Expert Q+A: Mandi Wheeler, Administrative Director of Women’s Services at North Central Baptist Hospital

Amanda:

Hi, I am here with Mandi Wheeler, who’s the Administrative Director of Women’s Services at North Central Baptist Hospital. And she is joining us on our Expert Q and A series for Bloom 2021 to talk about and answer all kinds of questions you’ll have about the birthing experience, hospital care, postnatal care. So before we jump in, Mandi, will you just tell us a little bit about the Baptist system?

Mandi Wheeler:

Absolutely. So I’m super excited to have this opportunity and the timing couldn’t be any better with some of the changes that are going on in Women’s across Baptist right now. So we have really exciting growth at a couple of our facilities. St. Luke’s and North Central are both going through a bit of a refresh is what we call it. So you know, updating our rooms and we get to throw in new equipment and just really fun stuff there to make it nice and pretty. And you know, I’ve seen the plans for both of the facilities and it’s just such a warm feminine feel. So I’m super excited for that. Almost disappointed that, you know, I’m not going to have, you know, delivering grandbabies in this hospital, but so neat, but and then we’ve got some other facility changes where, you know, the market decided that they wanted to target kind of a different population and make sure that we were serving different parts of San Antonio.

So Mission Trail is opening their women’s services. And so they’re just super engaged, super excited about the growth down there and the opportunities that they’re going to have to serve that community. So I think it’s something that’s been, you know, well-deserved for some time now. So we have, you know, [it’s] really unique inside Baptist that we have so many different facilities that are delivering. And so we’re able to, you know, share our practices with one another, but also we’re not cookie cutter. And I really love that each of our facilities really garners not, not necessarily the care, but how they deliver the care based on what their community is asking them. So what works for me and our population at North Central might not be what the patients at Mission Trail are looking for. They might not be looking for the same kind of experience. And so we’re able to kind of bounce those ideas off of each other and work collaboratively to make sure that, you know, we’re all doing the best and that we’re meeting the needs. So, you know, the forum like this and asking these questions really helps us start, you know, putting those thinking caps on like, “What do we need to do better?” and “How do we challenge ourselves to, you know, to do exactly what you’re asking us to do?”

Amanda:

So in full disclosure, I just had a NICU baby at North Central Baptist this last fall. And I know that that facility is a level four. Is that right? A level four? So talk to us a little bit about the kind of special things that you have for mothers and babies that are like that.

Mandi Wheeler:

Sure. So you know, the levels can get kind of confusing. But they’ve got a level one through four that the state kind of predetermines, you know, this facility at this level, we would expect to meet these expectations, ensuring that, you know, patients with a certain acuity are being treated at a facility that can safely provide that. And they’ve got the competency in that. So Baptist Health System has two level-four facilities—that’s North Central and St. Luke’s—and then we have some other levels, you know, between New Braunfels, the Resolute facility and our others through Baptist here. But that doesn’t mean that those facilities are just kind of, you know, out there in the wind on their own. So we’re helping whether it’s in, you know, in the form of training, but also transferring babies to and from those facilities to make sure that they are placed in the right place. So you know, you’re gonna find some of those higher-level facilities with, you know, those additional resources, specialists and, you know, additional whether it’s, you know, the chaplain that’s coming in and seeing you every day or the lactation consultant that’s garnering, you know, their care and their support to the acuity of your infant. And so it’s just very personalized, you know, no matter where you are, it’s going to fit the bill for that facility.

Amanda:

It was so incredible to me to see the resources available and just all the different people who got involved with my son’s care and knowing that that’s available to anybody in the city, like it’s here for us. We are so lucky to live in a city that offers that. Okay. Let’s talk a little bit more about the birth experience in a hospital. So if someone—let’s say she has her heart set on having a very low intervention birth, whether that’s in a birth center or at home, and then finds herself with no choice but to have a hospital birth, what are some ways that she can kind of advocate for as much low intervention as possible because obviously if your plans have changed from very low intervention to needing to be in a hospital, you’ve got a reason, I’m assuming? And then kind of for anybody, I guess, that after delivery, and we can circle back to that.

Mandi Wheeler:

So I would say number one, always have a backup plan. You know, the best-laid plans are obviously going to go awry. So, you know, I love and appreciate the, you know, having the heart set on, you know, whatever looks perfect for you and for your family, but, you know, these babies and our bodies determine whether they’re going to do it. We don’t.

Amanda:

Welcome to motherhood, where things never go as planned.

Mandi Wheeler:

I would say number one, just be thinking and maybe planning for that backup plan. So though you may be just absolutely against, I don’t want to end up in the hospital, if you are, you don’t want to in that moment, decide to communicate your plan and figure out what that facility looks like and what they have to offer. That’s not the time. Right. And so it just leads to a lot of, you know, maybe disappointment and, you know, there’s a lot of let down with that. So investigate it a little bit, whether you’re going to a birthing center or whether, you know, that’s with a midwife at your home, look at, if something happens, where would you transfer me, or where would you recommend that I be admitted for this delivery and then start visiting with that facility. And so, you know, there’s a couple of navigators throughout our system that are just perinatal navigators and that’s their job is to kind of work with that person and say, you know what, this is what our facility looks like. This is what we can offer. Tell me what you want. And then let me like, let me support that and let me communicate that to the team. So they’re excellent at it. And, you know, there’s a navigator at St. Luke’s and you can find that on their landing page, on, you know, on their Internet; same at North Central. And we’re happy to help you with that even at the other facilities. If, you know, if Northeast is your backup plan or Mission Trails ends up being that backup plan, then your expectations are set. If you come in, you know, in an urgent situation, you at least know, this is what it’s going to look like. Secondly, write it down, write your plans down because, you know, if you’re communicating with that doula or midwife or, you know, you’re in a facility and you’ve communicated, and then you do end up in a hospital unplanned again, not the time to try, you know, give a narrative, you know, just write that plan over and say really, you know, I really had my heart set on A, B, and C and, you know, B’s out the window, but let’s see if we can. Right?

Amanda:

And I think even having it written down for your spouse or your partner, who, because in the moment, they’re going to be worried about you, not the plan that you made, or maybe that you told them.

Mandi Wheeler:

Please don’t depend on your spouse to memorize that because there is, it’s not happening.

Amanda:

So we always get a lot of questions about gentle C-sections and I know that that looks different at all hospitals and that kind of circles back also to kind of skin to skin and having a plan for after the baby’s born. But explain to us a little bit what a gentle C-section looks like at North Central Baptist. And can you still do skin to skin if you have a C-section and if you want immediate skin to skin, if you’re having a regular push it baby I don’t know what the right word for that is.

Mandi Wheeler:

Okay. That’s okay.

Amanda:

You pushed it out instead of having a belly birth. How to ask for that. So I know that that’s kind of three questions in one.

Mandi Wheeler:

Yeah. It’s okay. And, you know, I would say the same thing when you, when you are establishing that plan with your OB, have those conversations, have them well in advance. So let’s not be thinking about those or communicating those the morning that you get here 15 minutes before we go to the OR, you know, so it makes it a little bit harder to make sure that, you know, the entire team is engaged and that we have the right, you know, support or equipment in the room to facilitate that. So, you know, it’s kind of standard practice anymore in the OR to have a clear drape so that if you want to visualize, you know, baby being delivered in the C-section, then do, you know, and that’s going to be facilitated. That’s not for every mom, not every mom wants to, you know, wants to see that.

But if I know that ahead of time, then, you know, I’m going to make sure that I’ve got that clear drape in the room so that we can make that happen you know, we have yeah, there are terms differently, baby catcher, or a transition nurse, you know, we’ve got someone dedicated to that, that infant care at delivery and our transition nurses, our baby nurses are very passionate about, you know, supporting whatever mom’s desire is. So it’s not uncommon at all to have a mom come in and say, I really want to do skin to skin in the OR. Again, not all moms feel comfortable with that. I mean, some moms just feel kind of crummy in that situation. And we’re fine with, you know, their support person holding baby next to them. And, you know, they can, they can have their bonding time a little bit later. You just want to get through that crummy moment. So you walk in, have that plan established with your OB, and start communicating like on admission, tell your nurses what you’d really like to see, and that doesn’t necessarily need to be a written plan. And you just say, Hey, if we can make this happen, I would love to do skin to skin in the OR, and if that baby’s stable and you’re stable, we’re going to make it happen.

Amanda:

I was going to say, I was going to add that sometimes the things we want are not necessarily what’s best for us and baby right at that moment. And so sometimes that doesn’t happen, but I love that you just said to ask the nurse because they are amazing. They’re incredible, they’re amazing. And they want to do everything they can for you and it’s yeah. To communicate, communicate, communicate, communicate. Right?

Mandi Wheeler:

And I, you know, I’m going to throw in there and you’ll see, in most cases, you’re going to see your anesthesiologist before you go back, whether that’s scheduled or not scheduled, but particularly for a scheduled case, your anesthesiologist is right there upfront and personal with you for that entire C-section. And so there’s a unique little relationship that’s built right there between the two of you or the three of you. So, you know, definitely share that with them too, that, you know, “Hey, I’m, I really am, you know, hoping that I’m able to do this,” because they’re really integral in making sure that you’re stable enough to make that happen.

Amanda:

A great point. That’s so good. Thank you. Oh my gosh. Okay. So now we’ve had our plan for giving birth and we’ve maybe had to go to the OR, and we’ve done skin to skin. What are some other newborn tips that you think would be helpful for parents while they’re in the hospital, or maybe even kind of transitioning home?

Mandi Wheeler:

You stole my thunder, skin to skin we’re just an entire campaign at North Central right now. And we’re really trying to adjust, you know, provide every opportunity we can to make that happen and really encourage, rather than just let it happen by default if mom ends up doing that on her own.

Amanda:

Yeah. What does that look like?

Mandi Wheeler:

So we do a quick, what does most every mom want to know as, you know, as soon as they can about that baby, how much did that baby weigh? What did I do? You know? And so if we want that, if we want to know what that weight is, we can get that real quick, but really we want our goal is to have as few interventions as possible from the time of delivery until you’ve completed that, you know, newborn transition period, a mom to adjust to you and you to adjust to mom or baby to adjust to mom and have that bonding and sometimes first feed. And so whatever we can do as nurses to facilitate that baby’s stability in that moment then skin to skin is absolutely encouraged. So and, you know, in the C-section, so even if we’re not able to do that in the OR, that’s one of our first priorities in recovery now, and that hasn’t always been done.

And some of the feedback that we’ve gotten from our patients is that they, you know, they had just such a different bonding experience with a vaginal birth versus C-section. And it was just very, it was very disappointing, you know, kind of disheartening to them. So we really focused on that. I would say probably in the last six months, that’s been our top-quality project here at North Central is just working on the quality of time and, you know, and, providing the most resources we can to ensure that that’s happening. So you know, there’s I would say the other key point I would give moms is not to forget yourself, you know, that self-care, you know, especially whenever you get home, you know, you don’t hit the ground running. And so it’s, I mean, there’s a lot of that self-care you really got to stay on top of. So rest, your diet, your nutrition is so important to your overall just general health, but for supporting baby, if you’re breastfeeding and, you know, just that healing process. So don’t forget you. That’s key.

Amanda:

Talk a little bit about that postpartum care for mom. How can your birth experience in the hospital kind of support you through that? Are there resources available or what does that look like with y’all?

Mandi Wheeler:

Yeah, no, there absolutely are. So you know, in addition to lactation, I mean, lactation is just terrific support for us. And our lactation consultants have really changed their process this last year, too. Moving from seeing our patients on the backend, and by backend, I mean, after you’ve delivered and sometimes that’s next morning, after you’ve delivered before you were seeing a lactation consultant, and though our nursery nurses and our postpartum nurses are just excellent at supporting that, sometimes there’s just those tips and tricks that those lactation consultants have that we just don’t, you know? And so to get them, you know, engaged and having conversations about your feeding preference, whether it’s bottle-feeding or breastfeeding that we’re supporting that in the delivery room and before you deliver. So our lactation consultants have now started seeing all of our patients in labor and delivery.

Yeah. And so they come in and just kind of introduce themselves and “Hey, how can we support you?” And give some information on what skin to skin is going to look like. So you haven’t thought about that and you haven’t planned it, know what that’s going to look like whenever you deliver and whether you choose to participate or not. And so it’s really, it’s not only increased our breastfeeding rates here at the hospital, it’s just provided, you know, a tremendous appreciation with our patients for that support that we’re offering. So it’s really changed the dynamics to just move them, move them up by one day. And it’s just incredible, the response. Something that we’re seeing more and more now, and I would really like to see really grow this year, is physical therapy support.

And so, you know, we have our moms, a good number of moms, unfortunately, will spend, you know, weeks, sometimes months in an antepartum unit where you’ve been kind of confined to a room and you don’t think about that just loss of activity. And even if you are bed-bound, what is that, you know, what can we do to facilitate some better just overall health? So our physical therapists are working on plans for what that support looks like and how we can engage the OB’s and utilizing them to support that, you know, that antepartum health. But then after delivery there’s a lot that a physical therapist can do to help you in that postpartum period. So, you know, getting you back to that optimum, you know, pre-delivery, pre-pregnancy state of health is something that they can absolutely facilitate.

C-Sections, you know, our body just goes through an incredible, I mean, it’s just a beating, you know, after the C-section sometimes. So those, again, just lend to such a complicated and very unique recovery that some of our physicians will recommend that therapy on an outpatient basis to kind of help you get back where you need to be. So if you are struggling or you find that you need a little bit of extra support, don’t hesitate to talk to your OB about that. There’s options. There’s a lot of resources that we’re probably not tapping into.

Amanda:

That’s incredible. It’s always important to remember and to remind moms of all stages that your body doesn’t just go back to the way it was. And sometimes we do need a little extra help in getting things back to a healthy, healthy place. What else, what else would you like us to know? What are some other things as we wrap up that you want people to go away knowing about North Central Baptist and just the Baptist system altogether?

Mandi Wheeler:

You know, I think one of the biggest changes that we expect this year, and I’m just super excited about this. I’ll backtrack just a little bit, you know, when I said there’s no real cookie-cutter way to deliver, you know, maternal services, couplet care is something that you know, I, I’m sure a lot of this group, you know, hearing this message, they’re going to know exactly what that is. And there’s a lot of blogging and a lot, you know, a lot of media out there around couplet care, but that’s not really all that defined. It can look like, you know, it can have very different structures at different facilities, right? So we’re looking at what does that look like for us and what do our patients expect of us and how, like, how do we get there? How do we navigate to that point?

You know, the ultimate goal is to try to keep mom and baby together as long as we possibly can, you know, and just to facilitate that family unit. So our next step, we’ve done a couple of things already that have just been, you know, incredible this last year, two years, but our next step is to push all of our newborn bathing to the bedside in postpartum and say, I’m going to go ahead and take baby to the nursery and mom, you’re going to miss it, but dad, you can come with us maybe, maybe not, but taking all of that care out of the room or out of the nursery and bring that to the bedside and just make it, you know, just make it exciting and make it a part of the, you know, one of your many firsts. Right? And not every mom and I, you know, I needed help on this too.

Not every mom knows the right way to bathe a baby. Oh no. Oh no. Oh yeah. Yeah. And they left that part out of the manual. It’s not, yeah, there’s not the perfect manual, the perfect book for that. So we want to make sure that we’re engaging the, you know, mom and dad or whoever those support people are in that period with this bathing experience and that doesn’t have to be right away. We’re, you know, we try to delay that out. There’s not a true benefit, you know, in most cases to bathe that baby an hour after delivery, let’s just do it whenever, you know, baby’s stable and mom is stable and we can all jump on board and be engaged in that.

Amanda:

So great. Cause you know, we always laugh. You leave the hospital and you say, I wish I could take all my nurses with me, and you may not be able to take your nurse home, but you could definitely take her bathing tips home with you.

Mandi Wheeler:

A hundred percent. That’s our goal.

Amanda:

Thank you so much. We appreciate your time today and so much good information. And if y’all have any questions, we will leave contact information for you to get in touch. And you know where to find Mandi, she’s at North Central Baptist and we will also leave information about all the other Baptist hospitals. I feel like they’re all over the city now, or they are all over the city. So that you can find one that’s close to you if that’s something that you have interest in. Again, thank you so much.

Mandi Wheeler:

Thank you. I love the opportunity. I appreciate it.

A fifth-generation San Antonionian - who happened to spend her formative years in Austin - Amanda loves the SAT from the confetti in her hair to the bluebonnets under her feet. Never one to miss a reason to host a party or decorate for a theme, Amanda revels in the 'mas Fiesta' attitude of the city. She's mom to Vivi (2012) aka #HurricaneVivi, Mac (2020) and wife to Francois, whom she met at Texas A&M (FTAC '05). She has a Masters in Early Childhood Education and a Doctorate in Making it Up As She Goes - which means she's a sometimes-fun-mom. You can find her on Instagram . She loves confetti, croissants, and a cold Ranch Water. Favorite Restaurant: Piatti's Favorite Landmark: Johnson Street footbridge in King William Favorite San Antonio Tradition: Fiesta Medals