in the middle of the night to care for and
comfort your baby.  You can begin to learn together about how to interpret
your baby's cues."
"The first few days of breastfeeding are very important in determining your
milk supply.  You need to feed your baby around the clock.  The more your
baby breastfeeds in the first few days, the quicker you will have a full
milk supply."

You can probably think of other positive messages to add to this list.  

The nurses need to learn and believe these statements.  Then they will
naturally pass them on to the mothers.  Some nurses "get it" right away,
others take a while to get adjusted, and still others may learn to say these
things even though in their hearts they don't truly believe them.  It is
also very important that the maternal-child health supervisors really
support this idea so that they can be role models for the staff.

============================================
Ellen A. Steinberg, RN, LCCE, IBCLC
Tarzana, CA


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