>
> When a baby is born vaginally in the birthing room, a nurse is assigned
> specifically to that baby. She is responsible for a large amount of
> tasks to be preformed within the first hour of life or less.  There is
> always a rush to get the mother baby couplet moved to the postpartum
> floor as quickly as possible because we have patients backed up in
> triage waiting for a labor bed.  The nurse taking care of the baby has
> been taught the importance of skin to skin and no separation. Many
> babies do latch at this time.  However, there are sacred routines which
> some nurses are unable to part with which disturb this.  The main
> obstacle I am running into is that the nurses want to bathe the baby as
> soon as the temperature of the baby is 36.6.  The nurses believe that
> giving the baby a bath (not immersion) helps them oxygenate and helps
> lung expansion.  Another argument that they give me is that the mothers
> don't like a "goopy" baby on them. I point out that usually a good
> drying off of the baby is adequate.




Mary, I for one would love the lit citations some of these nurses must have
for "helps them (newborns) oxygenate and helps lung expansion" I've never
read such a research report, but it would help explain why so many staff are
so willing to destabilize a baby by bathing him/her in the first several
hours. Every RN who gives a bath when a newborn's temp reaches a certain
number, also describes how the baby must be replaced skin2skin or (too
often) under a warmer after the bath, because the newborn's temperature has
dropped again during the bath. So staff should be asking why newborns are
being bathed so early if evidence indicates this practice results in
destabilization of newborn temperature. We should be asking how this impacts
BF, e.g. how does this affect glucose metabolism during the 1st 24 hours,
weight loss prior to lactogenesis 2, infant behavioral states, etc. if temp
destabilization could/does increase metabolic processes and if baby is
placed under a warmer it will result in evaporative water loss.

It would be interesting to study just how many mothers verbalize complaints
about their newborns being "gunky" (and how much of this thought is nurses
who want to avoid "gunk" contamination), and what mothers' choose when given
info about the advantages/disadvantages to newborn (the only one whose
physiological needs should be considered!) to make an informed choice re:
timing of 1st bath. (How many parents are even given any choice re: timing
of bath??)  I mostly hear complaints about feeling as if one/one's baby were
treated as part of an assembly line in L&D...

BTW, the lit re: timing of 1st bath includes some contradictory findings,
although what was looked at and how it was looked at differed somewhat. A
couple of more recent reports address temp destabilization. Several around
2000 indicated outcomes were similar whether bath was in first hour or
several hours later. However, I didn't have time for a close look at the
variables investigated and outcomes....

Bergström A, Byaruhanga R & Okong P (2005). The impact of newborn bathing on
the prevalence of neonatal hypothermia in Uganda: a randomized, controlled
trial. Acta Paediatr, 94(10), 1462-1467.

Medves JM & O'Brien B (2004). The effect of bather and location of first
bath on maintaining thermal stability in newborns. JOGNN, 33(2), 175-182.

Varda KE & Behnke RS (2000). The effect of timing of initial bath on
newborn's temperature. JOGNN, 9(1), 27-32. (Several in the year or few
before/after were similar.)


K Gromada (MSN, RN, IBCLC, FILCA)

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome