This is in response to Merrilee's question about the hospital bed  issue.
Our unit is all private rooms.  Our Pavilion rooms are small room for  only a 
sleeper chair and maybe a straight back chair and THE BED.  Our  Suites have 
more space (originally designed as LDRP rooms but soon delegated to  14 LDR 
and 15 Postpartum Suites) We have glider rockers and now new sleeper  sofas.  
Patients pay extra for the extra space on a first come availability  after 
delivery.  Sometimes you will find women on late day 2 or 3 (we are  the cesarean 
capital) out of bed in the chair. Chairs are for our large  families.
But in a society were Childbirth is viewed as less than Normal and Natural,  
but as an event that entails medications and interventions and no one thinks  
that it's anything else, then you must see that Mom is relegated to the 
hospital  bed. Their families support this whole heartedly.  
As a Mother Baby nurse and a Lactation Consultant I encourage my patients  to 
get out of the bed....I want them to shower...dressings are removed first  
thing in a.m....I encourage them to sit on edge of bed or at the tables in the  
larger rooms to eat.  Drink lots of fluids ( so they have to get up to  
void...it gets them out the bed).  Walk in the hallway and please go to the  Mother 
Baby class held daily where they will hear about breastfeeding and how to  
care for their baby.  Mothers with babies in NICU are out of bed, but they  
perceive themselves ill because their baby is in a place for sick babies.   This 
also the generation of not doing for anyone but themselves...it's all about  me. 
 It is amazing how many moms want you to be there for every feeding and  they 
find it difficult to initiate getting the baby to the breast....a lot  
literally want to have you their to hold their breasts for them...They are  amazed 
when you strip the baby down for skin to skin....take the blankets away  and 
strip off the mittens. 
"Why would you undress the baby to feed?"  "The baby needs the mittens  so he 
doesn't scratch himself."  
The Reva Ruvin Model of Postpartum Nursing should always be kept in  mind.  
The taking in, taking hold model is just too pertinent to hospital  nursing and 
postpartum for most patient care.  Never forget this is a life  altering 
event.  Yes, its is a Normal process but if they birth in a  hospital, hospitals 
are set up no matter how Mother Baby Friendly they are to be  just that a 
hospital.  The patient who tells you when I get home, I will do  it this way...but 
while I am here....well, she may change because of her  environment; while the 
patient who delivers at a birthing center or at home may  and most times take 
hold much more effortlessly. But it all boils down to how  much the birth 
process has effected this mother.  
So as a Lactation Consultant what can you do to encourage getting them into  
these other spaces...be patient with them...get their families out of the 
chairs  and maybe out of the room...or get the patient into the chair before the 
family  plunks themselves comfy for the day.
Get your staff to help to get them up early and shower early, encourage  
wearing their own clothing as opposed to the lovely and flattering hospital  garb. 
Get the beds made early ...who wants to mess up a lovely bed...it's too  nice 
to rumble. Take the pillows off the bed and put them in the chair...make  the 
chair the more comfy place. Tell her how good she looks in the chair or  
couch. Our chairs pull out so pull the foot out so she can have her legs  up.  
Remind her she should try nursing laying down at least once while in  hospital so 
when I encourage my nap time I will try to get them to nurse on  their sides. 
 Can we do this all the time,
probably not.  Why,  because hospitals are stretching us all too  thin...we 
are getting busier and patients are often more ill...but if you impact  one or 
two in a day, for only a day...you may go away feeling like...I got to do  my 
job a little better.
When the unit is due for a capital improvement suggest to your managers  what 
you think would be a better solution. When a room is empty have a  meeting in 
the room with them and ask them to look at the things from a nursing  family 
perspective. The decorators never do.
Good luck.
Leanne Jewell RNC, IBCLC, LCCE, FACCE
South Miami, Florida

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