- Associated Press - Thursday, April 24, 2014

GILLETTE, Wyo. (AP) - Delivering a baby is the oldest medical procedure in the world.

For thousands of years, as it is in the natural world, a mother and her child were kept together after birth.

But in the last century, a trend started to separate the mother and baby, said Dr. Jennifer Linden, physician at OB-GYN Specialists in Gillette.

Women started receiving general anesthesia that made them and their babies incapable of interaction after birth. As a result, hospitals created central nurseries to care for newborns, and infants were typically separated from their mothers for 24-48 hours.

Now medical facilities are reverting to couplet care - where the mother and newborn are placed together. Apparently, nature had it right the first time.

Campbell County Memorial Hospital adopted the couplet care model in November.

Couplet care has proven medical benefits over the nursery method. Those benefits influenced the hospital’s decision to make the switch said, Josephine LeMaster, director of maternal child services.

“It’s the best thing for moms and babies and it improves care,” Linden said.

New staff at the hospital wanted to make the switch to couplet care.

“There was a changeover of leadership in the maternal unit. Also, this area of the country is gradually making the shift to what’s being done nationally. Health care is always changing, so you need to be in that mode of ‘what do you need to do to keep up with best practice,’” LeMaster said.

“There’s an emotional and physiological benefit. It produces hormones that speed the recovery of the mother after childbirth, specifically with uterine contractions. The hormones also result in milk let down (the release of it),” Linden said.

Couplet care also allows the family to spend time and adjust to the new baby.

“It permits the bonding of the whole family with the newborn,” Linden said.

April Bankert had her son, Marshall, nine years ago at another hospital that did not practice couplet care. But when she had Jace on April 4, they were cared for by the couplet care method at the hospital.

“Marshall stayed in the nursery the whole time. Jace has been here with us the whole time except for testing,” Bankert said from the hospital.

“It’s not a huge shock when you get home. I like that my kids can come here. It’s important that they meet the new baby before he gets home,” she said.

“It’s a huge step forward. It’s definitely more family oriented than the older system.”

Sam Aikins and his wife, Agnes, had their third child at CCMH on April 6. Their second baby was born at the hospital about two years ago before couplet care was introduced.

The Aikins are from Ghana, Africa, and had their first child there. They said in Ghana, babies are placed with the parents after birth.

“When you have a baby, you want to hold the baby to get experience. You want the baby to be by your side all the time,” Sam Aikins said.

Bonding provides more than just emotional benefits.

“When you focus on the bonding aspect, it’s probably the most important win. The bonding helps both the mom and baby. In the case of the baby, it affects the temperature, sugar levels and breathing status,” LeMaster said.

Another benefit of couplet care is that it allows for skin-to-skin care (also called kangaroo care) - where a naked baby is placed chest down on the mother’s bare chest and covered with blankets to keep it warm.

“Skin to skin contact is better. Babies are calmer. It’s a return to treating the birth process as a natural phenomenon and less of a medical phenomenon,” Linden said.

It sounds like an old wives’ tale, but research backs up that claim.

In 2012, researchers pooled results from 34 tests and found that kangaroo care led to two times more mothers breastfeeding when their babies were 3 to 6 months old, compared to babies who did not have skin-to-skin contact.

In addition to improved breastfeeding rates, benefits of kangaroo care include mothers having less breast engorgement or pain at three days and less anxiety three days after birth.

For babies, there was less crying, improved heart rate, respirations and temperatures and a beneficial increase in blood sugar.

“It’s pretty impressive the things that can occur, especially when you keep the baby skin to skin. Dads can do it too. To me, that’s the most precious thing I’ve ever seen,” LeMaster said.

The researchers found no risks related to skin-to-skin care, but did find multiple risks of routinely separating moms from babies after birth.

Separating a baby from a mother after birth decreases the chance of successful breast feeding and raises the risk of the mother’s breast engorgement and anxiety. It also causes instability of the infant’s heart rate, respiration, temperature and blood sugar.

Babies who are separated from their moms and swaddled are 12 times more likely to cry.

The World Health Organization recommends all newborns receive skin-to-skin care, no matter the baby’s weight, gestational age, birth setting or clinical condition.

That doesn’t mean that safety precautions aren’t taken. If family members have infectious diseases like the flu, they still are not permitted to visit the baby in the hospital.

Despite all the evidence in favor of couplet care, routine separation of moms and babies occurs in 37 percent of vaginal births in the U.S., with rates ranging widely from state to state. In Mississippi, 81 percent of infants are separated from their mothers after a vaginal birth, according to the Centers for Disease Control.

There are about 750 to 800 deliveries a year in Gillette and there is the potential for future growth. As a result, the hospital is conducting a feasibility study to help determine the best way to update all of its inpatient areas, including Maternal/Child Services.

It also is considering building a new maternal unit in the next two years, but it hasn’t decided where or what it would cost.

“We would like to better utilize the space so the rooms are better sized and better equipped for the care that’s going to be provided - and that’s not just for the maternal unit, it’s across the board,” said Anne Raga, director of nursing at CCMH. “It’s a goal of ours to provide the best possible care we can for both the baby and the mom.”

“Using the couplet care model will certainly be considered when we are looking at space design, but it is not the single issue driving the need to update these areas throughout the hospital,” Raga said.

If completed, the maternal unit will be built with the couplet care model in mind, including beds for family and bathing spaces for the newborn, hospital officials said.

“The new unit will contribute to our ability to provide care more effectively. The room will be set up so that the baby and the mom are together and the things we need to do our job will be readily available in the room as well,” LeMaster said.

“The cost for converting to this process in our current location is minimal,” Raga said. “There will be some minor equipment, such as improved lighting needed in the rooms for infant exams by the physicians, and there will be another area for examination if that is the physician’s preference.”

Until a new maternity unit is built, CCMH is making do with the space and resources it has.

“If anything to me, having been in both models, it’s just doing it in the room as opposed to in a nursery,” LeMaster said.

“Initially, there is a cost outlay as far as staff and training, but once that training is complete, it’s actually a more resourceful way to deliver care to mom and baby,” she said. “You are taking care of them together as a unit - you end up using a little less staff. Conceptually it’s one nurse, two patients.”

Adopting the couplet care system also leads to efficiency of information.

The nursery method would have one nurse station for mothers and one for babies - leading to the slowdown of information because of the two different stations having to communicate.

“Ultimately, it could save a little money because we could deploy staff differently,” Raga said.

Couplet care is not mandatory, but nurses strongly encourages the practice.

“We support couplet care. We encourage the significant other to be a part of that journey with her.

“The key word is stability. If the mom is stable, we encourage the baby to be in that room with her with the staff assisting,” LeMaster said.

In cases where the mother is too tired to take care of her baby, there will be a holding room where the baby can go.

As the hospital is in transition, the nursery is being used. Eventually, CCMH plans to turn the lactation office into a holding room.


Information from: The Gillette (Wyo.) News Record, https://www.gillettenewsrecord.com

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