Birth center emphasizes mother-baby closeness

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

The Family Birth Center at Upstate Community Hospital has a baby-friendly designation. We'll learn what that means and what birthing a baby is like from nurses Julie Moore and Lindsay Miner. Welcome to "The Informed Patient," Ms. Moore and Ms. Miner.

Nurse Lindsay Miner: Thank you.

Nurse Julie Moore: Thank you, Amber.

Host Amber Smith: It's called the Family Birth Center. Does that mean more than just the mom-to-be is involved in the birth?

Nurse Julie Moore: Yes, it does. At the Family Birth Center, we try to include the significant other and one other support person to attend the birth with the patient. Sometimes that extra support person is a doula that is there to support the patient. But yes, we want them to feel welcomed and supported while they're here in the Family Birth Center.

Host Amber Smith: Now, Ms. Moore, some people may not be familiar with the term "doula." What is a doula?

Nurse Julie Moore: So a doula is somebody that is either provided by Onondaga County or somebody that the patient can hire that is basically a birth assistant. They will come to the hospital with them. Generally they'll wait until the patient is closer to delivery.

They can help with positioning, help the patient relax. They're basically there to guide them and support them, and they can even help them in the postpartum period with initial newborn care and teaching the patient how to take care of their baby.

Host Amber Smith: How does that differ from a midwife?

Nurse Julie Moore: A midwife is somebody who is board certified and educated to attend the delivery. So they are making the medical decisions and taking care of the patient basically from the time of conception through delivery.

They, I guess, are similar to a doula because they provide that individual support, but they're different in the respect that they are the ones that are making the medical decisions. Doulas are not allowed to make any medical decisions.

Host Amber Smith: I see. Now, there was a renovation not too long ago that created 21 private postpartum rooms. What can you tell us about them? Ms. Miner?

Nurse Lindsay Miner: These rooms actually are wonderful rooms. They're very, very nice. We have actually 20 rooms; one of our rooms was converted to a lactation room. And these rooms are designed for "rooming in," so what that means is that mom and baby would be together unless there's a medical reason that baby could not be with mom, in which case baby would be in the nursery.

Host Amber Smith: So the mom has her own bed, the baby has a bassinet next to the bed? Is that how that works?

Nurse Lindsay Miner: That's correct.

Host Amber Smith: I've heard of the term "couplet care," and I wasn't sure what that meant. Can you explain that?

Nurse Lindsay Miner: The way that I would describe couplet care is basically where my nurses are focused on the mom and the baby together, and making sure that mom has all the tools and resources she needs to take care of the baby, that we are observing interactions between mom and the baby, that mom has everything essentially that she needs, as well as making sure that the baby is getting their needs met. Julie, I don't know if you want to add anything to that, but that's the way I would describe it.

Nurse Julie Moore: So I would also add to that that couplet care means that the baby is rooming in with mom for the entire stay. Baby only comes out of the room if there's a procedure that needs to be done, or if the patient requests a couple hours of rest or whatever. Then baby might come out of the room at that point, but couplet care really means that baby stays in the room 24/7 with mom and dad, and they are treated as one.

Host Amber Smith: With the baby in the room there, in the postpartum room, is the mom allowed to have other friends come up and visit?

Nurse Lindsay Miner: Yes, mom is allowed to have friends come up and visit. We try to limit it to three on postpartum, but we do have sibling visitation, and there's no age limit on that, because baby could be a sibling of an 18-month-old or a sibling of a 15-year-old. It really could go either way, or they could have many siblings.

Host Amber Smith: What happens if the mom is ready to go home and gets discharged from the hospital, but the baby needs to remain hospitalized? Where does the baby go for that?

Nurse Lindsay Miner: Typically, if the baby is hospitalized, often in that scenario, the baby's in our nursery. but mom can very frequently stay as what we call boarding, which means that mom is discharged from the hospital and is no longer a patient but is allowed to stay on the unit, so they can be close to their child.

Host Amber Smith: And is there room in the postpartum rooms for the support person to stay around the clock?

Nurse Lindsay Miner: There is, and we actually have furniture that would convert to a bed for the support person to be able to stay overnight with the mom, as they desire to do so.

Host Amber Smith: Ms. Moore, can you tell us about the birthing rooms?

Because when the mom comes to the hospital, she doesn't go straight to postpartum. That's for after the birth, right? So what room does she have the baby in?

Nurse Julie Moore: Correct. So when they come to labor and delivery, we have six labor rooms, and we have three triage rooms. So if they're coming for induction, or we know they're in labor, they will go into one of our labor rooms.

They're all private. They all have a tub, which the patients can use throughout the birth process. And there's definitely plenty of room for her support person to stay in the room with her.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with Julie Moore and Lindsay Miner, two of the nurses at the Family Birth Center at Upstate Community Hospital.

In addition to the labor and delivery nurses, like the two of you, who are the other professionals that are part of the Family Birth Center team? And we've already talked about doulas and the role of midwives. Are there other people that may be involved?

Nurse Julie Moore: We have our providers. We have in-house providers, we have other providers -- if one provider's not available, they're our backup. We have anesthesia in-house. So all we have to do is call, and they're right on the unit to assist with epidurals (an anesthetic injection) or if we have to go to the OR (operating room). We have nurse practitioners, APPs (advance practice providers), which take care of the infants at delivery and after if needed. And we have a pediatrician who's in-house for part of the day; they will come round (check on) on the infants after delivery.

Nurse Lindsay Miner: In addition to that, we also have a neonatal "SWAT" team of nurses, and they do critical care, if needed, on a newborn that might need additional support from the nursing staff.

Host Amber Smith: Well, let's talk about pain management. I know some women may choose to experience natural childbirth, but some may seek an epidural for pain relief or some alternatives.

What are the alternatives that you offer?

Nurse Julie Moore: As you stated, we have the epidural. They can do pain medications through their IV, which are generally helpful in early labor. And then we also have nitrous (nitrous oxide, or laughing gas) here, which is available for patients to use, which kind of helps take the edge off. I wouldn't say that we use it nearly as often as the IV medications or the epidural, but it is a good alternative for somebody who's not looking for medications like that.

Host Amber Smith: Do you know roughly what percent choose pain relief of some sort?

Nurse Julie Moore: Pain relief? I would say in general probably about 50% of patients. We do have a fair amount that come here with a birth plan that are looking for a natural delivery, as you stated, so they try to avoid pain medications if they can.

I will say that we try to educate patients when they come in with a birth plan to remain flexible, because things do change, and to let us know if they get to the point where they decide they really need help with their pain, to make sure that they let us know so that we can help them with that.

Host Amber Smith: So, Ms. Miner, what does the baby-friendly (from the accrediting body Baby-Friendly USA, for upholding high standards) designation mean?

Nurse Lindsay Miner: That covers a lot of things, however, if I could best summarize it, it really is keeping mom and baby together as much as humanly possible, skin-to-skin contact, optimal care for feeding -- basically policies that support that mom-baby relationship.

If I had to summarize it in a sentence, I would say that it really encourages and focuses on that really critical bonding between the mom and baby during the time that they're with us.

Host Amber Smith: Do you find that that helps encourage women to breastfeed? I'm curious about how many women are choosing to breastfeed these days?

Nurse Lindsay Miner: I would say a fair amount actually choose to breastfeed as much as possible. we do try to facilitate whatever mom decides they want to do. But I'd say a fair amount actually do decide to breastfeed.

Host Amber Smith: Now, what do moms to be need to know about the Upstate Cord Blood Bank?

Nurse Julie Moore: The Cord Blood Bank: Our hope is that eventually, word will get out about this, and that more providers will be telling their patients about it ahead of time.

But the Cord Blood Bank is a great option for parents that want to donate their baby's (umbilical) cord blood. There is a process that they have to go through before they come to the hospital, or, if they are here for induction, they can complete it here. There's a survey that they have to complete that basically fills out their entire history, which basically allows the Cord Blood Bank to know if they are a suitable donor or not.

There's, like, private cord blood banks that use that blood specifically for that baby if it's needed in the future.

This cord blood is donated for any other person, cancer patients or whoever, that they are in need of that cord blood to help with their treatment, so it's donated for those purposes instead of for that individual.

Host Amber Smith: Can moms who deliver at other hospitals use the cord blood bank, or do they need to deliver at Community?

Nurse Julie Moore: All of the hospitals in the area participate in the Cord Blood Bank. I will say, and it's probably because they're right next door, that I think we do a lot more cord blood banking than any of the other area hospitals.

Host Amber Smith: I'm curious, on average, how early moms arrive at the hospital. In other words, from the time they get to the hospital until the baby's born, how long is that, typically?

Nurse Julie Moore: It's really dependent. I always tell people I wish I had a magic ball to tell you, like, when they're going to deliver, because that's always the magic question when they come in: How long is it going to take?

It really is dependent on what number baby it is. I would say if it's a first-time mom, this is her first delivery, to expect it to take, if they're coming in in natural labor, it could take up to 24 hours. If they're coming in for an induction, it could take a few days.

So it really depends. After baby No. 1, it tends to go a lot quicker; then we're half a day, maybe, but first-time babies like to take their time.

Host Amber Smith: I know labor and delivery nurses like yourselves have years of experience helping moms prepare for their babies. I wanted to ask each of you, what is the advice you find yourself repeating time and again to the new moms? Ms. Moore?

Nurse Julie Moore: Before they deliver or after?

Host Amber Smith: Oh, let's do both.

Nurse Julie Moore: For me, when a patient first comes in, like I was saying earlier, I really try to explain everything that they may expect while they're in the hospital with us before delivery. I think really the best thing I can tell them is to relax and just kind of go with the flow, because when you fight it, sometimes it takes a little bit longer to get through that labor process.

And then after delivery, enjoy every single minute of it. There's nothing like having a baby, first time, second time, 10th time. It doesn't matter. It's really, truly, a miracle.

And my advice is: Just enjoy every minute of it.

Host Amber Smith: Ms. Miner?

Nurse Lindsay Miner: I would say, kind of jumping on what Julie was saying: Go with the flow. There's a lot of folks, I think even myself included, that had a birthing plan down to a T, and it absolutely did not go the way I planned.

And you know what? At the end of the day, as long as you have a happy, healthy baby, that's really what matters.

So things will change. In all likelihood. So be prepared for that. And it's OK. Things are going to change. We're going to get through it. At the end of the day, you're going to have a little one you've got to take care of. And afterwards, I would say there's a reason for the saying "it takes a village." It's OK.

Whether it's your first baby, fifth, 10th, being a parent is hard work, and it's OK to need help. It's OK to ask for that help. It's OK. There are resources if you need it. If you don't, that's OK, too. But I would really encourage anybody who needs help to definitely reach out and ask for it, because it's out there for you, available in the community.

Host Amber Smith: Well, thank you to both of you for making time for this interview.

Nurse Lindsay Miner: Thank you.

Nurse Julie Moore: Thank you, Amber

Host Amber Smith: My guests have been nurses Julie Moore and Lindsay Miner from the Family Birth Center at Upstate Community Hospital.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

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