Dear Lactnet community
It almost seems impossible that we will be able to reconcile the issues around the benefits of skin to skin/cobedding and hospital concerns re risks. Having worked as a hospital mat nurse for many years I have great sympathy for these nurses who are really stuck between a rock and a hard place. They may be full supporters of facilitating early skin to skin and the benefits of keeping moms and babes together in bed but every single hospital and governing organization policy prevents it (or makes it so unrealistic to implement on a busy unit). Sure, if a nurse stays in the room, the mom can be skin to skin, but she does have 5-10 other moms/babies to care for. I'm guessing that kangaroo mother care in the neonatal nursery at least hasn't had this barrier as nurses are a constant presence. 
The tragic death in our hospital a number of years ago involved a tired postpartum mom (aren't they all tired?) breastfeeding sitting up in bed and who fell asleep (quite understandable) with babe in arms and woke to find a cyanotic baby. The nurse had been in to check periodically but as you know, this might  quite reasonably be every 10-15 mins or so. What was done? Well, a good thing, but not necessarily anything that might prevent this in the future. The unit changed their policy and made every postpartum room private and invited (almost insisted) that a support person be present day and night. Now this was wonderful, but would this have prevented the death? - tired mom breastfeeding, tired dad sitting propped up in chair also asleep. No, it wouldn't have. But at least we have a more 'family centered' care unit now. BTW, I don't believe an autopsy was ever done so the cause of death is unknown. 
So what to do? 
Would side car bassinets help? Ones designed to be attached to hospital beds so that mom could bring baby over to feed and return to the bassinet easily? Not entirely. We are still left with the situation of mom falling asleep during the feed with babe in arms or skin to skin. 
How about if babes who are being kept skin to skin are in a proper kangaroo gown/tube top ala Nils Bergman? This might work as it would keep baby positioned high on mothers chest in a safe position even if she were to fall asleep. But this doesn't help if mom has her babe in a position for feeding lower down on her chest where suffocation might potentially be an issue (I know - incredibly rare but hospitals try to prevent being blamed for even rare events). 
What to do? Has anyone come close to tackling this conundrum at their hospital?
Meggie Ross, MSN, IBCLC
B.C., Canada
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