labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Saturday, April 19, 2008

Hospital Nurseries Never Die

After some email discussion about nursery practices with a reader, I got to wondering what people are seeing as "the norm". Every hospital I have worked has a nursery that staff an RN to oversee the duties of the nursery. The duties typically include newborn assessments and testing, bathing, and coordinating care with the attending pediatrician while ensuring nothing gets overlooked with any baby. However, despite the push for "rooming in", a concept that is not exactly new, babies always seem to find their way into the nursery for long periods of time.

One hospital I worked received newborns within the first 2 hours of life; the nurse examined the baby, bathed him, and sent him back out to his parents once they got settled into their postpartum room. Typically the labor nurse brought the baby down as the same time as the mother if it was a vaginal birth, but took the baby to the nursery sooner if the mother had a c-section. As a nurse, this set up worked quite efficiently on most days, as there were several nurseries (it was a big hospital doing most of the cities deliveries) that took turns admitting babies. Rarely was there a time that you would get two new babies at once, so a nurse could whip out a baby in 30 minutes if she was good. That time the baby was in the nursery also allowed the postpartum nurse to complete the admission on the mother.

Another hospital I worked, one with a more old school thinking, encouraged mothers to send their babies to the nursery each night. If she wanted to breastfeed her baby then it was sent out for the feeding and brought back as soon as it was done. If she didn't specify this, then the baby got bottles through the night. When the day shift came on, the nurses would start with doing all the baby vital signs and assessments before allowing the baby to leave the nursery to be with their moms. This was 12 years ago when I was a nursing assistant, and I've been back to this hospital since becoming a nurse. It hasn't changed much.

My current hospital had this spell where they tried to get rid of the nursery altogether. I was all for it, as I believe babies need to be with their mothers, except for the fact it would overload an already overworked nurse assignment. The postpartum assignments are not fairly laid out, and it gives the nurses very little juggling room as it is. Bringing the baby to the nursery for its newborn exam and bath has been made necessary on part of the postpartum assignments. There is no way to possibly do newborn exams, baths, teaching, etc while also caring for 4 other couplets. And the nursery nurse is too busy to come out to the rooms to do that stuff for the postpartum nurse. It's a terrible set up, and of course the banishing of the nursery lasted all of 2 days.

My clinical site also has a nursery, but surprisingly they seem to have figured a way to keep most babies in the rooms. The only babies that seem to make it back to the nursery are those under the phototherapy lights or having their penis trimmed. The labor rooms are very big, and its set up for a nurse to do all the baby stuff right there. The drawback here is that the nurse at the delivery does all of the assessments as soon as the cord is cut. So the mom gets to hold her baby for about 5 minutes. The baby never leaves her room, but she only gets to watch her baby in the first 30 minutes or so on a warmer across the room.

In all the years I've worked obstetrics, I've yet to come up with a way that never separates the mothers and babies. The hospital systems just are not set up to accommodate this. There are so many tasky things the nurses have to do, and because there isn't enough staff to be able to do these things with the mother or without rushing I have come to believe that hospital nurseries will never die. The only way to keep mothers and babies together is to have a homebirth.

34 comments:

Anonymous said...

We have 2 babies, both born at different hospitals. We used a very good doula for both and had a set of birth preferences, which had that the baby was to remain with us at all times. Bath/checks, everything was to be done in the room. My sister's baby was taken out of her room for a bath, then kept away due to being too cold; it seemed like a snowballing situation to us.

When we showed our birth plan to our ob for the first birth, she said that the hospital/nurses would not agree to it. However, they did everything in our labor room. We kept the baby with us for the majority of the stay and only sent to the nursery for ped checks.

For our second child, we were warned that they would want to keep it in the nursery as much as possible. Someone had to be awake in the room in order for the baby to stay in the room. I was very against this and even debated bringing a thing of bells for the door to wake me up when someone entered the room.

Second baby was washed/checked in our room and went with us to the postpart room (like we did with the first).

DH and baby 1 left me alone and I ended up sending the new baby to the nursery a lot. I was more comfortable with this second hospital than the first one, since I grilled the nurses and the lactation nurse about the bottle practices. Another difference was that the second hospital brought baby 2 to me right away when I called. First hosptial took their time in the return and sometimes I even had to call multiple times.

I was firm with both hospitals about what our expectations were with warming the baby on my, etc. Having the doula also helped in showing that we were informed in our decisions.

womantowomancbe said...

See, this is the thing that I don't understand. I've had two home-births; but when I toured the hospital (in case of transfer), the tour-guide lady said that the baby had to be in the nursery for all the newborn things, including bathing and being stuck under a heat lamp until he warmed up -- a process which she implied would take a few hours. And she basically rolled her eyes when I asked if my husband could be there with the baby. She also said that I could hold him right away, but at another time, made it sound like as soon as he popped out, he'd be whisked away to the opposite side of the room (while I was being stitched up -- like everybody tears or is cut?), so I'm assuming I'd get to see him for like 3.2 seconds or something.

Why can't hospital staff let the mom just hold the baby for a few hours before doing all of the newborn stuff, unless the baby obviously needs more care? Why can't the mother hold the baby and warm him/her up, the way it would happen at home? Why does the baby have to be bathed immediately? (My babies weren't bathed for even a few days.) Maybe women wouldn't need so much "teaching" if they were allowed to hold their babies (which is only natural) and then they might naturally pick up on what to do, instead of being made to feel like incompetents, by not being allowed to do anything, and only presented with a baby burrito after half an hour. Ok, this is sounding like a rant, and I suppose it partially is :-) but I really am serious in asking.

I don't know what all postpartum nurses have to do; but I also don't understand why all that stuff that is slowing down the system can't be changed to be more like home births. Maybe nurses would have more time, if they didn't have so many unnecessary things to do. Birthweights don't change too much in the first few hours, so why not wait until a convenient time? Ditto Hepatitis B vaccine and vitamin K shot. And the eye ointment can be delayed up to 60 minutes.

I probably already know the answer to this -- "it's policy and procedure." Sigh...

Kathy

Carla said...

At the facility I work in, we do bedside transitions. Either the SCN RN comes out to do the initial ax and measurements, or the L&D RN does. We only do VS in the first couple hours, postponing the ax, measurements, meds, bath, etc until about 1 /2-2 hours. We do not offer NSY care, but we do have Moms request it at night. Otherwise, we run the babies into NSY around midnight for a quick ax and weight check, then out to Mom they go. I have to admit, L&D nurses here are much better at keeping babies in rooms than the PP nurses here. I think the hardest part of 24 hr rooming in, is a combo of Mom requesting baby to go to NSY, and physicians who prefer to do the AM ax in the NSY. We are trying to break them of this though and sending the docs out to Moms bedside. Some nurses have a habit of putting "Please see me in my Mom's room" across the babys chart, especially if the baby was transitioned at bedside and has never left Mom's side.

But I agree, for true 24 hr rooming in, you are only going to get that with a HB.

Carla/Ohio

AtYourCervix said...

I worked in a small hospital with LDRP's where we (the delivery nurse) did all of our "tasks" with the baby literally right at the mother's bedside - not across the room or in a nursery. The only time you "really" need to do things away from mom was the bath and footprints. Truly. Everything else can be done while baby is on mom's chest. I try to still practice that way in the big city hospital (L&D is separate from postpartum), but our warmers are ALLLLL the way across the room from mom in a little cubby room, and we also don't do baths on L&D. Only reason I take baby from mom is for footprints. Baby is in mom's arms for everything else.

And we have that "mandatory" time frame after delivery, upon when the baby enters the nursery for admission/bath/vitals/assessment, where they stay until 4 hours of age. We usually bring mom and baby to postpartum around 2 hrs of age, where they are separated. I HATE IT. It's all about nurse convenience.

Labor Nurse said...

Kathy, you ask the very questions I've asked, as well as other nurses who want a different system. In my experience, particularly my current job, the need to do things (assessments, baths, meds, etc) ASAP is because of staffing issues. We don't have the luxury of waiting, because if we do then there won't be time later to get it done. And unfortunately the assessments, etc need to be done. We have policies saying we can delay meds up to 1 hour, and that the bath is to be done only when the baby's temperature is stable. But in reality if any of it is going to be done, it needs to be done quickly because in 2 hours there won't be time. And yes, it is policy and procedure, as much as I hate that because one of the main reasons for p&p is legality. If there was something in a baby's care that deviated from the norm and resulted in harm, and it was because p&p wasn't followed, we can be royally screwed. That is just reality in any health care field.

PE Mommy said...

My first daughter was born 9 years ago in a major university hospital in Belgium. We were military stationed overseas then. I was very sick with severe PE. In Belgium, they do not have newborn nurseries. I don't remember much from the delivery because of mag. Dh said they took her and he followed to a little room off the side of the labor room and did assessments. She was born at 11 pm. The nurse did take her to the nurse's station the first night and cared for her. Afterwards, dh actually stayed in the hospital with me because I was too ill to take care of her. If you are too ill to take care of the baby, family and friends are expected to do it for you. I do remember that once I got out of the ICU part of L&D, and finally got to the normal PP room, there was a glass room within the room for all the newborn stuff. The baby was to go in the glass room part at night. yeah. That did NOT happen. I kept her right by me so no one would walk off with her. (The rooms were huge and the glass room about 10 feet from my bed)


My second daughter was born in a small rural hospital. My ob actually encourages birth plans and gives you a template to follow at 34 weeks. I had severe PIH, so figured I wouldn't be allowed much. The let you help pull your baby out and all that. I want to do that next time but was too sqeamish this past time, lol. I was only allowed an hour with her, but was unable to do much because my ob gave me a dose of demerol literally 7 minutes before she was born. They didn't believe me when I told them that I deliver VERY fast. I have never pushed more than 3 times each times. 1st labor - emergency induction - 7 hours total. 2nd labor - emergency induction - 3 hours 7 minutes. YIKES. So I was too drugged to hold her and I was afraid I would drop her. After the hour, she was under ped's orders to go directly to the NBN and be admitted for monitoring. :( She was born at 1140pm. I didn't get her till like 9am the next morning. By that point, she had already had bottles, first bath, etc. :( Then they kept taking her from me because I was sick and SOMEBODY (my ob does not admit to it and it is not in my records) ordered the nurses to have me rest and the baby stay in the nursery. I finally waited for shift change at midnight. I asked to get my baby. Some nurse came out and asked if I had slept. I lied and said 2 hours and they gave me the baby back. I kept her with me (this was the second night). My case was not typical for the hospital. They encourage moms to keep their babies and stuff. Mine was different because I was sick and she was 35 weeks. They don't have a NICU there.

Next time, even if I am sick again (God hope not on Mag). I am going to request that the baby either be brought to me or me brought to the baby. I want to be the one to give the baby the first bottle/bath if I am able. I just hate that they were both taken away because they were preterm (36 weeks and 35/5 weeks) and I was sick.

Jack and Lexi's Mom said...

Here's how to do it right in a hospital... Be a midwife. I delivered without any pain meds. I felt great. I gave my daughter her first bath, went with her to her peds assessment, did her metabolic testing, and took her newborn pictures. She never left my sight.

Labor Nurse said...

jack & lexi's mom, you make a good point. Staff who are having their babies where they work know how to work the system and no one is going to give them hell about it. I plan to take full advantage of this knowledge when my day comes...who knows when...but my gyn is a doctor where I currently work and I plan to stick with her since she does high risk pregnancy. Unfortunately, I got the nurse/midwife curse of having medical problems that render me high risk...just sign me up for that damn c-section now, I guess. Ugh.

Nine Texans and friends.... said...

7 babies so far in different facilities. Had everything from mandatory separation for 2+ hours to never being separated and everything in between.
#4 was the 'perfect' hospital experience. Unmedicated, easy, complication, stress-free VBAC with CNM. Got to hospital at 8, SROM at 12:30, baby at 12:43. LDRP's. The well-baby nursery was there for babies and mom's that needed just a little help-someone to watch the baby while you were in the shower, phototherapy etc.... Healthy, normal newborns didn't cross the threshold for more than a few minutes. The one time I went in to ask a question it was totally empty with two nurses chatting in a very small space mostly taken up with boxes of supplies. Pedes did all assessments in the room. I was never separated from me dd and I didn't have to fight for it. It was heavenly. This was a moderately large city hospital. I'd guess about 20 LDRP's on the low risk side.
Usually my experience is somewhere in between nazi nursery nurses and no separation.
I do think that babies tend to stay with moms more in hospitals that do mother-baby nursing vs. PP mom nurses and nursery baby nurses. It only makes sense. One nurse, two patients in the same room vs. two nurses, two patients, in two places and coordinating care. It seems though a lot of ;nursery nurses' don't WANT to do PP adult woman nursing. They want to stay with "their" babies. That whole notion of possession has got to go. Even my incredible awesome pediatrician in CT had to fight with nursery nurses to bring her her baby. She had to send her practice partner to retrieve the baby as the nursery nurses were playing games and ignoring her.

amanda said...

They took my baby to be bathed an hour after he was born. He was gone about 2 hours. Then they insisted on taking him twice a day during shift changes. I don't know why it took 2 hours to bring him back after a shift change. On the 2nd night he was crying around 2am and I couldn't get him to stop...he was having trouble latching on. The PP nurse came in and was really rude to me about it, saying that I was disturbing the other moms who wanted to rest. She said if I couldn't calm him down she was taking him to the nursery, because he would calm down if he couldn't smell me. I was tired and full of vicodin for the 3rd degree epis and multiple stitches so I didn't want to fight with her. I had to call the nursery 3 times the next morning to get them to bring him back. I asked how he was during the night and they told me that he slept all the way through, that all he needed was to be away from me for awhile.

I still don't know why they had to be so mean to me.

Anonymous said...

I have wondered why they warm baby right away across the room. I have memories of my babies on the dumb warmer while I'm sitting there looking...and then they wash baby up for me. Why can't I do this? I can't believe I didn't ask for it before. If I ever am blessed to birth again I want to be the baby warmer, and I want to give the bath thank you. You can asses the baby on my belly. If you want to measure my baby, you can do it when I am finished feeding the baby and making baby comfortable, thank you very much.

This of course, is if everything is going fine...

Portland Mom said...

This is an interesting post; I guess I am naive. I thought nurseries were not in vogue any more but I am not in the medical field. I delivered at Kaiser Permanente Sunnyside in Clackamas, OR (outside Portland). It is considered a "mother-baby" friendly certified hospital. They won't allow you to send your baby to the nursery unless there is a problem. In my case, I wasn't separated from my daughter ever. The nurse midwife even let me help "deliver" her: pull her out once head/shoulders were cleared. The nurses rushed over a hat and blanket and I was able to breastfeed and hold her as long as I wanted- in our case, about an hour- until she had a bath/ weighing/footprints which was done 6 feet away from my bed & supervised by my husband. We were transported to a separate postpartum room together. The nurses we had focused on caring for both me and my daughter; they even encouraged us to sleep together which surprised me. Pediatrician exams, hearing tests, and lactation consultant visits were done in our room. The only thing she had to be taken out for were heel sticks (PKU & bilirubin levels as she had some mild jaundice) during which my husband and I always accompanied her anyway. Nothing about our stay made us think that any of these procedures were out of their norm; I think this is just the way they do things. So then, can it really be that hard?

Anthea said...

You need a visit to the UK!
My son was born at the Royal London by emerg c section. From theatre, we had a BF in recovery. From there, he was placed on my bed with me and wheeled up to the ward. He was then place into his cot that clipped onto the side of my bed. It wasn't fun reaching him from that angle but everytime he needed to be picked up, I did it. I did everything for myself for the next 2 days then went home. Going home was like going on holidays as I had my hubby there.
With my daughter, (born in Australia) after my VBAC someone wheeled her up to the ward as I waddled along side. I got a double bed and hubby stayed the night. She went to the nursery when I went to my physio class the next morning. Then we went home.
Both public hospitals too.
Oh, and why are these babies being rushed off to be washed?? My son was a bit mucky (meconium in his hair!) so we just cleaned him up. We were advised that baths were really necessary...

midwest labor nurse said...

I work in a L+D unit that does 3200+ births a year. Two years ago we switched from taking the babies to the nursery at 90 minutes to doing all the baby care in the delivery room and transferring mom and baby together. Due to time constraints, the baby usually gets bathed 5 to 10 minutes after birth while the MD is repairing the mom. We have found that the majority of patients love that their babies come to them clean for skin to skin breastfeeding. The MDs want to know weights and apgars, etc for their charting so these items are done for them. Plus there's the big issue of universal precautions; now the baby is clean and can be handled without gloves. We have also found that the bathing after birth just really stimulates those babies. They are eager to feed, not grunty, and transition much better than before. By the time the patient is cleaned up and put back together, we are totally done with her baby. It's a win-win for all of us.

Unfortunately, healthcare is a business just like any other where efficiency and productivity are important. Many things are the way they are because of the almighty bottom line. This has become much more obvious after my hospital system was purchased by a Catholic organization. Pt. care is not as imporant now as the bottom line is. Somewhat ironic, but true.

Megan said...

For my first baby (8 years ago), born in a mother-babyish hospital, he only left the room to get circumsized. Otherwise, he was with us the whole time. He was, however, taken upon birth right to a warmer (no cuddles for us right away) and weighed, measured, who knows what else since I couldn't really see, and not given back for about 30-40 minutes. So, besides seeing him for about three seconds after he was born, I didn't get to hold him or anything for quite a while.

My second baby was born at a freestanding birth center, spent the first hour or so on my chest, then held by daddy while I showered up. The newborn exam was done on the bed when I was out of the shower, and Vit K and eye ointment were given as we were leaving (about three hours after birth).

I much preferred the second, and don't know why more can't be done in a hospital while the mother is holding the baby!

yasmara said...

We had 2 baby boys born 19 months apart (oldest is almost 3, youngest is 16 months) in Minnesota. Both were uncomplicated vaginal births (with epidurals) in the local big-city university-affiliated teaching hospital. Neither baby left my side or my room for more than 20 minutes and that was just once for a hearing test they had to do on the machine in the nursery (one of us could have accompanied them, but we chose not to at the time).

I think there might have been one or two weight-checks in the nursery too, but they took less than 5 minutes and we did go along for those.

Absolutely everything else was done in our room, including the 1st "bath" (after the baby had snuggled on my belly for a while). I didn't think of the hospital as particularly progressive (although I did have CNMs for my care providers), but compared to some of the stories, we were pretty lucky.

FutureNP said...

First time comment here, but LOVE this blog. I am a nursing student starting clinicals in Fall 2008 and hoping to become a L&D nurse than then a WHNP.

I had good experiences with the hospital nursery after both of my births. This was almost 4 and about 1.5 years ago. Baby was out with me all day, and then at night I was able to choose how much I wanted the nursery. With DD's birth I had been up for about 36 hours at that point, so I chose to have her go to the nursey and they brought her out to be BF'd. I could keep her out as long as I wanted and they'd come to get her when I called. Worked out GREAT for me, I was able to have bonding time with baby AND get some precious sleep. Did the same thing with DS.

It helped that the nurses at this hospital totally respected my choice to BF and not a word was ever said about formula or sugar water, etc.

All that said, I do understand that I was pretty lucky. I really wish ALL women had as much freedom of choice about their birth and post-partum experience as I did, and they they ALL were respected for their decisions.

denise said...

"And unfortunately the assessments, etc need to be done. We have policies saying we can delay meds up to 1 hour, and that the bath is to be done only when the baby's temperature is stable."

P & P is hard to change, but what evidence based practice is the newborn bath? Part of what takes so long in the nursery is the bath, but I'm not sure why we really do it (I should do a lit search on this, I guess). We never did it at home. The baby's not dirty, nor will it be rubbing up against any other babies, or spilling germies into the air, given the aforementioned baby burrito. It would be so nice to go through P & P as the floor CNS (Clinical Nurse Specialist) and eliminate everything unnecessary. Ah, dreams...

Labor Nurse said...

Denise, I have several resources that discuss the first bath. The book Assessment and Care of the Well Newborn, 2nd edition states that newborns should be bath once their temps have been stable for 2 hours. There is also a concern for GBS disease in the newborn; even mothers who are GBS negative at 36 weeks could be positive for it at 40 weeks when they deliver because it can be a transient infection. So in that sense, I think baths are necessary. That being said, I don't think its necessary to whisk the baby off for a bath ASAP.

And, I agree that going through the policy and procedures of the unit to make sure everything is up to date and evidenced based. Yet it can look really good on paper and never translate to reality on a unit.

Real said...

Labor nurse, I have a question about GBS transmission. How exactly does it work? I'm trying to imagine how a bath is going to keep the baby from contracting GBS.

And in the book you quote from, does it state WHY the baby should have a bath after temps are stable?

Kerry said...

The hospital where I had my babies (an Army teaching hospital, no less) has no nursery except for the NICU. Mom is given as much time to bond with the baby as she wants and then the baby is weighed, bathed, etc about 3 feet away while mom is fixed up, then they're taken downstairs to the Mom & Baby Ward together. Baby is taken away down the hall once or twice for hearing screening, for weighing, etc, but Mom is allowed (and even encouraged) to come along if she wants to.
I don't know how they manage it, but I'm very very thankful that we ended up stationed here during the time when we had our babies.

Labor Nurse said...

Real, there are several ways GBS can be transmitted; the way a bath may help is if the baby's skin was exposed as it is thought that late onset GBS disease could be from colonization of the skin. So in theory if the baby is bathed soon after birth, perhaps colonization may not occur.

As far as that particular text, there is discussion of thermoregulation of the newborn. Even healthy full term newborns are at risk for cold stress because they go from a warm intrauterine environment that is controlled completely by the mother's body to the cold extrauterine environment. In other words, the fetus has suppressed thermoregulation and must make a transition at birth. Even in the best of environments, babies can lose body heat quickly, and start compensating (which can set off a huge chain of events). Babies will lose body heat when wet due to evaporation, so making sure that the baby is able to hold it's temperature stable for several hours lets us know that their own thermoregulation is working ok.

Anonymous said...

I gave birth in an academic hospital in Toronto. The OB delivered my daughter's head and shoulders and told me when to reach down to pull th e rest of her out. She asked me whether I would like to do this prior to the delivery. Apparently I placed my baby on my chest myself but I blanked out from happiness so I don't actually recall the motion :) No one hurried the procedures after the birth. My daughter was bathed in the evening after an early morning birth once her temperature and glucose levels were stable (I had gestational diabetes). I was supported in breastfeeding and babe never left my side. Hearing tests were done in our room and so was the bath. It's called carts on wheels....

KathyH said...

At the large midwestern university hospital where I delivered my daughter there is no newborn nursery. I had a c-section and my baby and I were never separated. They did her assessment, weight, etc in the DR then gave her to me (with help holding her). Breastfed in recovery and stayed skin to skin for at least the next 12 hours. Bath (by me!) wasn't done until after 24 hours of life. Newborn screen, hearing screen, vitals, and pediatrician visit all done at my bedside. Now, I have lots of issues r/t my c-section and postpartum infection, but none regarding my baby's care and us being able to stay together.

Real said...

Thanks, LN. My question was more "Why did that text say you needed to bathe the baby?" Not really, "Why did the temp needed to be regulated?" : )

And you say that "in theory" if the baby is bathed, it will decrease GBS colonization of the skin. Has there been no research into that?

Labor Nurse said...

Real, sorry I misread your original question. I say "in theory" because a baby could become colonized during labor, and I suppose that colonization of any type of bacteria does not necessarily wash off. I don't know what the literature says about this, but I haven't specifically searched for it. The articles I have read about GBS say nothing about bathing. Everything focuses on intrapartum prophylaxis of the mother for prevention of early onset GBS disease.

Real said...

Well, I don't think I've ever considered this before. I certainly haven't done any research on my own. But it seems that there isn't a very good reason for the newborn bath. Especially in those first few hours when the baby is just getting used to regulating its own temp anyway. Is this just another case of tradition versus research-based practices?

OBRNinNE said...

I have to say, the infection control, universal precaution issue seems to be reason enough for the bath...

However, it wasn't too long ago that we had a death of a term baby who had been bathed within 15 minutes of delivery, ruled to be due to cold stress...so waiting is crucial in my mind, and in the minds of those who were present that day...

Amy said...

I had two babies at the same hospital. The baby was placed on my chest when she came out (the second time I said, "She's purple and covered with mayonnaise!" which is not the sweetest first thing to say to your new daughter, but it was true). After several minutes, while I was delivering the placenta, they took the baby to another area of the same room where they weighed her and measured her and stuff. Then she was swaddled and brought back to me. We cuddled and nursed for about an hour. Then they took the baby to the nursery (my husband went with them, which is encouraged) while I went to the bathroom and got cleaned up and then moved to the recovery/post-partum unit.

They bathed her and stuff. We declined the eye gunk, the vitamin K, and the Hep B shot. I'm pretty sure that she was examined by the ped. on call at that time, too. Then they brought her to my room and she stayed there virtually the entire time I was there. If she had to go to the nursery for an exam, my husband or I went with her. When our doctor came to examine her, I insisted that he examine her in my room (I got a bit of a fight from the nurses, but he was fine with it).

The whole time I kept telling myself, this is MY baby and I call the shots, and they can shove their policies and procedures if they don't like it. I was firm, but not confrontational unless I had to be, and I didn't have to be except for one time when a nurse with the wrong color badge tried to take her. All the badges were supposed to be peach, and we were told over and over in the birth classes not to let anyone take our child who didn't have a peach badge. Well, this woman's badge was faded to white. She was very nice about it, and rather than calling security (which is what we'd been told to do) I just sent my husband with her and the baby (they had to test her bilirubin levels because of jaundice).

Overall, I was pleased with the procedures that were already in place (like weighing and measuring in the delivery room), and the things that I didn't support were easily modified to suit my preferences (sending Dad with her to the nursery, etc.).

We have to stop worrying about being nice, and start worrying about what's best for our babies, and it starts the minute they're born.

Amy @ http://prettybabies.blogspot.com

dee said...

I delivered both of my girls at a local hospital that is about as close to nursery-free as one can get.

In both cases, immediately following delivery, everything was done about four feet from my bedside. The only thing each baby was taken out for, as far as I know, was the footprinting which only took a few minutes. They were then brought back in to be with me and roomed in the entire length of my stay.

The nurses basically told me that they prefer to have the babies with their moms and that the nursery was so small it was simply for things like footprinting, documenting the charts, etc.

However--after my second daughter was born, we had some complications (triple nuchal cord, apgars of 4, 6, and 7) and they asked if they could watch her for a bit in the nursery after cleaning her up at bedside. Sure thing.

They brought her in about three hours later and declared her good. My husband and I weren't entirely convinced however as she was mewling in an odd manner. The nurse must have also sensed something because she came in and offered to keep her with her in the barely-used nursery room. My husband, erring on the side of "this may be the last good night of sleep we get, let's take her up on the offer" and I agreed.

About 7 hours later, around 5 a.m. or so, a perinatalogist I'd never seen before woke me up to tell me that my girl was having seizures and that they were going to transfer her to the local level III NICU.

Turns out since my daughter was the only infant in the small nursery room, the nurse had her eyes on her all night and witnessed the very subtle seizures before calling in the peri, who then witnessed one herself. Thank goodness for that nurse--and a all-but-nonexistant nursery that afforded her the time and luxury to watch my baby all night long. Had we opted to keep the baby in the room with us, odds are we would have missed the seizures completely while we slept. For once, being greedy (by wanting to get some sleep) paid off.

Turns out my girl had a small infarct, right side, and the seizures were a result of the subsequent swelling. No idea why she had the infarct in the first place (nuchal cord? something else?). She had a last seizure at five days old, was discharged home after 11 days, and is now a healthy 15-month old.

So...my local hospital with the teeny almost non-existent nursery and its staff? Heroes in my eyes. I received excellent care during both of my deliveries, at the hands of compassionate and skilled nurses.

It's not entirely nursery-free, but I think it may be as close as one can get in this day and age.

Anonymous said...

I get delaying the bath but why wouldn't you want the baby to be clean. Some babies come out looking pretty good when rubbed with a towel and dried, but other babies are covered with bloody cheese, bloody crust in the hair, ears, eyes, ugh.

btw I work in two large urban hospitals as an RN, one has a newborn nursery which will babysit babies - nurses also do weights/ht/pkus there, etc but the second, which is extremely busy - does not. Hearing tests, weights, etc are done by a tech or aide rolling the cart door to door. Only sick babies go to the nursery and only until they can be transferred to the NICU.

tiff said...

we don't have a nursery (other than the NICU)where I worked.
Everything is done with the parents. Baby is not bathed for 24 hours after the birth. There is no choice but to room in. Even the heel prick test is done while mum is BF, so long as she feels ok about it.
The paeds do the well checks and the discharge checks at the bedside.
Only babes who are unwell are taken from their mums, oh and caesar babies, although we are trying to stop that as well. It can be done, it took Australia a good 20 years to get rid of the nurseries in public hospitals and some private hospitals still have them.

Anonymous said...

I had a c-section. I was very happy to have the baby in the nursery that night since I was still immobile, hooked up to a catheter, etc. I only got two hours of sleep that night due to violent throwing up. Imagine my shock the next morning at 9 when a nurse wheeled her in saying that they were shipping the babies out. I was holding a bucket and throwing up. Imagine my horror when the baby was placed in my arms. I was left alone falling asleep and trying not to be sick all over the baby. I'm concerned that so many in the comments advocate for no nursery. A C is major surgery and I needed time to recover not to mention just being allowed to have a catheter removed, stand for the first time, etc. It disturbs me that the baby is rushed to the mothers side when they clearly need time to feel better. But that is just my experience...

TracyKM said...

I've had 3 babies, all in the same hospital, the oldest is 8 1/2 years old. None of them left my room for anytime in the nursery except for the hearing test on the second day. We did have large LDP rooms, and the nurses 'helped' with the first bath which wasn't right after birth, right in the room. The nursery was not set up to take babies except for light therapy or mother/baby emergancy. They would not take any baby (even bottle babies) for the night. But I would have liked it so I could have gotten a bit of sleep instead of laying there wondering when she'd wake up because she kept making little noises like it would be any moment...for three hours...LOL.