The following notes are from the Mother Baby Summit Conversation Cafe round-tables.
1) Rooming-In – Bryson McHardy, MD & Amy Bue, RN (Hannibal Regional Hospital)
- Safety is important.
- Need to get physician buy-in. Many physicians find rounding is more efficient.
- Staffing issues need to be considered.
2) Skin-to-Skin in the OR – Courtney Barnes, MD (Women’s & Children’s Hospital)
- Criteria for S2S
- BFHI says “when mom is stable.” How does your hospital define “stable”?
- Need to develop system for transferring mom/baby dyad from OR table to bed.
- Need to staff baby in the OR. Can’t be mom’s RN or the anesthesiologist.
3) Skin-to-Skin after a Vaginal Birth – Sandra Ahlum, MD (Hannibal Regional Hospital)
- Requires RNs to change their routines.
- Increases patient satisfaction.
- Require documentation for S2S times.
- Some physicians want a baby weight so they can complete their charting.
- Some physicians want baby bathed. Benefits of waiting 8 hrs for bath.
4) Pacifier Predicament – Debbie Smith, RN (Fitzgibbon Hospital)
- Teach RNs to soothe babies using other techniques so they can teach moms.
- Hearing screening can be done while mom/baby are S2S.
- Teach prenatally so parents don’t expect pacifiers and don’t bring their own.
5) Purchasing Formula – Beth Sevart, RN, IBCLC (Truman Medical Center – Hospital Hill)
- There’s a perception that it’s more difficult for hospitals with a pediatric unit.
- Determine the actual monthly usage of formula vs formula given away.
- May mean moving formula to Pyxis.
- Using informed-consent form may decrease usage.
- Partner with Administration/Purchasing/Central Supply to determine a fair market price.
6) Banning the Bags – Kimberly Hamlin, MD (Barnes Jewish Hospital)
- Sometimes pediatricians want families to have formula as a back-up plan. Home health or WIC can make follow-up calls to help with breastfeeding instead.
- Some patients expect bags. They can call the number on the bottom of the coupon.
- Limit access to formula in the hospital (Pyxis or a locked cabinet).
7) Getting Nurse Buy-In – Diane Bibb, RN, IBCLC (Hannibal Regional Hospital)
- Find role models for new behavior. Early adopters talking to their co-workers helps with buy-in.
- Give the nurses the opportunity to brainstorm and problem solve how to change their workflow to encompass the new practice.
- Patient-Centered Care vs Nurse or Dr. Centered Care.
- Change takes time. Start with one small change using PDSA cycles. Celebrate successes!!
8) Using Donor Milk – Tamara Fusco, MD, IBCLC (Mercy Hospital – Springfield)
- Increases rate of exclusivity for CMS/Joint Commission for well babies.
- Sullivan & Schanler’s paper justifies use of donor milk in NICU
- May need to educate staff and parents on processing of donor milk to get over the “ick” factor.
9) Meeting Breastfeeding Education Requirements for Staff – Natalie Lavelock, RN, IBCLC (Fitzgibbon Hospital)
- Get creative and have fun.
- Songs (“What Would the Nurse Say?”)
- Create educational tools for staff to use with moms in OB clinic.
- Lactation visits
- Use online platforms for education.
- Don’t over-teach.
- Consider adult learning styles.
- Use lactation clinic.
10) What about Supplementation? Barbara Philipp, MD, IBCLC (Boston Medical Center)
- Make sure hospital systems are not the cause of the need for supplementation.
Eg, Early bathing makes baby cold -> decreases blood sugar -> need to supplement
- Download ABM’s protocol on supplementation for physicians who are poorly trained in lactation medicine.
- Have a supplemental feeding plan to follow, so order can simply say “Implement supplemental feeding plan.”
- Sample plan:
Encourage mother to breastfeed on cue or at least every three hours.
Pump after every feeding or at least every three hours.
up to 10 ml/fdg (0-24 hrs of life)
up to 20 ml/fdg (24-48 hrs of life)
up to 30 ml/fdg (48- 72 hrs of life)
Use alternative feeding method of mother’s choice (cup, spoon, syringe, etc)
11) What about Prenatal Education for Parents? – Heather Yocum, RN, IBCLC (Truman MedicalCenter – Hospital Hill)
- Enlist champions.
- Be creative with resources (eg, Family Feud)
- Continue education with new staff. Have annual audits.