Sunday, November 16, 2008

Question About Nursery...

So I haven't worked since Wednesday, and don't work 'till Tuesday, and I'm feeling like I'm missing something without blogging! I told myself that this blog wasn't going to be an online "diary" I was going to keep it work-related. So here's my weekend musing re: work.

I've talked to several people and after reading lots of other L&D blogs, here's my question: in a delivery in "your" hospital, who all is there for the delivery? Obviously the doc and the L&D nurse, but is there anybody else typically "required" to be there?

I know at our hospital all of our nursery nurses work really close to us L&D nurses. Our Well-Baby nursery (where all babies are admitted to at birth) is right next to our nurses station and they can see our "board" with patients and docs and progress, etc. All the nurses that work in Well-Baby are NICU nurses and everyday 2 float out and do "admits" and come to all our deliveries. Right before delivery, we hit our "delivery" light and it pages everyone on the floor that we're delivering and a scrub tech come in to assist the doc as well as a nursery nurse to take care of baby. They devote all attention to the baby, do the APGAR's, the footprints, and meds right there in the delivery room. It's also nice in a C/S because then nursery can take baby (and dad too most of the time) to the nursery before the section is over and get baby all cleaned up and assessed in a room warmer than our OR and have that all finished and have baby read for mom when she gets back to the recovery room. It is SO nice because then we as L&D nurses can focus on mom and her recovery, helping the doc, pay attention to uterine tone, etc. I think sometimes we get spoiled though... :)

Anyway, from what I've heard/seen/read our hospital is in the minority when it comes to this. I know that the hospital where I did my clinicals in school the nursery nurses came only when they were specifically called and it was up to the L&D nurse to take care of mom AND baby after delivery. It's taken me long enough to feel comfortable just taking care of mom after delivery, it would take me another couple years to feel comfortable taking care of both!

All of us L&D nurses are NRP certified, etc and I know we do have instances where 3 or 4 of us deliver at the same time and we don't have a nursery nurse for the first few minutes and we've all survived when that happens. We all do know what to do after baby comes out, but it just adds a little extra chaos to the room when we're trying to do it all and we're not used to it.

But I just wondered what the "norm" was at other hospitals and what other nurses thought about it. Or even if you're not a nurse and remember your own birth stories and what impressions you got from who was in the room...

7 comments:

  1. Well at the hospital that I shadowed at the nursery is in the Postpartum wing on the opposite side or the floor. After a NSVD the L&D nurse is in charge if the baby with someone else assisting. Usually that other person is Nursery but a lot of times another L&D nurse will help out. It makes for a lot of work for the L&D nurse!

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  2. We have separate units - LDR and postpartum/newborn is upstairs. At deliveries, it's usually the doc/CNM, primary L&D nurse, and a second L&D nurse to do documentation/help out prn. We only call for a NICU doc if it's indicated for maternal or neonatal issues. All c/s though we have one baby nurse (L&D nurse), and a doc from the NICU. We do all mom/baby recoveries/care together, with the one primary L&D nurse.

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  3. We the doctor and resident or the CNM, the primary L and D nurse, and then a second nurse called "The Flyer", who's job is simply to attend deliveries (we have approx 10-12 a day). They usually assist with transition, and depending on the situation--do the assessment, initial vs, etc. However, as we encourage skin to skin and breastfeeding within an hour of life, often they don't and it becomes the primary RN's responsibility.

    If there is meconium or a diagnosis of chorio is made, our NNP attends the delivery as well.

    The scrub tech is an interesting idea--I can't really imagine that they are needed that often. Our docs typically only need a 3.0 vicryl or a vac--what do they DO?

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  4. We have the doc (or docs, if it is a patient of the clinic service with the residents. The private docs dont use residents), the labor and delivery nurse for mom.

    The nursery has a nurse assigned every night to be on "birth team". We call them shortly before delivery , and they come attend to the baby. apgars, weight, initial assessment, etc. Then, they leave, and the labor nurse is responsible for mom and baby until transfer to postpartum approx 1-1.5 hrs later.

    If there is a preterm birth, meconium, or anything else concerning, a NICU NNP comes down with the birth team. All c/s deliveries have a NICU NNP come, too.

    We generally have only one labor nurse in the room, unless we are slow (ha!) or the case is a precip admission pushing, or the patient needs extra support.

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  5. Wow, not a nurse but a patient here. It's interesting to read all the people who are in the room. My husband commented that there were about five nurses in the room when I delivered the last one. I recall three around the bed, and maybe two for baby. Then the doc came in right after delivery. (baby born after 5 hours in the hospital, but suddenly after an hour and 1/2 of pushing). I wondered what each person's role was. One nurse appeared to just be there. I was hot, told her so, tried to take off my gown and she didn't lift a finger. However, afterwards, she and another nurse (who caught the baby) cleaned me up. It was weird, they walked me with pad between my legs to the bathroom. Never had that happen before, then they manually cleaned me up there. Weird. Anyway, I just really wondered what everyone was there for. I also noticed a person slip in after the birth who only dealt with the placenta and cord, took out cord blood for testing and the like. Not sure what that was for. We didn't donate the blood as I don't recall it was an option, so don't know what that one was doing. I saw the placenta and cord while this was being done because my baby was over getting meconium sucked out and getting bathed on the other side of the room. Nothing better to do than watch all these people mill around the room....

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  6. At our deliveries, we have the nurse, the doc (usually 1-2 residents), anesthesia nurse/anesthesiologist/CRNA (if there's a block), and the charge nurse or available nurse (who will come in and do the initial baby assessment, Vit K, erythro); neo is called in for distress, prematurity or meconium and the L&D nurse is responsible for baby/mom dyad or triad for the rest of recovery. All our nurses are NRP certified and can "catch" babies. At my hospital, there is no nursery. Just NICU and labor/delivery and Postpartum. We are a closed unit, so we can float to one another, but we don't have to float to Peds or whatever. I love how we're set up, but when it comes to a crash, it's hard to have to call 4 people, but we're lucky, we now have a laborist at all times, and they are all competent and worthwhile docs, so we're very lucky as a unit. We all get along swimmingly, too, which makes such a difference. I remember transitioning to nights and it is scary, but you'll get your own groove there. Your hospital delivers about how many mine does, so it's interesting to see how your "board" mirrors ours; also our Charge nurse makes assignments, we don't "sign up" for anything, but we can call the charge nurse and requst a certain side, like PP or L/D and "no pretermers; want a delivery, if possible" I, too, prefer to stay out of the OR, but now that's easy, too and it really doesn't matter. Good luck to you, girlfriend!

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  7. I'm not a nurse (but I'm reading your blog from the very beginning and trying to catch up to the present day!!). I delivered twins vaginally in a regular labor room (yeah, I know that doesn't happen a lot but the babies looked so excellent on the monitors).

    Anyway, at my delivery, there were 4 nurses, the OB and my husband. Tammy was my nurse. Vickey took over care of "Baby A". Robbie took over care of "Baby B". And Sherry was there to chart everything going on as Apgars and measurements, etc. were being yelled out. At our hospital all the nurses are labor/post-partum nurses. So a couple of the nurses I had for delivery also took care of me and the girls during our 2 night stay.

    BTW - I used "Baby A and B" because that's what they were throughout the whole pregnancy/delivery. I remember reading in one of your older posts that a vaginal birth of twins is pretty cool. And that you love it when your couple doesn't find out the sexes. Well, we did both!! ;) Could not have asked for a better surprise on the big birth day!

    Love your blog!

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