Heather Ly (Host): Hi there, everyone. Thanks so much for joining us for this latest episode of Medically Speaking. Joining me today is Dr. Mona Bonanno, who is the Pediatrician Newborn Hospitalist and Medical Director of Newborn Service at Millard Fillmore Suburban Hospital. Thanks for being here. Thanks for the invitation. We have a lot to talk about. First, let's dive into the role of a pediatrician and your role specifically at Suburban.

Dr. Mona Bonanno: So, I cover the newborns at Suburban after they're born, which is the most fun part. So, I get to celebrate with families and we check on the babies and make sure they're doing okay. We like to check in every day, talk to mom and dad, and help answer their questions, and also address any issues that might arise in terms of the baby's health while they're here with us in the hospital.

Host: So, it's that celebration. You said it's very important to you to make sure families have a positive experience. But also, preparing them as they take their new bundle of joy home. What do you do to prepare them, especially new first-time parents?

Dr. Mona Bonanno: Right. A bundle of joy is one thing, a bundle of nerves is another. And I think, speaking for myself at least, I was a pediatrician before I became a parent, but I still wanted to take the staff home with me after I left the hospital with my first baby, because there's so much new to learn. And so, we like to offer a lot of support along the way that starts in a prenatal period with baby classes, breastfeeding classes, and just some sort of general educational kinds of classes for parents to be more prepared by the time they get to the hospital.

And then, once they get to us, we have a whole series of educational videos on each of the TVs in the rooms that help prepare them, things like certainly breastfeeding, car seat safety, even infant CPR. So, we hope that between those educational tidbits and what we can teach during the hospital stay that they feel more prepared and confident.

Host: And also, knowing that there is that continuity of care, and you and your team are doing your best to prepare the families as you sort of do like a gentle handoff to the child's pediatrician outside of the hospital. How do you do that and how do you make sure that parents, you know, don't feel like, "Okay, you've left Suburban and now, good luck, you're on your own." It's certainly far from that.

Dr. Mona Bonanno: Right. So, we try to keep really detailed documentation about the baby's stay at the hospital, and all of that gets forwarded to the baby's pediatrician or primary care provider when they leave the hospital so that that provider can review those notes before the baby's first visit. And if there's anything that we feel warrants a little bit more detail or more explanation, then we're always happy to give the provider a phone call as a heads up.

Host: And I recently got the opportunity to see you hands on with one of your teeny, tiniest patients, 24 hours old, as you're doing some of those checks within that first 24 hours, what are you doing? What are you looking for before a family gets the okay to take their baby home?

Dr. Mona Bonanno: Yeah, I think that's a great question, and I think we forget sometimes that the transition between life as a fetus and life as a newborn is a really, really significant one. And it's kind of amazing to think of how many things have to go right in order for that transition to happen successfully. But once in a while, there can be some hiccups. So, those are the things we look for. We check their heart, we check their lungs, we check their skin tone, their skin color. We look for jaundice, which is one of the most common things we treat in the newborn nursery. We see how they're doing with respect to maintaining and regulating their temperature, because that's something that they'd never had to think about doing before. And now, they're exposed to air for the first-time. So basically, we're assessing how these tiny little newborns are transitioning to life outside the uterus.

Host: Yeah. I had, again, the chance to watch you pick up this baby, do all of the testing. You have such a way with kids. And I know that that seems like such an obvious being a pediatrician, but watching you just sort of in action, just that gentle touch, that delicate touch. What do you love about your job? You just seem like a natural.

Dr. Mona Bonanno: Well, that's very kind of you to say. I think I have the cutest patients in the world, right?

Host: Certainly. I mean, certain nobody is going disagree.

Dr. Mona Bonanno: But I think also I feel like we also can teach by what we model, right? So, for families who are taking care of a baby for the first-time, maybe they don't have experience with babies that young. They may be nervous about even handling the baby or, you know, how do we change a diaper? How do we do this? How do we do that? How do I hold when we feed? And those are all things that we can help them, not only by kind of teaching them, but also by showing them. And so, I would hope that some of what they learn from us is what they observe, not just what they hear.

Host: And that's so important too, right? Because there are people, first-time parents that maybe they didn't babysit when they were younger, maybe they didn't have a younger sibling. How do you take away-- you talked about that bundle of nerves, you know, coupled with the bundle of joy. What do you say to especially first-time parents to help them relax a little bit and let them know that they've got this, they're going to be okay, they're going to do just fine.

Dr. Mona Bonanno: I think sometimes they have to prove that to themselves, but you know, we are here to support them while they're learning, because it is a pretty steep learning curve and there are a lot of aspects to it. But we hope that with the education that we can provide, plus the one-on-one care that we provide to the baby between the nursing staff, the providers, that they feel more comfortable by the time they're being discharged.

Host: And you have four children of your own. So in addition to being very busy at Suburban, busy as a mom, outside of. But two of your daughters, actually, you delivered at Suburban?

Dr. Mona Bonanno: I did. Yep.

Host: I feel like that says something about the care that you knew that you were going to receive there and the trust that you had in the facility. Were you working at suburban when you delivered?

Dr. Mona Bonanno: I wasn't. I actually wasn't working at all. I did my residency in Boston and our first two boys were born there. My husband and I both grew up in the Buffalo area, so we were going to come home and have some family support and help. And so, when it came to my third pregnancy, you know, I experienced what it was like to deliver in a different setting at Suburban, and I just had a really good experience. I found that the staff was really nice. They were kind. They seemed like they were happy to be there, happy to work there. And I felt very supported. And that was a difference for me than how I felt when I delivered in Boston. It was sort of almost like a factory. You're in, you're out, you know? It's all very quick. And when I delivered at Suburban, it felt very comfortable and, like, my questions were answered and I felt really more confident, you know, when I was heading home. Even though it was my third baby, we know every baby can be different.

Host: Certainly.

Dr. Mona Bonanno: And there can be different situations, different challenges that might come up, but I felt very comfortable. So much so in fact that after I had our youngest daughter, I inquired about a potential position at Suburban because I felt like--

Host: This is a place you want to be a part of.

Dr. Mona Bonanno: It semed like a nice place to work. And here I am now, almost 12 years later.

Host: Using your personal experiences as a mom, both maybe the not-so-great ones you said with your first two versus your positive experience when you delivered at Suburban, how do you take those what went through personally and translate that into your practice to make sure that your patients have the best experience and have those positive experiences?

Dr. Mona Bonanno: I think, I try to approach my job as a parent first and a pediatrician second. And I guess I try to put myself, you know, in the shoes of the parents, whether it's first baby, second baby, et cetera, and try to really identify any concerns if they have them, try to address those. If I can take any of their stressors away, I feel like that's a win. Because as a mom, any less stress I have to deal with, the better. So if we can allay their concerns, if we can help address issues, if we can make sure that the baby's healthy, mom is healthy by the time they're heading home, we feel like that's probably, you know, the best hopefully success story we can offer.

Host: And you've done your job. I think a lot of folks, they think about deliveries and they think about Oishei Children's Hospital, which falls under the Kaleida umbrella. But we have plenty of babies that are born at Suburban. We have the amazing staff, we have the technology, we have the beautiful spaces. What do you want people to know about if they're deciding where do I deliver? Certainly, I know some doctors are at one hospital versus another. But if somebody is looking to choose, why choose suburban?

Dr. Mona Bonanno: Well, I hope that it's because they feel like they'll get good care. I did. And so, I hope that others in our community will feel the same way. Lots of our private obstetricians deliver babies at Suburban. In addition, we are linked with the specialists at Oishei. We're all colleagues. And so, if an issue might arise that needs a second opinion or perhaps the input of a specialist, they're a phone call away. And many of them can come out to suburban and see a baby if need be and help assess the baby. We also have a level II nursery upstairs on our fourth floor. So, the mother-baby unit is on the second floor, and we have some availability also on the mother-baby unit on the fourth floor. Across the hall from that is our level II nursery. A level II nursery can manage babies who are a little younger in terms of gestational age, 32 weeks and above. And also, any babies that have any additional medical needs that we can't really manage in the nursery.

Host: And I think that's important to note that we're all on one team. We may be in different buildings, but that collaboration and that teamwork exists in between those walls.

Dr. Mona Bonanno: Absolutely. In fact, our policies, our protocols are the same at both locations. And the staff that works in the level II nursery or our NICU at Suburban is exactly the same staff that works at Oishei in their level IV NICU. So, they have a ton of experience, a ton of expertise, and we do rely on them sometimes, even if it's just for a second opinion.

Host: Sure.

Dr. Mona Bonanno: But certainly, if the baby needs a little more help to get over that transitional period.

Host: A little extra love, right?

Dr. Mona Bonanno: Exactly.

Host: Speaking of extra love and those extra things that parents can do to keep baby happy and healthy, especially in those first couple of weeks and months, the benefits of breastfeeding.

Dr. Mona Bonanno: There are so many. We could have a whole day's worth of conversation about the benefits of breastfeeding. I guess what I would love for people to know about breastfeeding is that it's just normal. It is the biological norm. I think it's pretty cool that a mom who can develop a baby can also sustain that baby's life after the baby's born. We are fully equipped to do that and we just have to sort of learn about the process and trust it a little bit. Because, over the past few decades, things have changed in the world of infant feeding. Before the early 1900s, really, everybody breastfed. And it was the norm. And if a mom had an issue breastfeeding a baby, then somebody else would breastfeed the baby.

So now, we have formula available, which is a great resource for any mom who doesn't want to or, you know, are there any medical contraindication to breastfeeding. But the benefits of breastfeeding don't just apply to the baby. They also apply to moms. So for babies, we know that breastfeeding and exclusive breastfeeding if possible is associated with lower rates of sudden infant death syndrome. It's now called sudden unexplained infant death, lower rates of infections when babies are young.

Host: Is mom passing along-- what's the word I'm looking for?

Dr. Mona Bonanno: Antibodies.

Host: Antibodies, thank you. Mom's passing along antibodies, right? So better protecting the baby before they can get shots and before they're eligible for those extra protections, right?

Dr. Mona Bonanno: Right. Exactly. And so, anything that mom is immune to, that immune protection gets passed on to the baby through her breast milk. And it is so specific to each mom that it changes depending on whether the baby's born early or the baby's born small, or the baby's born on the larger side. Breast milk is a really, really unique and powerful way to really keep babies healthy.

Host: And the connection too, right?

Dr. Mona Bonanno: Absolutely. Yes. It promotes bonding, certainly. And it's even been shown to be associated with benefits that extend beyond childhood, specifically lower rates of heart disease, type 2 diabetes and being overweight.

Host: Wow.

Dr. Mona Bonanno: And for moms, the longer that a mom can breastfeed, the more powerful the benefits are for her in terms of reducing her risks of heart disease, type 2 diabetes, breast cancer, and ovarian cancer.

Host: Something that is relatively new to Suburban and is really exciting is the Baby Cafe. And again, that goes back to the support and the positive experience. I have heard from friends that maybe had some trouble breastfeeding and they said, "I feel like I failed my baby." And they wish that they had something like this previously. Talk about the Baby Cafe, what it's there to do, and how we support new moms.

Dr. Mona Bonanno: Yeah. So, I think we are so proud and excited to have started the Baby Cafe. We feel like it's been an opportunity to help us round out the way that we're supporting moms through breastfeeding. Because you're right, there can be challenges, and especially when we're learning for the first-time. So during, again, the prenatal period, we have breastfeeding classes during the hospital stay. We try to have lactation consultants on the floor 24 hours a day and on weekends. And after families go home, now, we have the opportunity to continue to support them through their breastfeeding journey with the Baby Cafe.

Host: So, they can come to the hospital and get that information and get that support.

Dr. Mona Bonanno: Yeah. It's in the building, just behind the hospital, but very easy to access and it's free. And so, you know, they don't need to show their insurance card. They're not paying for the advice they're getting, but it is our board-certified lactation consultants that staff the Baby Cafe. And it's for a two-hour period between 11:30, 1:30 on Mondays right now.

Host: And it's a safe space where there's nothing to be embarrassed about. There's nothing that you can't ask them or talk about in order to better the mom and to better the baby.

Dr. Mona Bonanno: In a completely non-critical environment. And it's meant, like you said, for moms who are learning or having any issues, but also for experienced moms who might want to share some of their insights and help other moms along the way. So, we're hoping that it becomes an atmosphere where moms can just exchange their experiences, ideas, their journeys, and make it sort of as much an informative session as it is a social kind of gathering.

Host: Yeah. We're also a part of a donor milk program. How does that work and what is that all about?

Dr. Mona Bonanno: So, that's another way that we are really hoping to help support families who choose to breastfeed. So, in certain circumstances, babies might need a little extra volume after they're born, either because their blood sugars might be low, maybe they have some jaundice, which is that yellowy undertone they get to their skin. Maybe they've had some weight loss. Maybe mom has had some issues after delivery and has not been able to feed the baby as much as she'd like. So for those indications, now we have the opportunity to offer babies in our normal nursery donor human milk, which we're really the only one in Western New York to be offering it to our nursery babies.

Host: Oh, wow.

Dr. Mona Bonanno: Yeah, our level 1 healthy, normal babies. So, the milk is obtained from a certified milk bank, and it is safe to use. So, it comes frozen and the moms that donate their milk to a milk bank are really thoroughly screened. And only if they pass the screening are they able to donate their milk and they're not compensated. So, they're not paid for their milk. These are just moms who produce more than their baby needs-- I wish. But they're able then, you know, to help other families, which is awesome. And the milk banks pool the milk from five different moms typically into one bottle. And, again, it's pasteurized, so it's safe, and anything infectious is neutralized. It's frozen, and then it's shipped to us frozen. And we have a very, very specific process by which we defrost it and are able to offer it to babies, but we can keep them that way exclusively breastfeeding, despite some of the challenges that might happen after delivery.

Host: That to me feels like a peace of mind for new moms and all of the things that we talked about. It's sort of going down that checklist, making sure they're comfortable, making sure you're answering their questions. And having a newborn again, it can be scary enough, right? And you said it earlier, support, support, support, right? All of those things are just offering that extra level of support for parents.

Dr. Mona Bonanno: Exactly. And so, we hope that Suburban offers them an environment where not only do they have great care for themselves while they're delivering, after they're having the baby, they have choices in terms of a feeding plan for the baby. And our goal really isn't to ascribe anybody's goals to them, it's just to help them meet the goals they've set for themselves.

Host: All right. Anything else that we didn't touch on, you can just tell that you love what you do. And again, I keep going back to that picture that I saw of you just with this teeny tiny little baby and just there was a special connection there. And I think that that is really special.

Dr. Mona Bonanno: Yeah. I think that babies are a blank slate, right? But they're capable of so much. They're born with all the same emotions we have. They just can't express them verbally. So, I feel like an opportunity to meet families at the very beginning of a child's life is so valuable as a provider because we can impart, hopefully, some knowledge that helps families understand why their baby's behaving the way they are, maybe, you know, what things to pay attention to that maybe they hadn't even thought about before, how to decode the baby's behavior even after they've gone home.

So, I feel very privileged to be able to meet families in that very special, vulnerable, nerve-wracking time. And hopefully, again, you know, take away some of the worry and just leave them with a sense of joy.

Host: And then, seeing them load them up into the car seat in the carrier and walk out. Do you have this feeling of "My work here is done" at least until the next one?

Dr. Mona Bonanno: Yes. In a way, yes. I think, I worry about people's babies that I take care of the same way that I would worry about mine. So, I hope that I offer them the care that I would expect from my own kids. So yes, when we wave goodbye, I guess, I feel like it's a parting of ways. I feel, you know, very privileged also to have seen several families come back with second, third, fourth, fifth kids by now, because I've been there for about 12 years. So, it's really nice to see families come back because they've had a good experience in the past. And so, you know, when they're having another baby, they come and see us again and show us pictures. And, you know, now, the older siblings can come and visit the hospital again. That COVID is all over. So, yeah, it's fun to see them all grown up.

Host: And it goes back to that positive experience, that support and the trust that they have in both you and your team.

Dr. Mona Bonanno: We hope so. We hope so.

Host: Well, thank you so much. Thank you, Dr. Bonanno, for being here. I know that you are very, very busy, but we appreciate you making some time. And we hope that you join us for our next episode of Medically Speaking wherever you get your favorite podcast.