Vol. 5 Issue 8
Babies & Mothers
Home care is a great new option for pregnantwomen and their newborns
Fourteen-year-old Janine stood in front of Stacey Bateman, RN, with the typical teenage glare.
"You have to stay in bed," Bateman commanded, just like she did every day when she stopped by. Janine ignored her, fidgeted, showed her boredom.
Typical teenage reaction? Sure. Typical teenager? Not quite. Janine was 30 weeks pregnant and in trouble. Her placenta rested directly over her cervix, causing her to bleed whenever she moved or stretched. If she didn't stay on bed rest, the placenta could easily pull away from the uterine wall, possibly killing the baby, and maybe the mother.
Janine didn't care. She was a teenager and not interested in being pregnant. Bateman, however, did. "I was out there five days a week," she recalls. "She would do nothing we asked her to do."
As a home care nurse and vice president of managed care for Flagship Health and its Women's Health and Maternal Child Program, Miami Lakes, FL, Bateman has seen more than a few patients like Janine.
For Moms and Peds
Sometimes caring for women with high-risk pregnancies and fragile newborns can be a challenge for a home health nurse. But they are patients that every home health nurse will encounter sooner or later.
And whatever the medical condition, there are home care programs for women and their newborn babies at all levels of risk. For example:
An otherwise healthy woman with severe morning sickness may suffer dehydration. She could go for IV hydration at the hospital, where she might be surrounded by infections and antibiotic-resistant organisms, or she could stay in her own home, while an IV nurse administers the therapy, said Vickie Cunningham, BSN, RN,BC, director, Lehigh Valley (PA) Home Care. The quality of care is the same, but the comfort and costs are dramatically different.
Another woman, like Janine, may be at high-risk for miscarriage and strictly bed bound. Instead of spending months in the hospital, she can stay with her family, in her home, and receive top care from a highly skilled OB nurse. She could be high-risk because she's carrying twins or because she's diabetic. She could have pregnancy-induced hypertension, have recently given birth or just be very young.
Women with no complicating factors may still benefit from home care. Caregivers can sometimes help women deal with common problems, such as back pain, postural and musculoskeletal changes, by introducing strengthening exercises or by using supports that either compress the pelvic ring or lift weight off it.
Post-Natal Benefits, Caring for Peds
Once a baby is born, home care's role is doubled. Not only does the mother need attention, but the infant does too. Despite the popular theory that once you have a baby, instinct kicks in and you know just what to do, many new moms need help. And now that more families are spread out geographically, new mothers often don't have their own moms close by to help them figure it out, Cunningham noted.
Post-natal home care addresses everything from the baby's physical health to the mother's coping skills. Because women leave the hospital within 24 to 48 hours of giving birth, acute care providers often don't have time to see potential problems, such as hyperbilirubinemia (jaundice). A new mother may not know her child is very sick and may not get him to a hospital for treatment. But if a home care nurse is checking in with her at home, she can both diagnose the baby and save him from a trip back to the hospital.
New technology allows nurses to use phototherapy and special blankets to treat these "bilibabies" in the home, where they can stay with their families.
Home apnea monitors can even help home care nurses and new parents protect infants when they stop breathing, a not uncommon infant condition, which has been linked to sudden infant death syndrome.
Medical conditions aren't the only things that can strike new infants. For every mother that is working hard to do the best she can to take care of her baby, there is another who either doesn't know how to, doesn't want to, or simply can't adequately care for her child. Sometimes home care is the only way to help these children.
Consider the following scenario: A young, poor woman brings her baby in for a wellness visit because he is very thin and inactive. The physician confirms that the child is failing to thrive but isn't sure why. He puts the baby in the hospital, where it undergoes a variety of tests to determine the problem. The mother is separated from her newborn, worried and scared. The insurance company is having a fit.
Consider now, that the same woman has a home care nurse. The nurse comes to visit and sees the same thing the physician saw. She goes into the kitchen, where the mother is making a bottle for the baby and discovers the problem. The mother, too poor to afford enough formula, is watering down the baby's bottles. No tests are needed. No separation. She just needs formula.
Bateman, who works in a predominantly poor area in Florida, sees this problem all the time. "You wouldn't pick that up unless you went into the home and the kitchen," she said.
By sending trained nurses into the mother's home, home care can make sure new moms have everything they need.
Carrie L. Adkins is an editor at ADVANCE.