Dear Lactnet Friends:

I am speaking for hospital staff.

My first exposure to an obese person was a patient with Chronic Obstructive
Pulmonary Disease (COPD)  in the medical ICU. She couldn't walk out of her
house; the fire department had to come and hoist her out through a second
floor window using a winch and a sling.

All 8 of us nurses working that shift would coordinate our schedules because
it took all 8 of us to wash her, assess vital signs and evaluate her skin
and general status, change her gown, and move her to a freshly made bed. Her
bed was 2 beds lashed together.  The ICU census was 9 but the number of beds
was 10.

Ever try to listen to a baby's heartrate when there is 6-12 inches of
adipose tissue between her skin and the uterus? Nothing is big enough.  Ever
realize that an obese client on an OR table necessitates more staff, who
have to hold body parts out of the way. How to move such a person quickly if
there is need? Sometimes its easier to put the person in a place where
emergent care can be quickly given, even if it isn't necessary at that
particular moment.

Hospitals are working to accomodate larger clients. This has meant increased
expenses, in an era where health care is underfunded and exploited. Larger
OR tables, stretchers, monitoring equipment, lifting equipment, are only
some of the required equipment.

People of that size are often too out of shape to assist in their own
movement. They must be carried and turned regularly and have deep breathing
assistance because   their chest wall can be too heavy for them to expand
their lungs enough. When their lungs can't expand enough, they don't get
enough oxygen and can be irritable as a result of air hunger, or have an
easier time developing pneumonia.

Personal hygiene can be another challenge; nothing like finding yeast or
mold or other nasty things in folds and crevices. One has a personal
reaction to a sudden blast of noxious smell; pretty difficult to avoid
although one learns to breathe through one's mouth all the time, to honor
the client.

There are always more than two sides to story.

Then, if the obese woman has a ceserean section, everything is intensified.
She's more likely to have the wound break open, or get pnuemonia or a
bladder infection. She's in too much pain to be very helpful with her baby.
She has to be physically lifted from stretcher to OR table, and back again,
and thence to recovery room.

Most hospital staff have more than one dyad to care for; nurses in my City
regularly have 5 or 6 dyads to care for; that is 10 or 12 people. Nurses
need mothers to care for their own babies. There isn't enough time for one
nurse to give enough individual care.

Nurses are required to present all sorts of educational information to all
mothers. Many times, patients are too busy texting to listen. Patients don't
want to be interrupted by a staff nurse who wants to give them useful
information,  and often complain on the Press-Gagney surveys, whose results
are used to harass nurses.

Another benefit of nap-time (besides less formula supplementation at night),
is that everyone rests and the nurses have a chance to get all their
paperwork done before the end of shift, instead of staying one or two hours
after end of shift to finish.

I'm just saying that there is more than one point of view.

warmly,

Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

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