Like Mother, Like Daughter – In Print

Anyone in academia knows how challenging it is to get published. First you need an issue or topic journal editors will want to explore, then you need data to back up the findings, then those findings need to be written and submitted, vetted by veteran experts in the field, and accepted. Then it undergoes multiple rounds of edits. A fairly high bar.

So, it’s easy to see what a point of pride it is for one’s work to be printed in a journal of one’s peers. And no doubt there have been occasions where members of the same family in the same profession might get published in the same journal, but years apart.

But what are the chances of two members of the same family getting their work accepted by the same nursing journal and both studies are published in the same month? Just ask Rebecca Hill, an associate professor of nursing, and her mother. Earlier this year, both had articles run in the same edition of MCN: The American Journal of Maternal/Child Nursing.

“I can't imagine it happens often because of all the hoops you have to jump through just to get published,” said Dr. Hill. “It’s really cool.”

Hill examined the breastfeeding challenges that come when a baby has tongue-tie. Her mother, Dr. Maureen McRae, wrote about the challenges that come with having a newborn stay with the mother during the hospital stay to promote breastfeeding. So, the topics were related.

“My manuscript got accepted, and then I got the publication date,” said McRae, who recently retired as a nurse from Winchester Hospital.  “And I said, ‘Rebecca, when is yours being published?’ And she said, ‘I don't know.’ I said, ‘Well, it's on the website.’ She went to check it out and sure enough - they were both going to be published in the same journal. We couldn't believe it. I've published before and she's published before, but for these to fall in the same journal, the same volume, the same edition was just a crazy coincidence.”

Hill had followed in the footsteps of her mother and became a nurse. Their careers have similarities and differences. Hill, a family nurse practitioner and certified lactation counselor, has a primary position in academic leadership. Her mother worked in nursing management prior to transitioning to nursing academia, where she retired as a professor emerita in 2013.  She then remained on the clinical side, logging more than 50 years in maternal child nursing before fully retiring last year. They both love nursing, maternal child health, and the research aspects of the profession.

The Need to Screen for Tongue-Tie

Tongue-tie, where a piece of tissue under the tongue doesn't let the tongue rise enough, is a common but not routinely discoverable condition that makes it difficult for a baby’s mouth to latch on to the mother’s breast. As a result, the difficulty for babies to eat often leads to undernourishment and discomfort for the breastfeeding parent.

Forty years ago, when infant formula was popular breastfeeding rates plummeted and it wasn’t as easily diagnosed because babies feed easier on a bottle than they do on a breast. However, in the past two decades, breastfeeding interest has increased, and that’s why it’s been seen as a potential cause of breastfeeding difficulty.

“But there's really not enough research out there to move clinical guidelines forward,” says Hill, who has conducted multiple research studies on breastfeeding. “So, there's many providers who will say either this is a fad, or it doesn't need to be treated. And there's just not enough data out there to support one way or the other.”

In the paper titled, “Breastfeeding symptoms with tongue- and lip-tie,” Hill and her co-authors looked at symptoms of before and after treatment of 121 mothers and their newborns.

“There were clear improvements in symptoms for both mom and baby,” said Hill, who is also Associate Dean of the School of Nursing’s prelicensure programs. “But lot of clinicians say, ‘Well, where's the randomized control trials?’”

And that’s the rub. Randomized control trials are the best research where some babies are treated, and some babies are not.

“Ethically we can't do that,” said Hill. “We can't withhold treatment if a baby is not gaining weight and they can't eat. So, I don't think randomized controlled trials will ever happen in this population.”

But additional research into this dilemma will occur, courtesy of a recent $30,000 grant Hill received from the Gerber Foundation. That research study will be the first to collect physiologic sucking data when the baby is feeding at the breast before and after treatment of tongue-tie. Hill is just the second nurse to be awarded a grant by Gerber.

Baby-Friendly Isn’t Necessarily Mother-Friendly

The Baby-Friendly Hospital Initiative (BFHI) was started in 1991 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) as a global program to improve successful breastfeeding. To obtain BFH designation, hospitals, among other steps, have newborns stay with the mother during the entire hospital stay following childbirth. “Rooming-in,” as it’s called, promotes early breastfeeding and maternal–infant bonding and is beneficial to the baby, but is it best for the mother?

In the paper, “Social interactions and institutional structures that influence 24-hour rooming-in for new mothers and newborns in the hospital setting,” McRae examined the issue from the nurse’s perspective. Seven nurses working a variety of different shifts were interviewed, but because the research occurred during the pandemic, the participation rates were small and with visitor restrictions, the clinical setting wasn’t routine. But the findings offer a glimpse of how nurses view the issue.

“The nurses’ perception is that it’s not necessarily mother-friendly,” said McRae. “And are we mother-friendly or baby-friendly? The decision should be really based on what the fully informed mother wants, with what the mother is comfortable with if they're exhausted after a long labor.”

According to the paper, “sometimes baby-friendly does not feel mother-friendly. Most (nurses) described feeling conflicted as they balanced meeting the needs of the mother and promoting 24-hour rooming-in. There was an underlying question; who is my patient, the mother, or the baby?”

McRae’s study pointed to concern over maternal exhaustion as a primary driver in the nurses’ decision to take the baby out of the room to give the mom a break.

According to the paper, “The moms are just like, ‘I can’t handle this anymore’ and they absolutely hit a wall physically and emotionally. Nurses were not the only ones concerned about the needs of the mother. Fathers advocated for the baby to go to the nursery so that the mother could get the rest she needed. One nurse said, ‘I find that it is not just the mothers that are asking for babies to go to the nursery. It is fathers. Fathers are asking for babies to go to the nursery.’”

While there is widescale agreement over the benefits and bonding and early breastfeeding that occur between mother and baby during the first few days, the overarching concern was the well-being of the mother.

“Some of the nurses will tell you that if the mother wants to rest, they'll bring the baby to the nursery between feedings,” said McRae. “While some hospitals have done away with the nurseries, I think that for the most part mothers still want the nursery to be available. If somebody's having their fourth baby, they don't necessarily need the baby to room in. They need the rest if they’re going home to three toddlers.”

Of all the journals Hill and her mother have been published in, the January/February 2023 edition of MCN: The American Journal of Maternal/Child Nursing is sure to always hold a special place in their hearts.

“I did notify the editor,” said McRae. “I said, ’We have a kind of a unique situation here. My daughter and I are both published in the same journal,’ so she thought that was fascinating. It's great. It's wonderful.”

Hill agrees and credits her mother for much of her success in the academic world.

“My mom actually was the one who pushed me to pursue a PhD,” said Hill. “So, it was amazing to see the fruits of the labor come to fruition and for us to be in the same journal together.”

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