The tragedy of a newborn babyThis tragic case of a newborn baby being suffocated and crushed whilst being breastfed, on a postnatal ward, is far from an isolated case. As many of you know by now, I'm a UK trained midwife of 29 years. I've heard this same story too many times. The scenario is all too familiar. Mum exhausted from labour is handed her baby to breastfeed in her hospital bed. The midwife may help latch the baby, supports the mum with pillows and leaves the mother to breastfeed alone. This scenario is more common during the night.
Some time passes and the exhausted mum falls asleep. She may have prescription drugs on board from labour and birth and may even have been given opiates on the postnatal ward. This combination together with birth exhaustion is a dangerous combination. Opiates such as endone, morphine and fentanyl depress the respiration. This can lead to a tired mum easily falling asleep.
A newborn baby cannot maintain their own airway and may have prescription drugs on board from the labour process. The prescribed drugs mum has taken may even have passed through her breast milk to her baby. It may even depress the baby's respiration and lead to the bronchopulmonary infection in the Bolton hospital case.
The midwife should stay with the mum whilst she breastfeeds to ensure safety. Ideally, the mum should breastfeed her baby in the chair which is usually in each patient room in every postnatal ward. However, if you have a mum who is exhausted or has had a caesarian she may choose to stay in her bed. This is where it all goes wrong. There should be a hospital policy that states, breastfeeding in a bed should have a midwife present during the entire feed and the midwife should return the baby to the cot after a feed and place them safely according to SIDS guidelines.
Staffing issues on postnatal wardThe problem arises on a night shift of staffing levels and meal break times. In Australia, the staff ratio is usually 1 midwife to 6-8 mums and babies on postnatal at night. Once a midwife goes for a break she is gone for an hour and the other midwives cover her patient load. That increases the workload significantly.
During the first 3 days, newborn babies feed every 1-2 hours. Colostrum is high in protein but low in fat so doesn't satiate a baby for long. During an average postnatal night, a baby will perhaps feed 6-8 times. It's obvious based on those facts that the staffing levels on postnatal wards are completely inadequate. Skill mix would help address this issue and is something that would maintain safety. Nursery nurses and auxiliary nurses are a way to bridge the staff to patient ratio, cover breaks and keep babies safe.
17 years ago when I was still working as a midwife in the UK the staffing levels were even direr. This maybe explains our poor breastfeeding rates in the UK. In Manchester, I was the only midwife in charge of a 26-bed postnatal ward with an auxiliary nurse! However we had very few side rooms, most beds were part of an open plan ward divided into bays of 4. Are sidewards a safe option on postnatal wards or should we go back to open plan? It is much easier for a midwife to keep an eye on her babies and mums and avoid dangerous risky situations. In Australia, most of the postnatal wards are side rooms only. Is this a good plan for the safety of babies?
UK staff ratio
Should all babies be breastfed in chairs during the night? Are mums less likely to fall asleep in a chair or is it still risky because of the use of pillows to support a newborn breastfed baby? Ultimately no matter where a mum feeds we cannot escape the extreme exhaustion of those early postnatal days and nights. A mum should never be left alone to feed her baby when she is so tired. Period.
"Bed-sharing 'raises cot death risk fivefold'," BBC News reports. The news has featured in much of the media, with headlines based on a large analysis of previous studies into the risk of cot death, or sudden infant death syndrome (SIDS), associated with bed-sharing.
I have a particular issue with the comments of the midwifery manager of this case at The Royal Bolton Hospital. She says, 'We are a Level Three UNICEF baby friendly initiative accredited unit which is the highest standard for breastfeeding and is a prestigious award, however, we always strive for improvement and so, taking into account the coroner's comments, will review guidance.'
Unicef Breastfeeding award
I have a feeling Baby Louie's mum and family don't give two hoots about her hospital's breastfeeding award when all they have is a dead baby. RIP baby Louie and I'm dedicating this blog to Louie and all other babies who have passed away on postnatal wards in similar situations. There are too many and this is a risk we need to address immediately. As a midwife who spent so many hours on a postnatal ward on a night shift, I know this needn't happen to another mum and baby.
- Tags: baby safety breast feeding fil_All things baby feeding midwife postnatal postnatal ward SIDS risk staff ratios tired mum