Our hospital has proudly opened a Transition Nursery to relieve the
pressure on the Level I Newborn Nursery. We have LDRs and will likely never
have LDRPs, so babies stay with mom for 1-2 hours in the LDR. Then baby
goes to the Transition Nursery. Sometime between 4-6 hours after birth, it
is considered safe to send baby out to mom's room.
Reason 1: Because of liability issues in the US, our hosp staff MUST record
Vitals every 15 minutes for the first hour, then every 30 mins for the 2nd
hour, every hour for the next 2 hours, & every 4 hours from then on. I'm
told that retractions are best observed when baby is naked in the warmer or
wearing a t-shirt, but not easily seen when baby is tucked in bed w/mom.
I'm told that retractions rarely begin after 4 hours of age. Our hosp Admin
is not willing to risk one baby with undetected retractions. Also, mom may
not know what grunting is. I know I didn't when I first started working
there. I commented in the nursery, solely in the spirit of conversation,
about a baby who was "singing". It started an examination that sent the
baby to NICU. If I had heard one of my babies do this, I don't think I
would have considered it something to tell the nurse about.
Reason 2: Mom needs the time to transfer to her own room, get oriented and
settled, get a shower, eat, etc. However, I find that this neat
coordination of events doesn't usually happen.
All this was a prelude to our opening up another floor soon with 4-6 rooms
dedicated to couplet care. We will have a small nursery on that floor with
one warmer, used primarily for procedures, and containing basic emergency
equipment.
Problem: I worked with 3 mom/baby pairs in couplet care today. One had a
BF in L&D followed by an ABM feed. Two had 2 ABM feeds in L&D. All had an
ABM feed in the Transition Nursery. I was called in to work my magic to
begin breastfeeding. Thank goodness two of the moms had already nursed two
babies & had a sense of confidence. But both believed they had no milk in
the first day or two & expected to supp w/ABM. I found the Primip mom
holding her "burrito-wrapped" sleeping baby, face up to the ceiling, trying
to stuff her colostrum-dripping nipple in baby's mouth. The nurse had told
Mom that baby must eat now because it's time, but baby was unresponsive. I
did manage to help all three moms get their babies latched on eventually.
The nurse doing the couplet care was stressing in her need to know that
baby "got enough" at breast. I suggested watching for suckling & swallowing
by baby, & little/no nipple pain or nipple distortion post feed for mom,
along with all the other s/s for 'normal' that she observes. The only thing
missing is the cc/oz fluid intake measurement.
And our Chief Neo expects to see an increase in Excl BFing with the
addition of couplet care to our hospital's services. I think we're off to a
rip-roaring STOP!
We add lactation consultants. We add couplet care. We publicise our new
services & support of breastfeeding to the community. But we still are not
reducing the use of formula. They just don't get it, do they?
Ok. Rant's over. I can sleep now and go back to work in the morning.
Thanks, all... :-)
--- Phyllis Adamson, IBCLC
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