Wednesday, June 9, 2010

S2S as the Standard That Should Be

I wrote a two-parter a while back on cesareans, not (for once) on how to avoid them or about the epidemic in its societal context, but instead about how, if one did become necessary, to make the absolute best of the situation. One post focused on birth plans, and the other on a doula's role when birth becomes surgical. Check them out if you haven't read them - I won't rehash here, but suffice it to say that there is MUCH that can be improved on, for both mother and child.

Needless to say, I was thrilled to see this post by veteran OB Nurse 35 Years, on one of the most potent factors: S2S - Skin to Skin Contact Minutes After C/S in the OR. YES. (And she links to the same excellent breastfeeding video I just shared, hooray!) Skin to skin is vital, whenever an emergency doesn't preclude it, due to so many things, like its positive effect on breastfeeding initiation, regulates temperature, reduces crying, the fact that it functions, itself, as an analgesic for healthy babes, and the simple profundity of, yes, bonding. Check her bad self out:
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………
And she then goes on to describe various barriers in the OR and how she has learned to cope with them. She closes with a final scenario, with a potent moral to the story:
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

Right on. Keep fighting for this, OB Nurse! We all know cesareans ARE sometimes necessary. There is no question about that - and thank God we have that available to us. But there is no reason that immediate skin to skin contact, and no routine separation of mother and baby, should not be THE standard of practice in all cases except when medically necessary. Make it happen indeed.

9 comments:

  1. Thanks for sharing your opinion! I read your blog alot (but never comment - sorry :(] and this post really hit home! I didn't have a c-section but I had to really throw a fit with my second birth and they brought him right to me, just like she did here, even though some of the nurses were (Very) frustrated.

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  2. I haven't had a cesarean either, but in the case I ever do, but husband knows to listen for APGAR scores and then say, "Since the baby is doing well, now it's going to be on mom," and then just take it. I told him that if they don't give up the baby, then to say something like, "If I don't get the baby now, we will charge you for kidnapping." I know it sounds harsh, but parental rights start as soon as the baby is born and we need to stand up for ourselves!

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  3. Wish all women knew how to stand up for themselves like that. I guess that's why I'm training to be a doula, to help women know that they CAN ask for and get what they need and want.

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  4. HI!
    StorkStories here!
    I want to thank you for finding that great video link, and for including my words in your post here! I am so happy for this particular mother and for any more moms out there who can experience STS in the OR. I seriously think that patients can push for it more. Truly, it's not hard for us (the caregivers) at all. It's not our baby anyway. It's YOUR baby and he belongs with you. (lol --> love the remark about kidnapping btw)
    You can and should speak up and ask for what you think is best for you and your baby. It is always best to discuss a lot ahead of time with your birth attendant so everyone is on the same page and there are no surprises, hopefully no disappointments. I'm telling everyone I work with to keep pushing for it. If anyone out there has to unfortunately undergo this type of birth....PLEASE ask for STS!! You and your baby deserve it.
    Thanks again.
    StorkStories

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  5. I asked about doing skin to skin in the O.R. but was told by the maternity coordinator that it wouldn't work due to needing to keep just below my chest sterile. It was okay, though as the stitching up really went quickly. I did hold him with my husband's help, though.

    As soon as we were wheeled out of the O.R. and into our room, the nurse helped the baby and I get skin to skin. It was really nice.

    The stories that make me really sad are the ones where Baby is taken to the nursery (usually with the dad following) and mom is left in the O.R. alone and then in recovery without her baby.

    My first baby was taken to the nursery as I was wheeled back into my room and was even bathed before he was brought to me. I was so upset about that when planning for my second baby's birth that I became very adamant that my baby was not to leave my sight unless medically necessary (which unfortunately did become the case).

    My 3rd., 4th, and 5th. babies were able to stay with me, though, which was perfect.

    *thanks for the congratulations, btw. : )

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  6. Seriously. Women have to DEMAND in order to get things to change. Have you seen the photo of the woman in Autralia who pulls her own baby out of her incision (gloves up to her elbow, OB helps direct her hands over the drape)?? that would be incredible. If I EVER had to have a Csection you can bet the Drs would be tired of me after too long and just give me everything I want to shut me up!!

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  7. ^^ AndreamS, yes I have! Check out my older post on c-section birth plans - that photo and article about that birth are included (scroll down if you don't want to read the whole lengthy thing).

    Stork Stories, welcome and thank you for such a great post! Even more thanks for being willing to go to the mat on this. The payoff is so worth it.

    Morgan, I'm so happy you had a good experience! To those who haven't seen it, Morgan has some great info on her blog about making cesareans as positive as possible, when necessary. Please check her out!

    Glad you enjoyed, everyone!

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  8. Did my first prenatal today and it is really important to Mom to have baby with her right after if there are no issues. I told her about how even with a c-section it is possible and she is going to ask her provider about it at the next appt. I am curious about what they say!

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  9. A similar story is delivery room football. I love it. Go check it out.

    http://www.thewellspring.com/flex/birth/2688/delivery-room-football-by-emmett-miller-md.cfm

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