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Posts tagged ‘STS’

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

Beautiful Skin to Skin after birth (iStock Photos)

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


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

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

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

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

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

“It’s impossible, “

“It can’t be done”

“There’s not enough room”

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

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

Really? Seriously? Watch Me………

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

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

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

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

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

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

SPEAK UP AMERICA…. MAKE IT HAPPEN

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






Overheard Hospital Roommate Discussion on Formula vs Breastfeeding

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We don’t often “double-up” the new mothers on the postpartum unit but occasionally in times of high census, we simply have no choice. We were incredibly busy this week, so short term doubling occurred.

In one room there was an experienced 3rd time breastfeeding mom (BF mom A) born and raised in an Eastern European country and her roommate was a new first time formula feeding mom born and raised in the USA (FF mom B).

Both were within about 12 hrs of birth.

I had been in the room doing basic exams/vital signs for each baby, asking each mother how she thought things were going etc. etc…. I stepped to the doorway to converse with a co-worker about unrelated tasks and that’s when I started to overhear a very interesting conversation.

I admit it…    I eavesdropped–> I learned.

😮

I stayed in doorway reading a chart……..

FF mom B: “So — are you breastfeeding your baby?”

BF mom A: “Oh yes– Is best for us” (heavy accent)

FF mom B: “Does it hurt?”

BF mom A: “No no- not hurting, good feeling. You do too?”

FF mom B: “Me? No, I’m bottle feeding. My mom said that was easiest.”

BF mom A: “I see…”  pause ……. “Why you not breastfeed? In my country– we are told is healthy way- natural way, most everybody does this. You are told this- yes?”

FF mom B: “Well– yeah, I remember hearing that it was best, but I didn’t try to learn about it because I have to go back to work in 6 weeks and my mom said formula was the same or just as good. And everyone can help me feed the baby too.”

(I’m still looking at a chart in doorway waiting……)

BF mom A: “Is nonsense…sorry don’t know words..false?”

FF mom B: “What’s false?”

BF mom A: “Is false- the baby bottle is same as mother’s breast. False. You are baby’s mother, you do what you must, but all more important reason to know truths– as his mother– so I tell you…  You need truths….   just ask nurse.”

I’m thinking, this will either be a great opportunity to educate a new mom further OR I’ll be moving beds because the bottle feeding mom is now all upset with her roomie…..

FF mom B: “Is it true? (She asked me)…. Is there really that much of a difference?”

I said actually there is a big difference and I’d be happy to talk to her about if she’s interested. I felt this mom was possibly considering to breastfeed and I wanted to preserve that gently… away from any real or perceived pressure. I invited her and her baby into a little conference room so I could have a private conversation with her and give her information without the possibility of her well-meaning roommate piping in.

We actually had a very good discussion. She had a lot of questions which I was so happy she felt very free to ask ….such as all the health benefits, combining work and breastfeeding and how to get started now after 13 hrs.  I answered them and asked her if she wanted to think about it or if she was interested in getting started.

She said she’d like to do it now before her mother got here. She felt fine going back to her room. Since her baby had been fed a bottle only an hour before this started, I suggested she spend some time skin to skin and maybe…. her baby would root and self attach when he was ready.

I assisted her into a comfortable position and we snuggled a naked sleeping baby skin to skin. She was smiling but not feeling very sure of things. I told her to rest and I’d check up on both of them.

Her roommate chimed in “You are good mother learning this for baby. You feel better yes? I help- if you need- I help”

In the end, the baby nuzzled, licked & rooted about a half hour after being placed STS, but didn’t self attach. I assisted her to latch him in a football hold. She was very surprised to see colostrum and became quite engaged in the process. She was breastfeeding when her own mother arrived. This grandmother was kinda taken back at her daughter’s change of heart but was more supportive than the young mother thought she’d be.

Perhaps the roommate had another discussion I didn’t overhear…….. Sometimes you never know…..

The door to more education opens from many different angles. Sometimes pushed open from an individual with a different background.

I hope we have more happy beginnings like this in the future.

🙂