[bfusco]

Is it generally accepted practice that babies are more "unstable" after a C-Section and therefore need more intensive nursing care for the first 24 hours? In our very small hospital (100 births a year) we are questioning the need to have 2 nurses present for 24 hours after a C-section when we have only one Mom and one baby.

[Fiona59]

I've never heard that. But then I worked in a postpartum unit where 100 babies a month was considered a slow month.

Most section babies stayed in the nursery until Mum was alert and orientated but then they roomed in with her. Maybe this is where your facility has concerns? The time involved with the recovery checks on Mum and the assessment time needed for the infant.

[sirI]

Originally Posted by bfusco

Is it generally accepted practice that babies are more "unstable" after a C-Section and therefore need more intensive nursing care for the first 24 hours? In our very small hospital (100 births a year) we are questioning the need to have 2 nurses present for 24 hours after a C-section when we have only one Mom and one baby.

Since your facility delivers at around 100/year, it could be viewed as a precautionary measure for your babies. High risk OB is not practiced there, I am sure. And I am sure you are below a Level III nursery. C-section babies are not considered "unstable" and unstable may not be the word you need to apply here...."at risk" seems to be a more appropriate term. Having two nurses in the nursery is probably a hospital policy for All neonates (and a good one at that).

So, your facility may be practicing global safety for all C-section babies.

[Jolie]

Are you working in a mother-baby unit, or a well-baby nursery? 2 RN's for each area (post-partum and nursery) might be excessive, but 2 RN's for a mother-baby unit, even with a low census is not over doing it!

C-section babies do have a higher rate of NICU admission, not only because of the method of birth, but also because of the conditions that lead to a C-section in the first place. C-sections done for CPD are likely to involve large babies, perhaps IDMs, who are at risk for blood sugar instability. Babies delivered by C-section following prolonged ROM are at risk for sepsis. Babies born by stat C-section for distress secondary to prolapsed cord, abruption, etc. are at risk for complications related to oxygen deprivation. Any infant delivered by C-section may be at risk for retaining fetal lung fluid, leading to TTN. Most of these newborns will "declare" themselves fairly soon after birth, within the first 4 hours or so, but it is possible for any infant to experience a sudden change in condition due to aspiration, sepsis, or undiagnosed cardiac defects. For this reason, staffing with 2 RN's is prudent, in my opinion.

Are there any other units in the hospital staffed by a single RN?

[bfusco]

This is a Level I OB unit, and I am asking about planned C-Section babies who have an apgar of 9/10 or 10/10. We have a policy that we have 2 nurses on the unit for 24 hours with C-Section babies and 8 hours with vaginal deliveries. And, by the unit I mean the whole unit including postpartum and nursery (they are all part of the same area that is about 6 rooms large.) I just think that the policy is arbitrary and unnecessary, we should be staffing based on the condition of the infant, not how it was born.

[SmilingBluEyes]

I think staffing ANY hospital with ONLY ONE OB/NRP-qualified RN is crazy as well as dangerous, regardless of acuity of your patients. I have worked in rural hospital settings where we did only 20-30 del/month and yet, would never have dreamed of staffing with one RN ever.

You have NO idea what the ambulance will be wheeling thru your doors, small or not.

[bfusco]

Originally Posted by SmilingBluEyes

I think staffing ANY hospital with ONLY ONE OB/NRP-qualified RN is crazy as well as dangerous, regardless of acuity of your patients. I have worked in rural hospital settings where we did only 20-30 del/month and yet, would never have dreamed of staffing with one RN ever.

You have NO idea what the ambulance will be wheeling thru your doors, small or not.

We do 10 deliveries a month, and our Nursing Supervisors are all trained to help on OB and help with deliveries.

[SmilingBluEyes]

that is good, but are they NRP qualified and immediately available? What if they are busy elsewhere?

[SmilingBluEyes]

Originally Posted by Jolie

Are you working in a mother-baby unit, or a well-baby nursery? 2 RN's for each area (post-partum and nursery) might be excessive, but 2 RN's for a mother-baby unit, even with a low census is not over doing it!

C-section babies do have a higher rate of NICU admission, not only because of the method of birth, but also because of the conditions that lead to a C-section in the first place. C-sections done for CPD are likely to involve large babies, perhaps IDMs, who are at risk for blood sugar instability. Babies delivered by C-section following prolonged ROM are at risk for sepsis. Babies born by stat C-section for distress secondary to prolapsed cord, abruption, etc. are at risk for complications related to oxygen deprivation. Any infant delivered by C-section may be at risk for retaining fetal lung fluid, leading to TTN. Most of these newborns will "declare" themselves fairly soon after birth, within the first 4 hours or so, but it is possible for any infant to experience a sudden change in condition due to aspiration, sepsis, or undiagnosed cardiac defects. For this reason, staffing with 2 RN's is prudent, in my opinion.

Are there any other units in the hospital staffed by a single RN?

this says it well.

[MissJoRN]

C-section babies do have a higher rate of NICU admission, not only because of the method of birth, but also because of the conditions that lead to a C-section in the first place.

I agree with this statement...was thinking the same thing but didn't have the wording.
You did catch me off-guard by stating that your nursing supers are trained for your unit though...maybe you can be more subjective with your staffing plans. My thought was to have the highest staffing policy in place because in my experience (on a peds unit average census of 4 and an LDRP/N with fewer than 200 births a year) is that our supervisors were clueless to the needs of these units. They understood the nuances of acuity in the units and MS floors but couldn't grasp why sometimes a peds nurse can take 6 pts herself and other times 2 nurses are needed for 1 kid. So I liked having best staffing in place in the written policy to back up why a nurse can't be floated today.