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Tuesday
Apr052011

The Hospital Tour Lady Said What?!?

It seems my daughter's going to be a font of humor regarding birthing in the hospital.

19w0d now, she recently went on her hospital tour and there, among other things, she learned women stay in their labor & delivery rooms until their epidurals wear off and they could walk again.

No mention of women who don't get epidurals.

She learned how much dads love watching sports on the new flat screen tv's... and if you get a Suite, you get two tv's! The lady mentioned the sports on tv about 18 times. Meghann said (outloud) that if a dad watches sports while his wife was in labor, he should be smacked. Go, Meg.

She learned that babies and moms are treated as "couplets," but that babies are required to go to the tiny Nursery for ten minutes a day to be weighed. I let Meggie know new scales, with wheels, have been invented and they surely have invested in one of those.

The baby, Meghann was told, also has to go to the Nursery after the birth for about an hour so s/he can be bathed. And since the bath makes the baby cold, s/he has to stay until her/his temperature is stabilized.

Ah, but if the baby doesn't leave moms' arms (or another loved one's arms), then s/he won't have to be separated at all! Cling to those babies, ladies.

But, my favorite part was when they walked by the little room next to the small Nursery... a room with closed blinds. The chirpy Tour Lady said something like, "And this is the circumcision room! Your baby goes in and then comes back out, good as new... and you never need to know what they do in there!"

My indoctrinated daughter said, "But if we want to go in there with our babies, we can, right?"

"Oh, no! Moms cry and dads faint... we don't let anyone go in there."

Meg asked if they could at least see the room, but was told they could not even peek in.

My rhetorical question, of course, is: If moms cry and dads faint, why the FUCK are we sending our brand new babies in there?!? HOW can we remotely think waving bye-bye to our 24-hour old human beings, letting them be strapped down onto lucite papoose boards, not given any anesthesia, clamping their penises with metal, crushing their foreskins and then slicing the crushed foreskin off is sooooo much easier for the baby?

IF YOU GET NAUSEATED THINKING ABOUT YOUR BABY'S PENIS BEING CRUSHED AND SLICED APART, THEN PERHAPS YOU NEED TO RECONSIDER DOING IT TO YOUR SON.

I cannot, for the life of me, comprehend how that peppy lady thought what she was saying was great. "We're going to take your baby away from you, the only person he knows in the Universe, imprison him forever (as far as he's concerned) and from out of nowhere, give him the most excruciating pain a person that age could possibly feel on the most sensitive part of the body."

And he comes back good as new? According to who?

Hmmm... these tidbits coming from Meghann's upcoming hospital birth aren't quite so funny after all.

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Reader Comments (48)

Yikes. Yeah, when I took my hospital tour, even though I made it perfectly clear that I desired an unmedicated birth, that I had previously birthed without medication, the nurse doing the tour said to me, "Well, you know. Anesthesia has changed a lot over the years. Even in the last two years." Um, hello? Did I ask about how it changed? I'll be sticking with home birth, thankyouverymuch.

April 5, 2011 | Unregistered CommenterLisa

Good on Meg, hope she's got an awesome doula to support her and her husband ;)

April 5, 2011 | Unregistered Commenterredpomegranate

And that is suctioning...for mec? I have a photo of mine I cannot even look at where they did this. She was born in the caul, bag of waters intact, and they took her. The liquid in that little tube was only a tiny bit colored, and likely she didn't need that suctioning. Ugh. Brings back a bad memory of me asking over and over again if my baby was okay (didn't know the sex yet) and everyone ignoring me...and my hubby going over to look, snap a photo, and tell me we had a Jillian Faith (this was baby #6).

Can she just RUN from that hospital?

I have a question about hearing screens too, they took my last born away for that and I was puzzled as they'd tested the last babies in my room. They tested her late at night because it was supposed to be quieter, so we had to be interrupted so I sent hubby to go with her. They wouldn't let him in the nursery as there were several crying babies lined up to get the screening, and the nurses were talking and laughing. What the? We had to do this at like 1 am? And my doctor kept wanting to take baby to nursery to evaluate her? Midwife was like, "uh, why?"

April 5, 2011 | Unregistered CommenterDawn

So is she reconsidering the hospital that she was at? I don't think the odds sound good for not being forced into a mold.

April 5, 2011 | Unregistered CommenterCasey

In defense of the scale issue, I can tell you that at our hospital (which is considered the nice one in our area) only has two scales for baby weights (we have a third, but we keep it aside so it can be wheeled into a patient room for weighing pads during a postpartum hemorrhage). Assuming we are full, that means there are 28 babies that need to be weighed during the night shift (the only time it gets done). If we bring the babies to the nursery, it takes about 30 seconds to get the baby on the scale, weighed, and then off again and back to mom and dad. The rest of the assessment is easily done in the room.

If someone takes the scale, it's guaranteed to be gone at least 10 minutes while the nurse does the baby's full assessment, and longer when the nurse forgets to bring it back! When everyone is trying to get their assessments done at the beginning of shift, it's already fairly chaotic. Having a scale missing really throws people off :)

We encourage our moms and dads to come to the nursery with us for baby weights (and anything else, like the hearing test), and if someone refuses to have the baby leave the room, that's alright too. But you can guarantee that the other nurses will grumble about the missing scale :)

It may sound silly, but wasting time on moving scales around for baby weights really does reduce the time we can spend doing other things, like helping with breastfeeding and teaching infant care and helping mom stay comfortable so she can bond with her little one.

I *totally* don't get the circumcision room thing. That's kinda scary. (Also, I don't get circumcision itself...totally unnecessary). We do our circs in the nursery with mom and dad allowed to come watch.

April 5, 2011 | Unregistered CommenterPurpleRN

I have a hard time sympathizing about the scale thing since it's just as easy to have a baby scale on wheels and have a nurse's aid weigh the child.

Not sure where it's going with Meghann's birth... it is her (and her husband's) decision.

I am her Monitrice-Doula. I hope that helps. :)

April 5, 2011 | Registered CommenterNavelgazing Midwife

Sarah's sitting next to me screaming her head off saying, "Boo hoo hoo! Who CARES that it's inconvenient to you nurses! Who GIVES a shit that you want to get things done at the beginning of your shift. I PAY YOUR SALARY & I HIRED YOU TO SERVE ME." She went on, but I think you get the drift.

She's right.

Nurses SERVE women. Customers don't give a crap if the mechanic has to find a torque wrench to repair their car, they bloody well want their car fixed. It isn't the car owner's responsibility that the mechanic doesn't have all the equipment to do his work... that belongs to the mechanic or his employer. Instead of boo-hooing about not having enough scales, perhaps someone should speak up about GETTING more scales to SERVE the women.

This is NOT about your convenience, nice nurse person. Not in the least. Please remember that.

April 5, 2011 | Registered CommenterNavelgazing Midwife

I figured I'd get yelled at. Oh well...

I wish we had nursing assistants to do our baby weights. However, at our hospital the RNs do full care on everyone (four moms and four babies per RN).

And we do serve our patients. We really truly do. I'm kind of hurt that you'd suggest otherwise, since I really respect you and your writing. I look up to you (even though I don't really know you) and consider you an inspiration into getting into Midwifery someday.

All I'm saying is that we prefer to spend our time with our patients, caring for them, rather than running around looking for a scale. Sorry to have offended.

April 6, 2011 | Unregistered CommenterPurpleRN

Why in the hell are they even weighing babies daily? In Australia, the protocol is weighed after birth, and then on discharge. That's it. Oh, and my son didn't even have a bath until I took him home. If you want your baby to have a bath, you do it yourself.

April 6, 2011 | Unregistered CommenterRosemary

Are there any baby-friendly hospitals in her area? I would write a letter explaining that most of the "procedures" can be done in the room with mom and partner present. And I totally second her opinion that a Dad who watched sports while Mom labored needs to be smacked! My husband is a huge Cowboys fan, and there was a game on while I gave birth to our son. My husband, however, was totally busy supporting me and never asked to turn on the TV during my short labor. He joked about it after Mathew was born, that I have terrible timing and did it on purpose so he could not watch the game (since I am an Eagles fan). About an hour after Mathew was born, he turned on the TV to be able to get the score. By the way, the Cowboys lost the game, but he said he was totally ok with it, since he had gotten his little boy!

April 6, 2011 | Unregistered CommenterJen B

Ooo, I was kind of nasty last night, wasn't I. Erg. I do apologize for my harshness... I was feeding off Sarah's perterb-ed-ness.

And even if I have a cow sometimes, doesn't mean we can't still like or respect each other, does it? Goodness, I *am* working in hospitals, so I see *some* redeeming value in them, don't I? I just wish her hospital tour would have gone like this:

"We are here to serve *you*, the laboring mom. While we have some pretty things in our rooms, they are only part of what we hope to do for you here. We really like it when women give us a birth plan; it helps us know you as a person instead of as a patient, so don't hesitate to write one out for us. Of course, short is better, but we do encourage individualization. After all, no one woman is exactly like another one."

Like that. Maybe I'll do a post right now about how my ideal hospital tour would look.

Anyway, please don't take too much offense. Sarah's the one who gets riled up about the service aspects. As a Monitrice-Doula, I see myself filling that gap between assembly line and ultimate service... that is certainly my goal, anyway.

Meghann will be talking with the CNMs soon about her thoughts and desires for her upcoming birth and I'm crossing my fingers they're going to say something like, "Oh, we'll treat you as one of our own... you can have as much autonomy as you want... we'll just be here in case you need anything." Wonder what the likelihood of that will be.

April 6, 2011 | Registered CommenterNavelgazing Midwife

Regarding the whole moving the scale issue. I'm a Canadian OB Nurse, and our policy is to weigh babies every 24 hours. We have two portable scales to do this. When I get my nursing assignment at the beginning of each shift, I note the time of delivery and if the baby turns 24 or 48 hours old while I'm working, I bring the scale in at that time to weigh the baby. In fact, around the time the baby is scheduled for a weigh in, I tell the parents to call me when the baby is awake and fed. We don't think it's necessary to wake babies and have them queuing up in the middle of the night. Just my two cents.

April 6, 2011 | Unregistered CommenterAngela C

I don't see the need in weighing right away or really even before you need to leave. I think that as long as baby is wetting diapers and nursing well then weighing before they leave the hospital is acceptable.

April 6, 2011 | Unregistered CommenterAmyT

Ugh. I am having a hospital birth with midwives, but I am so worried about the "requirements" that they put on us. It makes me want to have the baby in the shower at home, and tell everyone it just came too fast!
Thanks for writing this. I think it will come in handy when I go for my tour.
Kate
www.idreamloudly.com

April 6, 2011 | Unregistered CommenterKate

OK, having had a baby in that hospital less than a year ago I can tell you what really goes on.

-while the epidural rate is quite high it is the lowest in the city and the nurses are quite comfortable with unmedicated birth and they have birth balls etc....unlike when I asked for one at another facility and the nurse told me "we don't have anything like that here, everyone gets an epidural" At Meghann's hospital, I never even saw the CRNA or anesthesiologist. At every other facility (I've used 9) I've had a baby at even though I was planning an unmedicated birth anesthesia came in and did a consult (any dentures, reactions to anesthesia etc....) anyway. Not so at St._____________ . I was walking the halls in good hard labor and no nurse even batted an eye, they were actually giving me the thumbs up as I went by with my ear buds in. I was my usual vocal self and all that got was a "really cooking now, huh?" no one told me to be quiet etc....or suggested pain medication.

-they do all newborn assessments in the LDR. The baby is taken nowhere. My son spent his first hour in my arms and nursing and was only weighed after they asked if they could. I was also asked if I was doing eye ointment and Vit K and if I wanted it delayed. The baby nurse was a bit hyper about him not crying and my ob told her "He's fine. He is pink, breathing and his cord is still pulsing. Leave him be." She backed off. She was young and obviously hadn't done that many births let alone unmedicated and with this particular doc.

-my son went to the PP floor in my arms

-he went to the nursery for a bath and assessment with my permission. I wanted to have a little downtime with the dh and eat. I sent dh down to get him after we were done. I don't think I would have gotten too much push back if I had said I was keeping him with me. Some I'm sure but nothing angry or threatening.

-my son wasn't circumcised and no one asked why not

-they never attempted to give him a bottle or suggest I did, there wasn't a binky in his bassinet oreven on the cart because he was breastfed. The LC came in to visit and we had a lovely chat.

-St. ___________ is still a hospital but it is pretty close to a real mother-baby friendly hospital. stupid tour lady notwithstanding. I think she was saying what she though people want to hear. I honestly think that there is nothing for you or Meghann to panic about. Have Meghann talk with J. (midwife). She should be able to reassure meghann and she won't feed her a line of BS.


The kicker...this hospital system will not hire me, an experienced women's health educator who has worked at a large university hospital. Why? Because I am not a nurse. They will let this vapid twit work there and give tours and say inane things but I'm not good enough because I didn't finish nursing school. Yup. Makes sense to me.

The SA birth center is just across the street. It is another option that is not home and not the hospital. I know quite a few women who have had good experiences there too.

April 6, 2011 | Unregistered CommenterKaren

PS.
I don't recall if he left the room for weight daily. I am a mom of many, am usually alone in the hospital except for a few hours in the evening and if the baby is gone for 10 minutes in the nursery I can shower, brush my teeth etc...going to the nursery for a weight check just isn't a hill I wish to die on. That's just me. :shrug: I had a horrid experience with one nursery in town, they were OLD SCHOOL (nurses own the babies, not the moms) but they don't have maternity anymore and I never got that vibe at *all* from St.___________.

April 6, 2011 | Unregistered CommenterKaren

Rosemary - Our hospital's justification for daily weights is to make the sure the baby is really feeding well. If a baby loses over 10% its weight in the first couple days, the Lactation Nurse comes to visit to help make sure that Mom and Baby get a good start to breastfeeding.

Angela - I don't know of anyone on our unit who actually wakes a baby to be weighed :) Who would disrupt something as awesome as a nicely sleeping baby? However, since most of our babies are breastfed, they tend to be awake very frequently for feedings. I'll also usually have mom give me a call when the baby's awake and fed.

It would be lovely if we could spread it out over the three shifts to avoid a backup, but it's part of the breakdown of tasks for the unit. I don't know who came up with the policy.... But days take care of certain things (like discharges, mainly), evenings other things, etc.

April 6, 2011 | Unregistered CommenterPurpleRN

Wow you were harsh on that poor nurse who was explaining some our logistical challenges. I agree that scales should be rolled into rooms, even if it does take more time. But one thing I wanted to point out, at least at my hospital since the economic downturn, we often get the answer of "there's no money for that right now" (extra CNA's, more scales, etc.). We often ask for things that will make it easier to care for our patients, but many times we are met with resistance from the higher ups. It's frustrating.
It's sounds like your daughter needs to find a hospital that isn't in the dark ages when it comes to family centered care!! And I love your circumcision retort, awesome!!!

April 6, 2011 | Unregistered CommenterHeather

This post seriously depresses me. :(

I ended in the hospital with my second (was at birth center but transferred, my baby was posterior and military presented, 4 hrs pushing ended in cesearean) and was appreciative of the portable scales and baths. Granted I was pissed to be there, but I was glad they didn't try to take my baby (except right after the c-section), and they didn't push formula on me.

April 6, 2011 | Unregistered CommenterLaura

Another newborn nurse here. I feel I have to defend PurpleRN on this one. In our hospital, it is policy to weigh babies every 24 hours and do shift assessments during the first 4 hours of our shift. This sometimes means 3 nurses weighing and assessing 30 babies while also doing all our other tasks in between (charting, phone calls, bloodwork, vital signs on new admissions, blood sugar checks, etc). We don't "queue them up" either. Our nurse's aid is great at bringing the babies in and out a few at a time. Even if our census is low and we only have 12-15 babies, then there are only two RNs in the nursery at a given time. If one RN goes room to room to weigh babies, that leaves the other RN "stuck" in the nursery (someone has to remain there at all times if there are any babies there), unable to answer calls to help moms with feedings, diaper changes, etc. PurpleRN is absolutely right that by getting our weights/baths/assessments done on most babies in the nursery as opposed to in mom's room, it frees us up to have more time later to help with breastfeeding/teaching/just supporting new moms! Being a nurse means being efficient and organized, as well as compassionate.

Of course, we will always try to accommodate any special requests. I would not be a newborn nurse if I didn't LOVE babies and new moms! As a new mom myself (2 kids under 2), I know how important it is to keep babies with mom and I do my best to encourage skin to skin and exclusive breastfeeding... and lots and lots of rest for mom! NOTHING is mandatory for babies. You can refuse anything. If we come to a room and ask to borrow the baby for a weight and mom says no, that's her choice and we'll work with it.

We don't do things for our convenience. The fact of the matter is that hospitals are broke and we we have the bare minimum staffing. We do the best we can to be as supportive as we can to as many as we can in the amount of time that we have! (Without getting completely burned out ourselves). Unfortunately, hospitals are not hotels... nurses are not maids. We have a lot of responsibility and a lot of running around (phone calls, charting, teaching, blood work). If I've gotten a chance to eat a sandwich and pee once a shift, I'm a happy girl. Forget about sitting down for a half hour dinner break. While I'm at work, I put my patients first.

What I'm trying to say is... we are not the enemy. We're on the same team! :)

Respectfully,
Sigrid

April 6, 2011 | Unregistered CommenterSigrid

Regarding the "brief" separation for weighing and bathing. From what I observed as a student nurse midwife in a hospital with this policy, it was always put to parents as a 45 minute, one hour tops kind of separation. This was almost never the case. I would say a 2 hour separation was standard, particularly since they were rarely the only baby in the nursery. They were lined up to wait their turn. That bathing and warming back up bullshit was the primary holdup. Babies did not go back to mom until they were back to 98.0F, no matter how long they hovered at 97.9. As to the reaction against PurpleRN, I've got to say, the nurses who keep babies away from their moms while doing what I call "processing" tasks (packaging baby into the System) while they're in their quiet-alert prime latchon stage, usually do it with a big sweet smile and a plead that it's just the hospital policy, don't blame it on them and *please* don't make their jobs even harder. It's irritating.

The basic thing is that it's a lot easier to keep the baby in the room with you than try to get the baby back in after staff has carted him/her off to the nursery.

April 6, 2011 | Unregistered CommenterKatie

I do see we play in the same League, but not sure all nurses *are* on the same team. Those here might certainly be, but you know as well as I do, some nurses are not as kind and compassionate as you all seem here.

Please, please know you are preaching to the choir when you are talking to me; others might not know all you do, so it's great you're laying it out.

But, I will not, in any way in the world, acknowledge or accept that "hospitals are broke." They may be brokeN, but broke, they are not. Especially when it comes to maternity care coffers.

http://thehill.com/blogs/healthwatch/corporate-news/116745-hospital-profits-raise-eyebrows-as-medical-costs-continue-to-soar

Anyway, it is the selfishness and greed of insurance companies and hospital boards that (imo) create the lack of supplies and nurses needed. While some doctors do make gobs of money, I don't think it's nearly as much as others think it is. And nurses don't get a quarter what they're worth.

It's just so upsetting. All of it. I hate that you're pulled in so many directions. I wish there was a nurse for every 4 women instead of for every 15-20. *shaking head*

So, on that pitiful note, thank you, nurses... I *do* appreciate your love and care. I do need you to know that.

April 6, 2011 | Registered CommenterNavelgazing Midwife

By the way: There are maternity units with NO WELL BABY NURSERIES! And they work great! I worked on one as an RN. Well babies should be with their families, end of story.

April 6, 2011 | Unregistered CommenterKatie

I really don't like hospital protocols. Even if you ::can:: refuse certain things, the fact that they happen by default unless you ::do:: refuse them makes me uneasy. Your baby (not quite a baby, but still YOUR baby) is very lucky to have wise guidance through the system.

April 6, 2011 | Unregistered CommenterKate Donahue

@ Karen
Having given birth in THAT hospital, with THAT midwife, I can second that St.L is (or was) truly a different kind of hospital, I gave birth a year and a half ago.
In fact, I have a doula client (and friend) giving birth at NCB this summer, and I recently took the tour with her, and I was very surprised to find out how many differences there are between the two hospitals! I expected NCB to be very similar to St. L and it is not. Especially not postpartum. At St.L, my daughter was taken to the nursery because I had GBS, and didn't get the full dose of antibiotics, (That's what happens when you show up to the hospital at 9cm dilation!) so they took her to the nursery which I didn't like at all, but all the subsequent exams and baths were done in my room.
I had a fantastic natural birth in the hospital with a midwife (J), and the nurses were so wonderful and supportive. And as far as hospital experiences go, I was pretty impressed with how calm and peaceful everything was.
Having said all of that, I have heard that some staffing changes have been made that may be changing how things are there. I don't know for sure, but I suspect that may be why this tour seemed so at odds with our experiences.

April 6, 2011 | Unregistered CommenterAlissa

The more I read about hospital tours/experiences the more I think I lucked out twice! It was at a "baby friendly" hospital and all, but baby was never taken away from me, anything done without explicit permission to myself or my baby, and I was always offered a real alternative to choose from if I declined something or I was on the fence.

My nurses were always kind and respectful, all tests were done in room after baby had eaten but had not fallen asleep, baby was bathed, weighed, and all tests were done in room.

Heck, I even thought the food was pretty decent!

April 6, 2011 | Unregistered CommenterSinsd

@ Katie. Those kinds of PP set-ups are great. I had my #4 in a hospital like that. The nursery was used as a storage room for boxes and supplies :D Babies were with their momma's.
Problem is, many if not most mom's *want* to send their babies to the nursery, same way they want an epidural and want elective inductions and sadly, since maternity is a hospital money-maker, the powers-that-be bow to the majority, not the minority and competition for pregnant women's business is very high here. There are no less than 10 hospitals in the metro area that have obstetrics. It is mostly about the pretty wall paper and 24 hour anesthesia when women choose their facility and provider not the mother or baby friendly initiatives.

April 6, 2011 | Unregistered CommenterKaren

I'm pretty sure I could have kept my baby with me if I had put my foot down. But the truth of the matter was that I was so exhausted I was scared I would drop my son every time I held him. My husband went with him to the nursery and kept him moving on the conveyor belt. We declined the bath, and my husband made sure it didn't happen. At each "station," he would ask what our son needed and how long would it take. I got him back in 45 minutes. I was much better off for having taken a vicodin and slept a little, and my son was never alone.

April 6, 2011 | Unregistered Commenterchingona

This makes the little hairs on my neck stand up. :( Yet another blog post that points to several things that make me want to stay the hell away from the hospital. <shudder>

April 6, 2011 | Unregistered Commenterlabortrials

I am sympathetic to PurpleRN and other individual nurses. They really aren't in control of the policy in their hospitals as to when babies are weighed and they can't make the hospital buy more scales. When you are a nurse you are at a job where you have an employer, who is the hospital, and bosses, the shift charge, the nurse manager, and so on up. Also you have to get along with your fellow nurses. So if your hospital takes the babies to the nursery on night shift to weigh them, it won't be easy to change that way of doing things. You might make an exception for one mother, but all on your own you can't start doing it a different way. The way to get such things changed is by parents filling out patient satisfaction surveys... you can't believe how much attention hospitals pay to those... writing letters to administrators and saying they are going to X hospital instead of Z hospital because of-.

As for the money issue, maternity units are usually considered to be one of the money makers that keeps the rest of the hospital going.

The biggest money makers are things like same day surgery, but maternity is up there. Without those there would be no way for hospitals to pay for the people with congestive heart failure and chronic obstructive pulmonary disease, diabetic foot ulcers, ulcerative colitis... those who are long term tube feeders having their fourth admit for aspiration pneumonia, who also have a UTI and clostridium difficile diarrhea, contractures and skin breakdown, or those who can't be weaned off their vents but show no signs of dying any time soon and the only nursing home which might accept them is 200 miles away in New Jersey and doesn't take medicaid. These are the people I took care of when I worked as a nurse, people with multiple comorbidiites who outstay their DRG's (diagnostic related group; medicaid or insurances will pay for so many days for a diagnosis, you can only claim on one diagnosis per admission, and after that the hospital doesn't get paid if the patient stays longer.) So yes, hospitals can easily be broke, and the more humane they are about not kicking out old sick people before they are well the more broke they are, and maternity and same day surgery just keep them afloat.

Susan Peterson

April 6, 2011 | Unregistered CommenterSusan Peterson

@ Alissa.
Dr. K caught my baby. He was so hands off and is such a gentle soul, he definitely is our city's Dr. Wonderful. Too bad he'll retire soon. :(
I had a baby at NCB in 2008. Get my email address from NGM and I'll give you the lo down about that.

April 6, 2011 | Unregistered CommenterKaren

@Purple RN - Thanks for the explanation. It's interesting, because the rationale used in the BFHI hospitals here is that daily weighing has been shown to lead to poorer outcomes, not better ones. i.e. less babies being breastfed, more supplements, less total duration of breastfeeding. I guess it is part of a whole package though, because most hospitals in Australia (even many of the private ones) do not have nurseries. They have special care units and NICUs for sick babies but by default, babies stay with mum. Also, the preferred form of attachment for the first breastfeed is baby-led attachment, not directed attachment. So, the not weighing is probably part of that whole package.

Also, the not bathing thing is all part of the same deal. Bathing gets in the way of successful breastfeeding. But also, the baby is not admitted as a patient. The mum is the patient, the baby is just a boarder unless it actually needs treatment (ie jaundice, special care). So, the baby is seen as mum's responsibility (with support from the midwives). My little one had mild jaundice and the peadiatrician offered ABM (not realising that he was feeding like a champ) but it came in the form of a midwife coming into the room with a consent form, a pamphlet of information and a breastpump. Not a bottle of ABM in sight. She offered me the chance to pump first to 'top up' before going to ABM. I declined it all, put him to the breast and fed him again and again and again and nothing further was said.

Thanks for the info! I learn lots on this blog.

April 6, 2011 | Unregistered CommenterRosemary

Interesting about the baby not being a patient, but the mom is. Here, hospitals generally couldn't give a whit if mom checked out of the hospital after 6 hours, whereas the baby is almost universally required to remain for at least 24 hours. Interesting what being on the other side of the equator can do to a baby, isn't it? ;)

April 6, 2011 | Registered CommenterNavelgazing Midwife

Our hospital policy is that babies stay with mom. We even have babies under the bili lights in mom's room. The only time babies stay in the nursery is if mom requests it. It's more used for procedural things than anything else: hearing screenings, weight, car seat trials (for tiny/premature babies) and circumcision. Also has the emergency equipment, of course. Apparently our nursery was designed with "tradition" in mind, as it is huge and divided into two sections. The back section is used entirely for storage.

We also have an 8-baby limit in the nursery, so we try to limit babies to ones who have more need to be there. If mom is exclusively breastfeeding, we strongly encourage baby to stay with mom.

We work with the expectation that all moms will at least try to breastfeed. We don't give formula unless the parents sign a consent form. The only time we ever suggest formula is if the baby has very low sugars and is not feeding well by breast. Usually we only give enough to wake the baby so it can breastfeed. If the parents request formula, our first suggestion is for mom to pump and have the Lactation Nurse visit. We don't give formula at all in the first 24 hours (except for the aforementioned medical necessity) unless mom is adamant about it.

We do have a 24hr minimum stay for babies (36 hrs if mom had any indications of infection during delivery). I'm not sure what the policy is for moms who want to go home before 24 hours. I've never had one ask. Most of them seem to like a little extra help learning baby care and establishing breastfeeding.

Our hospital is working towards Baby Friendly status, as far as I know. Quite a few hospitals in our chain have done so already. I've only been on this unit since September, so I'm curious to see how things evolve.

April 7, 2011 | Unregistered CommenterPurpleRN

I understand, and believe, what the nurses on here are saying, but, on the same token, it would be nice to have them understand and believe our side of things. As a doula who has worked with moms in many different hospitals, I can tell you that all are NOT as accommodating or understanding. Case in point:

Working with a recent intent to homebirth turned hospital birth, mom had a great ob who helped birth her healthy baby vaginally when we all thought it was heading to a c. Babe scored 9 and 10. Mom was refusing eye eryth and wanted to delay vax for with her ped. She had no problems with vit k. Nurse stated, 20 minutes into breastfeeding, that mom was 'coming up' on her time with baby and it was time to 'give him up' for his 'mandatory 4 hour nursery stay'. I had prepped them well, though, and mom asked why it was mandatory. Nurse said 'well, we will bath him to make sure he can keep his core temp/stabilize. If he can't, we will have to keep him in observation. We also check his sucking reflex, do his blood work, and let the pediatrician come look at him to do his own assessment, which he only comes in once every 4 hours.. so it's mandatory.

She said, "my ped will be in tomorrow to check on ____, my dh already called and confirmed. so we don't need to worry about that. Also, how do you test his sucking reflex beyond him already breastfeeding?"

Nurse: "well, we give him just a tiny bit of formula.. nothing to mess with your breastfeeding. We'll do it about 2 hours from now, after his bath".

Mom: "well, I plan on bathing him myself once we get home, it makes no sense to me, if regulating body temp is a worry, to prematurely and intentionally lower his body temp and wash off his natural protection against the elements. So, we don't have to worry about the bathing. Also, I don't plan on giving him ANY formula, or pacifiers. You can use your finger if you don't believe he is sucking adequately. You ARE more than welcome to give him the vit k, check his blood work, and do the PKU here, in my room. I am planning on having my son room in".

Nurse: "well, that's not how we do things here, there are certain things that we just HAVE to do; regardless of what you WANT to do."

Mom: "well, he is in my charge and I make all medical decisions for my child until he is 18, correct? I choose NOT do consent to these procedures that I believe are unnecessary for his health."

Nurse: "I'll ask the head of peds, but you have to understand, in the end, it is THEIR decision."

MOM: "no, in the end, it is MY decision. As his guardian and parent, his, and thus, my federal rights as a patient is to refuse any treatment or procedure. Should I call my lawyer over something as silly as bathing, forced formula feeding, and forcefully removing a healthy, exclusively nursed newborn from his mother or are we at an understanding?"

Moral of the story, not all hospitals, and not all nurses, GET this... we aren't all trying to be belligerent, but, in the end, it IS our decision. I, too, understand the under-staffing of hospitals, but refusal of certain procedures requiring a modified care plan should be honored in all situations. I don't mean to come off cruelly or harsh.. in fact, we need more nurses like the ones who have commented here - ones that actually try to accommodate rather than bully.

April 8, 2011 | Unregistered CommenterCole

Great post! Would your daughter consider homebirth? I don't know of any other way to avoid the many insane hospital protocols.

April 8, 2011 | Unregistered CommenterChristy

If more women had the support they needed to birth at home, LD nurses wouldn't be so busy at the hospital with tasks that aren't routinely necessary or even helpful. I'm not saying nurses aren't helpful or caring, just some of the things they are required/expected to do, protocols they have to follow, limitations, etc., can be more trouble than they're worth. Especially on health women and healthy babies.

There is certainly a place for individualized hospital care when needed, but it seems those that don't have to be in a hospital should have more of a choice not to be. State regulation, people treating home birth like it's child abuse/insane, CPMs and CNMs getting caught in a web of red tape and legal issues, insurance, CYS concerns and threats...

April 8, 2011 | Unregistered CommenterLeticia

Ummm, scales with wheels? Why not just use a portable scale like homebirth midwives use, if the baby weight is such a critical thing to do? I mean, I probably wouldn't feel the need to weigh the baby daily anyway. Seems rather pointless, and a surefire way to have interventions (aka "formula") shoved down the baby's throat when he isn't gaining "enough." Regardless, if they really want to weigh the babies, and if the parents consent to that, those little hand scales work fine. You can even get a cheap digital fish scale for about $20 on Amazon.com and weigh the baby yourself, if it makes the nursery staff happy to know how much the baby weighs.

April 8, 2011 | Unregistered CommenterKim Pekin, CPM

Wow! I haven't read all of the commentage, but I was reading about PurpleRN's unit and only having one scale on wheels...really? Wouldn't it be awesome if they could get more scales on wheels and just share? How hard is it to weigh babe and then wheel the scale out into the hall for the next to use?

April 9, 2011 | Unregistered CommenterRhonda

I am a midwife in the UK, we are Baby-Friendly & our general policy on the delivery floor that I work on is:

Natural unmedicated birth (usually just entonox)
Baby skin-2-skin immediately for at least 1st hour - including at a c-section.
Scales in every room, baby removed from parent for maybe 15 seconds to weigh.
Allow baby to initiate the breast-crawl.
No baths.
No circs - EVER.
No nursery exists.
4 hour discharge home if mother & baby are well.
Visit next morning at home from midwife & visits every 24-48 hrs for a minimum of 10 days up to a maximum of 28 days post-natal.

April 11, 2011 | Unregistered CommenterLiz

*sigh* I wish, Liz.

April 11, 2011 | Registered CommenterNavelgazing Midwife

Longtime lurker here...

...I too was horrified by what this hospital tour lady said. Hope the hospital really is better than she presented.

Also, I wanted to note that not all circumcisions are as, well, brutal as the hospital version. The religious brit milah ceremonies I have witnessed (Jewish circ and naming) happen when the baby is eight days old, the baby is held by a family member (usually the grandmother) and the cutting very minimal and ritualistic.

I completely understand many people are totally against circumcisions in any and all situations, consider it genital mutilation, etc. But I wanted to point out it is not always as horrid as described here. I agree the hospital is NOT the place to perform it.

April 12, 2011 | Unregistered CommenterMs. Krieger

IF people are going to get their son circumcized, I *highly* encourage them to use a mohel. We have one here in San Diego that is also a Pediatrician and he'll go to the home to do it, too. I usually say, "If cutting a part of the body off can be more civilized, this is the way to do it." My clients rarely have it done at all, but almost all use this mohel if they do.

Thanks for the reminder.

And yes, Meghann met with one of the CNMs a couple of days later and had all her questions/concerns addressed. She felt infinitely better after seeing the midwife. When I go to Meggie's baby shower (part Blessingway ;) ) in July, I hope we can coordinate a prenatal visit, too, so I can meet at least one of the CNMs there. Is that too hands-on? I'll have to ask my daughter.

April 12, 2011 | Registered CommenterNavelgazing Midwife

I am way late on this one but I wanted to give my perspective on the daily weights...as an LC I find them useful, particularly for the late preterm babies whose feeding is already somewhat suspect, but in general to avoid unpleasant surprised for the parents at the peds newborn visit. Then it's "Your baby has lost 12% of its birth weight, give it a bottle of formula".I would rather see that the baby is 10% down BEFORE discharge, assess the situation and intervene as needed, and start supplementation in a way that is supportive to BF (at the breast, with mother's own milk or with donor milk) and send them home aware of the feeding issues and how to resolve them. Weighing at discharge is not going to give enough time to address that. Just wanted to say it!

April 27, 2011 | Unregistered CommenterRebecca

I just want to say to this:

I am a pediatrician and I do circumcisions. ALL of my parents/family are invited to come watch (havent had a Mom take me up on it yet, but several dads and grandparents). My babies ARE given anesthesia (lidocaine ring blocks) and sweet ease (sugar water that a gloved finger (preferable) or binki is dunked into). I do NOT strap down arms - legs, yes, but only b/c I refuse to wield sharp things near kicking legs. 95% of my babies sleep through their circs, and no, it's NOT because they're in shock from the pain.

They ALSO get a dose of tylenol immediately afterwards to help with the pain when the lidocaine wears off.

yes, I do know of people who dont do things like I do. In fact, one of my partners doesnt use lidocaine or any other form of anesthesia (which I think is inhumane).

Please dont assume that *all* hospital circs are evil. TALK to the person who would be the one to do it, and if you can, DONT let the OB do it - they're surgeons...and well, surgeons think differently. Not to mention that I would ONLY want someone with years of training in BABIES AND CHILDREN (not moms) doing *anything* to my child.

Oh, and I only do them if requested, if mom says no, that's obviously the end of it. it's NOT a necessary procedure, but it's also not up to me to judge those who want it done. It's WHY I continue to do them - at least I know that the babies that *I* circumcise are treated well by someone who cares.

May 22, 2011 | Unregistered CommenterStarflyr

*sigh*
sorry to say that but......Americans! *eyeroll*

I gave birth here in Germany.
For the WHOLE of my stay at hospital (which was 11 days because my daughter was macrosomic and had to have antiviotics because she almost developed neonatal sepsis) we weren't separated for even ONE second.

Our kid was NOT washed, merely rubbed down a bit, while I was present and she was layed on my tummy, right after birth.

We DON'T have circumcision here in Germany, unless it's for medical reasons, which is really, really rare.

When I had problems with nursing (baby was too tired to nurse, so my milk dried up again...), the nurses / midwives in the maternal ward were immensely helpful in getting things started again (sent me pumping every 3 hours for 2 days straight....SO tired....but my milk went up from 8 to 80 ml in that time).

The doctors came to our room to look at the baby.

When we had questions about stuff (e.g. nappy changing....first time parents, ya know), the nurses helped with that.

We were allowed to stay present for ALL procedures (she had to have an IV for her antibiotics and watching them stick a needle in her was the hardest part I've ever done....but we all knew a little pain now was better than a dead baby later....). Yep, I cried (after)...but they let me stay nonetheless.

When they weighed her at the start, the scales were in the room. Later on, we had to head to the nursing station for weighing, but there too, we were present and the nurse beautifully explained what she was doing and how a newborn's weight develops after birth and a lot of other stuff too.

Just one TV and nobody EVER mentioned what kind of programs it had, because they kinda assumed you'd be too busy with your newborn anyway to watch TV.

Also a hot tub to relax in after the contractions started (though it might be booked up if there were too many moms giving birth at the same time and they all wanted in...rare, but according to the midwife on site, did happen on occasion), birth balls (or whatever you call those big plastic balls you dan sit on /rest your arms on while kneeling), a small park where you could go for a walk when the contractions started...but also frequent, intermittent monitoring at the beginning and continous monitoring when things got serious.

I informed about the option of an epidural, but wasn't pushed into it, so I started without one, but the moment I asked (at 3 in the morning, after about 6 hours of labour), I got one straight away.

July 9, 2011 | Unregistered CommenterAnda

See? Civilized hospital birth CAN happen!

Thanks for sharing your story, Ada! Thanks so much.

I had a baby in Frankfurt am Mein. It's where I met my Zack, too. :) Apparently, nothing is where it was back in 1986. Oh, well.

July 9, 2011 | Registered CommenterNavelgazing Midwife

*g*

Btw, the hospital midwives were great as was the midwife that visited with us for a few times to make sure the after-birth care went well and who answered any questions we had (How do you use a baby sling? When do you cut the fingernails for the first time?).
Between the midwives, the nurses and the docs (pediatricians as well as OB/GYN's) we were INCREDIBLY well cared for and felt at ease, most of all because it was quite evident that they worked as a TEAM.

As far as Frankfurt am Main is concerned, I used to live pretty near there for a few years (small village in the Rheingau, right next to Wiesbaden) and I sometimes went to the SCA chapter near Frankfurt for some weapons training.

Oh....and if you ever come to Cologne, you're welcome to drop by for a cup of tea / coffee. ^_^

July 9, 2011 | Unregistered CommenterAnda

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