Same-room care for mothers, babies changes experience

June 08--Rhonda Pruden held her daughter in their hospital room as her husband, Casey Pruden, helped fasten a tiny green dress on 2-day-old Edith.

The new family is resting and bonding together in the same room, and attended to by one nurse as a part of couplet care, a new strategy at Owensboro Health Regional Hospital.

Rhonda Pruden, a nurse at the hospital nursery, was one of the first to cross-train in couplet care -- care for mothers and infants in the same room -- before giving birth on the first day of the plan's launch. She said she had no idea she would be delivering on the same day as the change, but she has been enjoying the results.

"I wasn't sure how far along couplet care was before, but I've been so excited to see it," Rhonda Pruden said. "One of the things I've really wanted was to room with my baby. I'm super excited to be a mom, and the time together has only made it better."

She said she is comfortable with her new family's stay at the hospital -- exactly the result pediatric care managers were hoping to reach.

Ashley Denton, manager of the special care nursery and neonatal intensive care unit, has been cross-training nurses to care for both mothers and babies since 2016. Denton said this new strategy was part of a longtime conversation nurses were having about how to improve care.

"It's a quality initiative to improve the kind of care we give," Denton said. "We want to make sure mothers are more comfortable and feel prepared to care for their baby when they go home."

With the new strategy, a newborn baby would be cared for in the same room as its mother by one nurse trained in care for both patients. A nurse will be responsible for caring for up to three families at a time which doesn't change existing workloads, according to hospital officials.

Cases of intensive care will still be treated in the NICU, and experts such as lactation specialists will still make visits to the room.

Denton said the streamlining of care will reduce interruptions and exhaustion for adjusting mothers, improve communication with the healthcare team and help coordinate care. A mother previously cared for by one nurse might not have gotten answers to questions about her baby, or might not have been able to see her child as quickly, would now have a single source for help.

"This doesn't mean patients will be cared for any less," Denton said. "Now, there will be a more coordinated care and mothers can make sure they get all the answers they need."

Beth Whitsett, manager of the mother and baby unit, who has also been helping to prepare the strategy, said nurses will still provide support, but are also listening to the mother's needs for time alone.

"The frequency of check-ins changes from hour to hour because we find as mom's become more comfortable, they would rather spend time alone with their baby," Whitsett said.

In Pruden's experience, she said the care she has received is more efficient.

"I think, instead of trying to figure out who to call, or trying to get a hold of three different people for three different things, I know one person that can answer all my questions," Pruden said.

The hospital's move to a new staffing strategy hasn't just been in effort to make mothers more comfortable. Studies from organizations like the American Academy of Pediatrics, which Owensboro Health refers to in their care initiatives, show results from couplet care which fly in the face of old teachings about separating mothers from babies.

In 2016, the AAP released a revised policy recommendation paper on same-room sleeping that cited skin-to-skin contact after birth as benefiting success rates of breastfeeding, milk volume and comfort levels for mothers and babies. The recommendation paper also states that same-room sleeping arrangements, a practice that will now start at birth with couplet care, reduces the chances of sudden infant death syndrome by 50 percent.

Dr. Lori Winter, an adolescent medicine physician at Cooper University Hospital and member of the AAP Task Force on SIDS, has studied couplet care methods and helped make recommendations on techniques to reduce SIDS with the task force. She said couplet care isn't meant to be a cure-all for childbirth complications, but is shown to improve health outcomes for mothers and babies.

"We say this is where the evidence is leading, and these are optimal practices that help prevent issues," Winter said. "What we do know is there are situations more hazardous than others that might need a higher level of care, and a cross-trained staff is better prepared for that."

Winter also said research has shown that mothers sleeping in the same room as their babies have longer and better quality sleep, refuting bygone medical teachings about mothers needing at least five days of rest away from their child.

Under other older theories of post-birth care, Whitsett said babies were kept from mothers up to five hours after birth before holding their child, limiting crucial bonding time. Now, bathing and testing is done directly in the room with the mother watching so "she is always in the know."

Whitsett said this extended time a mother has with their baby allows them to understand their baby's hunger cues and breastfeeding techniques more easily and quickly.

"The more the baby is in the room, the more you understand about them," Whitsett said.

Every baby's signs of hunger can be different, such as subtle movements of their hands near their mouths. Pruden said she was grateful for the time and peace she had in order to understand baby Edith, even after her experience in the nursery.

"I've been a nurse for a long time and I've seen a lot of babies, but every baby is different," she said. "You have to learn what their individual hunger signs are."

In their recommendation for breastfeeding as prevention for SIDS, the AAP also cites research showing that immediate skin-to-skin contact and couplet care can improve the baby's weight gain and the mother's milk production, and prevent jaundice. Winter said most of this evidence can be linked directly to in-room arrangements.

"It's almost impossible for a nursing staff to bring a baby back and forth to get the suggested amount of eight to 10 feeds a day," Winter said. "The close proximity and contact a baby gets ensures it more readily receives the nutrients it needs."

Citing benefits and comfort, hospital officials hope to see an improvement in results for their patients. Denton and Whitsett said the health group's move to a new facility in 2013 helped solidify the kind of changes needed for the nursery to make its transition. New equipment or facilities weren't required for the changes, and Denton said the transition has been going smoothly.

"We had already had a goal to better maintain togetherness for a family after birth," Denton said. "The only obstacle for that was not having a couplet care plan."

After the Prudens return home, more new mothers will experience similar care as the hospital has made couplet care a standard part of its offerings for mothers. Rhonda Pruden said she believes future patients will appreciate the new method.

"All of the nurses I trust so much, so it's great being able to have my baby in a place I know is going to take care of me and my baby," Pruden said. "I think the experience can be trusted just as much as before; the only difference is you can have one person to find answers from."

Jacob Dick, 270-228-2837, jdick@messenger-inquirer.com,Twitter: @jdickjournalism

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