Scientists who have studied the birth process have deemed the first hour after birth a momentous time for baby and parents. Staff at Brookwood Baptist Medical Center have recognized the importance of this bonding time and have developed clinical best practices for newborns delivered in their hospital. Skin-to-skin contact between mother and baby, immediately after delivery, is a major part of the bonding process and offers many physical and psychological benefits.
"We put the baby on mom's chest immediately after birth so they can begin bonding. That process also stabilizes the newborn's respiration and oxygenation, stabilizes glucose levels, and warms the infant," says Glenda Dickerson, Women's Support Services Manager. "Joining mother and baby immediately is important because the mother's estrogen and oxytocin are at their highest level which helps bonding. It also impacts the father, because she emits those hormones and encourages them to bond as a family."
Skin-to-skin contact also colonizes baby with the mother's skin. "That provides immunity benefits to the baby. It also decreases discomfort after the birth for both mother and baby," Dickerson says.
Nurse Educator Lynn Jeter says that skin-to-skin time is encouraged for both vaginal and C-section births. "Our goal is to provide the same care regardless of how the baby is delivered, so we keep C-section mothers and babies together during the birth hour. We have implemented things to make the birth experience more intimate, such as a clear C-section drape so the mother can see the baby being lifted out if she wants to," she says. "We also warm the operating room to keep mom and baby comfortable. A nursery resource nurse helps make mom and dad part of the birth."
The birth hour is also the best time to begin breast feeding, and skin-to-skin contact helps facilitate that process as well. Ali Hardy, a nursery resource nurse, says right after delivery baby will find its way to its mother's breast on its own during the skin-to-skin time. "We help mothers with positioning and the correct way to feed," she says. "When you educate mothers while they are breast feeding, it encourages them and gives them more confidence that they can maintain it."
Beginning to breast feed in that first hour also can make a difference in the mother's milk. "Early feeding has an impact on milk supply. The sooner you start feeding, the better the milk supply," Dickerson says. "A mother will tend to have a better milk supply in the first two weeks if she starts breast feeding in the first hour."
Over the years, nursery resource nurse Kim Massey has been part of the changes in the birth process at Brookwood. "Initially skin-to-skin care, focusing on bonding of the mother and baby and feeding during that first hour, was a culture change in our community. We found after we implemented these changes that the patients loved the new focus. When they are educated about the process, it is overwhelmingly positive," she says. "The sooner you get moms and babies together, the more confidence they have when they go home."
Another clinical practice is screening new mothers for signs of postpartum depression, a condition that affects one out of seven women. New mothers complete the Edinburgh Postnatal Depression Scale survey while they are in the hospital. "In addition to this assessment, we also watch mothers for cues such as tearfulness, not wanting to hold the baby, or wanting us to care for the baby," says Sandra Brewton, Labor & Delivery Director. "Postpartum depression usually occurs in the first week after delivery and can last throughout the first year, so it is important that we educate the family about signs of this condition."
During discharge, the father is included in discussions so he will recognize symptoms. "We tell fathers to watch for mom's disinterest in caring for herself or her baby or feeling overwhelmed. If symptoms come and go, that's normal. If they come and stay, that's when we need to be careful," Brewton says.
Cindy Jones, Director of Inner Path, Brookwood's outpatient psychiatry program, says it is not unusual for "baby blues" to affect mothers. "70 to 80 percent of mothers experience baby blues, a milder form of postpartum depression," she says. "Those feelings resolve themselves, but actual postpartum depression lasts longer and can become prolonged."
Jones says the quicker postpartum depression is diagnosed, the better. "If it lasts more than three weeks, it can affect the mother's ability to bond with her baby. She is overwhelmed, and it is important that we get them back to a balanced place so she can take care of herself and her baby," she says.
The most serious form of the condition is postpartum psychosis, a state of mind where the mother might harm herself or her baby. "These mothers feel completely disassociated and can't care for themselves. They are delusional and cannot cope at all," Jones says. "It is a rare disorder but a serious one."
Inner Path provides treatment that allows mothers to talk with people who are supportive, including some who have experienced some form of postpartum depression themselves. Anyone can self-refer online or by fax. "We provide an environment where mothers can better understand their problem and put it all in perspective. Inner Path offers hope," Jones says.
If a patient needs additional therapy when they leave Inner Path, the staff will refer her to a psychiatrist or therapist. "It is important to know that there is help out there, and there are ways to get the support you need on an outpatient basis, whether it is through Inner Path, a support group, a psychiatrist or therapist," Jones says.