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Posts from the ‘Today's Thought’ Category

Breastfeeding- Yeah- It’s Not Exact or Precise

Cartoon by Neil

Cartoon by Neil

The truth of the matter is that doctors, physicians assistants, med students, interns, yes and many midwives plus many nurses working in the mother/baby environment SIMPLY DO NOT have enough education about Lactation and Lactation Management to adequately guide new mothers. It is sad and pathetic. The vast majority of these individuals would rather work with precise numbers and are actually happier if a mom is pumping and feeding her milk in a container to baby.

It is no wonder this has transferred to the vulnerable new mother. WE have done this to her. There is actually a new trend to pump and feed expressed breast milk instead of ever putting baby to breast. I can help you with that.  Please know that a large number of these infants do get some formula until milk supply is established. Make an informed choice. These breastmilk-fed babies are not usually exclusively fed expressed milk thru out the first few months. It is a hard job to pump and feed and pump and feed. It is a damn hard job to build and keep up a full supply long term exclusively pumping!! It has been done. You can do it. Mommas are very powerful and they can do it SO if that’s the choice you make then GO FOR IT!!! Give it all you have got. But CONSIDER putting baby to breast and feeding the way nature designed your body. Work with an IBCLC. We need good lactation programs at EVERY facility that provides childbirth services. We need IBCLC’s in the hospital. We need prenatal education about the benefits of breastfeeding so mothers make a true informed choice.

The more I speak with and counsel new mothers, the more I get asked for exact numbers when it comes to feeding instruction. It is no surprise that the number one question on the mind of a brand new first time breastfeeding mom is “HOW do I know my baby is getting enough milk?”

Babies were born to breastfeed

WATCH the baby, Listen to the baby. Look for feeding cues or little things the baby does which tell you he is getting hungry.

Lets make it EASY with very little “rules”. Think of these as TOOLS– not RULES

First:  Attachment to breast should be DEEP and COMFORTABLE

Second: Baby needs to do the RIGHT JOB of effective drinking

Third: Baby needs to do this OFTEN ENOUGH each 24 hours…. about 8 for most moms – more is very common- feed on cue

Fourth: By the fourth day ( give or take a day), and EACH 24 HOURS thereafter Baby should be having around 6 ”good” wet diapers and about 3 -4 poops that are starting to turn yellow.

Please KEEP your baby with you at a times!! Just.Say.NO.

 

Bottom lineWeight Gain. Baby should be at birth weight by Day 10 (or at least on a proven good upward trend) and be gaining about an ounce every day thereafter.

After the first 4-6 weeks. This little chart comes in handy:

Copyright Nancy Mohrbacher used with permission

Copyright Nancy Mohrbacher used with permission

If a doctor or  nurses first suggestion is to give formula to your breastfed baby—for whatever reason— ask to see a Lactation Consultant, an IBCLC.

These are the only numbers to remember. TRY to stop stressing out.

This blog post is not a replacement for medical advice should you or your baby have an issue. This is applicable to healthy full term infants.

Copyright 2014 StorkStories RN IBCLC RLC

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PEER Counseling is Unparalleled Breastfeeding Support–> Do You Have a Great Story?

Read more

Consumer ALERT–> FDA Bans “SimplyThick” Breastmilk Thickener

SimplyThick

Does anyone use this product in your

NICU??

Did you use this product for your baby?

This product is used to help thicken feedings of breastmilk or formula for infants with swallowing issues or even to help with reflux.

Some Preterm Infants have become ill with a serious condition called NEC (Necrotizing Enterocolitis– where the lining of portions of the intestine become inflamed, lack adequate blood supply and subsequently, parts of the intestine can die). This particular problem is most often found early in the premature baby’s life before discharge home.

“To date, the agency is aware of 15 cases of NEC, including two deaths, involving premature infants who were fed SimplyThick mixed with mothers’ breast milk or infant formula products. “

Symptoms to watch for:

  • Bloated distended abdomen

  • Bloody stools

  • Vomiting greenish tinted milk or

  • green fluid

If you see any symptoms like this, please

contact your babies doctor and get

prompt medical attention.

Read more:  FDA ALERT

Wordless Wednesday–>Why Boys Need Parents!

Taking a study break…

I  became a mom 32 years ago today!

As the experienced mother of 2 very mischievous (now grown) boys and

a grandma to 2 boys

with that twinkle in their eye…

I can tell you this was an hysterical laugh out loud photo essay for me!

Happy 32nd Birthday to my first born son!

WHY BOYS NEED PARENTS


Happy Mother’s Day Antique Art

HAPPY

MOTHER’S

DAY !

1859 "Abundance" engraved by T.Vernon

1850 "The Gypsy Mother" engraved by E.Portbury

1840 "The Gypsy Mother" engraved by Greatbach

In the world of childbirth, Mother’s Day is a very special day. I have enjoyed years of watching a women become a mother either for the first time or again and again on this very day. It is always wonderful to share that experience with them. Fabulously Joyful!

But today, I get to be home, pampered by my hubby and just milling about… I came across some wonderful websites carrying fabulous vintage engravings and various clip art. I absolutely adore antique engravings! I have some framed and others saved for something I’ll get to one day… 😉

This first few photos above are images courtesy of antiqueprints.com depicting mother and children. There are two WONDERFUL Antique Breastfeeding Engravings! These are all steel engravings with hand color in the first two.

The remainder of art below is from a website called “The Graphics Fairy” and all of these photos are to Karen’s credit over there. Beautiful!

Enjoy!

Victorian "The Mother" engraved by the Illman Brothers

1880's Antique Engraving Children with Cherries

Beautiful old painting of a Mother with Children

Old French post card

Wordless Wednesday~ Twins

Yesterday I saw the BEST Twin talk video which I will put at the end of this post..

But first….. I wanted you all to have a look at some luscious twin breastfeeding photos I found on Google. I am in a twin mood today.

 

This has had over 2 million hits on YouTube!

 

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.

CIMS urges ACOG –> Remove Barriers to VBAC

Received this email alert and thought I’d pass on thru my blog… and encourage all to take action!

It takes 5 seconds to add your name to the list!

e-CIMS Action Alert Sept. 28, 2010

CIMS Urges ACOG to Remove Additional Barriers to VBAC
Join us in asking ACOG to take steps that will increase VBAC, reduce cesareans, and ultimately avoid unnecessary harms to mothers and infants.

In a Sept. 9, 2010, letter to Dr. Richard Waldman, president of the American College of Obstetricians and Gynecologists (ACOG), CIMS and 18 co-signing organizations urged ACOG to revise its current recommendation that VBACs (vaginal birth after cesarean) should take place in hospitals where emergency cesareans are “immediately available.”

CIMS will collect the names of additional organizations and individuals in support of this request through October 31, 2010, and will send the updated list of co-signers to Dr. Waldman. Add your name or your organization’s name now!

This request follows the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC, which found that VBAC is a reasonable choice for the majority of affected women. The NIH also reported that the “immediately available” recommendation was not based on strong support from high-quality evidence and had influenced about one-third of hospitals and one-half of physicians to stop providing care for women who wanted to plan a VBAC.

CIMS and the co-signing organizations also urged ACOG to revise its patient education publications and online consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC. Without transparency about the short- and long-term benefits and risks of routine repeat cesarean and VBAC, women cannot make a truly informed choice about how they want to give birth.

Additional Information:

CIMS Press Release “CIMS Responds to Promising but Conflicting Revised VBAC Guidelines”

American College of Nurse-Midwives Responds to ACOG’s 2010 VBAC Recommendations (PDF)

Take Action: Add your name or your organization’s name now!

Fabulous Vintage Breastfeeding & Mother’s Day Art

HAPPY

MOTHER’S

DAY !

1859 "Abundance" engraved by T.Vernon

1850 "The Gypsy Mother" engraved by E.Portbury

1840 "The Gypsy Mother" engraved by Greatbach

In the world of childbirth, Mother’s Day is a very special day. I have enjoyed years of watching a women become a mother either for the first time or again and again on this very day. It is always wonderful to share that experience with them.  Fabulously Joyful!

But today, I get to be home, pampered by my hubby and just milling about… I came across some wonderful websites carrying fabulous vintage engravings and various clip art. I absolutely adore antique engravings! I have some framed and others saved for something I’ll get to one day…  😉

This first few photos above are images courtesy of antiqueprints.com depicting mother and children. There are two WONDERFUL Antique Breastfeeding Engravings! These are all steel engravings with hand color in the first two.

The remainder of art below is from a website called “The Graphics Fairy” and all of these photos  are to Karen’s credit over there. Beautiful!

Enjoy!

Victorian "The Mother" engraved by the Illman Brothers

1880's Antique Engraving Children with Cherries

Beautiful old painting of a Mother with Children

Old French post card

NIH Conference on VBAC’S ~ Continuing to Spread the Word

Spreading the word from the NIH VBAC conference….It’s now coming thru via AWHONN Vitals!!!

This is at least a month old news to most birth junkies but….. but I find it encouraging that the news is coming thru from AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses). There are many many nurses and birth professionals out there that haven’t even heard about this conference. I know the big AWHONN convention is coming up in Nashville June 12th, and possibly this topic will be presented somewhere although late to get on agenda. Sometimes the nurses can help educate the docs…… ya think?

One topic on the Nashville Agenda is:

“SOLUTIONS FOR SURVIVAL: Working where Birth is NOT Considered NORMAL”

Boy~ would I love to go to that presentation!!!!!

From the recent AWHONN newsletter~

“Panel Urges New Look at Caesarean Guidelines”
The New York Times, Denise Grady
A government panel recently took steps that will increase women’s ability to find doctors and hospitals that will let them attempt a normal birth after a previous caesarean section. The recommendations came from a panel at a National Institutes of Health (NIH) conference convened to assess why the rate of vaginal birth after Caesarean section (VBAC) has gone from 28.3% in 1996 to less than 10% today. The repeat surgeries are contributing to the growing rates of C-sections in the U.S., which today account for nearly a third of all deliveries. Repeat C-sections were previously deemed safer due to concerns that the uterine scar would rupture, putting both the mother and the baby at significant risk. According to the chairman of the NIH conference, “We found the use of VBAC is certainly a safe alternative for the majority of women who’ve had one prior” C-section, as long as the incision was horizontal and low on the uterus. Approximately 70% of women who have had C-sections are good candidates for attempting a normal birth, and 60% to 80% of those who try succeed. The government panel urged the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists to “reassess” their guidelines, which have rendered many clinicians and hospitals unwilling to allow VBACs. The groups’ current guidelines require that surgical and anesthesia teams be “immediately available” during labor if a women has had a prior C-section. Some institutions were unable to comply, and thus banned VBACs altogether.
Link to Article