Giving Birth: Then & Now
It’s a typical movie scene — almost a cliché: A man stands in a hospital hallway, staring through a window. On the other side of the glass wait rows and rows of wrinkly infants, housed in identical transparent rectangles. He’s searching for the one that’s his.
These sterile nurseries were once pervasive. In fact, when the medicalization of pregnancy reached its height in the 1950s, it was par for the course for women to be placed under general anesthesia for labor and delivery and for newborns to be fed formula and housed away from their parents.
Today, hospitals have begun shifting back to practices that predate modern medicine. UVA has spent the last year improving and reforming its birthing experience. From achieving the Baby-Friendly® designation, to updating the physical environment of its maternity rooms, to hiring midwives, UVA has completely reimagined how babies, parents and staff interact.
Baby-Friendly®: A New Designation
Sally Miller, a nurse practitioner in the labor and delivery unit at UVA, explained that achieving the coveted Baby-Friendly designation was the driving force behind the changes.
Miller beams. “We’re so proud of this accomplishment; we worked for a long time to achieve baby-friendly designation.”
Baby-Friendly USA is part of an international initiative led by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Fewer than 300 hospitals and birth centers in the U.S. and only five in Virginia have earned the designation.
But what does “baby-friendly” mean?
To meet the standard, hospitals have to, among other things:
- Provide prenatal breastfeeding education
- Train staff on breastfeeding as a policy
- Offer post-discharge lactation support
- Only give formula if medically necessary or requested by the mother
The designation also requires staff to help a baby start breastfeeding within an hour of delivery. So Miller and her team mates facilitate close contact between mother and child from the moment of birth—even with Cesarean births. “Skin-to-skin contact is crucial,” Miller says. “We just put babies right on their mother’s chests from the start.”
Read our announcement of achieving the Baby-Friendly status.
Achieving Baby-Friendly designation involves “a very rigorous inspection,” Miller says. “You have to demonstrate robust support for moms and babies with breastfeeding, and you have to prove that you have met specific clinical outcomes and sustained those targets over time. …
“For example, inspectors randomly choose mothers to interview to see what they’ve been taught and remember about breastfeeding. If the mothers can’t answer their questions, facilities don’t achieve designation.”
UVA’s internationally board-certified lactation consultants also prove crucial to moms who face barriers and challenges to breastfeeding success.
Women look to “find out why they have sore breasts or get help with positioning and latch,” Miller explains. Having problems monitored by experts also means that other issues can be addressed.
For instance, “a baby might have a short frenulum (also known as tongue-tie) and might need a quick clip under the tongue; this not only helps them breastfeed but will help them with language later. Those kinds of things aren’t caught when you’re bottle-feeding.”
The breastfeeding program also has breast pumps available for rent.
A Refreshed Environment
Goodbye, Nursery: Single Room Maternity Care
Perhaps the most stark change UVA made was completely removing the nursery. Newborns now sleep nearby their parents in wheeled bassinets in the same room as their mothers. Unless a newborn requires increased observation or a specific procedure like a circumcision, they never leave their parent’s side.
Keeping babies with their mothers helps with bonding and breastfeeding, but it also increases security. “The best security for your baby is never losing a line of sight with them. So we feel like we’re providing the safest care for babies in providing single room maternity care,” says Miller. “Babies are happiest, more content and safest with their moms. So we provide that environment for them.”
In the past, mothers had to share rooms. After remodeling, however, UVA gives every new mom a private, beautiful suite.
“People in our community aren’t aware of the fact that all of our suites are private, so that’s something we’re trying to get out to the community. You don’t share a room with anyone else. You have the privacy of not having to share a bathroom or being woken up by someone else’s baby,” Miller says.
Room for More
The rooms are spacious.
This size accommodates “a care partner to sleep in the room with new mothers. Having a designated friend or family member to focus on the mother’s needs is really important, especially in America where the focus is often solely on the new baby. Women need to have someone present with them to care for their needs so that she can focus all of her attention on the baby and breastfeeding. If this is established in the hospital it naturally transitions to the home during her recovery period. I think it is an important culture shift to celebrate and care for mothers after birth,” Miller says.
Keeping It Natural — and Safe
Many local moms view UVA as the place to deliver a baby only when you or the child is very ill or very high-risk. Miller says the focus has expanded at UVA, and she hopes to expand the community’s perception, too.
“We do take care of the sickest of the sick and the highest-risk patients here at UVA,” she says, “and we’re really proud of taking great care of them.” The Neonatal Intensive Care Unit, for instance, is the only one in the area and has earned national awards.
But, Miller points out, healthy women looking to have totally natural births should consider UVA, too — not only because a higher level of care may be needed.
“UVA is where I want my daughter to deliver, because you have the whole range of help here. At UVA – you can have a very low-risk, non-intervention birth, with no medication, only emotional and physical support and, if for some unforeseen reason something medically challenging happens, you’re in a place that can handle your immediate needs. You don’t lose 30 minutes or an hour in transport to another facility.”
Midwives and Relationship-Based Care
A Swiss doctor once referred Miller herself, when pregnant, to a midwife. “He said, ‘You’re so healthy, I’ll be there for you, but you don’t really need me.’” He introduced Miller to the midwifery model of care where low-risk people get support from someone who helps with staying healthy and disease prevention.
“And I just had the most magical birth with that midwife. Then, 15 years later I went on to become a certified nurse midwife myself. That’s my story of falling in love with the midwifery model of care, and you’ll find a lot of women who have very similar experiences.”
As of October, UVA has three certified nurse midwives in practice. “They have begun seeing patients and attending births. It’s a very exciting time,” Miller grins.
What is a midwife in this setting?
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“Our midwives are licensed independent health care providers who have advanced practice degrees and are board certified. CNMs are licensed as nurse practitioners in Virginia specializing in women’s health needs. And, while midwives are well known for attending births, they can also provide primary care, such as annual exams, reproductive health, writing prescriptions, basic nutrition counseling, patient education and newborn care.”
Midwifery care centers on health promotion, prevention and the caregiver-patient relationship. “So it’s about being healthy and making the right choices to stay healthy and having someone present who is there with you to compassionately support and guide you in those healthy choices. Midwives work very hard to ensure their patients have complete and accurate information to make informed healthcare decisions. And they celebrate the birth as primarily a normal physiological process. Midwives promote watchful waiting and non-intervention in normal processes.”