Lethal breasts?

Baby breastfeeding

Last month I wrote about a spate of infant deaths in so-called “Baby Friendly” hospitals and asked whether the Baby Friendly Hospital Initiative ought to be renamed the Baby Deadly Hospital Initiative.

The Initiative virtually mandates keeping babies in bed with exhausted new mothers even when multiple modifiable risk factors for infant suffocation are present, including maternal impairment due to sedating drugs or exhaustion and soft bedding. Why? To encourage breastfeeding, of course. The paper Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards (2014) reported on the results: 15 neonatal deaths and 2 near deaths.

Over the weekend, a reader alerted me that this phenomenon is far more common than I had realized. In fact, it is so common that it has a name, sudden unexpected postnatal collapse (SUPC), and multiple papers exist describing the phenomenon.

In Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment (2013), Pejovic and Herlenius describe the findings in just one city, Stockholm:

Twenty-six cases of SUPC were found among 68 364 live-born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin-to-skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at

Conclusion

SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented.

Unexpected collapse in apparently healthy newborns – a prospective national study of a missing cohort of neonatal deaths and near-death events (2012) describes the British experience:

45 cases were reported, an incidence of 0.05/1000 live births of whom 12 infants died. In 15/45 infants, an underlying disease/abnormality was determined. In 30/45 cases (0.035/1000 live births), no such cause was found, but in 24, the clinical/pathological diagnosis was airway obstruction during breast feeding or in prone position. Mothers were commonly primiparous and unattended by clinical staff before collapse was recognised.

Not surprisingly, most cases occurred at times of low supervision and many cases involved known risk factors for sudden infant death syndrome (SIDS):

Collapse occurred between 21:00 and 08:59 h in 25 (56%) cases. Thirteen (29%) infants were presumed to be feeding at the time of collapse. Thirty (67%) women had received analgesia in the form of opiates or had had a regional or general (one case) anaesthetic in the 8 h preceding the collapse.

In 23 cases, the mother or both parents were unattended with their new baby at the time of collapse. When mothers were left alone with their baby, they recognised signs of collapse in around a third of instances. When another parent was present, they recognised the signs of collapse more often (75%)…

The long term outcomes were terrible:

Nineteen of the 24 infants with presumed accidental suffocation survived to discharge. At 1 year, five were noted to have neurological abnormalities (26%). Three have cerebral palsy, one has probable cerebral palsy with significant motor delay and the other has mild global delay and hypotonia…

Poets et al. reported in Sudden Deaths and Severe Apparent Life-Threatening Events in Term Infants Within 24 Hours of Birth (2011) on 17 cases of SUPC, defined as unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth.

There were 7 deaths (ie, 1.1/100 000); 6 of the 10 S-ALTE infants were neurologically abnormal at discharge. Twelve infants were found lying on their mother’s chest or abdomen, or very close to and facing her. Nine events occurred in the first 2 hours after birth; 7, were only noticed by a health professional despite the mother being present and awake.

CONCLUSIONS: SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant’s condition correctly. Closer observation during these earliest hours seems warranted.

An editorial in Archives of Diseases of the Child Fetal Neonatal Edition Unexpected collapse of apparently healthy newborn infants: the benefits and potential risks of skin-to-skin contact (2012) advises:

… it seems appropriate … to recommend that midwives check on the infant’s condition frequently during the first 2–3 h after birth, with particular emphasis on ensuring that when in skin-to-skin contact the infant’s position is safe and the nose and mouth are not occluded.

The ultimate irony, of course, is that there is no evidence that early breastfeeding or skin to skin contact has any impact on breastfeeding success. Correlation has been noted, but that is easily explained by the fact that women who entered labor committed to exclusive breastfeeding are more likely to initiate early breastfeeding and to value extended skin to skin contact than those who plan to bottlefeed. In other words, not only is one of the central tenets of the Baby Friendly Hospital Initiative unproven, but may actually lead to brain injury and death.

In a recent issue of The Journal of Perinatal and Neonatal Nursing, M. Terese Verklan, PhD, CCNS, RNC, FAAN points out that The Breast Can Be Lethal:

… I have recently heard of 2 incidences of newborns being suffocated when breast-feeding. One case involved a mother who was exhausted after feeding her newborn every 11/2 to 2 hours for the past 60 hours or so. It is believed that she fell asleep while the newborn was feeding and did not wake up until the morning. It was obvious that the baby did not survive the night. In the second case, the neonate was approximately 4 hours old when the parents excitedly summoned the postpartum nurse to check him because “he didn’t look right.” The nurse remembers seeing his legs looking mottled and dusky and that she had to lift the breast off his head and chest. He was in cardiopulmonary arrest and survived extensive resuscitation with major neurologic sequelae. Both mothers had had a lactation consultant spend some time instructing them on how to breastfeed, describing several positions to enhance latching for the baby and comfort for the mother. I believe both were being held in the football hold, but I am not 100% sure. I do know that both mothers were primiparas wanting to provide the best nutrition for these babies.

Verklan concludes:

… Given that we are using evidence-based practice interventions today as much as possible, perinatal researchers need to closely scrutinize the different practices taught to mothers and develop the science behind these “routine” interventions…

Mandated rooming in policies, encouragement of prolonged skin to skin contact, and pressure to breastfeed repeatedly and exclusively during the first postpartum days are interventions promoted by the Baby Friendly Hospital Initiative. Like all interventions, we need to examine whether there is scientific evidence to support them, and describe the harms that result from them.

Otherwise, the Baby Friendly Hospital Initiative will truly become the Baby Deadly Hospital Initiative.

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  • Cooperella

    Slightly OT: due to give birth soon at my local hospital that just received a BFHI designation. Lots of banners and posters everywhere. I am taking a tour of the L&D department tomorrow. Any questions I should be asking the tour guides? Especially in regards to the BFHI policies?

    • Samantha06

      I would ask what they do if a mom has no support person to help her care for her baby and she is unable to provide adequate care herself, ie- exhaustion/sleep deprivation, post-C/section and can’t get out of bed or tend to her baby, sleepy from meds.

    • Young CC Prof

      Definitely. Ask if they have a well-baby nursery if needed. If you don’t have someone who can stay with you 24 hours, ask what they do then.

    • OldTimeRN

      Ask them what the policy is on babies being in the well nursery if you are alone or just need a break between feeds?

      Do you want skin to skin immediately after delivery? What ever your answer is find out their policy. Don’t let them force something upon you that you don’t feel comfortable with. Ask when the baby will be weighed and assessed.

      Ask if the baby stays with you the whole time in. L&D? Does baby go for a bath while you shower and go to your post partum room? What if you are tired and Dad needs to leave?

      Use of pacifiers? They might not provide them. If you want your baby to have one I’d say bring your own.

      Ask if they have protocols in place concerning weight loss, hypoglycemia and supplementing, SNS usage if supplements are needed.(though I’m guessing they won’t be)

    • Alannah

      -Availability of respite care/well baby nursery if you should feel the need for it. Don`t be satisfied by vague or evasive answers, those are probably code for `when push comes to shove at 3 am you`re on your own`. For me, the immense sleep deprivation was the absolute worst part of the BFHI experience. Ask how they will deal with the risk of accidental suffocation presented by exhausted moms being left alone with their baby.

      – Availability of formula and which hoops you`d have to jump through to get it. Usually there is no problem if you formula feed from day 1. They tend to give BF-ing moms who want to supplement or switch a really hard time with waivers and mandatory `breast is best` lectures.

      – If this is your first baby, ask what kind of formula feeding education they have available. Handouts, bottle prep demonstration by the staff,… They have an obligation to teach you how to feed your baby, no matter which method you choose.

      – Bring a couple of pacifiers. They are banned so the hospital will not provide them but they are the best thing ever when baby is upset in the middle of the night.

  • fiftyfifty1

    Warning: I plan a long rant.

    “Bonding”–It’s such bullshit. It’s become such a THING. Everybody wrings their hands over it. This or That promotes bonding, This or That interferes with bonding. And nobody has even DEFINED bonding. What in the hell is it? It can be used as a threat or warning to make women do whatever you want because not having this magical thing sounds so bad in a scary nebulous way and the meaning can be subtly shifted. You can use it to mean Love–your baby won’t love you or you won’t love it. It can be used to imply mental illness–your baby will grow up anxious or antisocial if you don’t do this right. It can be used to mean Natural–as in you better watch out or the right natural hormones won’t kick in and you will wind up an UNnatural mother with no natural womanly instincts. It can be used to justify suffering—childless women are vain, self-centered, morally immature creatures who must suffer during the right of passage that is childbirth and breastfeeding so that they can “bond” with their infant or else I guess they will just ignore their infant to read Cosmo and go out with the other career girls for drinks, selfish bitches.

    Seriously, what the hell!? This is so misogynistic. These threats are directed exclusively at women. Men never even have to give this a passing thought. It is totally screwed up, and it is totally MADE UP!

    -end rant

    • Elizabeth A

      I agree – I’m pretty sure I’ve said it over and over myself. Bonding is totally undefined, so you can never be sure it’s happened, which makes it a source of potentially infinite anxiety.

      Human beings are mentally resilient, and they have a strong drive to form emotional connections. A person who doesn’t form such connections is either profoundly atypical, or in a situation that’s extensively conditioned them against such connections – see North Korean prison camp, or the kind of orphanage where they tape the babies’ mouths to keep them from crying. If you have a baby, and the baby is at all *capable* of forming an emotional connection, that baby will do so. (If the baby is not capable of forming such a connection, it’s not because you performed the incorrect emotional attachment rituals in the “golden hour” immediately after birth.)

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  • sb

    I was reading an article on the subject, and the advice they had was to supervise the mothers 100% of the time and to have this person repeatedly wake them up when they started to nod off. Sounded like torture to me.

    • Jocelyn

      Yeah, isn’t that an actual form of torture?

    • fiftyfifty1

      Yep, sleep deprivation literally is used as torture.

      Hint to hospitals: when a person falls asleep in the middle of doing a task or activity, it is a sign they are fairly severely sleep deprived. The answer is not to wake them up, but rather to immediately facilitate things so they can get a nice stretch of uninterrupted sleep.

    • RNMomma

      Not to mention, what hospital has the staff on hand to ensure observation 100% of the time? Ridiculous.

      • Certified Hamster Midwife

        The obvious solution would be to go back to large open postpartum wards instead of private or semi-private rooms.

        • Siri

          Yes, and if you leave all the lights on and play loud Souza marches round the clock, no one will ever doze off. You could put toast crumbs in all the beds too. Many lives will be saved.

          • Who?

            Toast crumbs!!!! What kind of monster are you??

          • Alannah

            You`re not thinking out of the box. We need to do away with the beds. Large wards with standing room only, fluorescent lights 24/7 and a marching band on repeat. After 5 days of that, every mom will tell you Elvis` current whereabouts, the loction of Al Qaida headquarters AND have a 100% exclusive breastfeeding rate. Anything to get out of there. It worked in Gitmo, so why not for BFHI?

          • Trixie

            Sousa marches and Elvis are actually my favorite genres of music. I’m probably in the minority, though.

          • MLE

            Skin to Skin Forever? Don’t Step on my Blue Suede Boob?

    • Elizabeth A

      If hospitals had enough staff to plant a nurse in each post-partum room to observe all the time, surely they would have enough staff to take the baby from mom and keep it happy until it was hungry.

  • NICU-RN

    I posted awhile ago on how our NICU has received several babies from postpartum with skull fractures resulting from drops to the floor by exhausted mothers. This post reminded me – it’s happened again! We admitted a baby with a fracture AND head bleed, the best part – he had been left alone overnight to exclusively breastfeed with his mother WHO IS DEVELOPMENTALLY DELAYED!! So delayed that our neo’s wouldn’t discharge the baby to her until she’d been evaluated by social services to determine her mental capacity. SMH!

    • Guesteleh

      That is horrifying.

    • Samantha06

      I wonder what their risk management people are saying about all that!

      • Who?

        This is such a classic case of the left hand having no idea what the right hand is doing. Sounds like that patient wasn’t a good candidate for admission to that hospital.

        Also, with the rise of mindless positivism, it can be really difficult to raise, and have taken seriously, actual practical concerns. I’m sorry to hear it is hitting medicine: there’s usually money and a bit of pride at stake in most workplaces, in medicine, it can be actual lives.

        • Samantha06

          And she certainly she wasn’t a candidate for rooming-in! It’s actually hard to believe that wasn’t addressed before she was even admitted. And, given the fact that this hospital has already had several infants with skull fractures from being dropped, it’s almost unfathomable they let this happen and with a developmentally delayed mother! I hope there will be a lawsuit over this.

  • Valerie

    Reading all of these comments is very informative! I had my 3 babies in a hospital that was in the process of implementing baby friendly practices, and perhaps it’s because it wasn’t fully implemented that I had such a positive experience. I felt like a tremendous amount of attention was paid to me and my baby, and while the nurse encouraged me to hold my last baby from the time I was in the OR until an hour after I had been in recovery, she never left my side and was constantly checking how I was feeling. She also encouraged my husband to be equally involved, and encouraged him to have some bonding time with baby so I could rest. They never pushed breastfeeding, and wanted to know if I’d brought formula or planned to BF. They gave me the option of doing all of the baby exams and tests in my room, although it wasn’t required. I’m expecting baby number 4 in May, and realize that things may be different this time around. I was pretty naive about the baby-friendly movement last time around, except that what I saw seemed pretty cool and I had a super positive experience. I can see now though that my experience isn’t necessarily the norm, and I feel badly for all those moms that are forced into an exhausting, unpleasant or even tragic situation because of new policies. Glad to have gained some perspective on the issue. I plan to ask my doc a lot more questions about the hospitals policies and her personal thoughts next time I see her.

    • Guestll

      I gave birth at a BFH and I have no complaints about the care I received postpartum. The nurses were fantastic. The hospital was austere and in evident need of funding/improvements (showers out of the 1950s, terrible, scant food, and signs of overwork among the nurses) but as for the hospital’s BFH status, it was not an issue for me, nor was breastfeeding or rooming in 24/7.

      But that was my experience and I acknowledge that this doesn’t work for everyone. Good luck with #4 in May!

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  • Christina Maxwell

    I would like to slightly adapt Alanah’s excellent post to tell my daughter’s story in a baby friendly hospital within the last fortnight.
    1. Get her in at 2 p.m on a Thursday to start the induction
    2. Put her in a six bedded ward where everybody is uncomfortable/in early labour/about to have their baby because nobody checked.
    3. Give painkillers and randomly check to see if baby is holding up.
    4. Be unable to move women to labour ward when needed due to ‘being too busy’
    5. Eventually move my daughter to labour ward at 6 p.m approx on Saturday, dilated to 4cm. Refuse epidural she had been promised ‘too busy’. Epidural finally given at 10 p.m and 8cm.
    6. Watch labour progress very slowly.
    7. Have a panic at 2 a.m. Baby showing signs of stress. Call OB, extra epidural juice, neonatal team etc etc. Roll daughter round bed, don’t tell her what is happening. Do tell her you are getting the giant salad tongs out (Neville Barnes forceps) thank God it is consultant OB doing forceps. Episiotomy, baby out, remarkable job, not a mark on her. Daughter starts bleeding. Consternation in the ranks. Bleeding stops, she’s lost a litre so no transfusion.
    8. Moved up to post natal ward eventually and that’s when the brown stuff hit the air circulating machine. Dazed, exhausted daughter and son-in-law left to themselves – as much as that’s possible in a 4 bed ward where everybody else is asleep. Son-in-law chased out, daughter commences weeping and trying to get tired new baby to latch. No chance in hell that’s going to happen and no nurses available to advise. Baby not bothered, daughter very bothered and unable to sleep due to ward being heated to 9000 degrees F. She spends the rest of the night fretting.
    9. SIL arrives next morning to find hysterical wife, crying but still sleepy baby and a bitchy midwife asking why ‘baby hasn’t managed to feed yet’. Cue hand expressing as pump not available till next day. Not a success.
    10. Rinse and repeat for all of Sunday and most of Monday. We visit on Monday and commence operation cheer up and support which works great till we leave…. the minute we are out the door evil midwife descends and tells daughter that it’s pathetic that she can’t feed her baby and that she obviously isn’t trying hard enough. Daughter (with husband’s and my support) signs out AMA at which point the threats start. “Your baby will lose too much weight”. “You can’t look after her properly”. “You are not even trying”. “You’ll just have to come back into hospital so why are you bothering to leave?”
    I don’t even know what I am trying to say here, except that thanks to baby friendly and worship of the holy breastmilk my daughter is worn out, shattered and distraught. She feels like she has failed her daughter because her milk pretty much dried up in a week. Evie (the baby) is fine, she loves formula. My daughter will get there when she’s had more sleep etc. My son-in-law is spitting tacks and so am I. Her step father has murder on his mind.
    It’s such a bloody shame, daughter reports that the staff in the induction and labour wards were lovely, as was the OB. She is making a formal complaint about the staff on the post natal ward and I will be fully supporting her. Sorry to go on so.

    • Samantha06

      OMG, the poor thing! I hate BF hospitals..

    • Young CC Prof

      What the heck is wrong with these people who don’t know the basic biology of lactation? Who declares a breastfeeding mother a failure at 2 days postpartum? No sane person! You give the baby a small bottle if needed, then try again. And of course a difficult delivery and hemorrhage will delay things further.

      Heck, she might still breastfeed just fine if she wanted to, I bet her milk just hasn’t come in YET. But after all of that, I doubt she wants to!

      • Christina Maxwell

        That was about the first thing I said to her! It did come in, on day 4 but not very much. She tried combo feeding but has just decided (11 days PP) to stick with formula. She is more relaxed, Evie is loving it and things are more settled generally, thank goodness. Her husband (who was quite pro BF) is also loving giving Evie some of her bottles.

        • Kelly

          I am so glad she had her family supporting her in order to get her back on her feet and doing what she needs in order to welcome her new baby. It is sad that behind the scenes, she was treated horribly by the people who should have known better.

    • Sue

      What a destructive environment!

      Without wanting to excuse poor professional behavior, that also smacks of an over-stretched/under-resourced workplace with frustrated staff, unable to live up to organisational imperatives.

      • Christina Maxwell

        Funnily enough Sue that was exactly the situation in the ward where she was induced and in the labour ward. My daughter understood that and was appreciative of the efforts the staff made there. She described them as “professional, kind and run off their feet”.There were numerous staff in the post natal ward, most of them seemingly with very little to do except be unpleasant.

    • Joy

      Is this in the UK? Am I your daughter? I guess I didn’t check out AMA and my baby did wind up getting dehydrated on the ward and needed an NG tube. No one listened when I said she wasn’t feeding. Good on your daughter for getting out.

  • American living in NL

    The Netherlands not only encourages home birth, they are baby friendly for those who choose to give birth in a hospital. After a 40+ hours labor I was sent home with baby just 4 hours after giving birth. The day nurse who would stay for 3 hours a day wouldn’t be arriving for another 6 hours. At home my son started vomiting amiotic fluid. We were new parents at home alone without a clue of what to do. But yes, I was able to spend a lot of quality time with my newborn.

    • FormerPhysicist

      That doesn’t sound very quality to me. In fact, it sounds horrifying.

    • Jocelyn

      Ugh, how scary!

  • RSM

    I sure hope the BFHI and 24/7 rooming in will go the way of the mandatory epistiotomy, forced shaving and enemas.

  • Amy M

    Dang, I was just at the obgyn for my annual, and I forgot to thank her again, for her excellent care when I had my boys, and for the great non-BFHI hospital care I received too. Whenever threads like these pop up, I am grateful all over again. It is amazing and awful, the shit new mothers are subject to in the hospital–in the hospital!–and then they go home and get bullied by frenemies and online-sanctimommies. Every time I hear of a friend or family member getting pregnant, I warn her about this crap.

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  • Alannah

    So what these baby friendly hospitals do to women is basically:

    1. First have them miss a night`s sleep (labor and birth will do that)
    2. Put them in a bed
    3. Give them pain meds, aftereffects from anesthesia, and antiemetics
    4. Put baby right next to them 24/7
    5. Tell them to breastfeed all night long whenever baby gives a peep
    6. Tell them to let baby suck on a bone dry breast for hours
    7. Withold formula
    8. Leave them alone
    9. Keep this up for entire duration of hospital stay
    Big surprise: these moms fall asleep! With their babies at the breast!
    I wonder what the BFHI geniuses were expecting when they devised this cunning plan.
    There is only one possible solution to this problem on planet lactivist: blame and shame the mothers! How dare they need sleep to function. How dare they use pain relief. Good moms stay awake for the full five days and don`t even take as much as a Tylenol.

  • anh
  • GiddyUpGo123

    The idea that this is “baby friendly” is total BS. It’s “budget friendly.” For the hospital. And this idea that it promotes bonding and breastfeeding is just a very, very convenient excuse for doing away with the baby nursery and therefore cutting back on staff and bottles/nipples and other expenses. Hospitals like baby friendly because it’s good for their bottom line.

    • Cobalt

      I guess doing away with the evil collaboration with formula companies was a false economy.

      • SporkParade

        They’re still doing plenty of collaboration with all the other evil baby product companies. Admittedly, I am outside the grasp of the BFHI, but I still got plenty of swag at the hospital, including a receiving blanket emblazoned with the logos of both the hospital and of Pampers.

    • rachel

      My hospital has received Baby Friendly designation. It was initiated by one of the few family practice docs who does obstetrics and spear-headed by several of the labor nurses and lactation consultants. Hospital administration had nothing to do with it. Our normal nursery had already been closed and babies that didn’t warrant admission to the Level 2 nursery were kept at the nurses’ station. To my knowledge, we had to pay several thousand dollars in application fees as well. While I’m no Baby Friendly fan (both as a patient and an ob/gyn who practices on the unit) I wouldn’t say there has been any financial motivation behind it. If anything becoming Baby Friendly has actually hurt our bottom line (no more free formula but still plenty of moms who opt to formula fee so that comes from our budget, have to make our own “goodie bags”, etc).

      • CrownedMedwife

        I’m embarrassed to admit to being a part of a movement during my time in administration to achieve BFHI shortly after the first few US hospitals received accreditation. In retrospect I’m relieved the bottom line reached a hard stop when purchasing formula was discussed. My own personal hard stop occurred when it had been suggested that RNs would keep watch over newborns at the Nurse’s Station rather than a newborn nursery. How is there any safety in keeping newborns at a Nurse’s Station (when there is a perfectly capable and available space formerly know as NB Nursery just down the hall!), precluding RNs from doing their jobs and more importantly, without suction or O2 when emergencies arose? This, along with so many other components of BFHI isn’t serving the best interests of hospitals, staff, parents or infants. I agree, BFHI doesn’t do anything to improve that bottom line or much else.

    • gingergirl

      BFHI accrediation is about as useful as LEED standards in architecture. It’s mostly about posturing and getting prizes. The intent was good, but there isn’t much follow up or care for the people or buildings. Bad design kills – it kills people in buildings and it kills people inside bodies that weren’t optimally designed as well. My body was not designed to carry a baby to term in an optimal world. It took more than a few tries and many failures. My body was not designed to pass a child through my vagina. My body was not designed to breastfeed. I didn’t know the last two until I already had babies. We worked it out and it was wonderful after we worked it out. Do I get a certificate now?

  • Elaine

    I kept both my babies with me even though there was a newborn nursery available, but I had relatively easy labors so wasn’t TOO, too worn out, wasn’t on any painkillers stronger than ibuprofen, and also had my husband with me in both cases. I’m glad I had the option to do this, but I think everyone should get the choice, not be pushed/coerced/forced one way or the other. Quotas for health care drive me so bananas. Their only function is to tell providers that X is the standard, which maybe it’s nice for providers to know the value of X, but you have to treat the patient, not the quota.

    And while I’ve done a lot of sleeping semi-reclined while nursing when my kids are a bit older, I was really trying not to do so in the hospital, and regardless I did fall asleep once nursing my son in the hospital bed and woke up with him under my breast. I remember having the thought process of “I just went to all this work to have this baby and now I’ve suffocated him”… thankfully, he was fine.

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  • Eskimo

    Dr. Amy… I’m reading the new Amy Poehler book and she totally takes apart the natural childbirth loons. Go get a copy!!!! Funny stuff!!!

    She says she could barely go to the movies without getting stoned, why on earth would she have a baby without drugs?!?! So funny.

  • expat

    One of the nurses where I delivered 3 times had perfected the, “look who doesn’t want her baby” look, whenever a mom asked for her help, in order to sleep. She held newborns like footballs or pushed them around in bassinets while she took care of her other responsibilities and always looked put upon. There were probably 10 or 20 nurses who worked there, but I recognized her every time. She served as evidence of a culture problem and a staffing situation which cut too many corners.

    • MaineJen

      Umm…..?

    • guest

      It’s really disturbing to hear this kind of comment regarding nurses. Especially your comment regarding the “look”, it sounds demeaning and stereotypical. I agree that there are culture and staffing issues in nursing and I have seen them over and over in many hospitals. However nurses are on the front lines and have to please the public who tend to blame them for policy decisions over which they have no control and are forced to abide by. There are lots of nurses who post on this blog too, so please remember that when you make comments.

      • auntbea

        Huh? She said she could recognize her out of 10 or 20 nurses. Obviously she was an anomaly. How is that stereotyping or demeaning nurses in general?

    • Cobalt

      There is a wide range of attitudes and ideologies among nurses, same as any other group of people. There are some who be willing to bend or break “baby friendly” protocols in the interest of actual good care, and others who actually advocate for “baby friendly” policies. Being the front line of patient care, they can really make or break your hospital experience.

  • TsuDhoNimh

    I have an idea …

    Before any hospital can implement the BFHI, the entire administration and anyone else who wants to implement it has to spend a month wearing one of those fake pregnancy suits, with lots of fluids at night so they HAVE to get up to pee, then spend 8-24 hours** with severe cramping (I know some legal herbs that can do it for them if they don’t want the electrical stimulator) while they are working out in a gym with increasing intensity.

    Then they spend the next 8-24** hours with one of those fake babies set to be super clingy – It will screech if it senses loss of skin to skin contact and screech if it isn’t continually rocked. Your nurses will be channeling Nurse Rached or Florence Nightingale**

    You will have visitors and medical staff** coming in to talk to you and noting your answers.

    With a suction pump** on an automatic cycle attached to their nipples to emulate that ludicrous idea that incessant nursing in the first day is essential … because an adult male has about as much milk as a PP in the first day or so.

    At the end of this qualifying experience, remind them that they have to go through it every year to keep the certification active. Because what’s sauce for the goose, etc.

    ** The time intervals, pump pressure, nurse personality, and number and style of visitors and staff is generated by a random number generator.

  • Sara M.

    Breastfeeding is exhausting all by itself! Those early days are so tough as it is. I remember being disappointed when an nurse told me they don’t come home with us! What!

  • Bomberjacket

    OT

    I am 24/25 weeks pregnant and took my blood glucose reading with a home meter a few times just randomly during the day (not fasting) and got readings between 175 and 245 and other times normal readings like 93 and 115. Assuming the meter is working properly is it possible to have sugar spikes that high and NOT have GD? I was told 2 readings over 200 is a diagnosis for type 2 when I was taking care of my grandmother. Idk if gd is different.

    I’m doing the 1 hour test tomorrow. I have failed it with all 3 of my other pregnancies, but always passed the next one. This pregnancy though I’m feeling sick and measuring 29 weeks (never measured large in any pregnancy either).

    If I pass either test I’m just wondering what could cause such high readings if not GD so I can avoid or treat that and not feel do crappy.

    Obviously will talk to my ob, just fishing for answers until the apt.

    • Therese

      Yeah, assuming the monitor is accurate I think that you must have GD. I don’t think there can be any other explanation with readings that high.

    • Who?

      Take care of yourself, hope it goes well.

  • OB Doc

    As the chief of OB at my hospital, I have it as my mission to avoid the BFHI entirely. I’ve been able to shut down talk of it on at least three occasions when administrators have suggested pursuing it. I have the full support of all our OBs and peds. I just cannot sign onto something that a) essentially negates the *fantastic* work we are already doing on L&D by implying that it’s not BF just because we don’t jump thorough some adminstrative hoops and b) is but another way to shame new mothers into doing something for idealogic reasons rather than based on medical evidence and what is best for their families. Ugh! It really irks me.

    • NatashaO.

      I hear you. For me, I have to live with it. Now I just try to find ways to soften the harsh edges, and continue to provide safe, respectful and caring support to new moms/families. It will be interesting to see how this whole BFHI thing plays out over the next 5-10 years.

      • Anj Fabian

        I think in the states, it will stall out and probably reverse.

        We have four major health care organizations in our city and to my knowledge, none of them have adopted BFHI.

        • guest

          I hope it does stall out and reverse. My only concern is that they’ll re-open a nursery, but not increase staffing levels. I’ve worked in both BF and non-BF and I overwhelmingly preferred the non-BF with a fully staffed well-baby nursery.

  • NatashaO.

    So I work at a Baby Friendly hospital, and we will take the baby to the nursery if there is any kind of safety issue! This is left to the nurse’s judgement… there is no policy against doing it- it is just documented as a safety issue. In fact, we don’t allow moms who can’t get up on their own safely to have the baby in the room (other than for awake/breastfeeding times) unless they have a support person that is willing and able to take care of the baby… Does any one else work at a baby friendly hospital who could chime in on their experiences with this?

    • guest

      I’ve worked in two BF hospitals and neither had well-baby nurseries. It was mandatory rooming-in and horrible for new moms. I can see why hospital administrators would love it, it’s a great cost-saving measure. But like all these crazy policies, it will end up costing them more in the long term.

      • NatashaO.

        It actually did not change our staffing on our unit… as we never had dedicated ‘nursery’ staff. But I could see how at larger hospitals it could change the picture.

        • guest

          You’re lucky. I actually worked in such a unit several years ago. It was an LDRP, but we still had a well-baby nursery. We didn’t have a designated nursery nurse either, so whoever wasn’t particularly busy at the time watched the babies in the nursery. Most of our moms preferred rooming-in, but we were able to take their babies if they wanted to sleep. It worked out really well.

    • rh1985

      I don’t work at a hospital but I delivered at a hospital trying to get the certification. They still had a nursery. They took FF babies there without issue. My daughter was FF so it worked great for us. She was in my room all day then spent the full nights in the nursery where the nurses fed her and I got the rest I needed to recover from my c-section. However I’ve been told by BF moms that delivered there that they are VERY reluctant to take BF babies to the nursery even if the mom is feeling very sick, exhausted, etc.

    • rachel

      No well baby nursery on my unit either, but it was closed prior to becoming “baby friendly”. Now it’s just a storage room. However, we occasionally turn one of our labor rooms into a “withdrawal” room so that we can put all of our babies that are withdrawing from meth and opiates with one very unfortunate nurse. Otherwise, once there are 4 or 5 withdrawal babies in the Level 2 nursery it becomes hard to properly care for the 33 weekers, etc. Babies that aren’t admitted to the Level 2 nursery are encouraged to stay at the bedside no matter what. If the parents insist they hang out at the nurses’ station with whoever can keep an eye on them. I’ve been known to spend a busy night rocking or feeding a fussy baby between deliveries because the nurses are too busy (I’m an ob/gyn). The so-called support person…that’s a joke in my “Baby Friendly” hospital.

      • Young CC Prof

        4 or 5 withdrawal babies… that sounds exciting.

        • rachel

          Yeah, it’s awesome. And I’m supposed to be concerned with breastfeeding rates. I’m spending most of my time trying to get women to stop smoking…everything. Luckily, we generally have one, maybe two babies withdrawing at any given time. It’s only at the really busy times (maybe twice a year) that there are 4 or more. I practice in an average community in the Midwest. I read recently that 1 in 5 babies born in Louisville (1 hour south of me) are addicted…primarily narcotic abuse.

          • The Bofa, Being of the Sofa

            How were the leaves this year? 😉

          • lawyer jane

            That is so sad! Do they get held? I would volunteer to hold them.

  • poop on dr bitch amy

    Do you not see the problem is that women are given too much sedation and pain relief? The problem isnt BFing-and-take-care-of-your-own-kid, its that dr’s and nurses arent checking as often as they should on the mothers who were given meds for pain or something else that knocks them out. They are responsible for this, and are being neglectful causing deaths of infants.

    • CrownedMedwife

      Nonsense. I’ve had three easy, fast unmedicated births. My first two children were delivered before the rooming-in concept or lactivism were widespread. Babies came in to nurse at night and I went home well rested and capable to take on role as new breastfeeding mother.
      Third baby came along and we roomed in. After 36 hours without sleep and a baby nursing continuously during the previous four hours, I pushed my baby in the bassinet all the way down to the nursery donning my lovely easy access nursing gown for a few hours of respite. When I arrived at the nursery, a dear friend and nursery RN said “Well, now don’t we look fancy? Here’s let’s help put them away and I’ll take the baby for awhile.” I looked down in horror to realize that while I thought I had it all together, both breasts were dangling thru the easy access slits of my nursing gown and I had just paraded down a hallway full of my own patients and coworkers essentially topless. Sleep deprivation will do that. I was a much better and more concealed mother after a few hours of much needed rest. Narcotics didn’t do that, exhaustion did. I’m just grateful my little peep show was the worst of it and my baby didn’t suffer from the dangers of an exhausted mother with a suffocated baby at the breast.

      • CrownedMedwife

        ETA: Providers checking in enough does nothing to prevent an event that takes moments and far be it from a mother being pushed into the fallacy of the benefits/expectations of continuous rooming-in. They’d decline on fear of shame for not doing ‘the best’ for their baby. Little do they realize, most of the other mothers around them are just as exhausted and in need of rest/newborn assistance. The BFHI just makes mothers hesitant to admit to it.

    • KeeperOfTheBooks

      Right. Because I know I’m a much better mom when I’ve just had major abdominal surgery a few hours ago and have no pain relief.
      I assume, of course, that you forgo all analgesia for any surgery you may experience?

    • Mariana Baca

      It is not just sedation. Being too tired from not sleeping is also a risk factor for suffocation — you can’t really tell moms to be “less tired” after not sleeping and laboring for ages. Checking up on them while they sleep is also not going to encourage rest.

      • poop on dr bitch amy

        just like checking up on them during labor is not going to encourage labor? hmmm. Its the nurses job to frequently monitor patients to prevent disasters like these. Otherwise face court.

        • guest

          And, what, pray tell, are the nursing staff to do when a mom is really tired and the baby won’t stop fussing? There’s nowhere to send the baby and I guarantee you that in 99% of the cases the nursing staff cannot babysit you’re baby for you if they haven’t been staffed for it. They have other patients to monitor and take care of. You’re missing the point.

          • Guest

            I think we’re all missing the point. Do you know what your point is?

          • Guest

            Ok, my disqus is all screwed up and that comment originally showed that it was from poopy. Which was just making me EXTRA confused because he seemed to be contradicting himself left and right. Now that I see that he didn’t leave that comment, I apologize for this one and wish I could delete it!

          • guest

            Oh haha! Well, there’s my point 🙂

          • guest

            Lack of staff and well baby nurseries to look after the babies of tired moms results in dangerous sleeping practices that lead to infant deaths. Boom. Your turn.

          • Guest

            Read my comment below. Stupid disqus is messing with me.

        • Guest

          One of these disasters can occur in a matter of a few minutes. How long would it take for a baby to fall off the side of a bed if they were bed sharing and mom fell asleep and baby rolled out of her arms or off the side of the bed? SECONDS. Are you seriously trying to imply that a nurse should be constantly stationed in every room?

        • Mariana Baca

          The patient, in this case, would be the baby. Which can be checked in the nursery if mom cannot safely cosleep.

    • Spamamander

      Yes, I know I was totally bright, chipper, and wide-awake after being in labor for 19 hours.

    • Mariana Baca

      Also, a mom who labored with an epidural *may* have had a chance to nap. And an epidural is non-sedating. The case quoted above makes no mention of sedation, only of exhaustion from constant breastfeeding. You don’t need drugs to feel exhausted after being awake for amost 60 hours, with brief naps.

      • Spamamander

        That was the dog-send of my epi, I needed to sleep, badly. I had it just long enough to take a nap, which relaxed my body and allowed me to finish dilating. I woke up ready to push, the epi was permitted to wear off, and I was able to birth with renewed energy.

    • guest

      I see Mr. Poopy is back..

    • Stacy48918

      Ummm….you’re an idiot.

      Poopyhead.

      • guest

        After his last disaster commentary on the other post, you would think he would have enough smarts to change his screen name.. dumb, dumb, dumb…

        • Stacy48918

          There’s really no point in arguing with him. He’s an absolute closed-minded moron. It’s much more fun to poke at his name. Stupid silly little poopyhead.

          • guest

            For sure! Hopefully everyone else will realize what a poophead moron he is and steer clear. The poopy little troll! lol!

        • auntbea

          Poopy is a dude? (I haven’t be around much lately.)

    • PrimaryCareDoc

      “Do you not see the problem is that women are given too much sedation and pain relief? ”

      What is “too much” pain relief???

      You want women to be in pain. Ergo, you’re an asshole.

      • Bombshellrisa

        Yeah, that ibuprofen they offer just sedates women into a coma.

        • Cobalt

          If pain is the only thing keeping me awake, ibuprofen knocks me out. As it should.

          There’s no reason for moms to suffer in that dark space between pain and collapse for the sake of breastfeeding.

    • moto_librarian

      You know what? Screw you. After my first delivery, I was so weak from blood loss that I passed out on the toilet. I was also in severe pain from a cervical laceration and 2nd degree tear. I gladly took oxycodone as it was the only thing that took the pain away enough to allow me to sit up and attempt to nurse. It amazes me that plenty of hospitals would leave me to care for my infant in this condition for 23 hours a day.

      • poop on dr bitch amy

        I agree with the last statement- thats why i said its the nurses responsibility to monitor for these problems as they administered the meds, and its their job to monitor for random problems.

        • moto_librarian

          Do you really not understand how BFHI gives hospitals incentive to cut nursing staff by doing away with infant nurseries? Yes, nurses should be supervising patients closely, but when their numbers are cut, this is what happens. It is not that women are being given too much pain medication.

          • guest

            Don’t waste your energy trying to discuss anything with this idiot. He was commenting on another post last week and he seems to be just a troll trying to rile people up. I can’t remember which one it was, but his comments were insane. He can’t be reasoned with.

          • Amy M

            Let’s say a hospital did use this as incentive to cut pain med use,of opiates. So now you have post Csection moms in agony, no more able to care for their babies than when they were too sleepy with painkillers. Hopefully this will be obvious, and no one will even go there. And as has been pointed out, epidurals aren’t going to make people drowsy, so cutting those out could lead to more exhausted moms who didn’t get any rest during labor. Some of whom might be traumatized by the pain, too. Any hospital that tries this is highly unlikely to see any uptick in successful breastfeeding numbers and definitely not in patient satisfaction.

        • RSM

          And what are they gonna do with a baby when mom is obviously to dangerous to help now that there is no nursery and not enough staff?

    • guest

      Not me. I took ibuprofen, that’s it. Yet, I was in labor for close to 2 days with maybe 4 hours of sleep. When I finally kicked into active labor I went from 3cm to complete in less than 3 hours and lost a lot of blood (but not enough to qualify as a hemorrhage). By the end of the first day I had had 5 hours of sleep in 48 hours, a rough delivery, and was nursing on demand (fortunately he only started fussing every 2-3 hours). I was at a hospital with no well-baby nursery and my husband was sick and had also been up 48 hours. I wouldn’t let ANYONE in that sort of state (mine or his) watch my children. NEVER.

      Thank goodness our nurse took pity on me when my baby refused to sleep and offered to take him with her. Otherwise I shudder to think what might have happened. I’m almost certain I would have fallen asleep in the bed with him. I actually know very few moms that have needed anything stronger than ibuprofen and those that did really, really needed it. Taking away much needed pain medicine is not the answer.

      • poop on dr bitch amy

        haha i never said it was. i said since they were administered, and theyre causing the mother to be out of it enough that she cant keep her kid safe, its the nurses responsibility to watch them.

        • guest

          But what are they supposed to do if they sense a problem? Where do they send the baby? If the units aren’t staffed to take care of the babies of exhausted moms then mere observation certainly isn’t going to solve the problem. While Nurse A is in “monitoring” Patient B, who then is monitoring Patient C if they’re both exhausted? What happened when there’s a whole floor of exhausted moms? This is exactly how these babies are dying. It’s lack of staff that causes the lack of monitoring.

        • Serenity

          It only takes four minutes of no oxygen for the baby to be brain damaged. There’s no way a nurse could check often enough.

          I am really glad this problem is being highlighted. I had my first baby in a hospital without a nursery, had a near miss experience the first night, caused by lack of sleep for me, narcotic pain meds, inexperience with babies and breastfeeding, and full breasts that blocked her little nose. If my mom hadn’t been sitting next to me to notice her turning navy blue, I would likely have one less child today. I didn’t notice. I still feel horribly guilty about it.

        • Who?

          Here you are with your compassionate, thoughtful words again, podba.

          Funny how the acronym is less stupid than the name, it’s usually the other way around.

        • rh1985

          which is why it makes sense that when the moms are too out of it to watch the baby safely, that the nurses can take all the babies to one room, and watch them, and when they wake up hungry, if mom is BF, they can take the baby back to mom to feed and only have to individually watch them during the feeding, then if mom still can’t stay awake they can take the baby back…

          Oh wait… they used to do that yet people like you campaigned to try and not allow that anymore

        • Sarah

          You sort of did when you said ‘the problem is that women are given too much sedation and pain relief’ actually. If you thought it was fine for women to have both and the only issue is that medical professionals aren’t performing enough checks, you wouldn’t have referred to the use of pain relief and sedation as ‘the problem’.

    • The Bofa, Being of the Sofa

      Nah, the problem is that doctors and nurses aren’t coming in to slap the mothers often enough. If they’d just knock them around a little, that would keep them awake.

    • Jocelyn

      You know my experience that I wrote about below? No medication during labor. Only ibuprofen afterwards. And still in an exhausted, dangerous, my baby could have gotten seriously hurt situation.

    • KarenJJ

      That’s true. Severe pain could keep a mother more awake post-birth. Delaying the inevitable sleep crash for a few days more could mean that these deaths are recorded as home deaths and not hospital deaths. Win-win….

      • Who?

        Nah, podba would prefer deaths in hospital to prove how bad and dangerous hospital is.

        Oh and podba don’t bother coming in all outraged…

    • Kq

      Hi there.

      Fuck you.

      Signed, a mother who CHOSE and NEEDED pain meds, who was tired from being awake for three days straight, and who is thankful daily that her child is healthy, happy and undamaged by the stupid and heartless “baby friendly” policies where he was born.

    • rh1985

      Agreed with Kq. F you. I had surgery and was recovering from pre-eclampsia. I needed pain meds and I needed sleep to recover so I could care for my baby when we left the hospital. Human mothers were never intended to provide 24/7 care completely alone from birth. If you are so pro natural you should know that. Female relatives always helped new moms.

    • anh

      too much pain relief? are you freaking serious?

    • Mishimoo

      No, just no. I lucked out and my labours weren’t as bad as my period pain, so I didn’t need pain relief BUT anyone that does feel that they need it should have easy access to safe pain relief. They should also have access to assistance with bub if they want it, without being shamed.

    • theadequatemother

      It’s not too much sedation and pain relief. Pain relief is a basic human right and pain scores are the “fifth vital sign” according to the WHO. It’s a failure to adequately monitor women receiving pain meds and a failure to appreciate the contribution of sleep deprivation and the draining but physiologic demands of labour. After sedation or general anesthesia we tell patients not to drive or sign any legal documents for 24 hrs. It boggles my mind that women in the same condition after delivery are considered fine to care for a newborn.

      In addition, the ability of physicians to make decisions and their reaction time after a 24 hr shift is equivalent to the legally drunk. Postpartum women are not different if they’ve been up that long due to labour. In fact the time threshold may be shorter because of how draining and intense labour often is.

      If hospitals don’t want to care for newborns or can’t care for them they they need to discharge them. Because as long as they are admitted patients the hospital is liable and responsible.

    • Jessica Nye

      I’ve had 4 babies, and was definitely the most exhausted after laboring WITHOUT an epidural.

    • Rabbit

      This is not just a problem of over sedation.

      I had quick, easy labors, and did not have an epidural. I was on nothing stronger than tylenol after the births. All three were scheduled inductions, so I was as reasonably well rested as a 9-months pregnant woman can be when they started in the morning. Still, by midnight of the night each baby was born, I was done. I could not have safely cared for my babies the rest of the night.

      I will be forever grateful to the nurses who kindly suggested that they take the baby with them after a feeding session around midnight, to do tests/give a bath/something else they made up so I wouldn’t feel guilty about not rooming in around the clock, and then didn’t return the baby until 4-5 hours later. I got a good chunk of sleep, baby was cleaned and loved on by alert, competent adults, and we all were in a better place the next day.

      • !!! I Ewana Parks Post This Testimony Coz My Husband Is Back Thanks To Dr.Ukaka

        My Name is Ewana Parks..I never believed in Love Spells or Magics until I met this powerful man called Dr.Ukaka. My husband divorce me with no reason for almost 3 years and i tried all i could to have him back cos i really love him so much but all my effort did not work out.. we met at our early age at the college and we both have feelings for each other and we got married happily for 4 years with one kid and he woke up one morning and he told me he’s going on a divorce..i thought it was a joke and when he came back from work he tender to me a divorce letter and he packed all his loads from the house..i ran mad and i tried all i could to have him back but all did not work out..i was lonely for almost 3 years…So when i told the spell caster what happened he said he will help me and he asked for her full name and her picture..i gave him that..At first i was skeptical but i gave it a try cos have tried so many spell casters and there is no solution…so when he finished with the readings,he got back to me that his with a girlfriend and that his girlfriend is the reason why he left me…The spell caster said he will help me with a spell that will surely bring him back.but i never believe all this…he told me i will see a positive result within 24hours..24hours later,he called me himself and came to me apologizing and he told me he will come back to me..I cant believe this,it was like a dream cos i never believe this will work out after trying many spell casters and there is no solution..The spell caster is so powerful and after that he helped me with job promotion spell 3 days later i was promoted at my place of work..Now we are very happy been together again and with our lovely kid..This spell caster has really changed my life and i will forever thankful to him..he has helped many friends too with similar problem too and they are happy and thankful to him..This man is indeed the most powerful spell caster have ever experienced in life..Am Posting this to the in case there is anyone who has similar problem and still looking for a way out..you can reach him via email:freedomlovespell@hotmail.com contact him on his website address: freedomlovespelltemple.yolasite.com

    • RSM

      Oh you are back, how classy.
      And of course you missed the point entirely.

    • araikwao

      Oooooh, I am infuriated by this comment! As I have shared before, I was thoroughly under-medicated post-partum after an excruciating unmedicated birth, and utterly exhausted from being up a couple of nights in the hospital. Breastfeeding and taking care of my own kid was extremely difficult due to the LACK of analgesia, not the overuse. I thank God I didn’t fall asleep on my baby.

    • PODBA, do you know who you remind me of? The Phelps family in Topeka, Kansas. They protest every event from funerals to concerts, waving their “God Hates ____” all over the place. They are extreme, but they aren’t real. They’re a show, a circus, an act. They have one goal…to piss people off enough that they’ll act in anger, giving them the opportunity to pounce…legally….and make a dime or two.

      In a way, that’s what you’re doing, right? You’ve got this extreme name that surely you understand makes you un-credible by default, and you make these ridiculous statements knowing that many of us are going to get angry and fire back at you.

      Good people, the only way to make the circus stop is to not feed the animals. I propose cerebral warfare in the most basic form….silence.

      Let’s not waste our time and energy attempting to reason with PODBA. Nothing is contributed by this person, and it’s simply a waste of precious energy that could be directed towards something meaningful.

      PODBA, I refuse to even skim your comments from here on out, and I hope others will join me. Poof! You no longer exist.

  • KeeperOfTheBooks

    *sigh* As usual, hindsight is 20-20. I really resented that Indian (from the continent, that is, not Native American) nurse who kept pushing formula and kept offering to take DD for an hour or two, or even just long enough for me to get a nice, hot shower. To my mind, she was OBVIOUSLY trying to sabotage our breastfeeding, and OBVIOUSLY she just wanted to cuddle my baby.
    The formula suggestion totally wasn’t made because DD was losing weight at an abysmally fast rate and that nurse had her priorities in order, having, unlike the white and fairly privileged LCs, seen babies die of malnutrition. The watch-her-while-I-shower offer wasn’t made because I just plain smelled from all the night sweats associated with losing 15-20 pounds of water weight in three days and might feel better if I were clean. No, it was all a Nefarious Plot by the Medical Establishment to Ruin Everything! *rolls eyes*
    Now she’s one of the ones I want to send chocolates to, and when the next kiddo comes along, I’m totally requesting her as my nurse. There were some other good ones, don’t get me wrong, but she was one of the best.

    • Ha, after I went home with my baby (years ago) about three days later I began wandering the house to try to figure out the source of “that weird smell”.
      After a while I realized it was me. OOPS.
      But this BFHI thing is really horrifying and perplexing to me. My son is 18, and I recall specifically I was not allowed to be alone with him because of fears I would pass out and drop him right after giving birth. Granted, I was somewhat unwell, but still.
      After you give birth, there’s a reason you stay in the hospital, right? It’s because you’re not totally up to par, right? So there’s some expectation you may be in some way physically impaired, right?
      So why would any responsible hospital staff leave a newborn with someone who may possibly pass out or be ill in ways that have not yet be determined? A new mother is, for all intents and purposes, in that vague medical state called “under observation”. Am I right? IANAD.

      • Samantha06

        And, the hospital staff don’t have a choice but to leave the baby with the mother as there is no longer a staffed nursery in these so-called BF hospitals. It’s a situation of the hospital’s making that is putting moms and babes in jeopardy. I think the only way this will change is with enough pressure from the public and some serious injuries and/or deaths.

  • GuestWonders

    Does Baby Friendly actually *require* 24 hour rooming in, or does it require that it be *allowed*. In other words, *allowed*, in that the hospital does not have any policy/practices that preclude it? I know some hospitals have taken this to the extreme, and stick to the former, which is unfortunate. There should always be a safety net for moms who need it. Safety and respite are important. What do people think dad/partners role is in this equation? It does not seem to be mentioned much in this discussion…

    • Elizabeth A

      I think it has to be assumed that the person in the hospital may not have an available partner.

      I love dad/second parent involvement. I think it’s awesome. But I don’t think it’s appropriate for hospitals to shift the burden of patient care onto a standyby family member. Not everyone has one of those, for starters. Maybe dad is elsewhere – on deployment, at home with a toddler, skipped town months ago, working to maintain health insurance, having health problems of his own, or deceased. So no one should be making plans on that guy’s involvement without consulting the mother, and consulting him.

      • KeeperOfTheBooks

        Couldn’t agree more, but the assumption I’ve seen seems to be the opposite: not only will dad/other parent be there, but he’ll be able to change the diapers, help mom in and out of bed, help baby latch on, etc. Not always a valid assumption, to say the least.

        • Awesomemom

          I got the stink eye and a lecture from a night nurse when I dared ask her for help with nursing my youngest son. I was using a nipple shield and a sns to feed him and needed like 20 hands. She wondered out loud where my husband was and why he wasn’t here to help. If I hadn’t been so tired I would have ripped her a new one. He was watching our two older kids because the csection ended up being sooner than anticipated and our child care aka grandma and grandpa had not arrived yet.

          • Elizabeth A

            What a jerk that nurse was! I’m so sorry.

      • Cobalt

        Even if he is there the whole time, it means he’s been there, probably awake, the whole time. The support person didn’t deliver the baby, but has been supporting their loved one through labor and delivery. They’re tired too. Moms need 24/7 available support postpartum.

    • GuestWonders

      I guess I just find this push back against rooming in very interesting, since when I had my kids years and years ago, neither hospital had any sort of ‘nursery’, so there was never an expectation that the baby could go anywhere while I slept. However, I had a good support person with me. I think the pendulum will probably swing back to somewhere in the middle, which seems like the most reasonable place to be?

      • KeeperOfTheBooks

        It would be nice. I’m all in favor of more options. I’m not against rooming-in, you understand, just against having moms in a position where they’re risking baby’s life due to no respite care.

    • Amy M

      Dads and partners are all well and good, but not all women have them, and some have children at home that need minding. So the hospital should not be counting on dads/partners to pick up their slack. Not to mention, if the dad/partner was there for the whole labor/delivery, he/she is probably just as tired.

      • Kelly

        Even the support needs sleep in order to help out the mom. My husband stayed with me both times and it was just as important that he got some sleep as well. The night nursery really helped us.

    • Ceridwen

      From the criteria hospitals are expected to meet for BFHI in the US: Criteria for Evaluation:

       Of randomly selected mothers with vaginal births, at least 80% will report that their babies were not separated from them before starting rooming-in, unless there are medical reasons for separation.

       Of all randomly selected mothers with healthy term babies, at least 80% will report that since they came to their room after birth (or since they were able to respond to their babies in the case of cesarean birth), their infants have stayed with them in the same room day and night except for periods of up to an hour per day for facility procedures, unless there are justifiable reasons for a longer separation.

       Observations in the postpartum unit and any well-baby observation areas and discussions with mothers and staff confirm that at least 80% of the mothers and babies are rooming-in or, if not, have justifiable reasons for being separated.

      It also includes this language: The facility should provide rooming-in twenty-four hours a day as the standard for mother-baby care for healthy, full-term infants, regardless of feeding choice. When a mother requests that her baby be cared for in the nursery, the health care staff should explore the reasons for the request and should encourage and educate the mother about the advantages of having her infant stay with her in the same room twenty-four hours a day. If the mother still requests that the baby be cared for in the nursery, the process and informed decision should be documented.

      To me, this stops *just* short of being a requirement (given that is says “justifiable reasons” for separation are permitted) but its WAY more than just *allowed* or even *encouraged*. They don’t explain what justifiable reasons are and the language associated with a mother requesting the baby be taken to the nursery supports a lot of coercion being used to keep her from being able to make that choice.

      • Ceridwen

        On the partner topic: My labor was 40+ hours long and I had a PPH. My spouse got to sleep more than I did, but we were both running on fumes by the time the baby was born and then it took ~6-8 hours for them to have me stable enough to move me to a postpartum room where we could actually even think about sleeping. We were thrilled to have the nurses take the baby and keep her at the nurses station (there was no nursery, but they happily volunteered to take her) so we could sleep. She came back to me to nurse every 2ish hours overnight and I felt dramatically better the next day. My partner honestly took longer to recover than I did because his sleep needs are much higher than mine. I could not have trusted him not to fall asleep with our daughter the first night, and while I might have been able to stay awake it would have been extremely dangerous and certainly impeded my recovery. We had no other support people available as we live far from family. And that was for a first baby. Whenever we have a second it’s unlikely he’ll even be able to stay with me overnight. I don’t see how it’s reasonable to expect the support person to be filling the role the hospital is being paid to do in terms of taking care of the baby during the first few nights.

      • PrimaryCareDoc

        I wonder what they claim are the advantages of a baby being with its mother 24 hours a day.

        • Ceridwen

          The document only claims that it is “a procedure that encourages exclusive breastfeeding”. Which of course does fuck all to explain why they expect it to take place regardless of whether the baby is being breastfed. Which then implies that part of it is about attempting to force (“convince”) women who are not interested in breastfeeding into doing it.

          • Amy M

            Yeah, “educate” them,like the Chinese “educated” anyone who wasn’t so into the Great Leap Forward.

          • rh1985

            Yep, my kid already had the dreaded formula and we were clearly a lost cause, so no problem with using the nursery. The BF moms are heavily pressured not to use the nursery. Maybe they’d allow it if the mom won’t back down. But they definitely try to prevent it. I feel awful that the nurses were (presumably) being made to do that to BF moms because of policy. I had amazing nurses who took great care of me and my daughter and I’m sure they would have felt awful about the BF moms who wanted the nursery that they had to try and refuse.

        • D/

          From various BFHI materials:

          Benefits of rooming-in
          > Reduces infection
          > Helps establish and maintain breastfeeding
          * Increased frequency of breastfeeding
          * Earlier lactogenesis and increased milk production
          * Increased infant intake
          * Decreased need for formula supplementation
          * Decreased jaundice
          * Improved breastfeeding duration rates
          > Improved parental bonding with and confidence in caring for infant
          * Earlier identification of & response to infant feeding and stress cues
          * Calmer infant and improved infant sleep
          * No significant difference in maternal sleep
          > Facility benefits
          * Cost savings by elimination of newborn nursery
          * Less staff time. Families are directly responsible for their infants.
          * Requires minimal equipment
          * Requires no additional personnel

          • PrimaryCareDoc

            I wonder if they have any actual science to back up those claims.

          • Ceridwen

            There are studies on most of them, but all I can get are the abstracts (my university doesn’t have a med school so our subscriptions to medical journals are lacking). And most of the abstracts are not remotely clear enough about the methods to give me a feel for how solid the science is on any of it.

            I can’t even tell from the abstracts whether any of them are actually comparing forced nursery with forced rooming in rather than either of those being at maternal request (which is what we all are advocating for). I can totally see it being true that when you compare forced nursery to forced rooming in things could come up as a bit of a wash because some moms will sleep worse with baby in the nursery just as some will sleep worse with baby in the room. But I would expect that if you compared forced nursery with on-request rooming in and forced rooming in with on-request rooming in you would find that the on-request scenario lead to the best outcomes for mom and baby.

            Then there’s the issue that this particular post was written to address. That even if there is strong scientific evidence of these positive effects of rooming in, it MUST be balanced against the risks of rooming in. Right now, those risks are effectively being assumed to not exist. This is a serious problem, because the studies presented in Dr. Amy’s post point out just how serious the risks are, and how devastating the potential outcomes can be. There are an awful lot of tired moms who are being told that it’s bad to send their babies to the nursery or nurses station, but not being told anything of the risks of NOT sending the baby away if they will sleep better with nurses watching over the baby.

            I’d also like to see studies that better address how well mom recovers and how well she adjusts once she gets home with the baby in forced vs. on-request rooming in situations. This seems like it would be a very holistic way to address the quality of sleep vs. quantity of sleep issue brought up by Dr. Kitty. Even if moms report the same total amount of sleep regardless of where baby sleeps, isn’t it actually more important how well they recover and cope with baby once getting home? Solid blocks of sleep may well be much better for recovery than short pieces.

          • Amy M

            Exactly. I don’t really buy that rooming in will cause earlier lactogenesis, but even if it did, is that really worth the risk of death to the baby? I am also skeptical about the “increased breastfeeding duration,” the “increased bond between parents and child” and “improved infant sleep.” I find it hard to believe that a night or two with the baby in your hospital room is going to have that huge an influence on any of those things.

          • Ceridwen

            As far as I can tell from abstracts, in the case of sleep assessments they are only looking at sleep on those particular nights the baby and mom are in the hospital. Not long term sleep patterns.

            Increased bond between parents and child is partly referring to studies showing fewer babies being abandoned with rooming in being practiced. But it’s not clear what type of rooming in was being studied because I can’t access the whole article. Also, not abandoning your baby isn’t a very high bar for attachment. And does not necessarily mean better outcomes for baby in the long term.

          • rh1985

            I think it’s ridiculous. I never shared a room with my daughter. She went into her own room at home from the day we got home because of my sleeping problems. She is definitely attached to me. We shared a room for the first time this month at a hotel when we went on vacation. She didn’t sleep any better. I slept worse because every little sound woke me.

          • Cobalt

            I could see these as clear benefits of ALLOWING rooming in vs. mandatory separation. Once you get to mandatory rooming in, however some of these benefits will disappear and risks will remove the rest.

          • D/

            Sounds like an original approach to hospital rooming-in … 1940’s style.

            “Rooming in is not applicable to all mothers, and should not be imposed on any mother who is hesitant or willing.”

            http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.38.5_Pt_1.689

          • Samantha06

            Interesting article!

          • Dr Kitty

            What does “no significant difference in maternsl sleep” mean?

            Ok, let’s say rooming in mama slept for 6 hours and nursery mama slept for 6hrs. No significant difference, right?

            BUT let’s say over an 8 hr period nursery mama was woken four times for 15 minutes at a time to feed, and took 15 minutes more to get back to sleep.
            Meanwhile rooming-in mama woke 6 times, fed for 15 minutes and took 5 minutes to get back to sleep.

            Which night would you rather have had?
            Four 90 minute sleeps, or six hour long sleeps?
            Yeah…that’s what I thought.

            Humans require REM sleep, which doesn’t happen effectively in cat naps.

          • rh1985

            I read one of the studies that is often cited by forced rooming in advocates. The others required paid subscriptions. If I am remembering right it studied one hospital where rooming in was allowed but not required. The moms all got similar amounts of sleep. The study is completely worthless to justify forced rooming in, since the moms who were likely to have more trouble sleeping – moms with very fussy babies, moms who were too anxious to sleep with the baby there, moms with sleeping problems or worse pain who couldn’t easily fall back asleep between feedings – were able to use the nursery.

      • rh1985

        the 80% standard is ridiculous. Especially when 30% of moms have a CS, on average. The ONLY thing that should be of any relevance is that the moms be allowed to room in as long as there is no medical reason why it’s unsafe. If mom chooses not to, that should be the end of it. I’m pretty sure that particular qualification is the reason why my hospital tried to only take FF babies to the nursery.The percent here that never attempts to BF is small, definitely under 20% I’d guess.

      • Amy M

        It says 80% of vaginal births….Oh that was meant for rh1985 below

        • Ceridwen

          It says 80% of vaginal births the baby should not have been separated from mom prior to the start of rooming in. But it says ALL full term births the baby should be rooming in as soon as mom can “respond to the infant”. This includes all c-section moms. So hospitals are allowed some leeway in separating babies and moms who had sections during the first little while after the birth, but rooming in is still expected to being as soon as it is remotely feasible, regardless of delivery mode.

      • Roadstergal

        “When a mother requests that her baby be cared for in the nursery, the
        health care staff should explore the reasons for the request and should
        encourage and educate the mother about the advantages of having her
        infant stay with her in the same room twenty-four hours a day”

        Should the health care workers educate the mother about the disadvantages of having her
        infant stay with her in the same room twenty-four hours a day? Like, possibly accidentally killing said infant?

  • mythsayer

    My little Japanese hospital kept her for the first night. I couldn’t move until like 1 am because of the CS drugs and I guess they figure that you need your sleep the first night. I was totally cool with that. I’m sure some people freak out (MY BABY HAS TO HAVE CONSTANT SKIN TO SKIN). I was super happy to sleep.

    But then the next morning, they wheeled her in and left. And I didn’t know what to do. No one told me what to do. They didn’t speak English. I think I tried to BF her, unsuccessfully. The day she was born, around 1:30 pm, I was in my room by 3 pm and they brought her to me and helped her latch and we did that for about 15 minutes and then they took her for the night, like I said. But the next day, I didn’t know what to do with this baby in my room. Were they going to feed her? Or were they going to give her a bath, or change her? I’m really embarrassed to say that we didn’t change her diaper for like 12 hours. At some point it clicked that they weren’t coming back. Even thought I’d gotten sleep the night before, I know I was still out of it, so I blame it on that.

    They’d left diapers underneath the bassinet but didn’t tell us we were supposed to mark when she ate, how much, and when we changed her. Oops. I think it wasn’t until day 3 that someone finally told us what to do. By that point, she’d lost a ton of weight. I stupidly didn’t bring a bottle with me and for the first 2 days I tried to EBF. It clearly didn’t work. And we’d only been in Japan for a few months and didn’t know much at that point… if we had, we’d have known that the 7-11 down the street was still open and would have had bottles. We had formula… we just didn’t have any bottles.

    And at one point, she started screaming and just wouldn’t stop. After awhile I demanded they take her away. It was a battle, though. They did NOT want to take her. I didn’t understand… wasn’t that their job (I’m thinking to myself)? But no… apparently Japan is big on rooming in, too. They just hold off for the first day. But after that, they are hands off (except for the bath… they take them for baths and weighing every day).

    So yeah… the first few days in the hospital I barely changed my daughter, I starved her, and I barely picked her up for the first day because I thought they’d just brought her in for me to look at and that they’d forgotten to take her back. Like I said… it literally took like 12 hours before we realized… hey… maybe they aren’t coming back and we’re supposed to, you know, feed and change her and actually act like her parents. That was really embarrassing.

  • MLE

    They will never slaughter the breastfeeding-at-all-costs cow. Analgesia will be even more frowned upon than ever.

    • Roadstergal

      That was my comment on the first post she made about this topic. This will just add ‘no pain relief’ to the BFI cult.

    • Jocelyn

      See poopyhead above.

  • theadequatemother

    My health region is going baby friendly. I’m very disappointed in them. When my youngest was born a year ago, they weren’t baby friendly “officially” but I still felt I needed to do things like sneak in ready to feed formula. It was just easier than arguing. I also noticed as a second time mum, I got next to no support, or help from nursing staff. When hubs went home to look after the toddler I resorted to wheeling the bassinet into the bathroom so I could pee. Which I had to do with the door open because we both wouldn’t fit in there. Next time, if there is one, I’ll probably just put the kid in the bathtub. They also did interesting things like supply you with only 6 maxi pads. After that you were SOL. Really? Is this the cost cutting we are resorting to? Do they limit the bandages for other surgical patients? No. So why are maternity patients different?

    • Therese

      It seems like they should be happy to supply you with extra maxi pads and then just charge you/your insurance company an astronomical amount for them.

      • theadequatemother

        It’s Canada so the provincial govt is the insurer…hence ridiculous cost cutting meaures like maxi pad rationing

  • Kq

    These stories chill me to the bone. 4 years ago tomorrow my boy was born healthy and perfect. I’m grateful he didn’t lose that perfect start to 5 he fact that I several times “woke up” to him smushed between me and the pillow on the bedrail. Not that I was actually sleeping, just nodding out from pain meds and recovery from labor & cs.

    • FormerPhysicist

      I did that so many times. I think it helped that I brought my ‘boppy’ to the hospital, so my little one was propped up on a harder surface than a pillow and less likely to slip to the side.

      • KeeperOfTheBooks

        Yep. I lay on my back in a semi-recline with DD lying on my chest with her head between and above my breasts. I had a boppy under her feet so she couldn’t slide down.
        I loved all the snuggling, but in retrospect, especially considering the opiates I was on for post-op pain, it wasn’t safe.
        My mind still boggles at the setup the LCs had us in one afternoon, wherein DD was in the football hold to nurse and lying on/surrounded by soft pillows and soft boob, with a light receiving blanket over her entire body, including her face, on the idea that this would be warmer and darker and more womb-like and would encourage her to nurse. Also, according to them, I should take that opportunity to nap.
        Again, the snuggles were great, but the pillow setup was nothing short of insanity at its finest.

    • Elizabeth A

      I vividly remember a helpful nurse swaddling my newborn son and putting him next to me on the bed, so we could snuggle and nurse. And then she left. I’d had a post-partum hemorrhage, and was very nearly gray. I fell asleep, and the kid was fine, but this was not remotely “safe co-sleeping.”

      • Maria

        Wow! My hospital was a rooming in hospital, but they were very vocal about baby sleeping in the bassinet and not in bed with me.

        Now that I think about it, I am so grateful my husband was able to stay the whole time for both babies (he left for a few hours with our second, but my Mom filled in). I would never have felt okay trying to take care of them by myself in that sleep deprived state.

  • Michele

    I just had my second two weeks ago and I am so grateful that my hospital is not officially “Baby Friendly.” I had the option for skin-to-skin after my (elective, repeat) c-section and for rooming in. But no one gave me any static when I asked for help getting baby back in the bassinet and for the nurses to take him overnight between feedings so I could sleep. No pressure to give formula since I had stated that I preferred to breastfeed. They asked me if I wanted to supplement only once, when baby wouldn’t settle after nursing and I desperately needed some sleep. We didn’t need the supplement after the nurse helped me give baby the other side. If it had been needed, I was glad that there wasn’t going to be any lecturing about it.

    • araikwao

      Congratulations!! Hope you are all doing well!

  • Karen in SC

    Unfortunately this trend of DIY health care is only increasing. A friend who had a masectomy was released with drains from her wound and more than one medication. Her husband was her caregiver and he set up a spread sheet to keep track of dosing. They were supposed to measure the fluid from the drains and fax that info to the surgeon’s office! I was shocked and thought that if I ever needed that level of care at home I’d have to hire a nurse.

    • Ellen Mary

      My friend has a little boy with Noonan’s syndrome who also had leukemia. She has been *shocked* at what other parents of children with special needs are asked to do by themselves @ home . . .

    • theadequatemother

      what do you guys think all the “aging gracefully at home” and “dying at home” campaigns are for elder care? Ways to shift costs from the HC system to individuals and their families. I get why people don’t want to be in LTC, and I get why staying at home as long as possible is attractive. But I also know that individuals and their families underestimate the costs associated with it. From real costs (paying for helpers/ nurses beyond the skimpy help supplied by our public system) to unmeasured costs (time value of money for the adult children that end up doing the shopping, the transporting etc)…

      • Dr Kitty

        Not to mention the reality of what it actually means to be elderly and frail and living in your own home, maybe with carers calling three or four times a day for 15 minutes at a time.

        Alone, with no human contact or company other than those fleeting visits from people who are rushing to wash, dress, toilet and feed you, and whatever visits your family can make, if they live near to you.

        At least in long term care you could talk to other residents, engage in planned activities and someone will always be available to help you.

        I make Housecalls to frail elderly people whose main issue is loneliness, not illness. I have others who are less frail and are able to come to see me- often for trivial reasons. Mostly we just chat.
        Residential and nursing homes may not be the best solution, but living out your final years isolated and lonely in your own home isn’t great either.

        My grandmother, who at 99 has severe dementia, but is physically very well ( she walks faster than I do) has excellent care in her nursing home. She does much better somewhere where she can safely walk laps of the courtyard with staff members watching, thinking she is in a lovely hotel.

        • Who?

          I’m going through this with my neighbour at the moment. It’s difficult to not be judgy of her children-all in their 50s. She’s so lonely and sad, doesn’t eat properly, clothes are never clean, never sees anyone but the daily 15 min drop in lady and me. She won’t have any assistance other than a bit of housecleaning and the daily drop in.

          She’s going to really hurt herself, or get really sick-bad history of utis, heart trouble, mostly can’t see-and I hate to think of her there on her own, but there is only so much I can do. She has one of those emergency button things but it seems to have been set up by morons and they really struggle to make contact when they need to-I’m the primary contact, her children being around the corner rather than next door.

          She’s not an easy person-doesn’t for instance like female doctors-and is a curious combination of passive and stubborn.

          I think she’s decided to die at home. Happy dementia sounds like a good thing for your grandmother.

      • Liz Leyden

        As a home health nurse who has worked in nursing homes (and will never do it again unless my family is facing immediate homelessness), I think aging-in-place is a good idea. Done right, it allows elders to stay in their homes, with their familiar community, routines and pets.

        I worked in Assisted Living, which was basically elderly housing with full-time nursing staff. Residents who needed help with feeding or who declined too much were discharged to the nursing home. Hospice care was handled by the VNA.

      • Elizabeth A

        I worked as a home help for homebound elderly people for one summer in college. My clients who were at home were incredibly likely to be lonely and severely depressed. Signs of gradual decline tended to go unnoticed until a crisis hit.

        My clients who lived in assisted living facilities were a whole different ballgame. There were tons of activities, and it was much easier for them to get around the building. The facilities had also done a certain amount of community outreach, so community theater productions happened in the Assisted Living facility’s auditorium, for example, and it was pretty common for high school or church musical groups to come by and perform. There were a ton of activities for residents, from bus trips to bingo night. I would so far rather grow old in one of these places than in a house I can’t get out of by myself.

        • rh1985

          My grandfather tried assisted living, hated it, and ended up moving out. He was much happier with his own place. He remained pretty healthy until the last year of his life and ended up dying at home right before what would have been his 90th birthday. My other grandparents are in their 90s, live in their own home, and are firm that they do not want to leave unless there is no other option. Up until the last couple of years they went out frequently but now, not so much. I think both should be options.

      • Liz Leyden

        I have a friend who, thanks to an extended bout of unemployment, ended up moving cross-country to be a live-in caretaker for her 93-year-old mother. Mom has dementia. Friend has no caregiving experience. Town has very few resources, including no public transit or elder transit. Neither of them had a car until a few weeks ago, and the town has very few cabs.

        Things are not going well. Mom will likely end up in a nursing home by the end of the year, leaving my friend still unemployed.

      • araikwao

        Our consultant in pall care told us they support families and pts who want to die at home, but with the explanation that the care can’t be as good.

      • Christina Maxwell

        A few months ago I had to put my mother into a nursing home. She had been living at home with a carer but it had reached the point that one carer was not enough as Ma is pretty much immobile and doubly incontinent. It was a major battle to get her to stay in the nursing home at all, and even to convince some of her friends. They all wittered on about how they could help (which they never had, not once) and that surely she could afford it (she’s a wealthy woman by most people’s standards) but no, it would cost over £100000 per annum just for the care she needs and then another God knows how much to adapt the house. She’s not that wealthy. The nursing home costs about £50000 per year and is much safer. The staff are lovely and her dog gets to come and visit. She seems to be accepting it now. What has become apparent is just how much her mind had deteriorated in the last few years, hidden, I suspect, by habit and having the same carer for nearly 4 years.

    • sdsures

      That’s awful.

    • mythsayer

      After my tummy tuck, I had to drain my drain and keep track of the levels, too.

    • Elizabeth A

      As someone who has had two mastectomies and a failed reconstruction, allow me to defend the practice of releasing a patient who still has surgical drains. Those bad boys stay in for 2-3 weeks, and require about 90 seconds per day of low-skilled attention. Anyone with working hands and a graduated cylinder can handle them. (I was offered a visiting nurse once, but I opted to go without – I was experienced with drains by then, and scheduling the entire family around twice daily VNA visits didn’t sound appealing.)

      Plus: As long as I was in hospital, hospital policy demanded a blood test every 12-24 hours, and my surgeon and the nurses had irreconcilable differences about whether it was okay to get drain sites wet – which worked out to a daily fight over whether I was permitted to shower. When they offered me the chance to go home, I threw my stuff into my suitcase and escaped before the phlebotomists showed up to blow my last vein.

      Post-surgical pain meds can be really complicated to keep track of, but most people still prefer to handle them in the comparative privacy and comfort of home.

      • Karen in SC

        thanks for another point of view.

    • MaineJen

      After my husband’s abdominal surgery he was sent home with two drains in place and an open incision, as well as a colostomy bag. We had a visiting nurse to help some of the time, but I did all of the dressing changes myself, as well as keeping track of the really nifty pain meds and other medications and trying to maintain working full time. My poor husband dealt with the colostomy bag himself, mostly while still wigged out on medication. Not something I would want to do again. Caring for someone at home is no joke; if we had needed to do it for more than the ~month it took his wound to close, I’m not sure I could have managed. It makes me wonder where they think all these home-carers are going to come from.

  • Rachel

    I just had my first baby two months ago. When I was trying to breastfeed her in the hospital, I felt like she was being smothered by my breast. The lactation consultant told me not to worry about it because baby noses are designed to allow the baby to breathe while breastfeeding. I was still worried and spent a lot of time trying to latch her in a position that left her nose completely clear, which didn’t work because she was too small and hated it. So she got pumped milk and formula. I had been kind of regretting not latching her in the hospital because even though she’s big enough now to nurse without me worrying about smothering her, she still doesn’t, and I thought it might be because we missed that early chance. Now I’m so grateful I listened to my instincts instead of to my lactation consultant!

    • mythsayer

      I remember being worried about that, too. It really seems like they sometimes can’t breathe!!

    • namaste863

      “Baby noses are designed to let them breathe while breastfeeding?” What planet full of unicorns, pixie dust and glitter are these wack jobs living on?

      • Amy M

        Didn’t you know, they come with little snorkels?

      • Mishimoo

        Oh, I was told that too! That belief was promptly chucked out the window as soon as I saw my breast forming a very neat seal over my eldest’s nose and mouth. Luckily, I found a position that was safe and comfortable for both of us.

      • KarenJJ

        Yep. I got told that one at the Australian equivalent to La Leche.

      • LovleAnjel

        That’s a terrible misunderstanding. Our anatomy allows babies to breathe while *suckling* (not swallowing). The hard palate separates our mouth from our nose – so you can breath while food or liquid is in your mouth. Babies can suck in a bunch of milk, then pause breathing just long enough to swallow.

        They still need a clear airway.

    • Guest

      You did the best for your baby. My first latched immediately on my first try at hospital but refused to latch again at home. My second was barely latching and never sucks if latched we ended up using nipple shield and pumping till I dried and she still can latch after 4 months!. So even if you didn’t stop direct breastfeeding we just don’t have control on what our babies favor/can do.

    • MaineJen

      Ugh. I was told “the instinct to breathe is stronger than the instinct to suck; therefore, a baby will never smother while feeding, they will always move their head to breathe.” I think we’ve all seen this isn’t true by now…in addition, newborns have no head/neck control, so how is that supposed to work? The crap they tell expecting and new mothers is astounding.

      • Cobalt

        And they can go from feeding to sleeping instantly and without warning.

  • Jocelyn

    My two postpartum experiences were at different hospitals, and very different in quality. The first was at a non-BFHI hospital, and it was awesome. They told me I had the option of rooming in with the baby at night, or they could take her to the nursery and just bring her back when she was hungry. I thought, oh, we’ll be fine with her in here! So I told them just to leave her in the room. A couple hours later, after not being able to fall asleep, I asked the nurse to take the baby to the nursery. She did, and I was able to get great sleep for the rest of the night. They brought the baby in one or two times to feed, and took her back to the nursery afterwards so I could sleep more. The whole experience was great.

    The second hospital was BFHI. They did not have a well-baby nursery, and my husband could not stay overnight to help me as he had to go home to stay with our two-year old. So, I was alone with a crying baby in my room the whole night, with no one to help me and no where to send her to. This was Saturday night, and I hadn’t had any sleep since Thursday night (Friday night is when I went into labor and had the baby). It was, frankly, dangerous. I fell asleep several times with the baby in my bed. I didn’t want to, I knew it was dangerous, but I was just so exhausted and I couldn’t keep myself from dozing off while she tried to nurse from my empty breasts. The bed was high, too; it was adjustable so that it could be as high as the baby bassinet. This made transferring the baby from bed to bassinet easier, but it also made it more dangerous during the times I fell asleep.

    Looking back, I can see several solutions that would have rectified this dangerous situation. Number one – have a nursery (obviously). If I could have sent her there, I would have, and I could have slept and not fallen asleep with her in the bed. Number two – offer me formula for her. She was crying all night because she was hungry. My milk hadn’t come in (it was only the first day), and she had already had twelve (yes, twelve!) poopy diapers, so I assume her stomach was cleared out. She was only calm when trying to nurse. When we got home the next day, we gave her a bottle which she instantly sucked down and then fell asleep for hours. If I had had that in the hospital, she wouldn’t have ended up in bed with an exhausted mother.

    • KeeperOfTheBooks

      Your second experience is what I expect my next one to be like, too, now that DH will need to stay with DD. I’m twitching just thinking about it. In my case, I’m so short that even with the bed on its highest, I still couldn’t reach to put DD in the bassinet, and I couldn’t get out of bed while holding her because of my incision. Not. Okay.

  • Karen in SC

    This explains in stark terms what happened to a family of my acquaintance. During the first day of life, the baby was noticed not to be breathing in his mother’s arms. She was a primapara and had been discharged from a birthing center a few hours earlier. The diagnosis given at the time was “Interrupted SIDS” but SUPC seems more likely. The child survived with major impairments.

    While not at a Baby Friendly hospital, it was still the modus operandi of skin to skin, breast feeding early, and parents fending for themselves just after the birth that seem to have contributed in this tragic situation.

    • Amy M

      Just like the Traditional Natives, that Dr. Romm is always going on about, right? I wonder how often Traditional Native practices lead to this sort of tragedy. (yes, I know there are countless traditional native practices, and I would hope that all of them include some supervision of the new mother and baby so accidental suffocations like this don’t happen a lot)

      • Karen in SC

        I guess at the Birth Center, the midwives want to go home too, so you get released after 4 to 8 hrs.

        • AmyP

          Yeah, that’s one of the features of birth centers that Dr. Amy hasn’t given the full blast treatment–shockingly early discharges.

          • Therese

            In my state (WA) it is state law that birth center stays can’t exceed a certain amount of time. I want to say 6 hours. So it’s not always the midwives fault.

        • Amy M

          My PPH happened 8-9hrs post-partum. If I’d been sent home, and it happened there, I would have died. Awesome.

        • Liz Leyden

          How are they allowed to discharge women so early? Wasn’t there a big to-do over “drive through deliveries” about 10 years ago? During my maternity rotation, I learned that my state didn’t allow hospitals to discharge mothers for 48 hours after a vaginal birth, 72 hours for a cesarean.

          • rachel

            Not anymore (at least in my state). Commercial and public (Medicaid) insurers will cover a vaginal delivery up to 48 hrs postpartum and a cesarean up to 96 hours. No longer. You can leave as soon as you want and your doctor documents you are medically stable. Most of my patients stay 2 days after a vaginal delivery so they don’t have to bring the baby back for the 48 hr required metabolic screening and 2-3 days after a C-section. For the people who ask I’ll release as soon as 12 hours postpartum (especially in case of a demise or if baby has been transferred to a tertiary care center). I only stayed 24 hours with my own delivery 9 months ago.

  • Rita Rippetoe

    So, the medical establishment discourages bedsharing at home by non-drugged mothers, but mandates it in hospitals with mothers recovering from difficult births while still either exhausted from a long labor or dopy from a medicated labor. Wow, the logical disconnect is just amazing.

    • lawyer jane

      Well, I think what they are doing is mandating that the mother stay awake in the hospital while breastfeeding or doing skin to skin, not actually cosleep. So the logical answer would be to put the new mother on Ritalin in the hospital so she can stay awake to breastfeed.

      • Anj Fabian

        I think it would take something way stronger than Ritalin. To keep someone awake while they are
        a) In a bed
        b) Are physically exhausted
        c) May be short at least one night’s sleep
        d) May be on meds for nausea or pain management

        would take a fairly strong stimulant. Ritalin might work if you gave them a LOT.

        • lawyer jane

          Then they ought to continuously drip cold water on the mother, prisoner-of-war style.

        • Cobalt

          It would set up a perpetual race for breastfeeding moms to be on more stimulants than the baby. The mental image I’m getting is bad.

        • Alannah

          The obvious answer here is speed or crystal meth. Someone call BFHI headquarters, we figured it out!

          • Amy M

            I was thinking blow….

          • Medwife

            Meth will do it, but unfortunately the users don’t seem to be very interested in their babies. Gets them out of bed to go outside and smoke, though! (Yes, I see this on my unit. Sketchy friends drop by for a visit and suddenly mom feels AWESOME. Ugh.)

          • Cobalt

            You have to set it up like they do with lab rats. Give them a small dose after each activity you’re trying to encourage. They’ll be wide awake and all over that baby.

        • GiddyUpGo123

          I know, just take the bed out of the room. If Mom is standing up all the time, there’s no way she can fall asleep!

      • MaineJen

        I will never forget the day I realized, when my son was about 4 months old, that I had not slept for more than 4 hours at a stretch since the night before he was born. Not even in the hospital…thanks, rooming-in policy. It does crazy, crazy things to your brain.

    • Amy M

      I think they encourage rooming-in, where the baby is in a bassinette in the room w/the mother. However, I can see how this easily can become bedsharing: 1)an exhausted new mother falls asleep with the baby in bed, 2) a woman who just had a Csection can’t lift the baby back into the bassinette wo/help and/or 3)the baby won’t settle down in the bassinette, so the mom keeps it in the bed so she can keep the baby happy/get some rest.

      One simple fix, besides having a well-baby nursery, would be to make the bassinettes bed-height, so it would be easy to move the baby back and forth, or reach in and soothe baby wo/bringing it to the bed. But what do I know?

      • Ellen Mary

        My babies all rejected the bassinet as soon as they got a taste of a better option (from their perspective). So they would just cry in there. Which is fine, I don’t think it is that bad if a NB cries but I can’t sleep when it is happening.

        • Amy M

          Mine pretty much slept all the time, for the first 2 weeks, and they didn’t care where. We had to undress them to make them wake up enough to eat. They’d sleep in a bassinette, crib, someone’s lap, carseat, wherever. However, I certainly have friends whose babies would only nap if someone was holding them, or something like that. And later on, my boys had fussy times, when they wanted to be held, and wouldn’t settle down otherwise. I think all babies do that though.

          • anh

            yup, that was my snowflake. She insisted on being held ALL THE TIME refused to sleep on her own until I went back to work. we had to learn to safely cosleep but it was freaking horrible

          • Amy M

            I am so sorry! People don’t take new-parent sleep deprivation seriously enough. And from some of the BFHI stories I hear, it seems like some of those nurses or LCs find a sadistic pleasure in depriving new mothers of sleep.

          • anh

            before we learned to safely cosleep (thank you, Mom!) I was basically awake from Sunday morning to saturday night. at one point I was bouncing on an exercise ball to try and calm my screaming child (she was tongue tied and virtually starving at that point) and I remember realizing that if I didn’t sleep soon I was going to die. I remember thinking I didn’t want to die, so my plan was to sneak into work and volunteer to deploy to Afghanistan. I reasoned that even though my husband would divorce me and I’d never see my daughter again, but at least I could probably sleep on the plane.
            I have very low opinions of my Baby friendly hospital. How ANYONE could have discharged me in the condition I was in is freaking criminal. and I had a straightforward vaginal birth.

          • Amy M

            Oh my god, that’s nuts. I am so glad you got it all worked out before you hopped a plane!

          • anh

            hahah, yes! still married! I called my mom sobbing from the pediatrician’s office that sat morning (after we’d been told we had to bring her to the hospital for a second heel prick) and she raced down from NY to DC. She fed me dinner while I lay on the couch and then put me and my daughter to bed. She was amazing 🙂

          • anh

            I failed to mention I called my mom after I had fainted in the pediatrician’s office. I was so dehydrated and sleep deprived I just collapsed. fortunately my husband was carrying my daughter.
            After the appt my husband dropped me at home and took my daughter by himself to the hospital for the heel prick. The same staff that the previous day had let me nurse my daughter uninterrupted after her heel stick kicked my husband out when he wanted to give my daughter a bottle of formula to calm her after the stick. He says they made him feel like a criminal for even asking (despite the fact the doc has prescribed the formula)
            yeah, two years later, I’m still pretty pissed about my postpartum experience

          • FormerPhysicist

            I think (I hope) my pediatrician would interfere quite a bit if I collapsed in her office. She’s always, from the first, asked how I was. She truly believes you can’t be a good parent without being rested, sane, supported, etc. And healthy.

          • Jocelyn

            Holy crap.

          • lawyer jane

            I’m sorry, this made me laugh! Not at you, but in solidarity for the CRAZY thoughts one has under the stress of formerly unthinkable sleep deprivation. Yes, 8 hours of uninterrupted sleep would definitely be worth divorce and deployment to a war zone, no question!

          • KeeperOfTheBooks

            LOL–not at you, but at the situation. I was seriously considering something similar…I was just THAT tired.

        • mythsayer

          I readily admit to bed sharing. My daughter would.not.shut.up. She was always hungry or in pain because of the milk protein allergy and it wasn’t until we moved her into our bed that she settled down. It’s amazing how much they know even at only a few weeks old. She knew we were there was super happy about it. I had a boppy type pillow that had a strap on it (like the ones that pull through their legs and go around their mid sections) and I put her in that because she needed up to be kinda upright anyway so she didn’t have as much reflux and then I strapped her in. When she was really little, she couldn’t move and I had that pillow in a very particular spot so neither it nor she could move even if we did. I still barely got any sleep. Of course I was paranoid, but we did okay. I know it wasn’t “best” but she just wouldn’t sleep, even from the beginning, unless she was with me.

          She’s 4 1/2 and she sleeps with me. Of course she does, lol. We stay with my parents during the week and then go back to our house on the weekends (my husband works a lot, parents’ house is easier commute for me, and I have lupus so they help me out during the week). We have a Cal King split bed (sleep number… I wanted to be able to adjust my own side so it’s a split bed) and my husband is so sick of her taking up all the room that he just started sleeping in the office. Oh well… maybe one day she’ll move into her own room. She sleeps in her room every once in awhile. I bought her an awesome loft bed. So hopefully as she gets older she’ll move. I can’t say that I really mind all that much, though. It’s kind of nice to have company in the middle of the night.

      • Jocelyn

        The bassinet in the hospital with my last daughter was bed height. It didn’t get me any more sleep.

        • Amy M

          Dang! I thought I was onto something there….

          • Jocelyn

            Yeah, the problem was that my baby just wouldn’t be soothed unless I was holding her. So I’d pick her up, get her calm, put her back in the bassinet, and just a minute later she’d start fussing or crying again. Repeat for 9 hours…

          • sdsures

            *hug*

      • mythsayer

        Yeah… it’s really not helpful. I think one of those ones that attaches to the bed and doesn’t have a rail on the bed side would be better. You could kind of scoot the baby over. But I had pack and play next to our bed and it was bed height and you still have to reach over the railing to put them in and take them out, so I still found that I had to pull myself up into a sitting position.

      • MichLaw

        I had a bassinet that was bed height with the birth of my first child by c-section but because of the surgery I was unable to lift the baby into or out of it. Birth complications made me so tired that I could barely lift my arms. I couldn’t even get my son into a nursing position without help from my husband or a nurse. I don’t understand how any woman can safely take care of a baby on her own after birth if there are any complications whether from a vaginal birth or a c-section. I think that the baby friendly initiative will eventually be recognized as dangerous but unfortunately women will suffer and babies will die first.

    • KeeperOfTheBooks

      Yes, mine technically discouraged any sort of bed-sharing, and we got the standard “if you feel sleepy put the baby in the bassinet” lecture as soon as she was born. Problem was, she was only happy if held, I couldn’t get out of bed without putting her down, I couldn’t put her in the bassinet from the bed because the bassinet was too high, I was exhausted from surgery and lack of sleep…sleeping on my chest it was.

      I will say that the staff were absolutely fabulous about coming when I rang and asked them to take her so I could get in/out of bed to use the restroom, and they generally had her diaper changed by the time I got back, which was awesome. I was just so dead-tired and stressed from the crying that I couldn’t imagine calling them to hand her to me every time she started fussing. Ugh.

    • Therese

      I really doubt the medical professionals encouraging hospital bedsharing are discouraging at home bedsharing. It’s not like the “medical establishment” always speaks with a uniform voice. Most medical professionals are going to be against both practices, but you can always find a few that support both kinds of bedsharing.

  • Ellen Mary

    I agree that this is an issue & a danger, but I don’t believe women should be forced to choose between accepting formula for their neonates and having help while they are sleeping. I didn’t need to not Breastfeed or to supplement. I just needed some help watching my baby after I was done. He wouldn’t sleep in the bassinet & I didn’t want to sleep with him in my hospital bed. I definitely nodded out while holding him & I was terrified, especially as it was new for me to take opiates PP & I lean toward PPA.

    • Young CC Prof

      And many hospitals will take the baby for, say, 3 hours, so Mom can have a real nap, and then bring the baby back to eat. It’s not impossible.

      • Are you nuts

        I think a subtle change in language is important. Rather than saying, “rooming in is encouraged,” hospitals should say, “new parents have the option of rooming with their newborn or allowing the nurses to care for them in the nursery.” It seems subtle, but many moms, especially first time moms, will be reluctant to choose to do something that isn’t “encouraged.” My hospital made it very clear that rooming in was the preferred route.

        • Ellen Mary

          You are right. I would have made rooming in a point if pride, but after have a Cesarean, even I realized that rooming in & opiates don’t necessarily mix. I had a nurse actually say ‘no’ when I begged her to take my baby for a few hours so I could sleep @ night . . . Everyone else had been so nice that I was really taken aback. I was upset because my portion of the hospital birth alone was $4000 & I had chosen a hospital birth in part because I felt that it increased safety postpartum to have help with the baby even in a vaginal birth . . . But I was too newly PP to say ‘you have to’ or ‘let me talk to another nurse’. And my hospital was not yet BFHI.

      • Amy M

        This is how it was in the hospital where my babies were born. The babies hung out in the nursery in-between feedings, at night, because I wanted some sleep and also, wanted to make sure someone was keeping an eye on them. Although they did fine, as near-term preemies, they were more at risk for certain issues and I might not have recognized the signs.

    • Trixie

      I don’t see where Dr. Amy says otherwise. I breastfed both babies successfully without supplementation and they went to the nursery in 3 hour increments overnight.
      Letdowns used to make me so sleepy in the postpartum period. I really had to watch myself.

    • moto_librarian

      The issue here is that to obtain BFHI status, a hospital must demonstrate that babies are rooming in with their mothers for 23 out of 24 hours. This means that the newborn nursery is eliminated. This has absolutely nothing to do with breast vs. formula feeding. It is simply a non-evidence-based practice that serves no real purpose, and sometimes has shockingly bad consequences.

      • FormerPhysicist

        It has a financial purpose. Nothing to do with BFing.

  • veggiegal

    I gave birth late at night, met my baby, settled into sleep, and collapsed, sending the baby off to the hospital nursery. At 6am, I hear the voice of a chipper nurse, actively waking me up after a mere 3 hours sleep following more than 24 hours of no sleep, saying “Here’s your baby!!” I am not entirely sure, but I believe my reply was something along the lines of “go away! I’ll come to get her later. I want to sleep now”. 4 more hours of sleep later, I was able to be a happy mom. That is, until I realized I am exhausted again and desperately need a nap, and wasn’t going to have a “nursery” at home. Off back to the nursery went the baby, and me to sleep. When I left for home after two nights at the hospital, I was well rested and able to function. The young nurses probably thought I was an auger. The older nurses smiled and said something along the lines of wishing more new moms understood the importance of leaving the hospital well rested. My baby is doing GREAT.

    • Kelly

      I learned that the hard way with my first. With my second, I limited the amount of visitors and times that they could visit and I got as much rest as I could. When the second woke up every hour to nurse, the night nurse took her to the nursery for a few hours and fed her a bottle. I came out so much better. I even have a ton of help with my husband, church, and mother and I still struggle with the first three months. I don’t know how people do it on their own.

  • auntbea

    The baby in that photo looks he has a very shallow latch. It’s making my nipples hurt in sympathy.

  • gingergirl

    My sons were born in a BFHI hospital. We roomed in. Nurses woke me up every 90 minutes to feed my sons if I wasn’t already awake, on top of random people popping in throughout the day with surveys about said hospital. One of my sons had a wet lung that was not NICU appropriate, but was “a concern”. I was meant to monitor this as an exhausted first time mom. I kept him especially close in my hospital bed, because mobility was an issue for me (I couldn’t even put on my own underpants for a few days and had to have someone help me with that). The nurses and doctors were probably not OK with me asleep in a hospital bed with my sons, but the BFHI rules are rules after all. It was more important to the hospital that I got to the breastfeeding classes and see the IBCLCs and get on the pump and lactate while I was barely coherent enough to tend to myself. The doctors and the nurses were very nice and professional, but they were bound by the tenets of BFHI. Some of them could have gotten in trouble for sticking their necks out like they did for us, so they were doing the best they could within a system that does not work. BFHI is not friendly to mothers or babies.

    • JC

      We left the hospital 24 hours after birth because we were constantly being bothered. We only had two family members visit, but there was a stream of hospital personnel coming and going. I sent the baby to the nursery to sleep and then they came to take my blood at 5 a.m.! Are you kidding me? That can’t wait? In addition to nurses coming in and out, we had the birth certificate person (twice), the pediatrician, my OB, the LC (upon request), food being delivered, a photographer (not requested). It just went on and on. And it was so loud I couldn’t sleep all night even though I didn’t have the baby with me. I’m a huge proponent of hospital birth but this was a very annoying experience. And I know most of the stuff was necessary, but it was exhausting.

      • Cobalt

        Hospital birth is great for labor and delivery. Postpartum hospital protocols tend to be awful.

  • Young CC Prof

    We need a law: All hospitals with maternity wards must have a newborn nursery, and all mothers must be offered help caring for the baby.

    I must say, the hospital where I delivered has their collective head on straight. They understand that this risk exists. When I attempted to breastfeed, they carefully instructed me on making sure his nostrils were free and his head at a safe angle. They have a nursery and encourage women to use it, especially during the first night.

    But, they took him when we were ready. He was born (by c-section) in the afternoon, we were united as soon as possible, in the recovery room, and we were able to hold him the rest of the day.

    Promoting bonding time and keeping newborns safe are not conflicting goals at all. You just have to ensure that a staffed nursery is available, and remove the policies that prevent nurses from using their common sense.

  • lawyer jane

    It is really kind of terrifying how the health of the mother is increasingly being written out of the story in the US at the same time as maternal expectations have increased. Not only do we have no maternity leave and weakened extended family structures that mean fewer mothers & sisters around to help, but now we are expected to go it completely alone in the hospital with a newborn (after a 40-hour long “natural” labor, of course), pump around the clock to increase supply, and go back to work after 12 refreshing weeks of this. The ONLY bright spot I can see in this scenario is that it pretty much forces dads to step up to the plate.

    • auntbea

      Or go back at eight weeks because you need a break and a nap SOMEHOW.

      • ArmyChick

        pffffttt eight weeks? I had a c-section and I went back to work the following Monday. It was sort of… Brutal.

      • Liz Leyden

        I traveled 500 miles round-trip (not alone) to a job interview when I was 9 days post-partum. Between sleep deprivation and mental fog descending I didn’t do too well. I was hospitalized 2 days later with post-partum pre-eclampsia.

        • auntbea

          I did a job interview at 5 days PP, but I am pretty sure you win.

  • attitude devant

    I had, with my first, a fairly routine labor for a primipara. Around 30 hours. I still marvel at how overwhelmingly sleepy I was for the next day. I could not have kept my eyes open if my life or my daughter’s had depended on it. If I’d been the sole person responsible for care of my tiny newborn, she might not have survived, but this was in the days of hospital nurseries and my nursing colleagues took loving care of her. THAT was friendly to her and me.