As a NICU nurse at a large teaching hospital (that claims to be baby
friendly), I would like to remind us all of the "trauma" of being born via
NSVD , not to mention a difficult delivery. Specifically in reference to the
case of the Premature baby who aqcuired a clavicle fracture and had to
tolerate deep suctioning x 3. Someone wrote asking for reccomendations on how
to promote early breastfeeding and I must speak up. At my hospital we
routinely allow skin to skin contact immed after birth only if a midwife
delivers . Depending on who is working in Transitional Nursery the baby will
not be allowed to breastfeed as long as it wishes , because we can't allow
the bath or shots to be forgoed until the nurturing was done, heaven forbid.
It would disrupt the work load among the nurses. I have seen more than one
baby admitted to NICU with PPH after being bathed and given shots right after
a stressful delivery and not given any time for the cardioresp and neuro
systems to relax, adjust and be nurtured.Clavicle fx's are common in large
babes, difficult deliveries and rapid dels. Remember that the bones are much
more flexible and heal quickly in most infants , even when not splinted
properly. Not to say it does not hurt, but from my experience imprinting and
alertness right after delivery make it an important window time in terms of
how the baby reacts later  to treatment at that time.Deep sucx frustrates me
to no end. What do we think we are doing? You can't suction away adventious
lung sounds in the bases , they are in the alevoli, and no suction cath I
have seen is adept enough at reaching the alevoli. Routine sucx is not
allowed at our hospital anymore, thank goodness. A baby rarely needs sucx at
all unless there is Meconium at Delivery and then the infant would be
intubated and suctioned that way, if indicated. If there is mucous coming
from the infants mouth in copious amounts or interfering with airway mangmnt
, usually passing a small orogastric tube and GENTLY sucx out the stomach and
esophagus will be sufficient. Anatomically speaking, remember how small the
oral and airway space is in a neonate and the potential damage from deep sxc
should be carefully weighed. I will get off my soapbox now, thankyou....

 Lisa Mooney, LT, NC , USNR , RN, BSN , (Taking IBCLC exam in JULY)

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