It seems that things that we feel strongly about create the most
traffic.  I will try not to be too repetitive.

Hospital #1 (the more interventive one--I'm sure that must be a word; I
use it a lot).  Moms deliver in LDRPs.  However, most of them don't stay
there.  We usually need the rooms for laboring patients or inductions
(vast majority induced and have epidurals).  Babies are supposed to stay
with mom during recovery.  I think they do most of the time, at least
during the day.  Last time I surveyed, over half the breastfeeders were
offered breast in first hour of life.  With C-sections, they are
supposed to get baby in recovery, but depends a lot on the nurses.
Admission procedures including eye meds, Vit. K injection and Hep B
immunization are done in room, usually within minutes of birth.  Skin to
skin used frequently for temp control, but if cold, they are to go to
onto warmer.  We no longer do glucose checks on all babies, but LOTS of
babies qualify--SGA (small for gestational age), LGA (L=large),
premature, low apgars, low temp (even explainable, e.g., parents left
baby loosely wrapped and not skin-to-skin).  Bottles of formula for
glucose  below 40 is common, though policy allows for breastfeeding for
hypoglycemia.  Alternative feeding method policies in place, but
utilized primarily by myself and sometimes by CLEs and CLCs.  Some
doctors require bottles for supplementation and require lots of
supplementation (for all the (quasi) reasons we have previously
discussed.  Did couplet care for about 6 months.  Pediatricians and
nursery nurses complained relentlessly and every problem was blamed on
the system .  Couplet care ceased a month ago.  Mothers can still keep
babies in their rooms, but are encouraged by most nurses to send them to
the nursery.  Many also are so kind as to offer to feed the baby, too,
so mom can have a good night's sleep!  (Of course, you know the
results).  In the eyes of some, supplementary bottles of formula cure
everything, particularly at night!  Some docs examine babies in the
LDRPs which have otoscopes and ophthalmascopes mounted on the walls.
Some call ahead to have nurse gather up all "their" babies to be
examined in the nursery.  Most nurses see no importance to having babies
examined in mom's room.

Hospital #2  Policies are identical to #1.  However, babies usually stay
in the rooms at night.  Supplementation of nursing babies is decreasing,
now below 50%.  Procedures always done in labor room (no LDRPs exist) if
mom and baby healthy.  Offering breast in first hour of life is
routine.  Using skin-to-skin for warming is gaining ground among nursery
trained nurses, at least during day shift.  Getting baby to mom during
recovery after C-section seems to be a problem.  (Lots of formula
here.)  More nurses cup feed than at Hospital #1, although bottles are
still most common method of supplementation.  Babies always examined in
mom's room--otoscope and ophthalmascope are mounted on a moving pole to
make this easier.  Babies leave rooms for circs and PKUs.  Many nurses
more willing to give babies time during sleepy period before pushing
them to eat.  A little knowledge is a dangerous thing.  Sometimes the
nurses wait too long for a baby to eat or don't recognize poor latch or
a baby who is at the breast but not breastfeeding, so sometimes I'm the
one pushing supplements or blood sugars.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA