Nurses who support natural laboe

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Permalink Reply by megan henley on May 12, 2009 at 6:41pm

Yes! Although I am currently not working in L&D, I maintain my Certified Childbirth Educator status and I am a neonatal nurse at this point in time. I still attend deliveries, but I am there for the infant. However, as we all know, the desire to have a more natural birth experience doesn't end with stage 3 of labor! In my job, I fight for moms to be encouraged to room in, for skin-to-skin contact, for EXCLUSIVE breastfeeding in the absence of medical need for supplementation, etc. I think whether we are working in L&D or Neonatal, those of us who are for natural birth experiences are oftentimes at odds with our peers at work. When I give report and I am excited that a preterm infant is breastfeeding well, I get the rolling of eyes at times, especially from old school nurses. My mother, sister, aunt, and myself are all OB nurses who fight to get nurses to stop doing what's easiest for them and do what's right for the couplet. From encouraging epidurals to encouraging moms to send their babies to the nursery at night to be fed in, we are constantly at odds with certain nurses and some of their practices. I would love to share ideas and encouragement with another RN. I do think that we are in a slightly different spot than the average lay person; because of our education and jobs we can't simply "pick a side". Does that make sense? It isn't such a polar issue that we can absolutely identify with one "side" or the other. We are in an interesting middle ground. There are times that we have to intervene, but we certainly try to avoid it if at all possible. I have had nurses roll their eyes at me for avoiding intervention, and I have had families critisize my practice when intervention is needed for the safety of mom/baby. As I said, we are in an interesting position. Let me know what you think. Where do you practice at?

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Permalink Reply by Rachel on May 12, 2009 at 8:20pm

I've got to run right now, but I just wanted to write a quick note. I also used to work in the NICU:) And have found myself in that middle ground...sometimes that is really hard. I work in Provo, UT which is the baby capital of the world I think...we have around 4000 births a year and average about 10-12 per day. It's sort of assembly line birth here because of that. The sad thing is, more women are wanting to do things different, but don't have the support they need, so usually just end up falling in line.

Just a quick question...since you work with neonates...do you think that using routine oxygen and suctioning is necessary for every newborn regardless of how they are doing...NRP says no, but most nurses I know will still do it. What do you usually do? And what do you feel works best?


megan henley said:

Yes! Although I am currently not working in L&D, I maintain my Certified Childbirth Educator status and I am a neonatal nurse at this point in time. I still attend deliveries, but I am there for the infant. However, as we all know, the desire to have a more natural birth experience doesn't end with stage 3 of labor! In my job, I fight for moms to be encouraged to room in, for skin-to-skin contact, for EXCLUSIVE breastfeeding in the absence of medical need for supplementation, etc. I think whether we are working in L&D or Neonatal, those of us who are for natural birth experiences are oftentimes at odds with our peers at work. When I give report and I am excited that a preterm infant is breastfeeding well, I get the rolling of eyes at times, especially from old school nurses. My mother, sister, aunt, and myself are all OB nurses who fight to get nurses to stop doing what's easiest for them and do what's right for the couplet. From encouraging epidurals to encouraging moms to send their babies to the nursery at night to be fed in, we are constantly at odds with certain nurses and some of their practices. I would love to share ideas and encouragement with another RN. I do think that we are in a slightly different spot than the average lay person; because of our education and jobs we can't simply "pick a side". Does that make sense? It isn't such a polar issue that we can absolutely identify with one "side" or the other. We are in an interesting middle ground. There are times that we have to intervene, but we certainly try to avoid it if at all possible. I have had nurses roll their eyes at me for avoiding intervention, and I have had families critisize my practice when intervention is needed for the safety of mom/baby. As I said, we are in an interesting position. Let me know what you think. Where do you practice at?

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Permalink Reply by megan henley on May 13, 2009 at 7:18am

Hey! Oh my goodness NO! Please tell me they aren't using deep sxn and O2 on most babies! I am (an NRP instructor by the way) such an advocate of NOT deep suctioning most kids. If you give them some time they typically clear all that on their own. People expect these kids to sound clear at 2 minutes of age which is such a ridiculous expectation. We see such an issue with these kids that are deep suctioned then having feeding issues in the next 24-48 hours. They are gaggy and don't want to feed because of the irritation and edema. In terms of the O2, there just isn't any reason to do it. If you give them that first 30-60 seconds when you are drying and stimulating anyway, there typically doesn't end up being a need for blowby anyway. It is so hard to make people change. I think that if the same people who over intervene on these kids were responsible for them over the next 24-48 hours to see the effects of their actions they might reconsider. Sounds like my hospital is similar in size to yours. We have done as many as 13 deliveries in an 8 hour shift...too many! Do your L&D RNs do your resuscitations or your NICU RNs?

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Permalink Reply by Rachel on May 14, 2009 at 9:37am

If kind of depends on the nurse, but yes a lot do routinely sx because they feel like the baby sounds wet...of course they do...they were just sucking in water:) I'll usually wait a while and see what baby is doing, if he looks like he is struggling or limp then I'll suction. My concern with the routine sx is the feeding issues and the bradycardia that could be a complication. You mentioned that sx can cause gaggy babies...I didn't know that. I find that interesting because nurses will sx babies if they are gaggy down on postpartum. Most of our L&D nurses will do normal resuscitations. If there is problems we call in the NICU team.

I'm just curious, from your experience, have you seen good outcomes/benefits from skin-to-skin. I just recently started using that more, but the moms are gone before I can see any outcome:)

megan henley said:

Hey! Oh my goodness NO! Please tell me they aren't using deep sxn and O2 on most babies! I am (an NRP instructor by the way) such an advocate of NOT deep suctioning most kids. If you give them some time they typically clear all that on their own. People expect these kids to sound clear at 2 minutes of age which is such a ridiculous expectation. We see such an issue with these kids that are deep suctioned then having feeding issues in the next 24-48 hours. They are gaggy and don't want to feed because of the irritation and edema. In terms of the O2, there just isn't any reason to do it. If you give them that first 30-60 seconds when you are drying and stimulating anyway, there typically doesn't end up being a need for blowby anyway. It is so hard to make people change. I think that if the same people who over intervene on these kids were responsible for them over the next 24-48 hours to see the effects of their actions they might reconsider. Sounds like my hospital is similar in size to yours. We have done as many as 13 deliveries in an 8 hour shift...too many! Do your L&D RNs do your resuscitations or your NICU RNs?

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Permalink Reply by megan henley on May 16, 2009 at 2:31pm

Hey Rachel. I think skin-to-skin is great. I don't think you can refute all the studies that show its benefits. The fact that a stabilization in HR and RR is often noted is so cool. Although I don't think we are going to see the famous "crawl" to the breast every time we put a baby skin-to-skin to encourage nursing, I certainly believe that it helps. I often times use it when I help a mom nurses, especially with preterm kids or really sleepy kids. I think it should absolutely be done immediately after delivery. There just isn't any reason not to. Is it your policy to ensure that baby goes to breast within one hour? We also don't separate moms/infants who are vag deliveries. C/S babies go to the nursery for a brief exam only, and Dad usually goes with them, then they are never taken again. I was shocked when someone said that their hospital takes babies into the nursery for up to 2 hours each day. What? Why?! Peds. should do exams in rooms so they can speak with parents anyway. I would love to know some of your practices.

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Permalink Reply by Rachel on May 20, 2009 at 8:05pm

I work at a few different hospitals so things are a little different at both. At one hospital, the nurse mostly just take the baby for an assessment and then return it to mom. It used to be that they were whisked off soon afterwards, but that is starting to change. Our manager is encouraging more skin to skin and taking baby down with mom to postpartum. At the other one I work at, mom stays in room with baby the whole time except for a bath and ped visit. I really wish the peds would go to the room, but they don't. I also don't know why they can't bathe the baby in the room also, but such is life. Most moms don't care anyways, but I think it's because they haven't experienced it any other way. Many moms want the baby taken to the nursery at night to sleep. That's their choice, but many nurses encourage it.

megan henley said:

Hey Rachel. I think skin-to-skin is great. I don't think you can refute all the studies that show its benefits. The fact that a stabilization in HR and RR is often noted is so cool. Although I don't think we are going to see the famous "crawl" to the breast every time we put a baby skin-to-skin to encourage nursing, I certainly believe that it helps. I often times use it when I help a mom nurses, especially with preterm kids or really sleepy kids. I think it should absolutely be done immediately after delivery. There just isn't any reason not to. Is it your policy to ensure that baby goes to breast within one hour? We also don't separate moms/infants who are vag deliveries. C/S babies go to the nursery for a brief exam only, and Dad usually goes with them, then they are never taken again. I was shocked when someone said that their hospital takes babies into the nursery for up to 2 hours each day. What? Why?! Peds. should do exams in rooms so they can speak with parents anyway. I would love to know some of your practices.

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