February 10, 2012

Small Steps in the Right Direction

The longer I work in labor and delivery, the more I see that there is a need for things to change, especially regarding c-sections. (No, this isnt a post about how there are too many c-sections...that's whole huge post and discussion for another day. Yes, avoiding c-sections altogehter is the best answer, but until we get to that point, there are still many c-sections being done and we need to manage things better until we get to that point) I'll admit, since 4 of my 3 kids were born by c/s, 2 of them preterm and one emergency, it hits a nerve for me. Why is it routine to take babies born by c-section away from their mothers? In certain cases, obviously there isn't a choice, either the mom is too sick or the baby is too sick. What about those non-emergent cases, like a failure to progress, scheduled repeat, or a repeat c-section in labor, or the like? It seems routine that the the baby is born in the OR, taken to a warmer where most the time the pediatrician is in attendance. Baby is held up to mom so she can see her baby, then Dad goes with the nursery nurse, pediatrician and baby to the nursery and the mom is left alone with strangers while they finish the surgery. The baby has already been evaluated and is fine, but stil they go to the nursery. Why? Had my last baby been term, I had already stated that he would not have left the OR. I knew he would be given a good once over by the pediatrician and nursery nurse, so I saw no reason why he should leave. He could hang out in Husbands arms until they were through with me, Husband would give me the baby and I would be wheeled out of the OR into recovery with Caleb skin-to-skin. But, that bonding wasn't able to happen until I was in recovery because he was 34 weeks. And this is where a lot of c-section moms start having trouble. Here they are, sometimes they feel like their body has failed them because they need a c-section. So their baby is delivered through their abdomen, they will have a longer recovery and the baby is taken away from them. They may seem "fine" during the short 2-3 day hospital stay because they have their baby and they do all the typical things new mothers do. But it's not until after they are discharged that the emotional turmoil begins for some. They start to realize they missed out on those first moments. They weren't able to hold their baby for 1-2 hours, in some cases, even longer. Here they carried and loved this child, labored and they are the last to hold the baby. Some women even feel like it was their "punishment" for not being able to deliver vaginally. And these feelings start spinning out of control and when they try to talk about these feelings to others, they are brushed off. "Well, you got a healthy baby. Why are you so upset/sad/angry?". Yes, the most important thing is a healthy mom and a healthy baby, but the birth experience is also very important. I know even for myself, when I tried to talk about my unsettled feelings about Calebs birth, some people look at me like I'm nuts, that I should let it go, "it's been a year plus, just move on". The thing is it's not that easy. Yes, I'm very thankful he was delivered healthy, considering his early gestation, and he is an absolute joy. But, I am still unhappy with the lack of respect I was shown in the day and hours leading up to his birth and during. I was almost denied the option of having Husband there. What would have happened if I hadn't worked in OB? Would I have thought to say "no, if the baby and I are fine I want to wait"? Probably not. That disrespect cut much deeper than the scalpel blade. Those physical scars have healed, but the emotional scars are still a bit tender. But having the opportunity to have Caleb skin-to-skin within an hour of his birth and being able to take him in, to hold him against my chest, eased some of the pain/guilt I was feeling. Ok, back to my main point. Why not keep the baby in the OR with mom? Why can't we keep her child with her, bring him/her to her so she can see, touch and yes, even hold her baby (it is possible) while the docs finish up surgery. Then the baby can go with her to recovery and she will be able to be with her child those first few moments and maybe that will help. I've been doing this lately. I've asked the nursery nurse and pediatrician if the baby can stay in the OR. And I've not met ANY resistance. The results have been awesome. I can't speak to how the moms feel after they are discharged or if it has any effect on possible emotional turmoil they may feel, but in the immediate here and now, they seem happy. They don't lose those first few minutes. They don't watch helplessly as their baby is taken to the nursery even though everything is fine. They get to do skin-to-skin as soon as they are in recovery and guess what? These babies have all nursed great in recovery. Coincidence? Perhaps. It might be a small step in the right direction. Maybe it won't have much impact. Or maybe, just maybe, it will make a world of a difference. It can't hurt to try.

13 comments:

amanda_cake said...

I love this post... while I'm not a mother, I know a lot of women who are mothers and who weren't satisfied with their birth experience. I want those precious moments with my child and it's good thing that other people realize this and want the same things.

Jessica said...

We don't usually keep our babies in the OR, but they go directly to the recovery room, not the nursery, so mom and baby can be together as soon as she's wheeled out of the OR. Great idea though! Maybe we should just keep them in the OR!

Anne said...

Unless baby needs extra help, they stay in our OR. If mom feels up to it and is interested, we help with skin-to-skin and breastfeeding while she is being stitched up. It is possible!

Dr. G said...

It's very hospital-dependent. If your hospital's policy is to wheel the baby away right away, then they're not going to stop doing that until someone up in administration decides that it needs to change. It's great that you're advocating for it, as we need more baby-friendly hospitals.

Melissa said...

This would be wonderful, As a Mom who has had both c-setions and vaginal births this would be a great way to bond early with your baby. With my last c-section even though my baby was in the recovery room with me I would have loved to have held my baby right away. Instead of watching him lay in a bassinet I could not reach or even attempt to after having a C-section.

michelle mom of 9 said...

I've had 8 vaginal births and my last a c-section, and it was really emotionally an awful experience. I didn't see her come out of me, I only caught a 1 second glimpse of her face swaddled up in blanket - no vernix, no new baby smell. They did have to work on her for bit, but it was on the other side of the curtain. I asked why the bassinet was there - and - no one could answer. The doctor said that it was actually a good idea and needed to be considered when they built the new hospital. I would have done much better seeing her because it turned out all they were doing was just holding her upright as she looked around, but no one answered my questions as to why I wasn't hearing her cry. Basically she was out of my site except for nearly 2 hours.

Melissa said...

There's no reason you can't keep a well baby in the OR; we do it all the time where I work. In fact, if mom's up to it, baby goes skin to skin oh Mom's chest. It takes some maneuvering with the drape and the cardiac leads (and sometimes a fight with anesthesia, but they've gotten much better since we've made it our standard of care), but it's doable. We've even had babies nurse on the table.

Hospital routines should never trump best practice. I know I'm preaching to the choir, but that's what this boils down to.

Nurse Lochia said...

Thankfully it's really more of a "it's what we've always done" thing. Not a hospital policy. Our idea of what is "best" is changing in a positive direction. It's been wonderful lately since I've been asking that the baby stay in the OR, for everyone involved and I'm glad I've not met any resistance. We are working on changing our processes to keep babe with mom, moving towards being more baby friendly. We have implemented skin-to-skin with all vag deliveries so we'll be pushing to do that with c/s deliveries as well.

Erika said...

Wow. I am so grateful that on my unit, we keep babies in the O.R./ by mom (with support person holding baby)- even doing vitals while support person HOLDS baby. Yes, I have also seen the effects it has on mom- even right post-partum- to even have to have a c/s and feeling like a failure, even though it was emergent or whatever. AND, I have seen not having baby skin/skin or in their arms...minutes seem like hours (if they aren't out of it). My sister also had 3 c/s and trouble bonding later that resulted in PPD. I am heartbroken that THAT was your experience and you even KNOW the ropes and they KNEW you. Yes, things need to change. We don't even have a nursery to keep well babies. We have special care (like a step down unit up to level 2 NICU) AND for a baby needing a longer transition, we extend recovery to 4-6 hours, depending JUST TO SEE if the baby really needs the extra care- even letting them transition with blow by and O2 sat monitoring. :) Sorry, ran a little long there. Yes, I agree with you and have enjoyed your blog for like I think at LEAST 2-3 years or something. (Lost count).

Pietrowski's of North Andover said...

I really appreciate this post. After 3 children I have never had that defining moment that we wait, not only 9 months, but our whole lives for...those first moments with your child. My son was delivered vaginally, but wasn't breathing and had to be intabated (sp?). So even after 18 hours of labor and an hour and a half of pushing out an 11lb baby, he was wisked away and I still feel cheated out of that moment-- of course I know it was medically necessary...but it has always something I get I missed out on...and my 2 daughters born section were held up and then brought to the nursery...and like you said, i was left alone to be stitched up...in the freezing OR...i wish someone had suggested my babies stay while surgery was finished! I think what you are doing is great!

Anonymous said...

Wow, I feel sad for the women this happens to. I had two vaginal births and the last by c-section due to GD and baby size. It was just as if I had had the baby in the LDR room, only the OR. Baby went from womb, to my chest, to daddy's arms and then to the warmer to get cleaned up etc. The warmer was 2 feet from my head so I could see everything. Then Daddy brought baby back to me and we were all together before going to recovery. I just thought that was how it went. I hope you can make progress for those other women! How sad to be cheated of those moments.

Julia said...

Keep up your work in the OR and keep those babies close to their Moms! I totally admire what you are trying to do for them!

I had a c-section for my twins and because they were early I only saw them briefly before they had to go to the NICU. I sorely missed bonding with them, I know I couldn't because they were early. But it still made everything harder.

There is something so incredible about those first few moments after birth, it makes such an amazing bond, breastfeeding easier and the relationship between baby and mother better.

My 2nd birth was better but my 3rd was the icing on the cake. Home birth and amazing bonding time! Its incredibly important!

Just wanted to say thanks for all you do!

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