Dear Listmates,
Ann writes:
I am looking for information on two fronts regarding giving newborns an
"initial bath."
This is an excellent discussion topic. Years ago I heard Marshall Klaus
speak at a DONA conference. He planted the seed, for me, that the routine
newborn care that is done according to the hospital's "Standards of Care" just
might be a deterrent to establishing bonding and successful breastfeeding.
Molly Pessl has spoken about newborn care practices that delay or disturb the
breastfeeding relationship. Also, at the last ILCA conference, this topic was
discussed at one of the general sessions in great depth with recommendations
about delaying the infant bath, no mother bath, no passing the baby around to
family members, etc until several good feedings had been accomplished. All
this goes along with Dr. Nils Bergman's information of the
neuro-physiological-behavioral aspect of breastfeeding.
Our local hospital's standing orders for the newborn are "Bulb and Bundle."
Baby is usually put on mom's chest, with or without her gown in the way,
depending on the nurse present, for a short period, less than a minute. The
baby then is taken off the chest and brought to the warming table, where it is
vigorously dried off, bulb suctioned again (babe is usually suctioned after
the delivery of the head), diapered, shirted, hatted, banded, and then handed
back to mom bundled in two blankets.
If the mom is lucky she will have a nurse who immediately unwraps the baby,
takes the shirt off (not the diaper and hat) and places STS with mom. We are
talking about babies who usually have APGAR scores of 8 or 9 at one minute,
not medically fragile babies. We no longer have CNM's who receive babies,
(another story), just OB's and medical students under the direction of the OB's.
In my capacity as a childbirth/lactation educator and doula, I speak with
moms prenatally and inform them of the benefits of immediate and undisturbed
skin to skin contact with their newborns to help get breastfeeding off to a
good start. I have spoken with the head of the Respiratory Department and given
him written references on this subject. (Respiratory therapists attend all
deliveries at our local hospital.) He was okay with immediate and
undisturbed STS, as long as the baby's condition was stable. I educate the moms about
delaying the infant bath, and teach that the other newborn procedures, such
as weighing, Vit K, eye prophylaxis can be done with the infant in the
birthing room. Three women I have worked with personally in the past year have been
able to accomplish this when their written "Baby Birth Plan" wishes were
respected. One, my daughter, had every intervention, short of a cesarean
section, known to "Obstetrichood"; she is successfully breastfeeding my nine month
granddaughter, who has not had a drop of ABM, despite mom returning to work
full time at three months!
It is my hope that this will become the new standard of care for all
well-born and healthy babies, not just breastfeeding babies, when the
maternal-newborn education at our hospital becomes evidence-based and the pediatricians and
obstetricians actually base their practice on evidence.
The AAP Breastfeeding Statement in Pediatrics, February 2005, has great
references.
Mary-Jane Sackett, RN, BSN, IBCLC, RLC, CCE, CD(DONA)
Registered Lactation Consultant, Certified Childbirth Educator and Certified
Doula
Maternal Child Health Visiting Nurse
Pittsfield, MA
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