Carol,

I hope I am not overstepping my bounds here, with some suggestions. I have 
only the babies and mothers best interest in mind. (As I am sure you do, too.) 

I am assuming that these protocols are done in most hospitals. Is the 
concern "how can they be done in the first hour?" or "WHERE can they be 
done, later on?" I assume a large staff is in attendance. None of these 
procedures (with the doubtful exception of a "birth weight" which in most 
hospitals easily done in the birthing room or OR.) need to be done immediately.

Can these procedures simply be done IN the mother's room? Scales can be 
wheeled down, Ballard doesn't have to be done in any special environment, the 
mom's room is adequate, eye prophylax can wait at least an hour or two (so 
baby can see better to make eye contact. All my babies were born via C birth 
at large city hospitals, and eye prophylaxis was postponed, per our request for 
several hours after birth and then done in the Recovery Room, in my dh's 
arms) and can certainly be done in the mom's room,  Vit K etc can also be 
done in Mom's room. 

It may require a little more footwork from the staff, but at the benefit (as you 
know) of encouraging bonding and attachment between baby and parents is 
worth the extra steps each staff member will need to make. 

My last baby was born in 1999, a "preterm" 36 week 5.5 lb baby. She stayed 
with my dh and I in the Recovery Room for over an hour, the only test done 
was a weight and length, done in the OR. (And monitoring to make sure she 
was breathing properly, which she had no problem with.) She was whisked 
to "Special Care" then, when I was moved to a room, as I was told her body 
temp was "low." (but not until she had left my side.) I refused to allow her to 
stay in SC and she was brought to me, we kangarooed, and in less than 20 
minutes her body temp was "normal." (IMO, her body temp was low, because 
of the separation. As soon as we were reunited, it returned to normal.) This 
hospital, also, did not have a Central Nursery, so most tests, procedures etc 
are usually done in Mom's room. (I have heard that in some cases the Special 
Care is used for these tests, but my dh and I had requested no separation if 
baby and I were OK after birth.) (The situations of my two older children's 
births, in the 80s were not the same. We were "denied" rooming in, as it 
would "disturb" my roommate, and "exhaust" me, with the first baby. (And I 
went home with the unrealistic notion that my High Need Baby only needed to 
be nursed every 4 hours, on the dot!)  And had to fight for even "adapted" 
rooming in with our second. But, that was in the Bad Old Days. ;) ) Both 
hospitals I used have eliminated their "Central Nursery" more than a decade 
ago, with the belief that healthy babies need to be with, and taken care of by 
their mothers, 24/7, not Centralized or "Institutionalized" as we once referred 
to it. ;) Many hospitals have found eliminating the Central Nursery not only 
helps moms and babies bond, but actually helps increase patient time for each 
staff member. 

I am not working in a hospital environment at the moment, as an LC,  myself, 
(I am working Private Practice)  but seeing in-room care work well in many 
places, even large hospitals with large birth rates, it appears possible to have 
most of these protocols performed in the Mom's room. 

Is that a possibility? 

Has your hospital eliminated the Main Central Nursery? (Or I am confused 
about what "transitional" meant? I'm sorry.)  The hard part, now, is getting the 
staff and the Powers That Be to understand that a change in *where* these 
procedures are done (and maybe how soon after birth they "need" to be done) 
is essential not only because of the elimination of the unneeded "Central 
Nursery" but for the Well Being and Bonding of the Mothers, Fathers and 
Babies. 

Even if the hospital still has a Central Nursery, strong encouragement of 
rooming in, as well as not allowing family separation in healthy births (even 
healthy C Births) as well as using mom's room as the main place to do these 
procedures could soon make the Central Nursery obsolete and eventually a 
thing of the past. 

Good luck! 

Mary Jozwiak IBCLC, RLC, LLLL
Private Practice 




On Thu, 27 Mar 2008 10:57:26 -0600, Bill & Carol Lesperance 
<[log in to unmask]> wrote:

>Hi!
>We are finally implementing our breastfeeding guidelines which state that 
babies are not to be separated from their moms for the first hour of life...and 
remain skin to skin. Although this is going to happen, the nurses want to know 
how people with comparable delivery rates do this. 
>Here is their dilemma. We have no transitional nursery..so they do all the 
baby "stuff" as well as mother....weights, measurements, eye prophylaxis, Vit 
K injection, Ballard etc. We have 5-6,000 deliveries per year. Since it is 
required to have two nurses at a delivery, the "baby" 
>nurse has been doing all the above stuff before she leaves the nursery. If we 
keep mom and baby together, how and when to do these procedures? It 
seems like most of this can be done while mom and baby are together???
>Thanks!
>Carol Lesperance, Albuquerque, NM

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