Special Care Baby Unit

[joeyb]

Hi!
I'm new to this site, and new to gestational diabetes. I was diagnosed 3 weeks ago and am currently 33 weeks pregnant. I am controlling it with diet and exercise and so far its all going really well . Today I met my consultant and obstetrician for the first time and was informed that it is hospital policy that no matter how well I control the diabetes and how heallthy the baby is when born that they are taken into the Special Care Baby Unit for 24 hours after birth. When I told them I wasn't happy with that, they agreed with me entirely and said it is something they have been fighting to change for a while as most hospitals don't do this and they believe babies should stay with the mums unless absolutely necessary.
Apparently the reason for this policy is that it would require extra midwife support to come and check the baby's blood sugars while on the ward rather than in the SCBU and their staffing levels are never good enough. The consultant and obstetrician have suggested I write to the midwifery manager and chief executive to try to argue my case and I am trying to get as much back up as possible. I have the NICE guidelines which say that in the case of gestational diabetes the baby should stay with the mother unless there are health complications. DOes anyone know of any other research I can use to back my case up? ANything about the benefits of babies staying with mums?

Sorry for the really long first post, but I could do with your support!

 

[hanadr]

Go with your maternal instincts.
My cousin had gestational diabetes about 35 years ago with her second pregnancy. the baby was born weighing 12 pounds. the biggest at that hospital that year. He was monitored in special care for a bit and I believe put onto a special baby formula food. He grew up strong and healthy and has 3 children of his own now.
My cousin did go on to develop T1 a few years later. she's got it under good control and is a fit healthy grandmother of 5

 

[Orchid]

Hi Joeyb

I've have type 1 diabetes and have two children - a boy now 15 (born in 1993) - i was induced at 37 weeks and it was a bit of a struggle "getting him out" and he wasn't so well on delivery - I think more because of the birth than anything to do with diabetes. He was taken to the special care unit, I think probably because 1. He wasn't so great after a difficult birth and 2. Mum was diabetic. - he was 6 lb at 37 weeks.

My second baby - a girl now 10 (born in 1998) was very quick birth, no IV drip, no epidural and despite me being type 1 we both went together to the "normal" ward. She was born at around 11.20 pm on the Tuesday night and we were discharged from the hospital around lunchtime on the Wednesday! That was 10 years ago.

All the best
Orchid x

 

[Mags]

Hi there,
I had gestational diabetes with my first baby and I am currently pregnant and have gestational diabetes again.
My daughter was born three weeks early for a reason completely unrelated to diabetes and ended up in Special Care because she became seriously jaundiced. She was in for five days.
There are a couple of things you could do. If you are planning on breastfeeding you can tell the nurses in SCBU to ring down to your ward to get you when the baby needs feeding. SCBU also usually has family rooms and you could ask to be moved into one of those so that you can keep the baby in the room with you and the nurses can pop in when they need to test the baby or you can wheel her to the room where they do any of these tests. I was eventually moved to one of these rooms when it looked like they were going to discharge me from my ward. I did not want to go home without my baby, primarily because I was breastfeeding (but I also just didn't want to leave my baby!)
Hope this helps a bit,
Mags

 

[Katharine]

Could you offer to test the baby's blood sugar yourself? The tests are done on a heel prick on regular bs monitors just like you will be doing yours. If the baby tests low you could contact the midwife.

 

[FindingNemo]

If you PM me your email address, I have lots of references on this has have just completed an assignment on this.

The unit where I am insists all babies of mothers on Insulin are taken to SCBU, for the staffing levels that you mention. This is contrary to all the current guidelines, NICE, Nsf for diabetes etc, which all clearly state that in te absence of any other risk factors babies should be able to room in with their mothers. The very fact that you have good control with just diet and exercise also implies this is potentially unneccessary intervention.

The other things that are worth considering now are your feeding intentions. If you wis to breastfeed, which is the most ideal way to feed your baby, providing you and your baby with many documented health benefits, it is worth considering starting to express before the birth. Any colostrum you express now can be frozen, ready for birth and should your baby be unable to feed at the breast for any reason after birth, there will be no need for any kind of formula supplementation.

I am type 1 and have had 2 babies. The first, there was no mentionof SCBU, but due to excessive blood loss on my part after a C/S, I was 'specialed' on delivery suite for 12 hours with 1-2-1 care, and she was regular given to me to breastfeed and we had hours of skin to skin time, which was very special. With my 2nd, the protocol had changed and he was expected to go to SCBU, but we fought it as he had already been with me in recovery for 6 hours, fed really well twice and his initial blood glusoce readings were excellent.

The other importnant thing is not to allow blood glucose readings to be taken too early as these results are skewed and infulenced by the mothers BG levels within the first 3 hours. If your baby is warm, pink, alert and feeding well then with a diet controlled mother, our protocol is to test no more than 4 hourly for the first 12 hours and observe in total for 24.

EDITED TO ADD: I am a 3rd yr student midwife, I am NOT yet qualified.

 

[catherinecherub]

Hi joeyb,You say that this is policy. That does not mean it has to be adhered to. It is not a legal document. Make it very clear that you want your baby with you at all times and short of kidnapping your darling newborn there is not a lot they can do about it. Stick to your guns and be assertive. Policies can be changed and if enough mothers question the rights of a particular policy then it will be changed.
The team you saw are on your side but obviously don't want to rock the boat.
Staff shortages are a problem in all walks of hospital life with the exception of admin.
Regards, Catherine.

 

[FindingNemo]

Also, ask to see their written policy and the evidence they are using to back it up!!

 

[wiflib]

And I'm gobsmacked that any baby that is otherwise well would be admitted to a SCBU. The staff shortages there are usually worse than the Midwifery ones! If you have given your permission for you and your baby to be admitted to a postnatal ward, then the staff there have a duty of care to look after the both of you.

The key to a low blood sugar is food. The best way to make sure your baby has regular access to food is to wear it (just a nappy, possibly a hat and covered) and give it free access to a boob. SOME neonatologists don't like breast feeding because it is not measurable. There are a few breast milk banks in the country, you may be living in an area that has one. I don't wish to make light the dangers of a low BS in the neonate. It is a serious condition that needs attention, but a baby whos mother has controlled her BS throughout her pregnancy has a decreased chance of problems.

I would like to reiterate that it is your baby and you have the responsibility of caring for it, not strange staff that think they own it. Question everything and keep your baby close.

wiflib

 

[FindingNemo]

Wiflib,

Our unit 'does not do' any transitional care, so all babies that require observations are kept in SCBU and when SCBU is full, then they have to provide the staff to come and do the observations. I find it all incomprehensible myself, as by saying that you 'don't do' tansitional care means that you are stating it is not possible to see your women and their babies every 4 hours in most cases. Which irrelevant of any care that may be required, you should be seeing all your women at least that frequently anyway, even if just to offer regular analgesia. I appreciate I am only a student, so care for no more than 1 bay of 6 women usually, but I can manage it. Howvever, at the moment the unit I am at is taking a stand on it, so there is no compromise. Not because they do not wish to offer transitional care, but because they want to prove the need for extra staff and ensure that need is catered for before we take on the 'extra workload'.

 

[catherinecherub]

Hello Finding Nemo,
Please don't put yourself down by saying that you are only a student. You are a valued member of the team and I bet you do more than your job description.
When I work on nights I look forward to having students with me, they are mostly eager to learn, have values and disciplines that I admire and always put the patients first. They are only supposed to observe but we could not manage without them. They make the ward a brighter, caring place.
Regards, Catherine.

 

[FindingNemo]

Haha!! Thank you. It wasn't intended to put myself down, I do that in all other areas of my life, but not as a student, that, I take very seriously!
It was more meant that although I am offering what knowledge I have, and I hope it is of use, that I am not the oricle and it is not meant to undermine the advice and care of the team involved. It is very easy to make judgements on an internet forum and give advice, but we only get a snippet of the whole story, do not have access to complete medical records or history etc and whilst someone may come across as very knowledgable, it is difficult to guage understanding or that your advice has been taken in the way that you intended.

These places are great for information gathering and we can help to arm people with information but we have no control over what they do with that information and the care of a named professional is still very important.

 

[wiflib]

Hi Nemo.
(sounding good may I add!)

Ours is a major referral unit.
Any baby that needs observation only, ie, BS, temp, HR resps, phototherapy or even IV antibiotics etc has this care on the PN wards (mums take the babies up to SCBU for the antibiotics). The neonatologists come to the wards once a day but are obviously 'on-call' if the Midwives need to refer.
In the case of a mother with diabetes, the baby is only admitted if a low BM cannot be corrected with feeding or other problems occur.

I have often uttered the words, 'get me your registrar' when one of the SHOs wont listen to my concerns!

wiflib

 

[samwithsweetners]

With my pregnancy I ended up in a normal bay in pregnancy unit (boy born 35 weeks) had the incubator in the main ward (for 2 days) as their was no room in special care unit. And i think because of my age and maturity (35) at the time left me to my own devices. Was in hospital 8 days. The midwife
did the heel pricks and babys blood sugar was only accumulating 1.7 from breastmilk so switched to formula and by the end of the first week his sugars were 5.5 and we were ready to go home.

I didnt have the excitment of a normal birth - he was extended breech throughout the pregnancy and had to have an emergency c.

I did donate to the special care baby unit - even though they didnt help me directly they need alot of funding to make more complicated births happen!!! Im sure you will be looked after by the trust that will be taking care of you.

sam

 

[joeyb]

Hi all!

Just wanted to say thanks for all the advice and support. I have now been in quite a bit of contact with the hospital who have agreed that my baby won't be whisked straight away to SCBU, they will instead send a nurse to the delivery suite to do the initial tests, and as long as everything is normal and remains that way then s/he can stay with me on the post-natal ward. And I will have it in writing so won't have to fight after giving birth! So thanks again - I really needed the support and am feeling a lot calmer about it all now (4 weeks to go!)

 

[Orchid]

Please come back and let us know, can't wait to hear your news

I really hope all goes well for you!

Take Care
Orchid x

 

[suzi]

Thats great Joeyb,
I'm glad they have taken your wishes on board and i wish both you and your baby a safe delivery. Keep us posted,
best wishes,
Suzi x

 

[Dipsy2]

:shock: at automatic SCBU! I'm so glad you got it sorted, and hope all goes well/has gone well.

I've had gestational diabetes for at least 2 of my 6 pregnancies, on insulin (unnecessarily in my opinion) for the last one. I had a home birth - they wrote a new hospital policy especially for me! :mrgreen: I insisted on it basically, as I didn't want a drip, or major monitoring, or anyone messing with my baby, not to mention leaving my other 5 children, or getting to the hospital on time.

It was fine - lovely in fact. I self monitored during labour and never went above 10 (which would have been recommended to go in to Hospital) and monitored the baby afterwards. The midwives had a monitor they wanted to use, which needed a massive amount of blood compared to the acucheck, but fortunately it was broken, so baby just got one bruise from them, not many. Acucheck said it was fine to use my monitor on the baby, and I was happy to do so myself. I was far gentler than them! My consultant said there has never been a study to test "normal" newborn blood sugar, so it seems a bit pointless to me, anyway. It is far better to look at the baby and decide if action is needed, IMO.

I managed to express colostrum in the last few weeks of pregnancy, which I gave via a syringe when baby was a bit sleepy and the midwives were getting twitchy. I only expressed a few drops at a time, several times a day, and did so straight into a little lid from a baby bottle, which I kept in the freezer, covered with cling film. It is fine to express onto the top of frozen milk - I did this when I donated milk to a breast milk bank. Even if you only get a couple of ounces, it is well worth doing.

 

[Robinredbreast]

Hello

My daughter was born at 33 weeks when I became ill, I had Type 1 for 11 years then. She had to go into SCBU, I didn't see my baby for days until early one morning a nurse from SCBU brought her up to me, I still remember every little detail X
Even though my circumstances were very different from you, the care and support from the unit at my hospital was excellent.

Many new mothers are well enough to visit their baby in the unit and you should be able to spend time with the baby. The hospital is making sure that the baby is healthy and well and 24 hours goes by so quickly.

If you really don't want your baby to go to SCBU then it might be best to write down all the questions you need to ask when writing or speaking about your concerns. Go with what you think is right and don't let anything or anyone pressure you.

13 years ago when my baby was in SCBU, it was very very busy and I'm sure your hospital wouldn't do anything that wasn't really necessary. I'm sure whatever you decided, it would of been the right thing to do. I hope all went well and you had a safe and happy delivery RRB Edited due to the original date of posting

 

[ela]

I had GD at 28 weeks with last child but due to other compljcations I went into preterm at 24 and deljvered at 32wks, he was in scbu for 7weeks and I felt I missed those first few days bonding, you can stay there as long as you wish and I was known for all night sittings but not the same. Kangeroo skin to skin care is impotant for baby and they need be with you for that. Also if your breast feeding its not viable for baby to be on diff ward. Im 17wks with 4th now and although its looking like im starting insulin next week there has been no mention of my baby staying on scbu unless ill. Good luck x