Taking the “Baby” out of MotherBaby

Biased

Another letter arrived last week from Children’s Hospital reminding me that they were in the middle of major negotiations with Blue Cross Blue Shield of Minnesota. Reimbursement rates are the contentious issue, with one side that they need to pay less and they other saying they can’t afford to. As they got closer to a July deadline, I think it’s time for some straight talk about what this may mean. Not just to parents WITH kids earthside, but those parents planning to give birth at one of Allina’s cutely named “MotherBaby Centers”.

OK, I’m no fan of Allina, something I made abundantly clear during both strikes, as well as pointing out that they have engaged in the exact same kind of bait and switch that got a mom a massing legal settlement last year. Should Children’s lose their BCBS contract, families who are planning to give birth at Abbott, United, or Mercy will be facing the possibility of facing financial ruin.

Crazy, right? But here’s the reality:

The “baby” part of the MotherBaby Center is handled by Children’s. If your little one ends up in Special Care or the NICU, all care is then given by Children’s. Now, in the past, this arrangement has already hurt families–Allina’s Lactation and Children’s Lactation Services are by no means equal. Lost in the shuffle, parents don’t get a very important nurse visit after they go home. Communication between two entities can be pretty awful.

But if you have BCBS insurance and are planning on giving birth at any Allina facility– or even a system that defaults all very serious NICU cases to Abbott (Unity’s NICU isn’t quite as robust)–here’s what a lack of contract deal would mean:

You give birth. In the chance that your baby needs extra care, your baby goes to a higher-level care facility. You may gave your birth paid for, but the baby’s care won’t be in network.

Let’s say a mom is on BluePlus– a Medical Assistance plan administered through an outside company. If that baby goes to the Special Care Nursery or the NICU—will the baby get turned away? Will the parents be separated from their kids?

Or let’s say the midwives at one of the Minnesota Birth Centers or Health Foundations decide a baby needs extra help. All of a sudden a family is facing huge costs from being forced to get care out of network.

Or, as I have learned, a mom with prenatal care at another hospital system shows up at Abbott or United because the marketing makes it seem like a better choice, will they end up going through hell if they don’t end up with a healthy baby?

Do you see how this works?

Look, I’m not a huge fan of BCBS. They are doing some pretty wackadoo things to providers. They haven’t always been my favorite as a patient. But Children’s? With your stupid galas and fundraising? Have you thought this through?

Probably not. As is usually the case, the powers that be at the top think of the birthing patients and their babies last. I mean, after all–what’s screwing over a bunch of families if it means they have more money? It’s better to hurt the smallest patients than have a smaller bottom line, right?

Wrong.

-Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

My kids were born with obstructive sleep apnea

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Before I was a childbirth educator, I was a mom of a little girl. I’ve written about her birth before; I haven’t really ever thought to talk about how both of my kids were born with sleep apnea, and how it took forever to find a pediatrician who would actually believe me.

When I first brought her home from the hospital, I noticed almost immediately that my baby girl would regularly stop breathing for a couple of seconds, only to gasp for air. Initially, my new mama instinct wasn’t sure if I was just being overly paranoid, or if she really did stop breathing for a couple of seconds before the big gasps I didn’t think were normal. Her Mayo Clinic doctor (who was a total and complete ass, BTW), ignored my concerns– he told me she was just congested, and moved on to something else.

(As an aside, I should tell you some day about the nonsense “parenting education” material they would give me every visit. Knowing what I know now, there was very little actual evidence behind it. All it did was foster doubt an insecurity by creating parenting expectations that would never be biologically normal. Even better, if I could find the sheets, it’d be a total hoot to go through it with a big red marker!)

When my daughter was about 4 weeks old, after sleepless nights and too many days nodding off during the day while I fed her on the couch, a friend encouraged me to look into safe bedsharing. I found the safety guidelines online, and during one nap time, I latched her on while in the side-lying position in my bed, and we both fell asleep for a life-changing 2 hours. I was a convert from then on out. It wasn’t until much later that I realized that since she and I started sharing a safe sleep surface, I no longer noticed that she would stop breathing. Instead of sleeping next to me in her bassinet on her back (which, until very recently, was the only AAP-sanctioned sleep scenario), she spent her nights cuddled up next to me, on her side. Sometimes I’d wake up and find out that I’d been feeding her without remembering when or how the feeding started. And then, when she was 9 months old or so, she started to turn sideways in the middle of the night and stretch out as much as she possibly could. That’s when we transitioned her to a crib in her own room. And at 9 months, she would sleep in whatever position she felt like sleeping in that night. By that point, she was not only rolling and crawling, but walking on her own, too. SIDS and back-to-sleep stuff was no longer technically an issue for her.

However– she was back having very, very audible sleep apnea. We’d listen to what I now understand was the sound made when her tongue would fall into the back of her mouth, then the little “kuh” sound she’d make right before the gasp as she started breathing again. We’d joke in a moribund manner that the gasp at least told us she was breathing…eventually. Moreover, we’d started to notice that when she slept, she always slept on her stomach or he side with her head tilted back to straighten and open her airway.

When she was 2 years old–maybe?– we brought it up again with her doctor. Keep in mind, smart phones weren’t a thing yet. iPods were big and bulky and only had hard drives and were only for music. We could really only convey what we were noticing by trying to recreate it ourselves. Her family med doc was again dismissive, though he did say he could refer us for a pediatric sleep study, but that it would take 6 months before we’d be able to get in. Shortly after that, our basement flooded, my husband got a new job that required him to commute 90 minutes each way, and then I got pregnant with her little brother… and life got super chaotic.

Once my son was born, bedsharing was started from day 1. However, he didn’t really nap on his own until he was about 8 months old, and when he did, he’d do what his sister did– he’d stop breathing. As he neared the 9 month mark, when I would put them both down for a nap in the same room, I’d listen to the baby monitor as they took turns having apnea episodes (which I’m sure did NOT help my anxiety). I can’t remember if it was at a well baby visit for him or a well child visit for her, but I mentioned the apnea episodes their pediatrician, who referred us to a pediatric ENT. She got her tonsils out shortly after her 4th birthday. At that point, they had grown so large that she barely had any room to breathe while she slept. A few days after the tonsillectomy, we noticed that when she slept–there was silence.

My son had his tonsils and adenoid out when he was 3 years old. He was also able to breathe perfectly while sleeping a couple days after surgery.

So there you go. My kids had obstructive sleep apnea, and now they don’t. I do think that both of them had and have tongue ties for a BUNCH of reasons. I had recurrent mastitis, nursing was super painful at first with my daughter, she didn’t gain weight all that fast, both kids had EPIC spit-ups. One child had speech issues that have been resolved. The other one tongue-thrusts to swallow and is very sensitive to food texture.I often wonder if I had had them sleeping on their own in a room from day 1, on their backs and not near me–would we have had a different outcome? We know (and the AAP recognizes this) that babies NEED to sleep in close range to their parents for at least the first 9 months, in part to help them regulate their breathing. When humans sleep on their backs, the tongue can fall to the back of the mouth, causing snoring and apnea.

Finally, I do want parents to know that if your little one stops breathing and then gasps for air, that is NOT NORMAL. If they sleep with their head always tilted back—again, not normal. Listen to your gut, and if your child’s care provider dismisses you–get a second opinion. Or a third. I know that there’s so much more to learn about this, SIDS, and other sleep issues, but I do think that parents can go a long way if we share our stories and compare notes.

On that note, Happy New Year!

Warmly,

Veronica

 

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Fact vs Fiction in Modern Birth: An Intro

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Childbirth is distinctly different than any other discipline of modern medicine: Unlike every other medical specialty, humans have been giving birth for as long as– well, for all of human existence. As modern medicine started to really develop at the turn of the 20th century, childbirth– once looked at a normal life process– was taken over by doctors who at first really didn’t know at all what they were doing and had very little actual understanding of the female body or birth. That either the mom or baby made it through the process of birth in early hospitals was often a matter of luck.

I joke sometimes in class that so much of what’s wrong with birth in the US, with our rising maternal morality rates, is thanks to the arrogant, misogynistic, vain, and ignorant decisions made by men of the medical establishment since at least the 1850s. Who came up with the idea that episiotomies should be routinely done without evidence to prove their claims? Men. Who decided, without any evidence otherwise that once a mom had a cesarean, all births should be cesareans after that? A man–in 1912. And I’m not saying this to make a generalization that men are terrible, but to point out so many aspects of modern birth came from those without any real knowledge of the process. Once medical research really kicked in in full force in the 1950s, we saw some outcomes in maternity care improve, but not always.  Here’s where I strongly suggest that you read Tina Cassidy’s fantastic book Birth: The Surprising History of How We Are Born. If you want to know the full play by play of modern maternity care–this is the book you need to read.

The reality is, while there are a few things that can be measured and quantified about pregnancy and birth (hypertension really being one of the most obvious situations, followed maybe by cholestasis of pregnancy), many doctors who provide maternity care struggle to fully grasp that birth can be really hard to study. However, just because some aspects about birth can be difficult to study or quantify, that doesn’t mean that evidence-based maternity care doesn’t exist–because it does. In addition to the 6 Healthy Birth Practices as laid out by Lamaze International, other strong resources and proponents of evidence-based care can be seen in the Report from 2008 called Evidence-Based Maternity Care: What It Is and What It Can Achieve and in the joint consensus statement  Safe Prevention of the Primary Cesarean Delivery from ACOG and SMFM, originally published in 2014 and reaffirmed this year.

I am a strong proponent of intellectualism. Our shift to anti-intellectualism in all facets of life is more than a little disturbing. And while I can’t address everything in the world, I can go through some of the aspects of maternity care in the US and abroad, explain where they originated, what the original motivations were, and place those beliefs in the continuum between fact and fantasy. This post is an introduction to what I hope will be a interesting project. The next couple of posts will cover the rise of early birth “methods”…and then see where that takes us.

Are you ready? Let’s do this.

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Corrected 2015 Minnesota Cesarean Rates and Insights

First of all, I had warned that last week’s post may have some numbers that end up changing. Yeah, a few numbers changed. The reality is, to calculate one hospital’s rate, you have to go on 6 separate screens to get 6 different numbers before you can figure out a cesarean rate for one hospital. And since I calculated numbers for the 89 hospitals that provide maternity care, that….that’s a lot of screen toggling.

Second, while I’ve been blogging about these rates every time they come out, the backlash to releasing the numbers was abnormally defensive. Comments on social media were not what I’d seen previously. There are a few things I want to get straight first:

  • From the joint statement from ACOG and SMFM: “In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused.” You can read through the full Obstetric Care Consensus here.
  • The sad fact is, while there are times that Cesareans are truly needed, our rising Cesarean rate is causing a rise in maternal mortality rates in the United States. Overall, Minnesota is better than the national average, but some rural hospitals have rates that are too high. Discussing these numbers is critical for protecting the health and safety of pregnant patients and their babies.
  • Multiple studies, including studies published by Consumer Reports and Blue Cross Insurance networks, continue to affirm that the biggest factor in if a birth will be done vaginally or by cesarean is the place of birth and care provider preference.
  • If you’re questioning how different clinics affect each hospital’s rates, check out my blog post from the beginning of the year with that information.

This information does matter- a lot. We believe that childbirth education and informed choices are the key to empowering families that will allow them to make the choices that best suit their situations. And I do want to point out that, at least in the Twin Cities, Cesarean rates peaked in 2009, with Abbott Northwestern reaching 37.1%. Rates have gone down overall since then.

In the next blog post, I’ll compare this year’s results with those over the last decade.

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Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Parent Shame and Car Seats

It’s National Child Passenger Safety Week!

Last week, in a fit of irritation, I wrote a little tweetstorm on how irritated I am with the notion of “parent shaming”.

And I really meant all of it. Yesterday, I got called to help a very well-meaning family who knew something was up with their car seat and wanted it to be installed correctly. Once I got there, though, I looked at the seat and realized it was not only an expired seat, but a recalled seat. But it’s so common to buy used car seats, many parents don’t even question it.  Or what about this viral video from last month? Here. Here’s a screenshot:

bad-car-seat

I haven’t watched the full video, nor do I care to. Why? Because every time I look at this I get sick to my stomach. Not only is this an infant seat that’s ONLY supposed to go backwards, but I’m pretty certain it’s close to 10 years old, the straps aren’t even on one of the little boy’s shoulders, and my WORD…what is going on with the seatbelt? It’s over the arm, it’s…it’s just a mess. There is almost no likelihood that this poor sweet little boy would escape a crash without major injuries or worse.

Or what about this video?

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The straps are too loose, they are falling off, and she’s too young to be facing forward. Truthfully, 99.9% of the videos and pictures parents post of their kids in car seats have at least one horrible, obvious flaw. Nothing else you buy is THIS critical to keeping your child alive. Nothing. And yes, for a variety of reasons, car seats are just really hard to use correctly. It also doesn’t help when parents so commonly are exposed to other parents making unsafe choices, such as:

  • Buying used car seats
  • Choosing to use expired car seats
  • Placing car seats on top of carts, tables, chairs….
  • Keeping babies in a car seat when they aren’t in a car
  • Turning a baby to be forward facing when they turn 1
  • Letting a baby nap in a car seat outside of the car
  • Not keeping a baby buckled in when the car seat is being used in a stroller
  • Using coats under car seat straps

Parents don’t want to hear that they’ve been doing something that puts their children in danger. I would never DREAM of going up to a parent when I see any of the above things. No matter how it’s phrased, it’s never taken well. Ever. So we try to educate broadly, and I go along and say a silent prayer every time I see a baby sleeping in a car seat, head falling forward, or a $450 car seat precariously perched on top of a shopping cart.

If you’ve been committing any of these car seat cardinal sins, today should be the day you stop. Car crashes are on the rise as more and more people are driving while distracted. Nothing is more important than keeping your children safe. There’s always a solution to every car seat problem. Have a trained professional, a Child Passenger Safety Technician (like me!), help you out if you need it. But really, don’t brush it off. Please.

Warmly,

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

Allina’s Replacement Nurses and Patient Neglect: Another mom’s story

Nurses Union

After I shared Lisa’s story Monday and Tuesday, another mom contacted me who had given birth during the strike. This time, the circumstances were a little different; Ashley had a planned cesarean. She was still suffered from incompetent care, and she wasn’t given food, water, or medication for long stretches of time for the duration of her 4 night stay.

When you read her story, please keep the following things in mind:

A few things are starting to become clear: While staffing during the strike might have been adequate in other departments and other hospitals, the night nurses at Abbott from 7PM to 7AM did not take care of the patients. Food, medication, and water were withheld from at least 2 moms for very long stretches of time. Only very vocal family members saved these moms from total neglect.

Penny Wheeler is a former OBGYN. Again, she claims up and down that the replacement nurses took good care of patients, but no decent OBGYN would find this to be safe care. How can anyone justify the care that these moms received? I’ve spent the last decade of my life advocating for good maternity care, and nothing has angered me as much as hearing this care happened within my own city.

As before, if you have questions about your care options after Monday, contact me. If you have a story about your care that you want heard, contact me. My phone number is 651-200-3343 and I can be reached at veronica@babylovemn.com

Ashley’s story is below. It was edited for clarity, and I have been given explicit permission to post it.

I had a scheduled C-section on June 22nd, 2016 due to my son being breech. When I arrived at Abbott, I noticed that there were hundreds of people walking around protesting only to learn these were the nurses I had gotten to know over my entire pregnancy journey.

I was scheduled for surgery at 12pm, and up until I was brought into the OR everything had been going great. Then things went downhill.  The nurse who was assisting with the surgery was holding the clamp opening up my incision pulled so hard that she fell backwards off of the stool she was standing on. This ripped my incision open larger than needed and made for an extremely crooked scar. I was not allowed to hold my son for a good 45 minutes once he was taken out, but not because there was any complication. I begged and pleaded to get some skin to skin contact with him as I knew it is very important in the breastfeeding process. I was told skin to skin was unsanitary for me while being in the operating room.

Once I had been all stitched up, I was put into recovery while they made sure my uterus was shrinking and I wasn’t going to lose too much blood. At this time, they noticed my son was grunting and took him to special care to be evaluated for fluid in his lungs.

Two hours later I was brought up to my postpartum room and was introduced to my first nurse. She was amazing, and I would take her again any day. She promptly gave my meds and kept my water full, but she wouldn’t allow me to eat anything. She informed me about everything going on and kept me cleaned up well. I asked when I could go see my son and she said as soon as my catheter was removed. I was told the next nurse would do it immediately after shift change at 7pm– at that time, it was around 6pm.

When 7pm came, I paged for my nurse. I was in excruciating pain and I was bleeding so much that I had bled through the pad I had on and the blankets on my bed had become saturated. I paged my nurse at least 3 times, but nobody ever answered my calls. My dad came to visit. He found me sitting in a bloody mess,  bawling my eyes out. I was desperate for help that I was not receiving. My dad was outraged and tracked down any nurse he could to help me. At 9PM I was finally given my pain medication. I asked again about having them take out my catheter; by 10pm it was finally removed and I could go see my son.

While my son was being kept in the nursery, the staff had done an x-ray and his lungs looked clear. I had received a call from special care at 8pm saying my son had still not been fed and he was delivered at 1:18pm. He hadn’t been fed anything at all since he was born, and his blood sugar dropped to 35. I asked to breastfeed him, but I was told that was not allowed. I was told I could pump to feed him, but because I’d had a cesarean, I wasn’t allowed to breastfeed him. I was heartbroken. The only options I was given for feeding him was donor milk or formula.

I got to him around 10pm and stayed until 11pm. I went up to my room to rest and let my body recover. I was told 3am was his next feeding time, and I was welcome to come bottle feed him–but I still wasn’t allowed to breastfeed. At 3am when I came down my son had an IV in his hand. Neither his dad nor I ever gave informed consent for this to be placed. Then the nurses told me they had to give him sugar water because his blood sugar was still too low. They didn’t mention to me that his blood sugar was low when I had been there 4 hours prior. Then they also informed me they started a preventative antibiotic while I was away to stop his grunting, and he was going to have to stay in special care for at least another 48 hours. I cried as they told me if he pulls out this IV would need to put it in his head. I felt scared, sad and angry that not only they had done these things to my baby without me knowledge or consent, but that they could threaten more procedures. Infection had been ruled out prior to this IV, so I knew my son was fine without then.

On day 2 of my stay again my morning nurse did a fantastic job. My night nurse completely neglected me; she never filled my water or told me where I could go to fill it. She didn’t bring me my pain meds until 6am– right before the end of her shift. This occurred all 4 nights I was there. By 7am I was begging my good nurse to help me get the pain managed again. And it would continue to relapse at shift change every time.

My last night I was finally able to have my son with me in my room. The morning nurse was there to help me breastfeed him finally for the first time. He latched great and stayed on 30 minutes each side she was so supportive of me the entire time wanting to breastfeed my son. She promised the second I got him I could feed him myself and kept her promise.

A week and a half after I was discharged, I developed a staph infection in my incision. Originally, they told me I was mistaken. I insisted on a culture. They finally did it and sent me home that I would get results later. Next day they called me and told me I had a serious staph infection;  they sent antibiotics to my pharmacy that I needed to get immediately. If nothing got better in 3 days I was to go to urgent care. Thankfully, the infection cleared.

I encourage anyone due during strike to do your research before going through with your delivery. I also want to apologize to any other mothers who had a terrible experience during their deliveries. The delivery of my son turned into the biggest nightmare I could have never imagined. I expected it to all be so happy and didn’t imagine I’d be so depressed throughout my hospital stay. Thankfully my son and I are both extremely happy and healthy since being home.

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

More Allina Strike Concerns

Monday’s post on the Allina strike has hit 4,000 views—in 48 hours. People are reading it, people are sharing it, which is great, but you guys? I’m not being hyperbolic when I say this– it’s going to be worse than I thought. I met Lisa in person, who was super brave to share her story, today. She’s been amazed at the response, that anyone cares what her experience was. And yes, she gave me permission to share all of this. But the more I learned as we spoke, the more disgusted I am with Allina’s CEO and administration to allow another strike to go on.

Once the strike started and after her Cesarean, not only was Lisa (and at least one other mom) left in recovery for HOURS– at least 2, maybe 3—without a single staff person checking in (AFTER SURGERY), once Lisa and her baby were finally taken to the postpartum wing, the room she was in didn’t have any diapers, and all attempts that Lisa and her husband made to get a nurse to help with anything were refused. They would not bring medication. They never asked what she was doing to feed her baby.  She was at least experienced enough with breastfeeding that she knew what she was doing, but if she needed formula, I don’t know if anyone would have been there to bring her any. The replacement overnight nurses did not check to see if her son was being fed. LISA WAS NEVER FED, save for some crackers her husband managed to find, until she reached out the next morning and after her midwife raised hell to get Lisa any care in any way, shape, or form.

So, let’s get this straight: I have seen union propaganda. I have been very diligent in getting as much detail as I can on all sides of this issue. I am not sharing this as union propaganda. I am sharing this because I am TERRIFIED to learn what hundreds of other moms and babies were subjected to during the strike. I’m sure Lisa’s experience was what everyone else had to go through. In 4,000 page views, nobody has told me anything was inaccurate. I’ve had people reach out and confirm that Lisa’s experience was a fair representation of what it was like and will be like during another nurse strike.

Someone needs to tell me why this is ok: A mom who gave birth at Abbot Northwestern during the June strike gave birth via major abdominal surgery, was left for hours immediately following with no care, was brought into an actual room with no diapers, nobody checked her vitals or her son’s vitals after major surgery. Allina’s replacement nurses did not care if she was fed. They did not care if the baby was fed. It wasn’t until an outside party stepped in that Lisa and her son had any care whatsoever. Most people who give birth at Allina don’t have the access to their OBs that would have allowed them to have an advocate that would have raised hell and gotten them care.

I’m sharing this because somehow, someone needs to speak up. This isn’t about not having a birth go a specific way. This is about a hospital system refusing to make sure that their patients are cared for in the slightest. Allina’s powers that be need to tell me why they are OK with letting their patients get not just sub-standard care, but likely absolutely no care, no food, and without their basic medical needs met. Allina’s CEO kept saying the staffing levels were adequate. She was either misinformed or outright lying.

As women, we are often told that as long as are babies are here and alive, we should shut up and be thankful. I’m here and I’m going to rock the boat for Lisa and for that other mom in the recovery room with her and for the hundreds of moms and babies that I have no doubt weren’t provided basic care. I have a blog. I have this platform. I can share Lisa’s story and hope it gives others the courage to speak up. Otherwise, I’m mad, I’m sad, and I’m scared.

If you need or want to reach me, the office phone is 651-200-3343 and I can be contacted by email at veronica@babylovemn.com

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

The Allina strike will put birthing families in grave danger

I have been blogging for almost exactly 5 years in this space, and maternity care outcomes and transparency hold a special place in my heart. I don’t know if anyone gets as excited as I do when new info comes out. After a lot of thought over the weekend, I am posting this. Buckle in.

The Allina nurse strike saga continues. In June, the nurses went on a 7 day strike. Back then, I had concerns about the safety of giving birth with replacement nurses. Now that a strike date of September 5th at 7am has been set, and after careful consideration, I can’t say this without enough emphasis: DO NOT HAVE YOUR BABY AT AN ALLINA HOSPITAL DURING THE STRIKE. CHANGE PROVIDERS AND/OR PLACE OF BIRTH NOW!!!!!

I may not make any friends with the system’s physicians or administration, but the evidence is more than circumstantial to back up my warnings. While I understand the political forces at stake with public opinion of unions in general, staffing ratios and staff safety are always issues at Allina. And in fact, the National Labor Relations Board ruled that the Minnesota Nurses Association’s complaints about unfair labor practices were with merit.

Historically, Allina’s hospitals have had some of the highest cesarean rates in the Twin Cities Metro Area. Recently, a change was made and births are no longer done at Unity Hospital, but in 2014, the c-section rate for Abbott Northwestern was 30.2%, it was 28.3% at Mercy Hospital, and 30.4% at United Hospital; all of these are above the state average of 26.9%. In 2014, 11,207 births occurred at Abbott, United, Mercy, and Unity–an average of 217 per week. With such high volume, Staffing problems will hit maternity services hard. Lactation services are sure to be hit hard as well, as union IBCLC RNs will also be on strike, so moms will have a very hard time getting appropriate breastfeeding help.

The last strike, which was limited to 7 days, cost Allina $20 million. On social media pages, nurses from other parts of the country are posting information they’ve received from staffing agencies recruiting workers to fill in for the striking nurses. Replacement nurses are being offered $6,900 per week and are not required to be licensed to practice in Minnesota. Additionally, because of such a high cost to replace nurses and because of the very large number of striking nurses (4,800), there is absolutely no way that Allina’s hospitals will have adequate staffing– in fact, only 1,400 nurses were brought in during the strike in June. A hospital system with a whopping 71% reduction in nursing staff is without a doubt incapable of providing safe care. While this creates a dangerous situation for all of the hospital units, because safe staffing ratios are so high– 1:1 nurse to patient ratios during labor and birth, and 1:3 nurse to patient ratios postpartum, there’s no doubt that having less than 1/3 the normal number of nurses will put mothers and babies in grave danger.

Very specifically, replacement nurses can’t provide appropriate care in the “Mother Baby Centers” of Allina hospital because:

  • Nurses will be much slower at charting in a system that they aren’t familiar with. Even if the nurses are familiar with EPIC, the most common EHR in our area, each organization has their own unique configuration. In births, charting is extensive– many, many things need to be documented in real time, taking away the nurses’ ability to provide patient care.
  • Maternity Care practices in our area are very different from those in other parts of the country. We tend to have better outcomes than in other parts of the US–meaning the replacement nurses will probably be used to maternity care practices that are considered outdated or unsafe. So, for instance, while Allina hospitals have Nitrous Oxide as an analgesic option for birth, it’s still rarely used outside of our metro area. Because the replacement nurses won’t have the training needed to provide Nitrous, parents will very likely find that options they expected to be available aren’t.
  • Patients with high-risk pregnancies are very likely to have replacement nurses that lack the higher training needed to keep medically fragile conditions under control.
  • Staff morale in hospitals during strikes always takes a major hit, distracting from the real need-providing patient care.
  • Even if the nurses were perfectly trained to work as Labor and delivery and postpartum nurses, even if they knew exactly how to use the Electronic Health Record System– In no way, shape, or form will there be nearly enough nurses to provide safe care.

When I previously wrote about my concerns, I wasn’t sure what birthing mothers would end up experiencing. However, last week, I made contact with one mother who gave me permission to share her story. Her name is Lisa, and her story follows:

I planned birth at Abbott due to VBAC.  I was aware of the strike and very concerned that I would go into labor during that time, but I was planning to birth with my midwife and with my doula and I was reassured that I have nothing to worry about. In fact I’m going to say what no one said to me when I was worried about the strike: RUN! I know everyone might not agree with that, but I speak from personal experience. I moved back from Alabama so that I could receive the care we’re accustomed to here in MN, and I still ended up with nurses from states where I would never give birth.  My due date was 6/19.  Same day as the strike. Water broke 6/16.  Labor never started so I went in 6/18 at 4am for Pitocin.

24 hours later [early in the morning of June 19th, the day of the strike], I’m laboring hard on Pitocin. I have a wonderful supportive Allina nurse. The best nurse I’ve ever had, but there’s a tension in the room so thick that you could cut it with a knife. We all know she has to go home at 7am, when her shift ends and the strike begins. In just 3 more hours. It was awkward. There was an elephant in the room. I considered asking her if she would stay with me but that seemed awkward and inappropriate.

So 7am came and she said “I’m sorry, I have to go now. ”

After that I had a stream of nurses. “I’m you nurse now. ..no I’m your nurse now. No I’m your nurse again.” I was in the shower and they kept interrupting me. I had a doula and a very supportive husband. I just wanted some privacy at this point, I wasn’t asking for extra support.

At another point I had nurses just standing around me with their arms crossed. Just watching me. Like they had never seen a woman labor before. Like I was a fucking zoo animal!!!!

At another point, one nurse was giving another nurse a tour of the room. “Here’s the warming station…” and then the two of them stand in front of the computer and discuss how the medical system works. I just hear whispering and taping on the keyboard. I’m butt ass naked, standing at the foot of my bed, huffing nitrous every 2 minutes for 90 seconds. I can barely speak. I’ve been at this for 30 hours. I wave my hand at them “They need to go. They’re distracting me.” I’m begging/irritated. My midwife then shooed them away.

This still pisses me off. I shouldn’t have to protect my own birth space like this. My midwife was there and my doula and my husband. But no one said anything. I had to ask them to leave.

It’s no surprise that soon after this I lost my ability to handle my Pitocin induced contractions. I asked for an epidural. Then my contractions went to 18 minutes apart and I ended up with a cesarean, again. Cesarean was 6/19 at 6pm.

They surgery itself had some parts that were less than what I would expect from Abbott and my post surgery care was grossly negligent.

I actually had to page my midwife on call during the overnight hours.  When the baby was born (unplanned cesarean ) we were told he could stay with us but would need to have his temp closely monitored due to prolonged rupture of membranes.  But they never checked his temperature the entire night.  Nor did they check my bleeding on the night shift.  It literally felt like everyone had left the hospital,  apocalypse. When she [the midwife] called me back I told her that I wanted to transfer with my baby to another hospital because no one was taking care of us. I paged her just after 7 am.  I knew I was supposed to have a new nurse and still no one had come to check on me or the baby.   I told her I was scared because we weren’t being monitored  and wanted us to be transferred to another hospital,  by ambulance if necessary.  She said “hold tight,  I’ll see what I can do and I’ll call you back.”

It’s my belief that when she hung up with me she called up there to the hospital and raised hell, because within a few minutes I has my day nurse and the charge nurse there.  They helped me clean up the blood that was dried from my waist down, changed my sheets and got me some food.  And filled out the white board.  There was definitely a turnaround of my care at that point.  My midwife called me back about 8am on June 20 and asked if I still wanted a transfer,  and  told me she could make it happen.  At that point I said we had a new nurse and I  felt safe again.  I told her we would stay.

Hiring a doula won’t be enough. Every single birthing family  with babies due in the next month needs to change plans on where to give birth, which likely will result in also changing providers, and they need to do it NOW. Changing is easy– I’ve outlined the process before. If you’re late in the game, you may need to change to a Family Med Provider who does OB care or an OB group. If you need help sorting your options, I’m happy to help. Call or email me– 651-200-3343 or veronica@babylovemn.com.

And Allina union nurses? I have your back. Allina’s C-suite? You are putting people at risk with your ongoing actions, and you need to be ashamed of yourselves.

Veronica

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

The Baby-Friendly Hospital initiative is perfectly safe

Last week, the American Academy of Pediatrics published a clinical report that took a look at safety practices of bed-sharing and rooming in. This wasn’t a policy paper, but instead more of a “this is what a group of Pediatricians think” sort of thing. Headlines have been all over the map on this one, though. Some wise nurse and professionals looked at the publication and took away the advice that hospitals need to have good staffing levels and well-trained competent nurses to make sure patients are safe. Sorry to sound flip, but DUH. I guess there are plenty of places that put profits before patient safety (ahem), but in 10 years of attending births, I’ve only seen poor care of a baby after birth in 2-3 cases.

And then, Elisa Strauss of Slate has her opinion: The paper proves that a Baby-Friendly designation makes a hospital inherently unsafe.

Are you kidding me?

In reality, the paper does mention that aspects of the practices outlined by the Baby Friendly Hospital Initiative need additional guidance for safety– but nothing shows that these hospitals are inherently unsafe. Strauss has a history of writing about studies in a very odd way– in January she tore apart the idea of having a doula based on the most inane logic possible. If you want to see someone hell-bent on espousing experience-based practices, she’s your writer.

How dies she even come to her conclusions?

First, she writes that, “Their [the researchers] first area of concern is the initiative’s requirement for skin-to-skin contact between mother and child directly after birth until the completion of the first feeding, and to encourage skin-to-skin contact throughout the hospital stay. The problem is not the skin-to-skin contact itself, which has documented benefits, but the fact that mother and child are often left unsupervised during this time.” Immediately postpartum, nurse coverage should be 1 to 1– a nurse should have no other patients than the baby and new mother. Yes, complications can develop quickly right after birth, and medical supervision in needed. However, the problem isn’t the skin to skin contact– it’s hospitals that profit from lean staffing levels. Further, Strauss doesn’t present any solutions– does she think these babies should be taken away from the new parents and placed in a nursery with dozens of other babies with only 1 or two nurses to take care of these babies? Or should the babies be left in the warmer in the room for a couple of hours following birth? Or…..what?

The next paragraph is a doozy. Strauss writes,

Other concerns in the JAMA paper include the encouragement for rooming-in, even when the mother is exhausted or sedated. They believe this can lead to unsafe conditions for the newborn, and that parents, thinking that such sleep-arrangements were hospital-approved, may continue sleeping in such a manner once they return home. Also, they question whether supplementation with formula should really be banned, as there is no hard evidence linking early formula use to a decreased likelihood of breastfeeding further down the line. In fact, one study suggests that early formula use might help increase breastfeeding rates by reducing stress among new moms while they wait for their milk to come in.

Where to start?

NO HOSPITAL in their right minds would EVER encourage rooming in when a mother is sedated. The hospitals I have worked at rightly and explicitly disallow rooming in if a mother is unconscious and nobody else is there to attend to the baby’s needs. I want to see proof that this is a practice any place actually follows. I’m also not sure what she means by “these sleeping arrangements”. In reality, current SIDS reduction practices actually encourage parents to have babies sleep within 15 feet of the parents– in the same room. As far as formula supplementation being banned– it’s not. Nothing about Baby Friendly designation bans formula use. It calls for hospitals to pay for the formula (rather than get an unlimited free supply from the formula companies) and it calls for guidance when mothers do supplement. That’s all. This oft-repeated myth is a great tool for formula companies who want to create public panic, but it’s simply a lie. And WHY do otherwise intelligent writers perpetuate the whole nonsense that until a mother’s “milk comes in”, there’s nothing to feed a baby. It’s called colostrum, and it works very well to feed human babies and all other mammals, thankyouverymuch.

Finally, according to Strauss,

They end the paper by arguing that the Office of the Surgeon General should reconsider its call for an acceleration of the implementation of the Baby-Friendly Hospital Initiative in the United States. “If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay. More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding.

The language she quoted does not exist ANYWHERE in the cited publication, and at no point do the authors even come close to encouraging the discontinuation of the 10 steps outlined as Baby-Friendly. Further, she doesn’t even include a citation for this quote, and it could be completely made up for all we know.

In reality, the authors of the AAP paper praise the 10 steps, saying, “The Ten Steps include practices that also improve patient safety and outcomes by supporting a more physiologic transition immediately after delivery; maintaining close contact between the mother and her newborn, which decreases the risk of infection and sepsis; increasing the opportunity for the development of a protective immunologic environment; decreasing stress responses by the mother and her infant; and enhancing sleep patterns in the mother.”

For better or for worse, there will always be a backlash against the movement of hospitals towards the implementation of the 10 steps of the Baby-Friendly hospital designation. However, it would serve all of us better to see this discussion happen in a place without twisting a clinical report to serve one’s preconceived editorial slant.

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.

About that Alabama birth settlement…

Last week, a mom in Alabama was awarded $16 million by a jury to compensate her for damage; they found the hospital “violated the standard of care for labor and delivery and participated in reckless misrepresentation of fact.” Evidently, the hospital had a pattern of what the jury described as “Bait and switch”. Of note was that they hospital’s advertising touted waterbirth until At least July of 2015, even though water birth had been banned since January of 2013.

Waterbirth bans happen. In April of 2014 in response to one of the dumbest, most illogical opinions ever published in the American Journal of Obstetrics and Gynecology, Allina hospitals banned waterbirths. At the time, I blogged about the controversy, writing,

Rebecca Dekker over at Evidence Based Birth does a really good job talking about the evidence to support (or not support) the practice of allowing women to labor in a tub and to give birth in the tub. I’m not going to reinvent the wheel, so go read it on her website. The upshot? This isn’t an easy thing to study due to logistics and ethical standards, but it has been studied. It’s been studied enough that the practice is considered safe throughout much of Europe. And guess what? Their water works the same there as it does here.

So, here’s the problem: According to an archived copy of The MotherBaby Center’s (really just Abbot Northwestern, an Allina Hospital) website from June 6th, 2014, waterbirth was still an option.

Waterbirth

Despite the fact that there was ample media coverage of the waterbirth ban, this page is, essentially, the very same bait and switch that the Alabama hospital was sued over. Waterbirth is being actively marketed, but it is not available.

This is not OK. It isn’t OK in Alabama, and it isn’t OK here.

While it’s true that Alabama ranks as one of the worst states in which to give birth in the US, with very poor outcomes for both moms and babies, cases like what this mom experienced happen all the time. As a doula, I have witnessed obstetric violence. I have been in the room as OBs told moms that if they didn’t comply, their babies would die. I have seen moms get episiotomies even though they explicitly stated that they did not consent. Some of these cases happened at hospitals that otherwise had good cesarean rates. Many of these actually happened while a patient was under the care of Nurse Midwives. Backlash from the medical community in response to last week’s verdict was severe; some doctors claimed that this verdict was not actually a victory for birthing families, but that hospitals would respond by caring even less about what her patients wanted and refusing even more obstetric choices. However, it’s important to point out that it took one mom who knew her options and knew her rights to stand up.

As expectant parents, it’s on your shoulders to take responsibility for making informed choices. Looking at a website and marketing is not making an informed choice. Staying blissfully unaware of the ins and outs of the maternity care system IS NOT assuming any responsibility for the outcome of your pregnancy and birth. You are the ones who need to ask questions. Put as much time researching your options as you spend researching cribs. Find out the difference between the different kinds of doctors and midwives that provide care. Look at freestanding birth centers. Tour hospitals and for heaven’s sake– ASK QUESTIONS. If they say they have waterbirth, ask to know the average times they use it a month. They know. If you must, tell them that you want to make sure what they market is really available.  And on the flip side, every single time something like the above happens, we need to make sure lots of people point it out and stay critical of it. Hold both marketing and maternity services to the highest standards. If nobody says anything, nothing will change.

In the MSP and surrounding communities, the voices of patients can and have produced profound change. And as much as I want to paint birth as a magical, shiny, unicorn-filled time, reality doesn’t always match that. Let’s talk about when it sucks, and when the places and people we trust create trauma, we need to raise our voices.

If you’ve seen a bait and switch in maternity care, I’d like to hear about it.

Warmly,

Veroniva

Veronica Jacobsen, BA, CD(DONA), CLC, CPST, LCCE, FACCE

DONA-Certified Birth Doula, Certified Lactation Counselor, Child Passenger Safety Technician, Lamaze Certified Childbirth Educator, Fellow of the Academy of Certified Childbirth Educators

Opening BabyLove in September of 2011 has allowed me to build a space where all families can come to get good information in a caring, welcoming environment. I have found that not only do I love teaching more than ever, but I also really love running a business. Hopefully my passion for every aspect of BabyLove shines through.
I live in Richfield with my husband, and I am a mother of a two great children. When I can steal a few free moments, I love to go on adventures with my family, cook, garden, thrift, can, and craft.