Practices That Put Newborns at Risk

When I was a young nurse I worked in the hospital nursery

Photo by Christian Bowen on Unsplash

My grandson, a senior in high school, asked me about glucogenesis.

“It’s your body’s emergency mechanism,” I said, “If you don’t eat before you workout, your liver and kidneys go into overdrive to produce the glucose you need. Without that metabolic process your brain cells would die. If you just ate an apple or drank some coconut water before, during and after your workout, your liver and kidneys would be much happier. They could focus on other essential functions, like filtering toxins and regulating hormones.”

I don’t think teenage boys are very interested in how their livers function, but the conversation reminded me of when I was a young licensed vocational nurse(LVN). That was in the early 1970’s, before I became a registered nurse and went on to get my midwife’s license.

As a new grad, I was hired to work for our local community hospital. I had been born in its surgical suite a mere 17 years earlier. The nurses who took care of my mother when she had me were still on duty, tending to other laboring women.

I thought I’d like to work in respiratory therapy because I had asthma, but there was a job opening in obstetrics. My passion for maternal child health developed slowly and was nurtured by my mentors, those amazing, confident and dedicated diploma nurses who ran a tight ship on swing (3pm to 11) and graveyard (11 to 7am) shifts.

As an LVN, I was in charge of the newborn nursery. Although I helped out with labor, delivery, and post partum care, the nursery was my assigned station.

Looking back, the first mistake we made was keeping babies separated from their mothers. The newborn nursery consisted of two large rooms lit 24/7 by bright flourescent lights. Now, of course, we know that mothers and babies do better together. Dim light allows a neonate to open their eyes and gaze at their mother, developing a bond that is essential to the health and happiness of both.

Believe it or not, in those days, our hospital policy and procedure manual dictated that babies should be bathed as soon as possible after birth and placed unswaddled in an isolette (a plexiglass enclosure that sat atop a huge and heavy metal box on wheels) to warm up. Contrast that with the modern practice of not scrubbing away vernix (a lanolin-like protectant babies are born with) and warming infants by putting them skin-to-skin with their mothers.

Back then, hospital policy also mandated that neonates were to be NPO, or not given anything by mouth, for 12 hours; ostensibly to prevent choking. By withholding fluids for 12 hours, we were putting babies at risk for severe dehydration, hypoglycemia, and stress. We were also likely causing cognitive development delays.

It wasn’t until the 1980’s that research revealed the harms fasting causes for newborns. Our policy was changed to prescribe feeding within two hours after birth. First, babies would get a little sugar water in the nursery. If that was tolerated well, they would graduate to formula four hours later, or breastmilk (if the mother was so inclined).

Now we know that breastfeeding success is largely dependent upon a newborn who feeds early and often. Four hour schedules are a thing of the past because they are known to sabotage the efforts of nursing mothers, and because babies should be fed when they’re hungry, not by what a clock says.

In those early days, another cringe-worthy practice occurred during night shift feeding time in the nursery. A nurse’s aid who had been there a long time before I was showed me how slicing the rubber nipples with a scalpel would make formula flow faster. We had silicone preemie nipples that were softer and colored red, and regular nipples that were colored yellow. The scalpel was applied to both.

Newborns over 12 hours old were swaddled, laid on their right side in a clear bassinet with their heads elevated, and given a bottle of formula capped with a sliced nipple. Some babies were held, but most had their bottles propped with rolled up receiving blankets. We circled the bassinets where we could see them, in case of choking or spitting up.

The milk flowed so fast they only had to swallow after giving the nipple a weak suck and the poor things were full in a few moments. It seemed like a practical solution to feeding 25 infants in the nursery within two hours, which was what we had to do. Now I’m ashamed of what we did, but at the time I thought it was okay.

You read that correctly. We propped bottles in the hospital, and deprived newborns of sucking in order to feed them faster. Today, propping bottles is considered poor parenting at best and a life-threatening hazard at worst.

Babies need to be held while they feed, not left alone in cribs, and sucking is an innate need that stimulates digestion, causes the release of soothing endorphins, and strengthens jaw muscles.

When I became a mother myself, I realized what a disservice our ignorance did to those little ones. And when I became a midwife, I made sure things were done differently. That’s how I made amends for the mistakes (and crimes) of those early days, when I worked in the hospital nursery.