Tuesday, July 04, 2006

Special

I went to the delivery of a full term baby yesterday whose mother's water had broken 24 hours before delivery. That's longer than usual and increases the chances that the mother and baby might get infections. In fact, this mother had some chills prior to delivery, and the baby's heart rate was fast, both signs of possible infection. After the baby was born she breathed more rapidly than she should, which bought her a trip to our special care nursery for some antibiotics and observation.

This was a pretty easy case for us. It's a fairly common situation, the baby wasn't very sick, and we weren't too excited about it. In fact, I wanted to get the orders done right away so I could finish my rounds. I'm always a little on edge until I can get those rounds done and the NICU babies' care, especially that of the critically ill ones, settled for the day.

For the parents, though, this was far from a routine thing. This was their first baby; the possibilility of a serious infection was a major worry. Also, they naturally wanted the baby in mother's room so she could breast feed. They had a million questions, and it was all I could do to remain patient and answer all of them.

This is a bit of a problem for health care workers. A huge, special event in people's lives - for example, the birth of a baby - is a routine thing for us. If that baby turns out to have a problem, it's an even bigger deal for the family - but still might be sort of a ho-hum thing for us, and it can be hard to treat it like the big deal the family expects it to be treated as. If we don't act like it's a major thing, we can come off as seeming cavalier to the family.

When I left the parents of the smelly baby in the delivery room, taking their baby with me, they seemed a little shell shocked. Fortunately, I was able to speak to them at more length later in the day, after I had finished my rounds, and we had a great conversation. They were an extremely nice family; it was a pleasure to play a part in the birth and well being of their child. It's just hard to remember sometimes what a privilege it is to have my job and take part in so many special moments.


P.S. A new grand rounds is up at Dr. Rangel's blog.

14 Comments:

Blogger Kristina said...

Thank you for understanding this fine point. I am grateful to read your words because I hope it reminds other physicians to be mindful of the *experiences* the patients are having.

It takes a few seconds usually, to explain to a patient what is happening and why. It takes patience from the physician to be willing to treat patients as individuals and not numbers in a long line of more numbers. Being a birth worker this is one of my hugest frustrations.

Sometimes just letting the parents know that babies are not separated from their parents for small reasons, and that the *separation* is taken seriously by the staff, helps to ease the wound it leaves with the parents. I always hate coming to the labor room the day after the birth and hearing that a baby was taken to the nursery and the parents aren't sure why. I am learning that it's not always that there wasn't enough explanation, sometimes it's just that hte parents didn't listen, or ask questions or whatever.

This whole switching from doula to premed thing is really enlightening. LOL - but I digress...

I just wanted to say thanks, from a doula and patient's perspective for honoring this! I was nodding in agreement as I read this post. :)

4:44 PM  
Blogger Flea said...

ND,

It's routine for us: all the more reason for us to reassure them with 100% confidence. The spiels we give often we should do well, right? We should smack home runs.

best,

Flea

5:20 AM  
Anonymous Leslie said...

I spent four months with my son in the NICU, and I learned quite a bit during that time.

I would like to see parent volunteer programs utilized. I don't need a volunteer giving me directions about how to find my way around the hospital; I need a former NICU parent who can hold my hand, explain things in terms that I can understand, reassure me that my infant is in capable hands. The physicians don't have time to do these things, but a volunteer who understands what it is like to walk in that parent's shoes can be of huge value to the emotional needs of those parents.

Some parents require hand-holding because they don't have the maturity, stability, or skills to cope with the situation. Other parents (like me) want a little hand-holding because they are afraid; they want to know the honest reality of the situation yet they want it delivered with compassion and respect.

In your blog, you often make comments that parents don't seem to listen to what you are explaining to them. I imagine that most parents aren't expecting to go through the NICU experience, so they aren't prepared with the tools that they need. Maybe when a baby is admitted to the NICU and the parents visit the bedside for the first time, they should be provided with a small notebook and pen so they can take notes during the conversation, write down doctors' names, keep a running list of questions to ask, jot down resources or websites that have been recommended to them, journal their fears, feelings, etc. Don't include the notebook and pen in a package or folder with lots of other information because they won't comprehend why it's important. Hand them the notebook and pen and explain how it should be used. It can in essence become the parents' "chart" and go with them everywhere they go or be left at the infant's bedside.

In my situation, I had advance notice that my child would very likely spend time in the NICU. I planned for it, studied for it, and toured the NICU in advance. Even with that, it was still an overwhelming experience to go there following delivery. Even now when we go back to the NICU for social visits with the doctors and staff, it's still overwhelming to a certain degree because I can flash back to all of those emotions and memories which took place there.

P.S. I'm listing my son's website, and once you go to his site, you will probably figure out how I discovered your blog (see "Inappropriate"). Keep in mind that I've continued to read your blog for past few months now. I hope that my son's blog will be as fascinating to you as your blog is to me.

10:36 AM  
Blogger neonataldoc said...

Thanks, Kristina. Flea, you are correct - as usual! Leslie, very interesting suggestiions,especially the one about giving parents a paper and pen when you first talk to them. I might try that. I surfed over to your son's blog - also very interesting, thanks for letting me know about it.

2:03 PM  
Anonymous Anonymous said...

Smelly baby?

3:07 PM  
Anonymous DawnCNM said...

Anonymous--yes, smelly baby. I didn't question ND's words because they are true. When you have a baby born from a mom with an infection, the amniotic fluid often smells foul (can't describe it any other way) and, of course, the baby smells foul too until he/she has been bathed. Sometimes, it's the first sign (mom has no fever, didn't know her water was broken, baby isn't tachycardic) and every neonatal nurse and MD goes onto full alert when a baby smells. (It's very different from a normal birth odor)

4:47 PM  
Anonymous maribeth, CNM said...

And smelly placenta too - docs get SO slack about really examining a placenta and it's important.

9:52 PM  
Anonymous Anonymous said...

Placentas shouldn't smell like the absorbant paper at the bottom of the steak package - metallic with an edge of lactic acid and sharpness.

1:44 PM  
Anonymous Anonymous said...

thanks to the commenters who explained the "smelly baby." it seemed like a nonsequitur to me and I was about to ask.

1:47 AM  
Blogger neonataldoc said...

Thanks, Dawn, for clarifying the smelly baby thing. I thought I had referred to the baby's odor earlier in the post. Obviously, I hadn't.

9:12 PM  
Blogger WendyLou said...

I'm glad that you have recognized that the routine to you is life altering to the parents. 3 days after my 34 weeker IUGR 2p 13 oz baby was born, I got a cold sore. I was denied NICU access, and this shattered me. Let me tell you, a few nurses recognized and seemed to care that this was impossible for me to be away from her. My OB paid attention and wrote me prescriptions, but from some of the administration staff of the NICU, I got a very caviller attitude about being unable to see my 3 day old baby. The social worker was fairly rude to me. I had to be cleared to go back in, and had I not been cleared on a Friday, I was told I would have to wait until Tuesday, because the person who does that was off for the long weekend. How devastating is that to be told that you may not be able to see your baby because of administrative snafus? I was told to be patient. Yeah, but my point was that if the sore was crusted, I should be allowed in, and someone should be able to clear me on the weekend.

My complaining about inconsistent policies got them to re-write the visitation policy. In the policy I was presented at birth, it says masks are allowed for parents. They re-wrote after I pointed out that they seemed to be making up the rules as they went, and not following their own policies. Now it is bold-ed that no masks are allowed.

Yes this may be routine for you, but not for me. This is MY first born you are talking about.

6:58 PM  
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