Postpartum
These past few days I've been really enjoying the postpartum courses of a handful of lovely women and their babies. I love that I can support them in their recoveries in ways that I was simply not when it was my turn. I've discovered recently that I'm actually quite good at this breastfeeding business. It's a joy to me that a long encouraging phone call and an extra home visit might just be the help a woman needs to soldier on through a tricky engorgement/sore nips phase. It's lovely to hear that a really tiny near-term baby is pooping like crazy (always a good sign) and really satisfying to show a woman how to hand express her milk. I love the challenge of troubleshooting a poor latch and watching a woman's eyes fill with relief and gratitude when she achieves an excellent latch and feels how great nursing a newborn can be.
I hate poking babies but I have administered my share of metabolic screenings this week, which for the uninitiated involve nicking baby's heel and collecting a few good drops of blood. Most babies, as you'd expect dislike the process. It's not my favorite. But I have invested (and I mean that in the fullness of the term) in some very fancy high tech lancets (tenderfoot) which seem to cause minimal distress and maximum collection (you really don't want to have to poke them more than once). In doing so I'm blowing whatever teeny profit margin a midwife might find in performing this screen: the state reimburses $2.50 to perform it, I paid $4 for the lancet, but hey. If I gotta poke 'em, I'm gonna do it as painlessly as possible.
I hate poking babies but I have administered my share of metabolic screenings this week, which for the uninitiated involve nicking baby's heel and collecting a few good drops of blood. Most babies, as you'd expect dislike the process. It's not my favorite. But I have invested (and I mean that in the fullness of the term) in some very fancy high tech lancets (tenderfoot) which seem to cause minimal distress and maximum collection (you really don't want to have to poke them more than once). In doing so I'm blowing whatever teeny profit margin a midwife might find in performing this screen: the state reimburses $2.50 to perform it, I paid $4 for the lancet, but hey. If I gotta poke 'em, I'm gonna do it as painlessly as possible.
posted by Louisa at 4:32 PM
6 Comments:
I always feel like it's more than a few drops...but my luck is never consistent with newborn screening pokes. I wish it was!
(I've used the Tenderfoot and now use the NeatNick but to tell you the truth, I'm not sure that I've noticed much difference all around. They're almost the same price, but I buy them by the box or two and it works out to $1 a piece.)
It's one of the first clinical procedures I have my apprentices master. I usually have apprentices do at least one postpartum visit on their own - and it's likely the one for the newborn screening.
Do you know what percentage of your clients want the newborn screening? It seems like we run at about 80% or so. We use the same lab (I'm in Oregon)...I've only had one positive screen come back and that was for hypothyroidism (the most common) and it definitely was hypothyroidism. I'm amazed at the swiftness the lab moves at when there's a positive screen. It's very reassuring!
I'd say probably 90+% of clients in the two practices I'm at will chose to do the screening (screaming).
I have recently been experimenting with a nice hot washcloth on the heel for 5 mins before the poke. I observe also that those babies who have had the vit. K IM will bleed less readily than those who declined it.
Some babies bleed like crazy, and others not so much...
Will check out the NeatNick, if it's as good then I'm all over it, can't beat that price, hey?
When we took Sis in for her pokey-test, Midwife had to poke her MANY times since she had received her Vitamin K shot a few days prior(which I now know better than to do again). However, Midwife suggested I nurse her while she pricked. That stinker barely noticed, maybe had one small whimper while she was pricked numerous times. So happy to have a boob in her mounth, she didn't notice the needle in her toes.
My favorite is the Neatnick from Hawaii Medical, I was going to post the site, but they are temp out of stock. Last order, I paid $90 for 100. They sweep like the neatnick or tenderfoot. I also like to heat the foot and have mom nurse. The last time we had a midwifery meeting with the guy from the lab, we asked how many of those circles they really needed filled. He said absolutely 1 and a second one for if they need to retest. So, if on day one, that babe is not bleeding so well...no problem. Why they have 5 circles on that dang card is beyond me. By the way, I love reading your blog.
Just want to second what Jen said, having baby nurse as you do the screen can help a lot. My first coombs positive son had to be poked 2x a week for a month b/c of pathological jaundice & he nursed/slept through all but a few times.
I'm glad you are feeling good about helping with breastfeeding, that's great!
Your postpartum work is super important--glad you brought it up!
At a time of extreme abandonment for hospital birthing mothers, midwives can fill in an extremely important gap for the women they served so faithfully all those pregnant months. You midwives, I love you all.
Post a Comment
<< Home