A team approach to caring for moms and babies
What do you do for a mother who has trouble with breast milk pumping?
Or a 35-week-old baby struggling with hypoglycemia?
What about when a patient is requesting more medication than she needs to manage post-partum discomfort?
These are the types of questions and situations that the team at Cape Cod Hospital Family Birthplace and the Pediatric unit is presented with daily.
Each morning at 9 a.m. a multi-disciplinary team of practitioners, who are involved in the care of the maternity and pediatric patients gather to discuss an individualized plan of action for each family on the floor. Rounding includes a pediatric hospitalist, lactation consultant, licensed social worker, certified nurse midwives, clinical leader, nursing supervisor, and others as needed. They offer a team approach to maternity and pediatric care which is similar in sophistication and detail to the hospital’s multi-disciplinary cancer tumor boards.
Members of the mulsti-disciplinary maternity and pediatrics team include physicians, RNs, nurse midwives, lactation consultants, social workers and more.
“We started multidiscipline rounding a little over a year ago,” said Dian Birch, director of women and children services at Cape Cod Hospital. “They keep the team structured and provide consistency across both units and our ability to provide safe quality care.”
Each family is presented to the group as a way to ensure everyone on the unit that day is on the same page with the planned treatment, consultation and recommendations. Our team’s goal is to review the status of all the patients for consistent quality care amongst the caregivers. The rounding begins with the pediatrician facilitating a comprehensive look at the child, then the certified nurse midwife provides input on the mother and other providers such as the social worker, nursing staff and lactation provide additional input on the family unit. These clinical discussions extend past hospital admission and include recommendations for care after discharge which includes medical intervention and psychosocial supports. This attention to detail not only provides the best care possible at Cape Cod Hospital but provides these vulnerable families the support necessary to be successful parents.
“We really try to look at the entire family unit,” said Teresa J. Reid, MD, pediatric hospitalist. “It’s important that each provider and the nursing staff make rounds and then gather here to share information so that we all know what needs to be done for each patient and, most importantly, the entire family. We try to tailor our care to fit the needs of the family, including their living environment, support systems and providing education.”
No case is the same
On a recent day, eight maternity and three pediatric cases were reviewed. Some were fairly straight-forward; calm veteran mothers easing back into breastfeeding and a four-year-old recovering from dehydration. Others were more complfex, including a hypoglycemic newborn whose Zika test was still pending, and a mother with a deep transverse cesarean birth accompanied by gestational diabetes.
The most complex case involved a mother with a history of bipolar disorder and past methadone use. This case, in particular, showed just how valuable the rounding meetings truly are. Nearly every team member had an experience to share that morning, and their accounts of the mother’s disposition varied greatly.
The unit’s on-duty clinical social worker, Daniel Rodrigues, LICSW, led the discussion and briefed the team on the mother’s entire history, which included addictive traits, struggle with postpartum depression and anxiety, and a requested psychiatric consult.
“She suffers from poor insight and doesn’t recognize her risky patterns,” added Rodrigues. “We can still do a really good job treating her with compassion and addressing her mental health without splitting our team.”
Certified nurse midwife Jennifer Gibert-Cohen offered recommendations for alternative therapies and emotional support as well.
“I think she could really use some support right now, to get through this period,” she said. “We should continue to document the alternative therapies we are using to treat her headaches and pain.”
The review of each patient’s and family’s case is thoughtful and thorough. Together, the group works toward a consensus on how to best treat and care for each family, while also providing counsel to one another.
“We are a very unique blend here on this floor, with both OB and pedi,” said Dr. Reid. “We have to work as a team, otherwise it’s two ships that pass in the night.”
“It takes a village,” added Rosanna Burke, supervisor and educator of women and children services. “Together we get to welcome life, while supporting and celebrating these families.”