JUST. SAY. NO. –> You can’t take my baby……

JUST. SAY. NO.

You CAN’T Take MY Baby to the Newborn Nursery!

All too often, we~ as hospital staff in Labor and Delivery- Mother Baby units or the Newborn Nursery, want to take YOUR baby away for this test or that exam saying we’ll be right back.  Well it isn’t always that quick- in fact it is RARELY that quick. One thing leads to another and before you know it, it is 1 to 2 hours before you have your baby back.

This is beyond wrong.

We are horrible for doing this.

We need to be a better support system for you.

I am working on getting all staff involved in increasing our exclusive breastfeeding rates. This begins with the first feeding. (well- it really begins with birth interventions but of course that is a totally different post)…….

Your baby should stay with you until he latches and feeds.

Stay.

Skin to Skin is the best way for him to get accustomed to his new habitat and learn where he will be feeding.

STAY WITH YOU

We can do virtually everything~ all routine newborn exams, procedures and tests at the bedside, with you right there.

Speak up and tell us NO

Thank You

Supporting my Non-Breastfeeding Daughter-In-Law… Part One and a Half

This is a form of general response to some comments/ an “addendum” of more history or “back-story” type of intermission.  So I am calling it Part 1 & 1/2. Part II about the next pregnancy is in the works and coming later this week or next….

I am amazed and thrilled at the volume of interest this post has generated. I’m not a big blog by any means (usually getting on average 35 – 70) hits per day even when I don’t write anything. Now I have over 700 hits for 3 days in a row. For some of you that’s normal… not me. It makes me want to make sure I get this right. Make sure the correct points are being made. Without monkeying around…

Breastfeeding Baby Monkey

I LOVE Sadie. I love her like my daughter. She is a very smart, strong, independent, confident and outspoken young woman. She has a large group of friends to whom she is always supportive, a good listener and would do anything to try and help with all types of situations. These types of things make me respect her tremendously! My son had met her at a party once in college then re-met her a few years later when she was near graduation and he was … well….. a college drop-out party animal at age 23 recovering from knee surgery after a car accident. (** drops head with embarrassed grimace **)  Sadie.. I always say.. finished raising my son. She did NOT put up with any of his shit.  She is responsible for or part of the catalyst (besides the car accident) in encouraging my son to turn his life around. He is now a 32 yr old successful business owner.  They are very much in love. They still talk for hours every day and crack each other up all the time. Lots and lots of laughter and fun!

I am very happy that so many of you understood that I was (and still am) LEARNING the new roles of mother-in-law and grandma. This is a story of my feelings and emotions as I attempted to do the best job I could….. respecting and honoring that my son and his wife were indeed the decision makers as they became parents, helping Sadie understand that she was most certainly going to be respected and supported in her feeding choices……. and learning to let go. I’m glad many of you realized that I knew it wasn’t always appropriate to provide information and advice … but sometimes, because of the professional I am and how important I feel it is for all mother’s &  parents to make informed decisions….. I found it hard to not say something if only for their protection.  I hope you all realize that I am not pushy and try to always be supportive. But I’m human and I can screw up…  I should have asked first what they read or researched about it before talking. As a breastfeeding advocate and lactation professional, I know that it is in my grandchild’s best interest to be breastfed. I also know that it is NOT my decision. This is a story of my journey to deal with all that so close to home and on a personal level.

I wrote this post “Breastfeeding, Bottle Feeding and…. Somewhere In-between…. Why the Guilt?”  two years ago and another.. “**ROAR** on Breastfeeding Guilt “ a little while after. I have a hard time with people having guilt- thinking proper education for informed decisions will cause guilt- others making rude comments about someones choice making them have guilt- a personal guilt anyone has because they don’t feel they did “enough”…. I just have a hard time with all that. I had guilt thinking I went too far with the kids…. (Dave and Sadie). Never did I want Sadie to have guilt because of something I said, how I said it or perhaps acted. It was important to me that the guilt factor was eliminated. There are so many opinions out there and mommy wars and stupid stuff actually (IMHO). We need to be supporting each other. ALL MOTHERS AND BABIES SHOULD BE HONORED AND RESPECTED. We don’t know their story or reasons for any choices they are making.  Some of you have had painful experiences and I am sorry that happened to you. I hope you can move past the memory to be supportive to the next person you meet… even if it’s just a smile.    For “Mama of 2″…. Your MIL is sounding unbalanced and in need of a psych eval IMHO. Seriously inappropriate! I hope you can throw out her comments with the dishwater (what an old fashioned saying…) which reminds me of an old favorite cartoon: (LOL)

That being said about the feeding issues. I want to talk about parenting. All the years that I have been a nurse sending new parents home with their babies, it has been important  that they are empowered to become loving parents with their own style. I have always encouraged them to discuss things among themselves and decide just what that is. I encourage them to smile and nod at “Grandma” or “Aunt Sue” and do things their own way. I had this same discussion with Dave and Sadie at the very beginning of the pregnancy. It isn’t my place to raise their child or decide what type of discipline for any situation… My role is to fill in while babysitting and try for consistency on their plans. Not to make the plan…follow it.

Supporting my Non-Breastfeeding Daughter-In-Law … Part I

 I first realized the initial true feelings Sadie had regarding breastfeeding before they were even married.  I was staying with my son and his fiance — my future daughter-in-law– while attending the ILCA conference in 2006. We were at an ice-cream stand on a warm summer evening. There was a family with young children nearby. The toddler fell down, then while the mother comforted him, he snuggled to nurse for a while. I looked on admiringly. Sadie was disgusted. She commented on how that was totally ridiculous for a baby that size to be breastfeeding! And in public no less! “It turns me off even more about breastfeeding! I will NEVER be doing that!”
I had often cared for young girls with negative feelings about breastfeeding in my career so that didn’t surprise me. What I wasn’t prepared for was that this young woman was going to be the mother of my future grandchildren. I was a little afraid inside. I don’t know why exactly but I was.  Somehow, it hadn’t entered my mind that she may not want to breastfeed. I took for granted that she’d want to breastfeed like all of my family had, and like all the next generation young females had indicated they would. That was wrong of me. I didn’t really know this young woman yet. I didn’t know her dreams, desires or plans regarding motherhood. I had to be able to support her– no matter what!

So how do I discuss this with her? How would you? Do I even go there? Does she even want to talk about it? All you breastfeeding moms with young sons out there….. have you ever thought about this?

As a breastfeeding advocate and a health care professional, I always encounter situations where a mom and/or her friends, partner, family etc., talk about breastfeeding negatively with obvious emotion and often certain misinformation. I try to carefully find an avenue to open the door to an informative discussion attempting to gently educate and dispel untruths. Sometimes that is challenging. Sometimes it is my professional responsibility.  Sometimes it is just an overheard remark by family and the opportunity isn’t quite ripe for a discussion so I can only say one little line with humor to “put in a positive plug” so to speak. It takes experience to know when to talk and a greater wisdom to know when to shut-up.

That day –> I choose to stay away from her personal feelings and instead said a few positive things about how the cultures around the world regarding feeding were so different from our American culture…. I was meeting amazing people at the conference… the average world weaning age was around 4 years old…etc…etc.  I talked about how her future husband was still taking a bottle at age 4 and how he needed that. Then I asked her if she had been breastfed. She was a twin and her mother had not wanted to breastfeed, so no.  She then told me that her mother tried to breastfeed her younger brother (Sadie was 14 at the time) but she had cracked bleeding nipples for 2 weeks and both her mom and her brother were always crying. Can you imagine how that experience, that imagery would stay in the mind of a young 14 yr old girl and impress her own feelings about breastfeeding? I’m sure! This had probably happened to many girls in America.

Through out the wedding plans and the actual wedding, Sadie and I were just fine. I was loving getting to know my new daughter-in-law.  I wanted to be a good mother-in-law and not interfere at all unless they wanted help or advice. Life was good. I let them alone and we enjoyed great visits/ great times.

Then Sadie got pregnant.

SO EXCITING!!! Now we have entered into my realm of expertise. I couldn’t help but ask some pregnancy health questions, feeding questions. I didn’t go crazy- believe me. She was open and sharing. I wanted to know a couple things every once in a while after she came from the doctor. I was wanting to have a feeding discussion with her so when the opportunity arose, I seized it. I was so thrilled that she told me she was going to breastfeed!!! I encouraged her to get some knowledge in ahead of time, like maybe a class or a book. I also said I’d be available to help or do whatever she needed. That may have been the last we spoke of it. At least while she was pregnant.

Our relationship then went straight downhill and it had nothing to do with breastfeeding! I had heard from the happy couple that they were going to have a boy according to the ultrasound. I was thrilled! So excited! I congratulated my son and later in the conversation mentioned to him that it is pretty good but not 100% accurate and that occasionally the U/S can be wrong…. I said this to protect them from possible disappointment. They both said they knew that and things were fine. We then had a case at my hospital where the baby was not the sex predicted by ultrasound! Like a stupid jerk, I immediately told both my son and Sadie. The reaction from Sadie was harsh to say the least. I got a long email from her stating that they had discussed it and they want me to be only a grandmother and not a nurse for any future communications! OK then. I had obviously overstepped! I needed to pull way way back. I was very hurt though. I had tried so hard NOT to be in her space. I deliberately tried to wait for information instead of seeking it out.  But I screwed up. I did. Now I felt like I couldn’t say anything…. EVER…. about pregnancy, birth, breastfeeding….. my life, my work–stuff I knew a lot about! This sucked!

So I kept quiet. I didn’t let her know I was bothered. I tried to just talk like a grandma. What the hell do they ask anyway? Does a grandma ask how do you feel? Does a grandma ask if you are feeling the baby move? Does a grandma ask how your blood pressure is? What the doctor says? Or does she just ask about the names, colors of the baby’s room and stuff like that? How was I supposed to know? I asked “nursey” type questions to any pregnant friend of mine so I don’t really know differently!! The pregnancy continued and I got very little information. Only what they told me…I kept being happy and cheerful. I was a little sad inside but I couldn’t let her see that. It wasn’t about me. She was the pregnant mother– not me!!!!  One time I asked if it would be alright to get a call that labor started so I could drive the 2 hours to the hospital. I wanted to know if it was alright to be in the waiting room. Sadie said “Of course! Why would I even ask that??? I’m the grandmother for crying out loud!” (Oh…that’s what we grandmothers do) YAY!

I got a call from my son Dave one Friday afternoon while I was at work. He was animated and excited and proudly told me that Sadie was going to be induced on Monday! (She was 37 weeks as of today and would be 37 3/7 on Monday). I immediately thought something was wrong. I started asking if the baby was OK, her fluid levels, her BP etc… “Yes relax yes everything is just fine mom!” I said “Well- why do they want to induce her?” Dave said “Because he’s cool, he likes us, and I cut his grass.”      *** ARE YOU F-&$%*& Kidding ME???? ***** is what I’m thinking.  Out loud… I said: “Oh Honey, all the experts frown on inducing this early if there’s no medical need. Please talk about it some more and find out some of the risks.”…… “There are no risks Mom, I trust him. He knows what he’s doing.”. Later I get another phone call from my son where he told me he did not appreciate that I couldn’t be happy when he was telling me good news.  I just said I was only wanting to make sure he made smart decisions now that he’s going to be a parent etc and just tell me when and I will be there. I had to shut up.      What would you do? Would you say more????

The next day, Saturday, he called and told me the doctors moved it up a week. A week from Monday. Who knows why—I’ll never find out. At least she’ll be 38 3/7 weeks. The baby had other ideas. Sadie went into strong labor one day before her scheduled induction. Her labor was not long for a primip at all. A total of 8 hours. 45min of pushing. She had an epidural. Just Dave and Sadie in the room. The waiting room was filled with her family and myself and my daughter. I was told by the other grandma that the baby had already been to breast!! YAY! I was invited back to the room to meet the baby and it was a wonderful moment. I didn’t ask any questions just commented on how good Sadie looked and how good the baby looked. I think I was afraid to do anything except smile.. I was very happy and everything looked good.

Later in the room, there was a bottle of Similac in his bassinet. The room was filled with visitors. Sadie asked me if I could feed him. I only asked when he ate last. She said it had been hours and she couldn’t get him to eat. I sat down with my new grandson and started to work on feeding him. That’s exactly what it was. Work. He had some kind of disorganized sucking pattern. He seemed to have a weakness on one side of his mouth and didn’t form a seal well on the nipple. I have seen a lot of this before and have worked with both breastfeeding and bottle-feeding babies who present this way. I was able to get him to take 15 ml and he went to sleep. Sadie and Dave were relieved. The next morning, I came to the hospital with some outfits etc… As soon as I arrived, Dave wanted to go have brunch with me. The baby was alone with Sadie.    During the meal I asked him about being a new dad etc.. and I asked him how well the baby was feeding. He was difficult to feed most feedings and Sadie was feeling upset. I asked him if she was still interested in breastfeeding and he said “I don’t think so mom. I don’t think so.” SO at least I knew. I had been afraid to ask because of the history and I wanted to be offering the correct information if they asked me feeding questions. I wasn’t upset. I really wasn’t. I wanted Sadie to be comfortable and happy with her decisions. I didn’t want her to feel at all “pressured” by me or my line of work.

I started to think of how I could help Sadie the most. I began to show her ways to support the baby’s mouth on the nipple and techniques to improve the suck. Dave and Sadie initially began to rely on me for feeding help while I kept encouraging them each independently. They got the hang of it. The baby got the hang of it. My little grandson started growing. I drove down to their home for babysitting when Sadie had to go back to work. She used all available relatives to avoid daycare and we were all happy to help. When she came home from work, she’d always politely invite me to stay for dinner. I figured she didn’t need me around at all, she needed to reconnect with her baby. I would leave once she got home. When I’d babysit.. she’d leave me a list in the morning, I’d do as much as I could and document for her what her little baby did while she was at work.  He still had feeding issues… but they weren’t difficult if you knew what to do. Most often, I never even saw my son. Just the baby. One time Sadie told me I was the only one who did things the way she wanted.  Can you believe that??? I was beaming inside. Her own family wouldn’t try to get food in him, they would say “He won’t take it!” “He’s fine Sadie.. when he’s hungry he’ll eat.” They interjected their own 2 cents and felt comfortable doing and saying things to her as they had all her life. I would never be able to talk to her that way.

So she thanked me. Thanked me for hanging in there. Thanked me for doing what she asked. Thanked me for respecting her requests.

Thanked me for being such a good grandma!  ;-

 See also: Part One and A Half  Then:  Part II  … The next pregnancy and baby

Amazing Woman has an Amazing Home Water Birth

Go GINA GO!

I lit my Blessingway candle in the wee hours of the morning when I saw that her labor at home was underway.

I faced the candle in a window towards her home 1500 miles away.

I like how the reflection makes it appear as though the light keeps spreading west towards her…….

sending love and support…..

Not only did she have a VBAC today–

She had a HOME VBAC !!

AND during Cesarean Awareness Month!

Gina of The Feminist Breeder is one of the most courageous women I have ever met!

Yep- I met her! She invited me … little ole me… to her Blessingway in March when I happened to be in town. I was so incredibly excited to meet her and all her fabulous birth team! Yep- I’m in that Blessingway post she did.

Photo of the TFB Blessingway Group

Here’s one of the beads I gave her for her necklace.

ICAN Cesarean Awareness Bead

Congratulations Gina and John!

Welcome Jolene!

But it’s her story to tell……. Head over to her blog and check the coolest EVER live blog birth event. The whole thing can be read and viewed from last night thru til this morning. The audio and video clips are for QuickTime player and each clip may take a few moments to load before you can push play.

I had it on today … at work… in the NICU and took the opportunity to try to educate..

Thanks for sharing Gina!

I am so so happy for you!

Happy IBCLC Day !!

Today is IBCLC Day which is held the first Wednesday of March every year!

 

Ecard from ILCA

As a former IBCLC, I know how hard many work to support and protect breastfeeding moms and babies everywhere. This profession deserves our recognition today and everyday…..Thank you all for your hard work.

Happy IBCLC Day! Good job!

Push for Real Changes in our in-hospital Maternity Services

The average consumer may not know what could possibly be helpful in exacting REAL change in our hospital maternity care. I am certainly no expert in this field and would welcome additions or corrections to what I say here….. but I want to offer a little perspective from the inside. Maybe this will help somewhere.

I am a Birth and Breastfeeding Junkie and I am proud. I don’t care if someone recently didn’t like that nomenclature….. That’s what I call myself and how I relate to other like minded individuals. I have a need to know what’s going on in that world.  We junkies read and discuss all the current evidence, all the latest recommendations from the WHO, NIH, CIMS, ICAN, ACOG, AAP, AWHONN, ILCA….. and so many more. We love all birth stories and learn from each other. We educate ourselves. We STAY current. We want informed decisions. We want options. We want this type of evidence-based care available where we live. We advocate for those individuals who may not even know there may be another choice. We want to see the women of America have access to respectful quality services everywhere!

Ok –> that said…. When I see new evidence, research or new recommendations; what I have done over the years to offer up any proposal for process improvement or care delivery change including whatever may be needed to implement these changes… is to collect resources, develop a policy or plan and present to docs, manager and staff. The response is usually positive. Sometimes I get a lot of “smile and nod” and “please hurry up I have other things to do I’m not really listening”…. but mostly positive. Sometimes it’s only positive in that “My you’ve done a lot of research..and Good Job!”  instead of–Yes let’s do this! The changes are not always adopted and there isn’t a total “Buy-In” from everyone to make it a successful total change in practice. Eventually and unfortunately, because these things aren’t monitored, many practitioners go back to their own comfort zone of past [outdated] practices. Arrghh

Project poster inservice example

There must be a better way.

I was sitting in a Professional Practice Committee meeting a few weeks ago listening to a mandatory (did I say Mandatory?) action plan presentation by the Director of Patient Relations/ Patient Satisfaction when it hit me how there may be more avenues for REAL change driven by the consumer than those of us in the trenches. All of the directors (suits) were there and were required to come up with unit-specific mandatory action plans to improve patient satisfaction and positive perceptions of their hospital experience.

She was presenting an action plan based on the latest HCAHPS report.

What is HCAHPS?? Maybe you know- maybe you don’t. Skip over this if you already know.

“The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. HCAHPS (pronounced “H-caps”), also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally.

Three broad goals have shaped HCAHPS.

• First,the survey is designed to produce data about patients’ perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers.
• Second, public reporting of the survey results creates new incentives for hospitals to improve quality of care.
• Third, public reporting serves to enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment.

With these goals in mind, the Centers for Medicare & Medicaid Services (CMS) and the HCAHPS Project Team have taken substantial steps to assure that the survey is credible, useful, and practical.” HCAHPS fact Sheet 2010

The reason hospitals are taking these results so seriously is that.. well… I’d like to say they ONLY care about the patient, but they are a business and it comes down to money in reality.

$$$$$$$$$$$$

If a hospital scores fall below a certain number in patient satisfaction… they can lose like 3% of Medicare Reimbursement. That adds up to a lot of money really. You may think that doesn’t apply to Maternity Services but it does, ultimately, because that survey goes out to all adult inpatients. If the scores for satisfaction are low for obstetrics, it can throw off everything, and affect the reimbursement to the facility. That, in turn, can affect how much money is available for overall improvements.

Medicare has also started to cut reimbursement to cover the costs of “preventable” conditions, mistakes and infections resulting from a hospital stay in 2009. That is older news so you may already know about that.

The thing is– what the big two Medicare and Medicaid… [The Centers for Medicare & Medicaid Services (CMS)] often set the bar and other insurance companies follow in the private sector. The 2009 National Health Insurer Report Card may give you more information about what is or is not paid. I don’t know much more about that.

HCAHPS is the first I’ve heard of actual patient satisfaction scores steering reimbursement which is transparent and publicly reported. I have heard many pt satisfaction reports but they were never given this much attention. At least in my hospital.. Perhaps I’ve been too much of a Birth Junkie to notice.

The other big catalyst for positive change is the new JCAHO Perinatal Core Measure Set. The MotherBaby Summit website has an excellent review of these 5 elements, explains them and provides further references.

There are two new employees who only work on JCAHO compliance and data collection. They are looking at the PC-05 Exclusive Breastmilk Feeding numbers and are not happy…. Well — neither am I !!  I have been trying to do something about that particular issue since 1988 !  Since these are now factors for regulatory compliance as well as patient satisfaction… Now we are going to do something. I am pleased to announce that we are forming a Breastfeeding Task Force!! YAY! We also have a new Pediatric Dept Chair who is a no bullshit we are going to do it kind of guy… so YAY!

Bottom line: The hospital is sitting up and seriously taking notice about the consumers opinion AND how regulatory agencies are now monitoring things have never been monitored before.

• Action plans are being developed to comply
• The consumer has more of a voice than ever before

Here’s what you can do

Before the hospital:

• Have a prenatal interview with your provider… ASK : Do they have current evidence based practices/protocols in place ….. do their standard orders reflect the most current evidence based guidelines and standards of care…. do the dept members all follow these standards. Do the nurses actually follow these orders….
• Do the same with your pediatric provider
• If you are not happy with the provider and choose NOT to use them, make sure they know exactly WHY… what were the points which caused you not to choose them.
• Have a birth plan and discuss it with all providers, nurses and even mail it to the manager where you will deliver. Ask your manager to please make sure your wishes are communicated with the staff.
  
• Use words like RESPECT, SATISFACTION, Patient RESPONSE Time JCAHO Core measures.
  
• Ask for numbers when you have your interviews.. for instance..what are your CS rates? VBAC rates? What are exclusive breastfeeding rates? If they don’t know, ASK for the name of a hospital person who can help you get that information. I am sure they have the numbers.
  

In the Hospital:

• Get the names of those individuals/ midwives/ doctors/ nurses/ etc who were good and those who were poor caregivers in your opinion. Write them down somewhere and why. Specifics help.
• If you don’t feel your wishes are being honored or disrespected, ASK to speak to a patient representative. There is most likely somebody on hospital staff who has that role and can assist you. Use the words Satisfaction, Respect or what is relevant etc…
• Ask for options if they are not discussed. Don’t rely on a Birth Plan you made weeks or months ago to be always remembered by everyone. Even if it’s right with your records. Different options may be available that weren’t before. For instance, We recently installed telemetry fetal monitoring allowing for increased mobility. If somebody asked a while ago, we did not have that option. You may have to repeat yourself… esp in a very busy Labor&Delivery or Mother/Baby unit. Sorry. That’s the way it is sometimes. It can get crazy but you are just as important as anyone!

After You Go Home:

• You will be very busy with your baby and good or bad… your individual experience will be a memory that could fade over time. We still need to hear what you have to say IN WRITING whenever possible.
• Please Fill out your survey –> it may be long but most are a multiple choice and allow for a write in comment section. Put in the names of the good and the bad!!  Please do it.. then actually mail it
  
• Please make written comments. Include names. Specifics help.
  
• Please Make Us Accountable. Write a letter to administration (Head of unit, Head of nursing or Head of hospital) include specifics. They HAVE to personally answer to this type of thing first! They get this info long before the surveys. Write for the good or the bad parts of your experience.  Including if you make suggestions. It may be monitored or tracked how many times they receive a comment about a certain issue. Definitely tracked for negatives– especially for specific individuals.
• Please also write a letter to the Head of OB or Pediatrics Departments and let them know who else you sent the letter to. Include everything from above.
  
• If you are certain what you experienced was NOT evidenced based medicine or care…. PLEASE mention exactly what you know.
  

 

Thanks for reading this, I hope somebody out there takes the time to give the needed feedback which will help mold and improve our care.

*Promote NORMAL Birth and Breastfeeding* & more New Year’s Resolution Ideas for all my Co-Workers… Any Ideas?

I am continually working (baby steps- a little bit at a time) on improving what we do to care for the moms and babies in my little neck of the woods. Sometimes it feels exciting, positive and helpful….. but other times frustrating or futile.

Since I have been recently consumed with my newest career as a NICU nurse, I have seen some of my earlier successes of positive changes (on the mother baby unit and L&D)…. slowly. turn. back. to previous bad practices ….. I come over to the units and I see so many of the older traditional care models in place again which we had worked hard to place in a vault! You get new doctors, new nurses, new anesthesiologists etc… and they don’t give a crap about any guidelines or protocols for a natural process! However if the CDC changes their Hepatitis B, HIV or  GBS protocols… they are all over it….  In. A. Heartbeat.

Why is it so hard for these professionals to relinquish control over all aspects of the birth process? Why can’t they look at any of that research? Why aren’t any of the recommendations for encouraging VBAC, discouraging scheduled CS’s without a TOL or keeping mother and baby together while delaying routine procedures taken as seriously?? Why?

I think I know why…I do.  But that isn’t really what I wanted to talk about today.

I want to provide some encouraging – positive – inspirational ideas for my fellow nurses, practitioner or heathcare provider to do what is best for each mother and baby in their car. Even if you all pick just one… it can make a difference. So don’t feel overwhelmed. Just try to add at least one of these to YOUR daily practice.  These suggestions are meant for situations without complications requiring urgent intervention of some kind.

Readers: Please ADD more in comments if you have them!

• Promote and Preserve NORMAL Physiologic Birth……  Try NOT to interfere. Please really find out what that means if you don’t know. Seriously. (sorry but please… my friends… it’s not about hurrying it up or getting it over with and closing out the chart!)
• Spend time each month reviewing Evidence-Based practice recommendations and changes with regards to Birth and Breastfeeding. You’ll learn something!
• SKIN TO SKIN…if you do nothing else… make THIS your project for EVERY mother/baby in your care. If you do this for them– nature can have a chance. Get them S2S at birth and several times each day to help with breastfeeding! (this one is my favorite!)
• Yes… Skin to Skin can be done in the O.R. Teach your fellow co-workers when just DO it!! Come on TRY IT!
• Keep a mother’s wishes at the forefront of your plan of care. Her birth plan is very important to her! Advocate for her and empower her. This is her birth, not yours.
• Advocate and Empower your patient to make truly informed decisions about her care. If she doesn’t have the right information to make a real INFORMED decision, please help her get the information or provide it for her!
• Embrace the idea and recommend Doulas to your patients. Keep a list of local doulas available and provide them at prenatal visits or out-pt testing.
• Question the doctor/midwife when an induction and or Cesarean is scheduled. Just ask why and discuss… Bring up points you’ve learned in your reading and find out the practitioners reasons for inducing. There is a way to discuss without challenging. Sometimes –> everyone learns from such a discussion. Perhaps the practitioner will realize his reasons for some cases may not be appropriate.. who knows?
• Breastfeeding and Formula feeding are not equal choices and remember it is inappropriate to indicate to a mother directly or indirectly that they are equal. She deserves correct information before making an informed choice. Utilize teachable moments to discuss the superiority of Human breast milk as the food for human infants. Show her where she can get more information before making a decision. Honor her decisions once she has made them.
• Keep the baby with the mother until the FIRST Breastfeed has taken place. Please delay all your routine procedures and help the mother (if needed) to start breastfeeding! This is recommended by ALL the experts.
  
• Keep the baby with the mother AT ALL TIMES. Almost everything we do can be done at the mother’s bedside. Think about it.
  
• Keep the baby with the mother AT ALL TIMES means at night too. Separating mother and baby so “Mom can rest” had been shown to be a barrier to successful breastfeeding. Encourage frequent feedings based on feeding cues.
• Teach and empower the mother. Include how to recognize feeding cues, signs of an effective feeding with appropriate latch, and how to recognize an overall good feeding pattern.
  
• Support the mother, support the mother, support the mother.

For some more ideas.. I have numerous previous posts about breastfeeding education, support and sited references such as the Coalition for Improving Maternity Services Ten Steps for example and other important issues.

Breastfeeding Evolution amidst the NICU Technology

 

 

Powerful Skin to Skin

Evolution

I love babies. I love being a nurse.

I love all the evolution of technology through which I have practiced. I love how I have had to continually evolve myself. I love helping mothers help themselves, advocating for them and their infants, facilitate when needed to support them making their own choices and watch as they evolve….. becoming the best mother they can be!

I know I haven’t blogged lately and it is because I have been having a bit of a rough transition… my latest evolution…  in my new NICU job. Orientation is somewhat difficult for me. I had previously been arriving at work already at the top of my game (for the last 25 years or so) and I have now found myself a student…. every. single. day. It is almost like I have gone to a totally new facility! EVERYTHING seems new or different. All new equipment/monitors/procedures/policies/protocols/doctors/practitioners/and staff.

The babies are the same. Since some are much more preterm than we have cared for in the past… their issues are more complex. Some are the same as we have always cared for, but with neonatologists now on board, the approach to the care of these babies is evolving.

I am unlearning some of what I have always known and relearning things in new ways.

Evolution

I was able to prepare and submit the mission statement and policy on Breastfeeding for our NICU population. The neo’s are extremely awesome on breastfeeding or breastmilk feeding promotion and support! So we have a very good start for breastfeeding support in our new unit. Excellent actually! I am happy to report that since opening our unit, most of the babies thus far have had a total exclusive diet of breastmilk or fortified breastmilk! I think that is fabulous! There have been some moms who after discussion and encouragement to provide breastmilk, wished to formula feed and their choice was supported without further discussion or question. My new co-workers have been very professional about that. There were a few who provided colostrum initially and then decided not to continue. This was also supported.

Coming from my previously comfortable world of lactation in the full term nursery, I find myself on a journey to find a balance between technology and nature……  precision, absolutes and finite accuracy vs the inconsistency, variables, and imprecise intake of an infant at the breast. We are calculating daily the actual fluid and kcal energy intake of each baby and comparing that with the kcal/fluid requirement per kilogram of weight. Changes are then made accordingly. Most of the preterm population is unable to take in their required fluid and caloric needs solely by mouth. Most have parenteral nutrition in the form of a glucose/ Amino Acid protein and Lipid (fats) at first by a central line or an IV (TPN) and gradually switch over to taking all their requirement by their GI system (Enteral). They don’t have the stamina to take it by sucking/drinking and they require a nasogastric (NG) tube so the remainder of food can go in by gravity or feeding pump (gavage feeding).

 

NG tube

I actually love learning all this. I thrive on having a detailed clear clinical picture of my patient. I am very detail oriented which is a good thing. Because of this precision, the measurements and the calculations—> actual breastFEEDING is not often seen until much later in the game. I understand this. I do. I want so much to be very helpful at transitioning to full feeds at the breast. I have to wrap my head around it each time (all the while being a student in all other aspects of the infant’s care) researching how to best advise each mother. We range from visits every other feeding to visits once or twice a day. Skin to skin is the most powerful tool I can use when faced with limited exposure or opportunity. Sometimes when the mom is arriving for my patient, I’m involved in other things and unavailable to do anything other than providing some private skin to skin time. Encouraging any licking, suckling or other feeding behaviors at the breast during gavage feeds is also good. When the baby gets more and more ready to take oral feeds… what I’ve seen so far is that they are already preferenced to the bottle nipple. The weight gain has been established, the precision of measurement seems to have become slightly less rigid. It seems that there is adequate physician support to encourage full feeds at the breast. There are hundreds of experts out there who have gone thru this, and reorganized policy and procedure to protect breastfeeding in the NICU.

I have to evolve myself again and re-learn more about transitioning to feeds at the breast before the bottle becomes a primary feeding implement. Once I can  find my footing- I hope to be strong and confident enough to start teaching moms and my co-workers.

Breastfeeding is NOT an exact science!

I need to figure out when the exact science of Neonatology can accept that….

into the feeding plan for each individual baby!

INSUFFICIENT MILK? Did You use REGLAN or DOMPERIDONE?? They Need YOU!

A message from the USLCA asking for mothers help!

United States Lactation Consultant Association Please encourage mothers who have used Reglan or Domperidone to participate in this quick survey. It is very important that research such as this be done to enrich our knowledge of how to better assist mothers with insufficient milk production.Thanks so much Marsha Walker, RN, IBCLC, RLC Survey of Domperidone and Metoclopramide Use in Breastfeeding Mothers Thomas Hale & Kathleen Kendall-Tackett, co-investigators We are pleased to announce our new online research study, a survey of women’s experience with the drugs metoclopramide and domperidone, which can be used to stimulate milk production.  We would like to collect side effect information on both drugs from as many mothers as possible worldwide. The survey link is: http://surveys.ttuhsc.edu/wsb.dll/s/60g759. For more information about the study, contact Dr. Kendall-Tackett at: kkendallt@aol.com Please let mothers know about our study. The more women we can get to participate, the more valid our findings. Thanks for your help. The survey takes 20-30 minutes to complete and is confidential.  It has been approved by the Institutional Review Board at Texas Tech University Health Sciences Center, Amarillo, TX.

Skin to Skin Minutes After C/S in the OR… Speaking Up and Making it Happen

Submitted for the Healthy Birth Blog Carnival #6: MotherBaby Edition

Skin to Skin immediately after birth is an extremely important part of the continuum of the nurturing of pregnancy, the process of birth and the transition of nurturing from inside mom to outside mom. This is the natural habitat where baby should transition and begin his own regulations of breathing, heart rate, temperature etc… This is recognized by the AAP in their changes to the Neonatal Resuscitation Algorithm back in 2000. The recommendation was to keep baby with mom and provide all initial evaluations and steps with baby on moms chest for all healthy babies!  We all know that babies have an inborn innate ability to self attach and nurse right after birth. These recommendations are not just for vaginal births. Kathy Petersen has a beautiful description of the importance of STS after a Cesarean birth on her Woman to Woman Childbirth Education blog in her 5/30/10 post Skin-to-Skin in the O.R. after a C-section.

As soon as I heard about the last edition of Science and Sensibility’s Healthy Birth Blog Carnival with a theme about “keeping moms and babies together after birth”, I wanted to write about my tiny little efforts, struggles and some successes in providing moms and babies with an environment that supports and protects their need to stay together. My recent role in the protection of such an environment and subsequent privilege of watching a baby self attach in the OR 15 min after a C/S birth has re-energized my efforts to get more mother’s and nurses to speak up and make this a standard for healthy babies!

Then….. I saw a link on Laura Keegan’s Facebook fan page for her book Breastfeeding with Comfort and Joy to an awesome video and a beautiful photo posted by the author of Cesarean Parents Blog about her birth. I had heard of Laura’s search for images of STS after C/S and asking for mother’s experiences. Amy Romano from Science and Sensibility alerted Laura of the photo: Kathy blogged about STS after C/S and I was working on this post! Such uncanny timing! I am just in awe of this marvelous networking community! Head over to Laura’s facebook link and share your experience for her info gathering. Here is the fabulous video they are all talking about “Breast is Best” from Norway:

Why is it so hard for the doctors and nurses to get on board? Most of them understand the word “bonding”.  But what many don’t realize is that it took a long time for the actual concept to take hold, to allow “time” for bonding to occur.  It sounds silly but many times if the baby and mother are still together after 2 hours…the nurses call that “extended bonding”.  I have been doing this for over 35 years now and the changes from the 70′s to now are fascinating and frustrating at the same time. To understand the process of change, we have to sometimes remember where we’ve been. I wrote about Medical Science vs Natural Childbirth a year ago because I feel history IS important to help us move forward. Often it is about control… but many times nurses and doctors are simply task oriented/focused and not patient centered. They want to complete all their procedures and charting and move on to the next task. I understand this, there is always a lot to do and document. I work there too! The environment provided to us, the health-care workers, is one in which regulations are abundant and staffing is not always optimal. Flexibility is needed. I know there is a way. This culture just has to change. And it happens in small little doses.

SO–> Skin to Skin immediately after a C/S? I have been told by coworkers, doctors and anesthesia:

“It’s impossible, “

“It can’t be done”

“There’s not enough room”

“This patient (the mom) is in the middle of major surgery!”

“The baby needs to be under the warmer, it’s too cold in the OR.”

Really? Seriously? Watch Me………

I have actually been working on this issue for the past few years…… Ever since I began staff education for World Breastfeeding Week 2007′s theme “Breastfeeding: The first hour — Welcome Baby Softly”. The focus from ILCA was: ‘Establishing a welcoming environment that keeps mothers and babies together.’ It was then that I gently tried to introduce the concepts for C-Sections as well as all vaginal births. I was getting a lot of positive response for vaginal births…not so for C/S.

Anesthesia is our biggest barrier. The chest area of the mother seems to belong to them somehow. The arms too.. I always politely ask the doctor for permission to have at least one arm released so she can touch her baby. (they are secured on armboards to her sides.) Really the OB’s didn’t mind what was happening outside of their draped domain. The Pediatrician is the next barrier because they want to finish a complete exam…. in the nursery…. before they returned to the office or whatever.  So I started with the Peds… hoping they would stop expecting the baby to be quickly removed from the OR. I started with just simple requests for prolonged “bonding”… because they all get that. “Look how well this baby is transitioning.. so alert and PINK! ” “I’ll write all the measurements in your exam note…. I’m fine… I know you’re busy….” I’d say.   Sometimes mom and baby got to stay together. Soon, for some of the doc’s, the expectation of baby leaving mom was gone. They got tired of waiting around and would leave. More moms and babies got to stay together…even if it was dad doing the holding. My co-workers were not always so understanding because of the work flow on the unit. It would work best when the birth happened any time other than first thing in the morning when it’s busy everywhere. Isn’t that sad? Sitting here writing this I’m thinking of ways to work on that….. another time…..

Anesthesiologists or Nurse Anesthetists are all different. There are some wonderful ones who are releasing both arms and pushing things out of the way for the baby and others who are constantly telling moms they are “under” anesthesia and can’t hold the baby, or they have given meds to mom right after baby is born so mom is now groggy. I talk to each of them respectfully and differently depending on their own approach. I have discussed my plans for STS if baby stable ahead of time. I have discussed how it is up to us to provide this protected environment for moms etc…  I have used the patient satisfaction discussion, the scientific evidence discussion, the patient centered care discussion, and the increased patient numbers due to higher satisfaction talk.  I have let them know that when a mother requests that–> we must do everything possible to help her experience this.

Slowly, over the last few months, I was able to facilitate some babies really getting skin to skin in the OR for short periods before going to the nursery. There were a variety of factors for why it wasn’t very long each time but at least it was happening!! It’s not a standard of care yet and I’m the only one working on it but others are getting interested… Communication has been very important to create the environment and reduce barriers. We still have a long road ahead. But we did pave a path for this mom….

She came in with an unknown double footling breech presentation in active labor and the doctors wanted to do a C/S right away. She was really upset and had a beautiful birth plan that was already getting discarded. “STS until first breastfeed accomplished” was on her plan and I was determined to help her with that! Things were happening fast. The anesthesiologist wasn’t my best STS supporter.. “oh well” I thought, “I’ll do what I can to help.” The baby was crying and pink when born and without thinking about it, the doctor, nurses and myself had him on the baby unit drying him. Mom went panicky! “Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!”  She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer).  I said “OK here he comes!”. So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!” Anesthesia saw the immediate transformation of his frantic patient to one with calm maternal bliss, admiration and cooing. He was then helpful to let her other hand out. This little boy stayed with mom, breastfed before he was 15 min old and went to the PACU with mom. She was so incredibly happy. I never got to see her after that since it was near the end of my shift and I wasn’t on shift the next few days. I saw that she exclusively breastfed in the hospital and without complication went home on day 3. At least part of her birth experience went according to plan!

If she hadn’t have been so vocal about what she wanted, so adamant… she would not have experienced what she did.

SPEAK UP AMERICA…. MAKE IT HAPPEN

Want to see more? This stunning video of a baby skin to skin then breastfeeding at birth in the operating room via @MothersUtopia @Laura_Keegan. What were your experiences? Please don’t forget to head on over to Breastfeeding with Comfort and Joy on FB to comment on your experience or opinion about this important topic!! Calling for women to share their experiences with skin to skin here, to help give a voice to the real need to make skin to skin in the OR routine practice in all ORs.