Arly,

You are so right that in hospitals where maternity and nursery staff are
separate, there is a continuous "pull and push" of "where you belong" and,
really, whose responsible for your supervision (read power).  I've worked both
in that situation and with the mother-baby staffing, and the latter is the
answer for many reasons.

Nursery nurses (please realize I am generalizing for all of you who don't behave
this way!) are, in my experience, less used to coping with adult interactions.
They get to do their tests (blood, etc) in the nursery where the patient can't
talk, complain and give feedback - to her or to her supervisor!  Here in PR,
they often refuse to help with breastfeeding because "I don't touch mothers"

Maternity nurses (again, same apology) tend to want the nursery nurses to "come
out of the glass enclosure and help".  Therefore they are forever calling the
nursery when they could, with a short interaction, solve the problem.  They tell
me they "don't know how to handle babies - especially if they are different -
read too big, too small, babies of diabetics, babies whose moms took
medications, etc."

When we changed from the traditional (which decade - weren't midwives in charge
of both?) nursing to the mother-baby style in a hospital I worked in 1990, it
was VERY stressful for everyone - but I think the patients benefitted greatly.
However, to make this sort of change is to require flexibility from nurses who
have chosen their jobs based on the earlier expectations and they don't like,
want or believe in change.  (Just like when I have to start a new computer
program after I had learned the last one so well!)

NAACOG published a "Mother-Baby Care" OGN Nursing Practice Resource in 1989
which addresses the process of change.  It can be very helpful for those who
want to try it.

As an LC coming in from the "outside" there are all sorts of 'political'
stresses occurring in the hospital and among the staff that you learn about only
with time.  It's often like walking on eggshells.  At times I think it would be
so great just to go home, see patients privately, and get away from all these
additional stresses (advocating bf in an area with 4% exclusive bf at 1 month is
stressful enough).  However, I see some changes occurring and every once in a
while a nurse seems to "get it" and starts helping moms herself - and I feel as
if I've just delivered a baby (Via a long labor and a  very long Transitional
Phase)!

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico