Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
I would go with NICU and I obviously delivered without one. But I don't want to ever be in the situation of being forced to stay at one hospital while my baby is at another. By giving birth outside a hospital, I would have wound up at same hospital as baby if necessary (or baby would go and I would be free to visit as desired since I was not admitted myself).
Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
I would go with NICU and I obviously delivered without one. But I don't want to ever be in the situation of being forced to stay at one hospital while my baby is at another. By giving birth outside a hospital, I would have wound up at same hospital as baby if necessary (or baby would go and I would be free to visit as desired since I want admitted myself).
That was absolutely the worst part of L's birth and subsequent hospital stay. I was stuck at hospital A after just having an emerg c/s and he was helicoptered to hospital B over 100 km away. It was awful. I wouldn't wish that on my worst enemy.
Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
I had this choice and went with the working toward becoming baby-friendly hospital with a midwife and great NICU. I'm really nervous about the baby-friendly stuff to be honest, especially after our hospital tour last night. I'm preparing DH to advocate for me as much as possible, and thankfully he and I are on the same page and he will be able to stay with me at the hospital. I'm still really comforted by having the NICU right there.
Post by BeagleMama on Aug 23, 2016 18:56:08 GMT -5
I just delivered in a baby friendly hospital and thought the experience was generally positive. I liked having her in the room because I felt like it gave me two days to "practice" her care with professional support. It was great to have care in line with what I had understood to be ideal (delayed cord clamping, golden hour, etc).
I will say my experience with the LCs in the hospital left a lot to be desired. Both baby and I had some complications during birth which left us, as my midwife said, "limping a bit." By the time we got to the pediatrician 3 days after discharge, baby had lost too much weight. That was after days of "your baby isn't hungry" and "your milk will come in, keep doing it." Well, no. My baby was starving. And, my body never made enough milk to feed her. It would have been nice to have some here-are-our-options, realistic conversations instead of constant head patting. Breastfeeding doesn't always work and hospital staff needs to be trained to be open to that... maybe they are, but it sure didn't feel like it.
What drives me nuts when I think about my delivery experience (Feb 2015) is that I really think my hospital had the best of both worlds:
1) Â All of the nurses were trained in lactation. Â The nurses were very helpful in helping me get things going.
2) Â They had an LC on the floor 24 hours a day
3) Â They did not hand out formula willy nilly. Â
4) They did skin to skin
5) They had us nursing within the first hour.
Other than them waking me to ask if they could give her a pacifier, I have no qualms about the nursing/lc care I received. Â But I know the "Baby-Friendly" purists would scourge my hospital (which was supposedly at a Baby-Friendly place) because:
1) Â They had a night nursery.
2) Â They had pacifiers.
3) Â They sent me home with some "just in case" formula samples because the baby lost 10 ounces by discharge. Â
Like, they did everything right, they helped me get started, all that jazz. Â But because they weren't strict disciples, they wouldn't be "friendly." Â Which is some seriously epic bullshit.
Where is this hospital? I need to move there so I can deliver my next one here.
Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
MD. I want to know i can get an emergency section if i need one
Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
MD. I want to know i can get an emergency section if i need one
Ugh. I hadn't considered that part.
I really hate my insurance! There's a great practice in town with MDs that deliver at both hospitals but they are out of network.
I know rooming in is the most hated of the baby-friendly practices, but I actually think the way it is done in most hospitals (baby in bassinet in mom's room) does actually model the safest sleep situation for when babies are brought home, which is room sharing without bed sharing. I think it also supports breastfeeding in ways well baby nurseries are unlikely to achieve.
I agree with this, but the 48 hours after birth is not the same as the next 6 months. The mom is still recovering from a huge physical ordeal, has likely been up 24 hours or more, and really needs to rest before being sent home with a newborn. IMO. I think it's well and good to allow moms to room in if they want to (and I didn't mind with Joanna), but I wish they would keep a (safe) alternative for moms who want to rest. H and I actually did have one of us room sharing with the babies for awhile after we got home, just not BOTH of us at the same time. That was unsustainable for us.
100% agree with this! I had a 3rd degree tear and a baby born after midnight. I really could have used a few hours of sleep!
Post by spunkarella on Aug 23, 2016 19:14:50 GMT -5
hamster I should probably clarify that I chose a practice with both OBs and midwives. I mostly see midwives but have rotated through the doctors just in case. If I become too high risk for a midwife, I will be transferred to one of the OBs seamlessly and immediately.
Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
MD. I want to know i can get an emergency section if i need one
A midwife at a hospital shouldn't prevent you from getting an emergency C should it? I mean you would just be transferred to OB care if that were the case. Obviously you might not know the OB, but I think a lot of midwives work with set OBs, so you might get a chance to meet them.
Maybe the alarm only worked on the whole floor (it's all such a haze at this point), but I feel like they didn't want us to leave the room. In any event, I did very little sleeping after my c-section.
Would you rather deliver at a baby-friendly hospital (with a midwife) with a NICU or a "traditional" hospital (with an MD) and no NICU. (This is of course assuming you won't know in advance you'd be in the NICU).
I'm pretty sure I know the answer here, but it sounds like there's extra self-advocating with baby friendly and that sounds exhausting on top of an already exhausting experience.
Post by sapphireblue on Aug 23, 2016 19:39:54 GMT -5
Ugh the hospital I delivered at last summer was baby friendly. Lots of it was good--although I am a terrible sleeper I wanted him in the room with me, and I loved the skin to skin, etc.
But, my milk never did come in. All of the nurses were trained in helping patients breastfeed but I just didn't have much to give him. They never suggested formula and a couple tried to shame me for pumping. Even pumping didn't produce much.
I am having another baby next March at the same hospital and I am definitely planning to bring pacifiers and formula. And if any of them give me any crap I am also prepared to blast them.
In hindsight, I got "lucky" that DS had low blood sugar so he was whisked off to the nursery for hours of observation and given formula while DH and I got some sleep after my late night c-section. Went on to successfully bond and breastfeed so win-win. You do what you have to do in the moment and hope it's the right choice.
my friend delivered at a baby friendly hospital last weekend and they DON'T HAVE LCS COME IN ON THE WEEKEND. WTAF? So they stayed an extra night so they could see an LC once or twice before discharge. Sure the nurses are trained to help, but dude, if you are going to put breastfeeding on a pedestal and make all your policies all about it, then have a freaking LC available every day of the week.
I delivered at hospital with same practices. Ridiculousness.
Post by katrinabennett on Aug 23, 2016 19:51:03 GMT -5
The nurse rescued me in the middle of the night and took the crying baby from me and told me to sleep. And then she brought her back an hour later and said 'I can't get her to stop crying. Here. Try not to feed her again. I just did' So for an hour, I was so happy. My Mom arrived at 7am and I said 'here's the baby. Good night'
I work at a hospital. You'll never convince me that the push for baby friendly isn't at least partially motivated by financial gain for the hospital. Not staffing a nursery saves them money.
I'm also positive that the exhaustion resulting from my baby friendly experience negatively affected my mental health immediately postpartum.
Have hospitals done away with nurseries as a cost saving initiative?Â
Ding ding dingSaveSave
Not exactly sure of that. Part of baby friendly is to "room-in" which eliminated the need. The biggest cost (nurses) shifted to another area. Think of it like this, Instead of 1 RN caring for 4 babies and 1 RN caring for 4 moms, 2 RNs care for 2 "couplets"; a mom and baby. Numbers are the same but distribution changed. At my facility they care for 3 couplets and make adjustments for NICU.
To my knowledge, exclusive breastfeeding rates are one part of JCAHO accreditation for large hospitals. But I'm not aware of any payer tying reimbursement to breastfeeding rates or baby-friendly status. Medicaid reimburses for lactation services provided by hospitals, but that's for all hospitals.
I'd bet you money there's some sort of financial incentives related to Medicare reimbursement rates for hospitals with baby friendly initiatives. Maybe not actual certification, but "perks" for encouraging breastfeeding. Of course if everybody is unhappy and gives low patient satisfaction scores, then there's likely no gain.
To my knowledge, exclusive breastfeeding rates are one part of JCAHO accreditation for large hospitals. But I'm not aware of any payer tying reimbursement to breastfeeding rates or baby-friendly status. Medicaid reimburses for lactation services provided by hospitals, but that's for all hospitals.
I believe incentives vary by state, not federally or via insurance reimbursements. So there isn't one blanket rule.
To my knowledge, exclusive breastfeeding rates are one part of JCAHO accreditation for large hospitals. But I'm not aware of any payer tying reimbursement to breastfeeding rates or baby-friendly status. Medicaid reimburses for lactation services provided by hospitals, but that's for all hospitals.
I believe incentives vary by state, not federally or via insurance reimbursements. So there isn't one blanket rule.
My "baby friendly" hospital wouldn't let me see a LC. I was supposed to wait until I had been released and then I could see one. The nurses I had gave me TERRIBLE advice on bfing and almost screwed me up for it. They also gave me a paci and would have taken DD so I could get sleep if I wanted. I don't think they actually paid attention to the whole baby friendly thing.
Exclusive breastfeeding is a Joint Commission Perinatal Core Measure. Whether funding is affected, I'm not sure. But it is considered a core measure to be TJC accredited. I've been hearing about this damn thing in staff meetings for the last 3 years.
Canada, but my hospital had many 'baby friendly' aspects. No nursery (probably the space was used for something else), LC trained nurses (but not all of them, and we got a lot of conflicting advice). Subtle discouraging of formula use. We spent 5 days there because A was so small and kept losing weight, and looking back on it, if I had been encouraged to give some formula it would have made for a totally different experience. But the consensus was that if I wanted to breastfeed, which I did, I had to nurse only - until she started losing a lot of weight. And then formula was given, but even then it was given by a nurse who cup fed her and didn't tell me anything about how to bottle feed or give formula...
Thank god I accidentally got a private room or it would have been an extra nightmare.
I have not gotten to read this entire thread and it's late but I have 2 thoughts. One, rooming in is so overrated. I was in no shape to be doing a thing for my kid besides feed her. H helped a ton but I still did too much and firmly believe it affected my recovery negatively.
Second, if she's been monitored more closely by the nurses, she might not have overheated from being double swaddled and ending up with a quick NICU visit.
I will say that they encouraged pacifier and formula use. Unfortunately I had been so brainwashed to believe formula was bad and refused it, resulting in over 13% body weight loss in the first 4 days of her life.
In summary, the breastfeeding pendulum has swung too far.
I work at a hospital. You'll never convince me that the push for baby friendly isn't at least partially motivated by financial gain for the hospital. Not staffing a nursery saves them money.
I'm also positive that the exhaustion resulting from my baby friendly experience negatively affected my mental health immediately postpartum.
1000% agree. After being up for 48 hours, 17 hours of labor, an emergency 8pm section and it all being my first kid, the absolute last thing I wanted to do was to learn to breastfeed. I wanted nothing more than to do it but I felt broken from the neck down. I woke up from an exhaustion/paid med daze to have the nurse holding my baby up to my boob and my husband just staring like "is this typical?!" I'm absolutely sure I would have done much better if I had a proper introduction with a clear head.
Exclusive breastfeeding is a Joint Commission Perinatal Core Measure. Whether funding is affected, I'm not sure. But it is considered a core measure to be TJC accredited. I've been hearing about this damn thing in staff meetings for the last 3 years.
The nurse at my pedi had worked at our hospital for years in mom/baby. She said she left once they started getting awarded "points" for moms who left breastfeeding. It's insane. I'm a medical professional myself and it downright outraged me.
my friend delivered at a baby friendly hospital last weekend and they DON'T HAVE LCS COME IN ON THE WEEKEND. WTAF? So they stayed an extra night so they could see an LC once or twice before discharge. Sure the nurses are trained to help, but dude, if you are going to put breastfeeding on a pedestal and make all your policies all about it, then have a freaking LC available every day of the week.
I had a similar complaint about the first hospital I delivered at... No lc working in the weekend. Likely part of the reason I struggled so much at the start. Wasn't a baby friendly hospital, but they pushed the rooming in.