Wednesday, April 7, 2010

Project Finished!!!!!

I completed my group project for school, and presented it yesterday evening!!!! Hooray, it's done! Our group did FANTASTIC, our poster was fabulous, our presentation funny and engaging, and our written report well done. Phew! That took some TIIIIIME! In the end we did a poster on oversupply--so, not the sexual abuse topic I was considering, nor the other topic I mentioned that I can't remember now....BUT, interesting nonetheless. I can't get blogger to upload my poster, so I'll see if Brent can save it in a format where I can so you can all see. I learned a ton. I cried in frustration at one point. I was overjoyed when we were done. I would be willing to bet we had the best presentation in the class. Shazzam!
[yes, I did just say shazzam]

Hurrah! Now, only one more class and then the final exam, and I'm done! I also have a job offer out of the class--one of my classmates is going to become a Lactation Consultant and open her own private practice. She is worried about meeting the demand in our area and is looking for a partner. At first I thought she meant another LC, but then she said she would be happy to work with a breastfeeding counsellor as well, and then we sorted out that YEAH I'd love to work with her and YEAH she'd love to work with me (I'd take the simpler cases and she'd be available if I needed help, and we would let women know that I'm not an LC), so that has potential to turn into something great! Something I could totally use one of my awesome name suggestions you guys gave me for!!! It's got potential, anyways.

And I need to debrief. I've been avoiding this because it's not so nice, to think about, write about, or respond to, and y'know, it could be considered slanderous if anyone from a certain NICU read it. But I have to debrief, and it's been percolating for awhile.
I went for a clinical observation day to a NICU in our area for the breastfeeding course.

The ward I visited was a 25 bed ward, and there were 25 babies. One incubator was empty because another bed had a set of twins cobedding in it. So the ward was pretty much full, and bustling. I was SO not impressed with the fact that I was supposed to 'float around' instead of being assigned to a nurse, because when I tried to introduce myself and observe, all the nurses said a friendly "Hi!" and then ignored me. Attempts to ask questions were either obviously unwelcome or met with short answers and backs turned. One nurse shooed me away because she was "too busy." I hated it. How am I supposed to learn in that kind of situation? The breastfeeding support I saw was in the realm of sabotage and setting up for failure with poor breastfeeding practice, information, support, and promotion. One woman was trying to breastfeed her jaundiced, full term baby, but the nurse kept giving the baby bottles of formula every time the woman left the ward. Most women with premature or sick (overwhelmingly both) babies were pumping, but a bottle of formula was set at every bedside and I'm positive they were used. One formula feeding shifts the pH of a baby's bowels to a more basic environment, making it a more hospitable environment for pathological bacteria to grow [with constant breastmilk feedings the pH returns to a normal acidic environment in 3 to 4 weeks]. Premature babies are at particular risk for Necrotizing Enterocolitis, where parts of the intestines get infected and die, causing pain, illness, permanent disability, or sometimes death. Formula feeds increase the incidence and severity of NEC for premature babies. I saw quite a few incidences of formula feeding in NG tubes or bottles, and several incidences of breastmilk in NG tubes or bottles. Not one preemie was put to the breast while I was there. Not one baby was put skin to skin. And here is the worst part, which was so traumatic, and which had me crying while I was driving home. Knowing what I have learned the research shows about Kangaroo Care for premature babies, the effects of separation and stress on babies (long term health deficits) which are even more pronounced for premature babies, it was really, really hard to see these babies lying in their incubators with no visitors. While I was there, the jaundiced baby's mom visited twice to breastfeed, and looked prepared to set up camp after she herself was discharged from the maternity ward. A baby who had been in the NICU for three months had a mom visit for an hour, during which time she talked and touched him but was clearly petrified to pick him up or do any baby care (understandably so, since random things caused him to stop breathing for up to a minute at a time--but I'm positive the culture of the ward contributed to her total disempowerment and overwhelming anxiety when it comes to caring for her baby). And the twins had both mom and dad there for two hours. So that is three babies out of 25. Actually, four. That last one was a set of twins, so that's four. Twenty one babies had no visitors. Their medical needs were met, their feeds were done, their health status monitored, but they were not held, talked to, or loved on by family. My textbook says,

"Physical closeness can help reduce emotional stress for both mother and baby."

"[Dr. Nils Bergman] describes the baby's (and all other mammals') physical reaction when removed from his natural habitat [which is on the mother's body, on her chest, tummy to tummy], the "proteste-despair response," which is programmed into the baby's hindbrain to ensure survival by decreasing energy consumption and growth via lowering heart rate and body temperature and massively increasing the production of stress hormones. As part of this response, the baby also emits a "separation distress call" to alert the mother that her baby needs her. Once mother and baby are reunited, baby's heart rate and body temperature increase and stress hormones decrease.
Research has found that skin to skin contact of mother and baby reduces the production of stress hormones by 74 percent. High levels of stress hormones inhibit gut function, digestion, and growth. Dr Bergman observes that what is currently considered to be the "normal ranges" of heart rate, temperature, and stress hormones of premies in incubators reflect this "protest-despair response," and that what is truly normal needs to be redefined based on a premie's physiological norms when in skin-to-skin contact with his mother."

When I saw how few parents were physically present that day I was dumbfounded. I know parents. I know TONS of parents. They all love their babies! They all spend tons of time with their babies! They all hate separation from their babies! If their babies are sick they are hovering insomniacs. So, where are all the parents? Some parents were probably sick, caring for other children, sleeping, or any number of legitimate activities, and I was only there for five hours so that leaves a good 19 hours of day (although I doubt many parents visit at night) I wasn't there to observe. I think also that one baby had been born prematurely to a drug addicted woman and apprehended at birth, so it makes sense that she would have been alone if she had not yet been matched with a foster family. But what about the other babies? Alone in their incubators, quietly protest-despairing? As adults we know these babies are well cared for, safe, and the focus of concern for many adults, including family, nurses, doctors, interns, and students. But from a biological point of view, this baby feels that it has reached maximum danger: separation from its mother. It does not know that it is the focus of all this care, but senses danger because of separation from its natural habitat: its mother. And it is left in this state for hours upon hours upon days upon weeks, with minimal interaction with what it knows as safe.
We know from research by Nils Bergman that it is 100% possible to bring together the miracles of modern medicine that is keeping these babies alive, and the miracles of a mother's touch, which sustains and settles a baby so it can focus its energy on the overwhelming business of living and growing.
What I saw seemed overwhelmingly inhumane. It was cruel.
I don't blame the parents, or even the hospital staff, but I would allocate responsibility to the NICU subculture. Not one of the NICU nurses or doctors had any breastfeeding training, and most seemed to equate formula with breastmilk as an infant food. Not one of the incubators had a bed for a parent, and the chairs that were present were not comfortable to sit in for long periods, and definitely not possible to sleep in. The space was limited, and any breastfeeding that was done, the nurses quickly rolled over a screen for privacy, which is considerate if that is what a woman wants, but sends a subtle message that what she is doing doesn't really belong in this space, particularly if it is not something she wants. Which was the case with the woman whose baby was jaundiced: she kept rolling her eyes at me when the screen was wheeled over, and it made things really awkward for her as she obviously did not want the screen.
I have been to a great number of pediatric wards during my career as a paramedic, and ALL of them have a crib or small bed for the patient, and A BED OR PULLOUT CHAIR WHICH BECOMES A BED FOR THE PATIENT'S PARENT. Why are sick babies any less in need of the presence of a parent? Close proximity to its mother is the only safe place an infant knows. Just because their protests are in the protest-despair mode, we don't clue in to the fact that they are in distress. In the absence of the presence of its mother, AN INFANT KNOWS ITS FATHER'S VOICE AND MANNERISMS, and should be place in HIS arms, skin to skin, for safety and comfort as much as possible.
I know that this NICU performs miracles every single day, and saves the lives of these tiny babies. And I should really consider and appreciate this fact more. I should. I know it. But sometimes, saving a life is not enough. You have to do it humanely. REDUCE SUFFERING. Studies show that a breastmilk only diet, early and eventual exclusive breastfeeding, kangaroo care, and the constant presence of the infant's mother results in better outcomes for sick babies. Fewer get sick and die, fewer have setbacks, their setbacks are less severe, they go home earlier, they thrive better, their parents feel more competent to care for them, and they grow up to have healthier lives, higher IQs, and more stable mental health than their non breastmilk-only-kangaroo-cared-mother-present peers.
One plus one equals TWO! We could be so much further ahead if we put NICU interventions together with baby friendly practices. And then I wouldn't feel the NICU was so cruel and inhumane, and I wouldn't feel so sick at the thought of 21 babies in medically functional but socially and emotionally sterile environments. Not to mention all that formula. No donor milk available, just mother's milk and fortified hydrogenated cow's milk proteins.

Anyways. Maybe you all think I'm crazy, or just too sensitive. But I feel that I'm a fairly seasoned paramedic who has seen all kinds of suffering, and my radar was screeching with dissonance and empathy over what I saw in that ward. Nobody was abusing any babies or mistreating them when they moved them around, nobody was neglecting handwashing or heigine, and everybody had an attitude of bustling care for these tiny patients. There was no INTENT of cruelty, but I believe there was systematic cruelty going on regardless of intent. It sucked. And it's hanging around in my brain, and now on my blog. For you all.

Thanks for listening to me rant. It was really hard to see.


ms emili louann said...

you're not being too sensitive! by golly. i would have been an untactful mess of tears and rants.

i've been watching too much baby/ mothering drama on tv - "16 and pregnant" and "birth day" and a couple other ones in there... and i find it so saddening how many mothers - young mother's especially - are left to "wing it" when it comes to the birth of their baby, and the care of their baby. no doulas, sometimes absolutely no support from family (in my "tv research" (harhar) found esp with the 16 year old mothers) too many c-sections, no breastfeeding, no skin to skin...!


and all i can say is that if my baby was a preemie, you LIKE HELL better bust out the cot, because i'm pretty much going to live in that hospital, dang it all.

women like you are astounding. we need you in there, educating and encouraging. you're awesome, mel!


Asheya said...

My heart aches, for those babies and for you. It's so hard to see, as you call it, 'systemic cruelty' which I think is a very real type of cruelty in institutional settings where everyone has the best intentions but not the best practice. You're absolutely right that medical care and physical survival is not enough. Human beings are emotional beings, and just being alive does not fulfill our basic needs. The need to belong is a basic need, which in an infant means the need for skin to skin with their mom, or as you say if mom is not available then dad or another adult.

It seems to me that the whole maternity system is full of this kind of systemic and institutional cruelty in one form or another; first to the pregnant and birthing woman, with too many interventions and bad practices in the name of good intentions, and then to preemies and newborns. Whatever happened to EVIDENCE BASED PRACTICE!!!

Mom. Skin. Breastmilk. Support the mom. Support the mom.

You're exactly the right person to be entering into this arena, and I do mean arena as an area where fighting occurs. I totally support you 100% and know that you are going to make positive changes for women and babies through your work.

Rachel Clear said...

You are not crazy OR too sensitive. This is really disturbing indeed. Part of what makes it so disturbing is that it is actually FIXABLE and that is heartbreakingly frustrating.

It's not like a monsoon that devestates people's lives and we can do nothing about it. This is something that we CAN do something about, but what?

Parents need to get themselves educated and empowered, but how?

Dana said...

Way to go on the awesome project! Can't wait to see the poster. I'd also love to read some highlights of your work.

My heart breaks for those babies and their families. I think Asheya put it well: "best intentions but not best practices". The only answer I could come up with when I ask myself why, is that it's hard to admit you've been hurting someone. It's just somehow easier to keep on as you've been keeping on rather than admit that what you've been doing, however well intentioned, has been hurtful.
Someone I spoke to at the Trust Birth Conference told me that THE Dr. Nils Bergman had spoken at her local NICU, and still nothing changed.

In addition to the educators and the activists and the informed Mama Bears, this situation needs prayer warriors. To me this is clearly a spiritual battlefield. Family is one of the enemy's favorite targets. We need to stand in our authority in Christ and cause the enemy to flee!

Deb said...

Rachel's last questions is the one that got me. As one of those uninformed mommas with a baby in the ICU (thankfully only for two weeks), I didn't know that I was allowed to tell the nurses "no, this is how we're going to do things". I was overwhelmed, desperate to get my baby home, and willing to do whatever they told me would make that happen first. I will say that the first NICU I was at was WAY more supportive of parents being around a lot, the second one had nowhere for mom's to even chill out when they weren't with their babies. There was one baby in there with a note on his board that said "I'll be back next Monday". HOW SAD - days and days on end with no family around! I definitely made myself at home, holding Aria for and hour or two of the three hour nursing routine, rather than just feeding her and putting her back in her crib (she really needs her sleep I was told once - I ignored her), but I was one of two moms who were there as much as possible - one came in for two feeds a day, others less than that... BUT what do you do when, as a friend of mine had, you have three little ones at home already? You can't just ignore all of them to be at the ICU all the time either!
I hope next time around this doesn't happen again, but I know that if it does, I'll be a little more adamant about the way I would like things to work. Skin-to-skin and immediate attempts at breast feeding will both be part of my requests.

tamie said...

No one could really accuse you of being too sensitive. Um, Mel, let's get a reality check here. You're a goddamn paramedic who tells some pretty grisly stories, even with humor! Too sensitive? Not exactly.

This is tragic stuff. I just finished reading a book on touch--you should read it, actually--and one of the things the author pointed out is that in orphanages where all of babies' physical needs are met but they aren't being touched at all, 30% of the babies die. Thirty percent! The need for touch is that basic. The other 70% probably will have lifelong psychological issues, according to the book, without some heavy-duty intervention.

The great part, like Emili pointed out, is that you are there, and you're wanting to do something about this problem. That is the really great thing. I think that for a lot of parents, education is all that's needed. Also for a lot of hospital staff. Well, not *just* education. Education plus empowerment plus good leadership and stuff. But education is sure as hell a great step in the right direction.

I can really really really identify with your sorrow and despair when faced with systematic failure and cruelty. Oh man, can I ever identify with it. We must find ways to keep hoping, my friend.

Tonya said...

What a heartbreaking post. I do hope that this NICU is the exception, not the rule. Bonding is so important. SO SO SO. Argh. Not much else to say but that this situation sucks.