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Flu Policy Issues - Elizabeth Unexplained
Lots of data but no answers
greyautumnrain
greyautumnrain
Flu Policy Issues
So, originally we had this nice plan that Margaret would attend the birth of her baby brother. This was not because we are especially crunchy granola people, but the pattern of our life so far is that Margaret does stuff with us. We take her out dancing with us about one Saturday night a month, so of course we'd take her along to the birth. Also, it eliminates any potential child care issues. Really, it seemed like the obvious plan, especially since we're hiring the same doula we used last time, which frees Warren up to watch out for Margaret with the doula takes care of me.

Mt. Auburn had a great policy about letting siblings be present at the birth. As long as there was one grown up designated to care for each child they were fine with it. Note the use of the past tense here. Effective November 2nd they have changed there policy and now no one under 18 can be present for the labor. This is part of their new flu policy.

I am kind of put out by this. I think it's an overreaction, not to mention not particularly effective in our case. Margaret has been vaccinated against both seasonal flu and H1N1. I'll be the first to admit that little kids are known for their prowess as disease vectors. On the other hand, if the change in policy is for flu specific reasons, then it's irritating because Margaret has had her shots and thus can't be a vector for that. Sure, she can touch stuff and spread any virus already on the ward around that way, but a little vigilance with the hand sanitizer could solve that issue.

I'd really like to have Margaret with me. I like my little girl and I enjoy spending time with her (though occasional breaks are welcome). I want her to be able to see her brother born if she's up for it. Assuming my labor is slightly shorter than last time there will still be a fairly long stretch where we'll be apart, and then there is the added issue that someone needs to look after her. Jomkwan would be the obvious choice, but the thing is she can't work more than 10 hours a day. I think part of the reason we've had such a positive experience with the au pair program has been that we've stuck very strictly to the rules, and Jomkwan has regular hours that she can count on working and well-defined periods where she is off-duty. If I go into labor in the evening again I can't very well say "Hi Jomkwan, I know you just worked a nine hour day, but can you look after Margaret overnight on no notice while I'm in labor, we'll contact you in the morning." My family is an option, but they'd have to drive up from New York, and given that there's at least a two week window in which the baby is likely to come it's really not ideal to have them camping out here waiting. Also, Margaret tends to be unhappy if she doesn't have me or Warren or Jomkwan present. Anyone else is unauthorized personnel. This makes the 'impose on friends' option a hard sell. I mean I can probably get takers for the job of taking care of Margaret overnight on no notice while I give birth even with the understanding that Margaret will likely scream bloody murder for the majority of the time, but it's not exactly something I'm anxious to put people through. Of course Warren could just stay home with her and very likely miss the boy's birth, but that would not be fair to him or the boy. In short, the new flu policy is not only irritating, it is highly inconvenient to me.

Of course I doubt Mt. Auburn is going to change their policy for me even if I point out my kid has had her shots, etc. Beyond venting about it here there is nothing I can do.
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Comments
dcltdw From: dcltdw Date: December 17th, 2009 03:20 pm (UTC) (Link)
What an odd policy. MGH is (afaik) similarly paranoid about H1N1 and generally has clamped down on visitors, but I believe the policy is that vaccinated visitors are okay.

Does Mt Auburn have an ombudsperson you could speak to? *googles* Hmm, or maybe drop a line to patientrelations@mah.harvard.edu ?

At any rate, I'm sorry to hear how frustrating this is.
chenoameg From: chenoameg Date: December 17th, 2009 04:44 pm (UTC) (Link)
Beyond venting about it here there is nothing I can do.

Well, you could switch to a different caregiver and do a homebirth or give birth in a different hospital. But those seem very unlikely.

It is frustrating given how likely it is people choose Mt. Auburn for the sibling policy.
greyautumnrain From: greyautumnrain Date: December 17th, 2009 11:36 pm (UTC) (Link)
I had heard from another blogger that you can't get a home birth, at least not legally, in this state, though I have no clue how accurate that is. In any event, I would not be comfortable birthing the boy in a non-hospital setting due to the Rh issues. I'm A-, Margaret was A+, and the boy is likely to be A+ as well. I've had my rhogram shots, but even so there is a rather small but non-zero chance the boy may need a transfusion at birth. Switching hospitals probably would not help, I imagine that all the area hospitals are at least as strict given that Mt. Auburn had the most liberal sibling policy before this.
enugent From: enugent Date: December 18th, 2009 12:22 am (UTC) (Link)
My understanding is that there is no law one way or the other on midwife-assisted home births in Massachusetts - it's not illegal, but it's not "authorized" or regulated either. (I don't think they can constitutionally bar a woman from deciding to have her baby at home if she wants - they can just license and regulate the midwives.)

But that's not really relevant since it's not what you want anyway.

I hope you can find something that works for your family.
psychohist From: psychohist Date: December 18th, 2009 12:47 am (UTC) (Link)
Personally, I'm planning to pace in the hall just outside with Margaret.
enugent From: enugent Date: December 17th, 2009 10:20 pm (UTC) (Link)
What a pain in the neck. I've read that a lot of hospitals are doing that, but I hadn't really thought about its effect on your family.

I hope you can figure something out. Maybe your doula will have some ideas?

Good luck.
jaedian From: jaedian Date: December 18th, 2009 02:09 am (UTC) (Link)
I sort of get why they changed the policy, you would be very upset if you saw little kids running about and then later you or your baby got very sick. I don't know about proving you got vaccinated, but RSV can be just as bad for newborns and you can't vaccinate for that. (not that adults can't carry things too)

We didn't bring the siblings to the births, it just seemed like it was going to be too distracting for me. Although they were at least able to make a short visit after the baby was born to see the baby, and see that I was alright - which won't be an option anymore.

We had my parents come up from NY as soon as we knew we were going into labor. (of course they had to pack and stuff, so that was realistically the next day) For Alex we had to induce so they were here in advance, which was super nice.

But for Juliette, she was 3 days preterm so it was a bit rushed I was able to drop the kids off with Rachel Henry (we prearranged this) and even managed to drive myself at the hospital. My guys were older, but Alex wasn't happy about it at all.

You could see if JomKwan would be willing to do one night in exchange for something. Extra time off (like double or triple the time?) Because if you go into labor at night it really isn't too hard for her to watch Margaret if Margaret is asleep anyway. At least that would give your parents time to get here, or someone else to get there.

I would be happy to help you guys if you need it. I am a little further away, so I am not sure if that is helpful or not. I think there is going to be a little bit of Margaret being unhappy no matter what in this circumstance.
psychohist From: psychohist Date: December 18th, 2009 05:03 pm (UTC) (Link)
"I sort of get why they changed the policy, you would be very upset if you saw little kids running about and then later you or your baby got very sick."

That would have been true before H1N1, though. And personally, I think I would have gotten upset at the minority of the nurses who didn't use the hand cleaner before handling the newborn, rather than at the kids who never got into the same room, but maybe that's just me.

Since my job is to take care of Margaret, if worse comes to worst I'll just handle her elsewhere. It was nice to have both the doula and myself helping Elizabeth last time, but just the doula would probably be sufficient if we had to do that.

Jomkwan would probably be willing to help, but she's usually out all evening and weekend, so it's more an issue of availability. Asking for one night is one thing, but asking for her to curtail her social life for, potentially, weeks is another.
jaedian From: jaedian Date: December 18th, 2009 06:50 pm (UTC) (Link)
A nurse who does use the hand cleaner is WAY worse in my book too. It seems like everyone is being paranoid about H1N1 right now, and I think likely out of proportion. I have had to justify my kids having a mild case of the sniffles taking them places too many times. (or my sinus infection being treated with antibiotics!) So it is probably overkill on their part, but it is the norm at most other hospitals, so maybe they felt like they could get away with it or that it could be a liability issue for them.

If Jomkwan is out a lot, that makes it harder. Although early evenings and weekends it is usually easier to get other people to help out too. And really, since labor is so unpredictable, you will likely have to make several fall back plans anyway.
greyautumnrain From: greyautumnrain Date: December 18th, 2009 05:50 pm (UTC) (Link)
You could see if JomKwan would be willing to do one night in exchange for something. Extra time off (like double or triple the time?) Because if you go into labor at night it really isn't too hard for her to watch Margaret if Margaret is asleep anyway.

That would still be against the rules of the program. It's not a matter of Jomkwan's willingness, we know she's would probably be willing to work overtime in exchange for money or extra days off. We don't feel comfortable violating the rules of the program. I know lots of people do it, and the au pairs go along willingly, but I think our relationship with Jomkwan has been better because we follow the rules so strictly, even though she'd probably be happy to go along with bending them now and then. We're talking here about a young woman who is smart and responsible and resourceful, but who is also living in our house thousands of miles from her own home with a limited grasp of English. She's also from a culture where deferring to authority is the norm. We are very sensitive to the fact that she has a diminished ability to tell us no when we make a request; following the program rules to the letter is an insurance against making her feel pressured to do things that she would rather not do.
enugent From: enugent Date: December 18th, 2009 06:28 pm (UTC) (Link)
I really admire your refusal to slide on this, and I agree that it's probably part of why you're having such a good experience with the program.
jaedian From: jaedian Date: December 18th, 2009 06:59 pm (UTC) (Link)
I really do admire your sticking so well to the rules. And I do know that there would be some pressure on her side to just say yes. Culture plays into that.

But I do consider this an extraordinary circumstance, which is why I suggested it. (It isn't going to happen again while she is working for you for instance) Perhaps you should discuss it just as a back-up plan? In theory she could do it? if you went into labor and she hadn't worked 10 hours that day? (like in the am?)

This is one of the hardest things, giving birth to a subsequent child. It is a struggle for everyone I talk to who doesn't have local family.

Call the hospital or talk to your midwives, and find out what can be done. Maybe supplying proof ahead of time of vaccination will help? If not maybe they can find a designated room for Margaret and Warren somewhere? Are children under 18 allowed anywhere in the hospital proper now?


greyautumnrain From: greyautumnrain Date: December 18th, 2009 08:14 pm (UTC) (Link)
Our doula urged us to go ahead and appeal the policy, which is what we're going to try first.
jaedian From: jaedian Date: December 18th, 2009 08:26 pm (UTC) (Link)
Sounds like a good plan.

It also occurs to me that Warren will be your health care proxy, not the doula. And laboring women aren't in the best of situations to make appropriate medical decisions. And if something went wrong, I would think the hospital would want Warren handy and easy to contact at a minimum. Certainly limits liability for them, so you may want to let them know that Warren would otherwise have to stay home with Margaret.
jaedian From: jaedian Date: December 18th, 2009 07:13 pm (UTC) (Link)
So what do they do with a pregnant mother who is in labor who has the flu? Do they send her elsewhere? ;-}
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