....from Marty
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 The HM Phase II Well Baby and NCCC initiatives are rolling! Currently we have 11 NICUs and 29 Nurseries enrolled in Phase II. We have made an organizational decision to welcome any hospital and any team at any time for any project. Enrollment at initiative start may best allow for team development, orientation, assessment of current practice and a greater opportunity to develop meaningful changes to practice. We are committed, however, to assisting any team at any time in getting up to speed so that participation in a current project can be meaningful and lay the needed foundation for participation in future PQCNC efforts.
After a spirited Well Baby call last week it was decided that we will more rigorously define skin to skin time for vaginal and cesarean deliveries. For vaginal deliveries, after delivery, there will be allowed a maximum time of 5 minutes to weigh and assess the baby. At that point successful skin to skin time will be defined as the baby being placed on the mother's chest/abdomen for at least one hour. If the baby shows interest in attempting breastfeeding during this time support should be available for mom and baby. In some cases skin to skin time with the father during this time might occur. That will be considered as part of the cumulative skin to skin time, though every effort should be made for the period of skin to skin contact to be uninterrupted. For cesarean deliveries it is clear that several centers are increasingly successful at promoting skin to skin time in the OR. We counted skin to skin time in the recovery room during Phase 1 and did not mandate skin to skin time in the OR. We all agreed that for cesarean sections, we will count skin to skin time in the recovery area for one hour as successful. Time skin to skin with the father will also count towards this goal. We look forward during the course of the initiative to hearing about centers efforts to promote OR skin to skin time. This will be a topic for discussion at our next webinar.
A second issue was raised regarding the Well Baby Initiative related to completing shift assessment forms for infants born just a few hours before a change of shift. In those cases some expressed concern that if an infant is only in the nursery for 1-2 hours then the expectations for a full shift regarding breastfeeding support will never be met. Two points. The purpose of the data is to help us individually as centers get better, not necessarily to compare ourselves to everyone else. Comparisons help us identify centers that might be able to help us improve more effectively. Fill the assessment forms out honestly. It will be possible to review sheets, or for us to do a separate report, if it seems that the major impediment to getting to 100% success is a number of babies only in the nursery for two hours. We will all have the challenge of babies admitted to the nursery close to shift change however, and we should have high expectations for the care we can offer that mother and baby. Second point related to this is that just because a baby and mom are only in the nursery for 2-4 hours doesn't mean we can't be working to support them early on. It may be tempting at 0530 to say the 0700 crowd will get to it. That may not be the case in any PQCNC nurseries, but in nurseries I've worked in during previous lives, these things might rarely happen. I'll confess I am tempted as a neo now when covering someone's service to do the same thing, and have to fight myself to not leave things for the "day team." We need to be pushing for consistency and the first few hours of mom and baby together are proving to be very critical. Again we are not looking for A's or a 4.0 average. We are looking to develop the culture that best supports moms on the breastfeeding journey.
Regarding HM NCCC, we have given ourselves two sets of orders for the next month. First, get mom's pumping as early as possible. Pumping at one hour may be very ambitious but is a worthy goal. It seems pumping by 6 hours is a necessary target. Second, make sure moms have arrangements for an acceptable pump when they go home! At a Vermont Oxford Meeting last weekend I spoke with a team from a Midwest Healthcare System. Every one of their hospitals has a lactation support person who has direct contact with the WIC personnel responsible for setting up pumps for moms with NICU babies. No mother leaves their hospitals without firm arrangements made for supplying discharged mothers with an acceptable pump to support her baby's nutritional needs. Assess these two aspects of human milk use in your NICU and make them a priority for EHM team.
Onward and upward!
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New Resource
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 A new resource is available on the extranet - Skin-to-Skin Care with the Father after Cesarean Birth and Its Effect on Newborn Crying and Prefeeding Behavior
Click here to view
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HM Well Baby II Learning Session - Save the Date!
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The first learning session for HM Well Baby Phase II is scheduled for Wednesday, May 23rd, 2012 at the McKimmon Center in Raleigh - registration information will be available soon...
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HM Well Baby Monthly Webinar
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 The April HM NCCC Webinar is scheduled for Wednesday, April 18, 2:00 - 3:00 PM. Monthly Webinars generally last no more than an hour. The updated schedule is always available at the link below.
to access the webinar.
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Contact
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Keith M Cochran
PQCNC Debrouillard
Keith_Cochran@unc.edu
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