“Your turn,” my colleague Jennifer said, “my feet hurt.”
The delivery bell had just rung and the light above the stabilization nursery door was flashing brightly, summoning one of us to yet another delivery. It was turning out to be a typical booming night in the newborn nursery. Jennifer picked up the phone with one hand and juggled a baby and bottle with the other hand. She spoke briefly with a nurse in a distant delivery room and then hung put the phone.
“Room five,” she said with a sigh, settling back in her chair. The baby in her arms was rooting around, mouth open like a tiny baby bird, eager to get back to the feeding.
Taking the stethoscope out of my ears, I hurriedly finished my assessment of the infant on warmer number one, and then headed out of the stabilization nursery. Rushing to the elevator near the secretary’s desk, I pushed the button and the door immediately opened. This was the express elevator, used solely for nursery-to-delivery room service.
“Got a boy for you,” the delivery nurse said when I arrived into her room, simultaneously handing over a tiny newborn and his records. “Vaginal delivery with forceps, mom had Demerol, APGARS 7 and 9,”was the report she quickly rattled off.
The little guy and I immediately headed for the Newborn Nursery. He was about 7 minutes old.
Yes, I worked at the “Baby Factory”.
Did you notice that my former hospital was not very baby-friendly? I did say “7 minute old”, and there had been no bonding, no skin-to-skin contact with his mother and no breastfeeding for this new couplet. The baby was launched into a harsh, bright, cold world and then whisked away from his former source of comfort, to a four hour observation period in the Newborn Nursery.
This was my first birth center job and I as far as I was concerned, this was “state-of-the-art care”. I had no idea that this was actually no way to care for a tender new family.
“Oh my, Jennifer, you’ve got to see this little guy! Cute as a button!” I exclaimed as I returned to the stabilization nursery.
Before the little baby knew what was happening, I had him stripped naked and was inserting a rectal thermometer into his bottom. This was followed by my rapid adjustment of his warmer-bed so that he was tipped, head down, into a slightly Trendelenberg position. This position would encourage the fluid and mucous to drain from his airway. If needed, I would vigorously suction any secretions from his mouth and nose with the hard rubber bulb syringe, just the way I had been taught. And if he had many bubbles coming from his mouth and nose, I would likely grab a feeding tube, insert it down his throat and into his stomach, attach a syringe and suck all of his gastric contents out, as he gagged and sputtered.
What I know now is that being in Trendelenberg is not so great on the fragile blood vessels in the baby’s head. And of course, being baby-friendly means that you are going to be very gentle with a baby’s mouth in order to prevent him from having an oral aversion later. But, things were a bit old fashioned at the “Baby Factory”.
My naked little guy would scream from the moment that I unwrapped him, until he had his bath, about 3 hours later. The Stabilization Nursery where I worked, a division of the Newborn Nursery, was one of the loudest rooms in the hospital. At any given time you’d find at least six of our eight warmers occupied with hysterical, flailing babies.
When I started at my current job, I was shocked to find out that a healthy baby’s normal behavioral state in the first hours after birth is “quiet-alert”. Yes, quiet and alert. That is how a baby reacts to skin-to-skin contact with his mother or to just being swaddled, held and spoken softly to. Seriously, I was astounded. I had no idea!
After a couple of hours, it was time for a very stimulating bath. Grabbing a pile of warm soapy washcloths, I would scrub him down from head to toe. Working him into a full lather, I was sure to clean in all folds and creases. Once his little body was done, I would swaddle him in fresh warm blankets and hold his head under the warm flow of the nearby water faucet, always insuring that his face stayed nice and dry. The no-more-tears baby shampoo would wash all of the vernix (nature’s cold cream) and blood out of his hair. Often that little head would be tender and swollen, having suffered the trauma of a scalp wire from the fetal scalp electrode, or vacuum suction marks, or even bruises and raised forceps marks. I felt bad having to wash those sore heads. I could not help but cause discomfort as I worked the comb through the hair as gently as possible, often feeling the baby squirm and let out a squeal. But usually, the baby was peaceful and calm for that glorious hair washing.
Did I mention that I worked in a fish bowl? If I had even a hint of performance anxiety before my “Baby Factory” job, it had vanished soon after starting that assignment. Windows surrounded the nursery on three sides and I had a gawking audience each night for the first few hours of my shift, that is until visiting hours were over. People would peer through the glass, staring at me like I was a zoo animal, watching me give injections and perform other basic cares. Thankfully my little baby friends didn’t seem to be modest.
Following the bath and swaddling, it was time to feed the baby his first bottle. Yes, all babies were given a bottle for the first feeding, even if they were going to be breastfed. Following the doctor’s orders, the infants were expected to take in a certain amount of formula. If the baby dared become sleepy during the feeding, I would move that nipple up and down and all around his mouth, encouraging him to keep going. He had a job to do.
Of course, that really is not the way a breast baby should be cared for. A breast baby should not receive artificial nipples until breast feeding has been established. We can only hope that the “Baby Factory” has changed their ways.
The end of his observation period was marked by one last disruption; a set of vital signs and a final assessment. Exhausted from his four hour ordeal, he didn’t stir as I wheel him over to the main nursery room to join thirty to forty other babies. His seven day adventure at the “Baby Factory” had just begun.
“It’s your turn Jennifer,” I said with a sigh…