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From:
"Leanne Jewell, Rnc, Lcce, Facce" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 10 Jun 2006 14:20:37 EDT
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I have been reading the postings on the inevitable first bath.  We  bath our 
babies where I work now as soon as the temp is stable after admission  the 
transition nursery.  They are bathed under a radiant warmer with warm  water and 
scream their bloody heads off, thus resulting in these ruddy red  babies.  
They are then diapered and placed supine under the warmer to  continue their 
transitions.  They then resemble a bunch of teenagers at the  beach crashed out.  
Once they have finished transition they are given over  the head shirts and 
swaddled x2 in warm blankets and boggan hats are placed on  their heads.  The 
nurse caring for the couplet is notified to come pick up  her baby and assess it 
again and take it out to Mom.  When they get to Mom  we match the bracelets 
and now the real fun begins...it's time to feed this dead  to world sleepy 
exhausted child.(we are the cesarean capital of Florida, not  proud to say).  So 
unless this baby was one of our rare vaginal deliveries  who had the 
opportunity to go to breast at the time of delivery, we are now in  the "race" to get 
the baby to feed because it's now between 4 and 5 hours. Our  patient population 
is largely Hispanic so there are many visitors in the room  who must have 
numerous photo ops, and Mom is usually nauseous or has been  medicated either in 
PACU or upon arrival to the floor for nausea....making her  al  ittle out of 
it.  Despite me and the other LC/RNs telling staff to  now go to skin to skin 
we hear repeatedly the baby is too sleepy to nurse.   YoHOO!! no clue.
So one of us will shoo out the crowd, go to skin to skin and  after a bit 
guess who latches on?
Not great, but enough that the parents think its great.  If we have  some 
trouble I remind them to "reboot the baby" that great concept of skin to  skin 
and don't mess with the baby for about 30 minutes and allow the kid to  reorient 
to Mom. It usually works well.
So my question to the nursery staff has been why wrap them in super warm  
blankets unless they are not hold temp, not to scrub them to shine like  apples.
 
Where I worked before was an LDRP....low section rate. But I did often a  
take off on the LeBoyer bath for the first bath. Immersing the baby in warm  
water for a few minutes...yes, under the radiant warmer without the overhead  
light on and just letting the baby feel the warm water...no scubbing this can be  
done with baby bath in the water. Then gently washing and gently drying.   We 
also had Jaccuzzis and I was even known to put baby in with Mom after the  
delivery recovery time and have her help with the first bath. This was  awesome!  
Babies even nursed for a few minutes. I would then take baby back  to 
stabilet and rinse in warm water dry and let them on the bedside stabilet  while Mom 
chilled out post delivery in the tub with a cool drink. I was able to  stay in 
the room and finish my notes, check on both Mom and baby. Mom would get  up, 
shower off and put on her jammies and go back to a freshly made bed with her  
baby next to her.  It was Camelot! This all took place after the first hour  
or so. We weren't a huge unit and we weren't busy. Pt;s loved it and so did the 
 staff.
I share with you this comparison because out in the world north of South  
Florida there are units where these can occur.  Our unit is not set up for  this 
and hospital is just not into that thinking.  I have had the  opportunity to 
bath babies in transition and try to use the gentle bath  techniques...it not 
so harsh but if you are bathing and transitioning upwards of  15 to 20 babies 
on some days its not what the nursery staff has time for.  Sad.
 
Only the patient's complaints can change things in many places these days,  
Patient Satisfaction and Patient Safety are the operative catch  phrases. 
I keep trying but they just don't think that something like that is an  
important issue.  It's okay for the babies to cry and crash....its to be  expected.
Leanne Jewell RNC, IBCLC, LCCE, FACCE
SFl

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