[bpobrn]

I am currently an RN in a high risk ob setting where we accept many transports from outlying area's as we have a neonatal icu.4 years ago we transitioned to ldrp's.Prior to this we had a labor/delivery unit and transfered mother/baby (after a 2hr recovery)to the pp unit which also housed our ante-part. pt's. I am doing a research project on ldrps vs seperate area's in high risk obstetrics. I would appreciate any feedback on your current patient care process or if you have changed to or from either and what works and why?

[CA CoCoRN]

I work in a metro area in Los Angeles county.

Our hospital is the "go-to" for high risk pts. We are Level II though. Any ultra-high risk babies (those that will require surgery) go to Children's Hospital of LA or OC.

We have separate PP units (with overflow and overflow's overflow) and antepartum units. However, when our census is like it is, we have to 'board' pp pt's on our unit too (like today). Our main problem is that when we fill up the way we are now, we don't have the staffing for the overflow from the overflow....so L&D gets backed up.
I believe our volume is a bit too heavy for LDRP to work here.
We also have a traditional nursery for pt's in our main pp area. They pick up baby post delivery, do all the nursery stuff and then take the baby to momma. If mom chooses, she may have baby with her or leave baby in nursery.
However, if mom is in overflow, then they have couplet care there.

[J-me-RN]

My hospital is in the process of going to LDRP's. There are a lot of unknowns. Right now we function as two totally seperate units. L&D and PP and either unit can take antepartums. Although L&D usually keeps the more unstable ones. We have a Level III NICU and we transport mother/babies in as well. My main concern with the LDRP's is how is the room cleaned after baby is delivered? Do you put mom and baby in the hall while housekeeping cleans up the mess? A smaller hospital in my area used to put mom and baby in the bathroom while they cleaned the room. Since some of the cleaning solvent can be irritating to baby. They went back to having two seperate units.

[palesarah]

Originally Posted by J-me-RN

My hospital is in the process of going to LDRP's. There are a lot of unknowns. Right now we function as two totally seperate units. L&D and PP and either unit can take antepartums. Although L&D usually keeps the more unstable ones. We have a Level III NICU and we transport mother/babies in as well. My main concern with the LDRP's is how is the room cleaned after baby is delivered? Do you put mom and baby in the hall while housekeeping cleans up the mess? A smaller hospital in my area used to put mom and baby in the bathroom while they cleaned the room. Since some of the cleaning solvent can be irritating to baby. They went back to having two seperate units.

I don't know if this will be helpful to you or not- I work on an LDRP (about 50-70 births a month, sometimes more). On our floor, housekeeping usually comes and cleans the floor & bed when we get mom up to the shower towards the end of her recovery, and then does a complete & thorough cleaning after discharge/in between patients. Although at night, when I work, we usually just do the bed ourselves and spot clean the floor, so we don't have to wait for housekeeping (they're on the floor during dayshift, but at night there's only a couple in the whole hospital). I know where the mop is and I'm not afraid to use it If we don't call them for a delivery overnight they'll do a more thorough cleaning when they come in in the AM.
If we have a really messy delivery, or a waterbirth, and we have a clean room open we'll often move mom & baby into the clean room after she's recovered and have housekeeping come up and turn the room over then.

[palesarah]

oh, I should probably add to my above post: I've only worked on this one unit so I don't really know any different, but nurses who have come to us from other hospitals have remarked that we have really clean deliveries. No routine episoiotomies, instrumental deliveries are rare (and then only vacuums, I was shown where the forceps were stored during orientation as an FYI/"that's where they are but no one ever uses them"), lots of midwife managed births, we rarely even break the bed down. In fact pretty much the only times I've ever broken the bed down was for a pregnancy provider who needed a place to fit her belly!
So our deliveries really aren't that messy, pretty much contained to the pads or underbuttocks drapes they throw on the bed before delivery.