Falls

The other day I was reading an article on the prevention of newborn falls in the hospital, immediately post-partum.  It turns out, most falls occur when moms fall asleep while breastfeeding, though the evil intentional co-sleeping was also mentioned, as was tripping over IV tubing on the way to the bathroom.

Possible interventions were cited, including:

• Not allowing moms to fall asleep while holding their infants
• Increased nursing presence (to put the infant back in the bassinet if the mom fell asleep and also to keep moms from falling asleep while holding their infants)
• Cessation of breastfeeding immediately should the mom feel sleepy or want to go to sleep
• Signing contracts on admission promising not to co-sleep

Yes there were other interventions mentioned, like better design of hospital beds for new mothers that allowed them to put the infant back in the bassinet by themselves more easily, without having to get up and negotiate non-ergonomic hospital bed rails and positions, and designing hospital beds that didn't have a giant gap between the bed and the bottom bed rails through which the infant could easily slide.  Unfortunately, these were listed AFTER the recommendations to force the mother to stay awake, and to never allow her to hold her infant when she's sleepy.

To their credit, the study also said that pain medications may contribute to sleepiness post-delivery, but they did not suggest withholding of pain medication in order to keep the mom awake. Phew! 

I must admit that the article made me laugh with bitter irony.  After I gave birth while I was in the hospital, I pretty much fell asleep anytime there wasn't someone in the room actively talking to me.  And actually, now that I think about it, I think I fell asleep then a couple of times too.  I remember when the Ob team was rounding on me, I couldn't focus well enough to be able to remember what year of the MD-PhD I was in because I kept falling asleep, and that was the day I got discharged.

Basically, if someone had prevented me from holding my baby at times when I might fall asleep, I would never have held my baby.  It's not like I was like, "Op!  It's time to go to sleep!  I'd better put the baby back in the bassinet!"  (frankly, if I'd done that, someone would have come in 5 minutes later to check my vitals anyway), it was mostly like, "No more stimulation.... falling aslee... zzzzzzzz........"

I remember being very worried about falling asleep while nursing (because it happened repeatedly), and that I would drop my baby.  The lactation consultant basically told me, yeah, you will fall asleep while nursing.  There's not much you can do about it. We solved this problem with a boppy, which provided better support and a more stable surface to rest the baby on than either my arms or a pillow could do.  But. according to the article, pillows are the enemy too (of course).  Oh!  And then there was the night that Dylan wouldn't stop crying unless my boob was in her mouth.  I guess a nurse should have thrown cold water on me to prevent me from falling asleep while holding her.  I'm sure that would have solved everything.  :-P

One thing, besides redesigning the beds, that the hospital really could do to improve this, would be to better organize the day so that the mom isn't constantly being disturbed by the 1,000,000 people who want a piece of her or the baby, so that she has time to rest for more than 5 minutes at a time.  I know this sort of thing has been studied elsewhere in the hospital (systematic sleep deprivation delays healing and leads to delirium -- big surprise!).  Not sure if this has been studied on maternity wards though. 

I sort of feel like as a hospital (particularly if they're not going to redesign the hospital beds / bassinets or restructure the day to allow moms to rest) you need to choose: Do you want to encourage mothers to breastfeed?  Or do you want to keep them from falling asleep while holding their infants.  Because basically, you can't have it both ways.

I wondered seriously if the author of the article had ever actually given birth, or been a patient in a hospital.  If they had, they must have had a baby / delivery that was way easier than mine was, or else I am sort of shocked that they could think these recommendations were even remotely reasonable. 

Gah.