Post Partum Recovery Time

Coastie_wife · Jul 24, 2008

Wow, that seems crazy! I don't work in L & D though I hope to one day! But, when I had my daughter 18 months ago, I was in the LDR at least 2 hours if not more! How can you get everything done in an hour?!

Nicky30, BSN, RN · Jul 25, 2008

Wow Good Luck!

We have no time limit on our ward, but as we are a very small hospital we take care of them postnatally too.

It usually takes me 2 hours to get everything done, i.e. mum to shower while I clean up or finish my notes (I can see and here her from where I am). I haven't dealt with many epidurals recently it's been a pleasant change. :nuke:

Maybe you need to question why there is such a rush? I mean will you really be able to take on another labouring patient if you still have to finish notes from the first?

Nicky.

rn4babies63 · Jul 25, 2008

The reason there is such a rush is we need to get the rooms turned over. 2 other L&D's closed and moved to our hospital so they don't have enough rooms! I've been doing L&D for 12 years and really thought I was pretty capable of getting everything done during recovery. Not now!

Jolie, BSN · Jul 25, 2008

our l&d has just implemented a new policy decreasing postpartum recovery time in the ldr from 2 hrs to 1 hr. i was pressured to to finish charting, assess the infant and mom q15 min, put baby to breast, remove epidural, lock iv, get mom out of bed to void (legs still possibly numb from epidural?), teach pericare, and take to postpartum floor in an hour? it was tough enough doing it in 2 hrs if mom was breastfeeding! what is your policy regarding this? i really thought i was doing everything as quickly as i possibly could!

emphasis mine. this ought to be enough to get your risk manager involved. having worked in a unit where a patient fell and broke her leg due to ambulating too soon following an epidural, i simply would not comply with the rigid timeframe set forth by your management. the notion of locking an iv that fast scares me, too. if you have a patient who needs 500ml to 1l of fluid with pit, you will be forced to run it too fast to be safe.

if a patient needs to be transferred out of a room, so be it. if she is not ready for post-partum status, then send the nurse with her to continue 1:1 care on the mother-baby unit.

KT-Jay731 · Jul 25, 2008

The whole thing screams "patient safety" issue to me; do you have someone in your hospital that you can go to, a risk management officer, etc??

We have LDRPs so luckily we don't need to move Mom, so many of the things you've described don't apply to us. But we would DEFINITELY not lock the IV within an hour. And if Mom can't ambulate, how are you supposed to get her up to the shower?!

And does your hospital really expect a PP Mom to remember the teaching that you've done in that hour after birth? She's running high on adrenaline or she's completely wiped, depending on her delivery. Highly unlikely she's going to remember the teaching you've done...

LKB82 · Jul 25, 2008

Our L&D has just implemented a new policy decreasing postpartum recovery time in the LDR from 2 hrs to 1 hr. I was pressured to to finish charting, assess the infant and mom q15 min, put baby to breast, remove epidural, lock IV, get mom out of bed to void (legs still possibly numb from epidural?), teach pericare, and take to postpartum floor in an hour? It was tough enough doing it in 2 hrs if mom was breastfeeding! What is your policy regarding this? I really thought I was doing everything as quickly as I possibly could!

I don't think we have a policy per se about recovery time, but we have to check moms every 15 minutes for a minimum of an hour, and babies every 30 minutes. We're a very busy L&D department and a lot of times we need the bed or we're going to have a new patient shortly, and the unwritten rule is basically out the door to post-partum in one hour. If their legs are too numb post-epidural sometimes we just straight cath them and put them in a wheelchair, sometimes I give them a little extra time. (Realistically, some of our anesthesiologists give very heavy epidurals and we could end up waiting hours anyway for their legs to come back 100%). As for time for breastfeeding, I will absolutely help my patient if she requests help or if the baby is on an accucheck protocol, but really most of our patients are more interested in visiting with their visitors or talking on the phone in the hour or so after their delivery. I've only been a L&D RN for a little less than 3 years, and the importance of a quick recovery (as long as the patient is stable) was engrained in me from the beginning. Unfortunately, we know which RNs on our unit take "too long" to recover their patients, and a lot of the quicker RNs start to resent it when they end up taking the next patient when they delivered after another RN who is still slowly doing her reovery. (I'm not saying that 2 hours is too slow, but just trying to explain my unit's culture).

Neveranurseagain, RN · Jul 25, 2008

"I don't think we have a policy per se about recovery time, but we have to check moms every 15 minutes for a minimum of an hour, and babies every 30 minutes. We're a very busy L&D department and a lot of times we need the bed or we're going to have a new patient shortly, and the unwritten rule is basically out the door to post-partum in one hour. If their legs are too numb post-epidural sometimes we just straight cath them and put them in a wheelchair, sometimes I give them a little extra time. (Realistically, some of our anesthesiologists give very heavy epidurals and we could end up waiting hours anyway for their legs to come back 100%). As for time for breastfeeding, I will absolutely help my patient if she requests help..."

Maybe I'm used to the relaxed pace of a birth center/home births/small OB unit but this sounds more like moving cattle instead of caring for people.

Batman24 · Jul 25, 2008

Emphasis mine. This ought to be enough to get your risk manager involved. Having worked in a unit where a patient fell and broke her leg due to ambulating too soon following an epidural, I simply would not comply with the rigid timeframe set forth by your management. The notion of locking an IV that fast scares me, too. If you have a patient who needs 500ml to 1L of fluid with pit, you will be forced to run it too fast to be safe.
If a patient needs to be transferred out of a room, so be it. If she is not ready for post-partum status, then send the nurse with her to continue 1:1 care on the mother-baby unit.

Agreed. I would get Risk Management involved here if needed. This is a lawsuit waiting to happen. I would just take the time I need to ensure patient safety. I wouldn't put my patients or my license at risk. Anything goes wrong and it will all be on you.

Jolie, BSN · Jul 25, 2008

"I don't think we have a policy per se about recovery time, but we have to check moms every 15 minutes for a minimum of an hour, and babies every 30 minutes. We're a very busy L&D department and a lot of times we need the bed or we're going to have a new patient shortly, and the unwritten rule is basically out the door to post-partum in one hour. If their legs are too numb post-epidural sometimes we just straight cath them and put them in a wheelchair, sometimes I give them a little extra time. (Realistically, some of our anesthesiologists give very heavy epidurals and we could end up waiting hours anyway for their legs to come back 100%). As for time for breastfeeding, I will absolutely help my patient if she requests help..."
Maybe I'm used to the relaxed pace of a birth center/home births/small OB unit but this sounds more like moving cattle instead of caring for people.

I couldn't agree more. The idea of performing an invasive straight cath on a patient simply because she needs an empty bladder in order to be pushed out the door of her labor room artificially fast borders on abuse. And we wonder why some L&D units get a bad rap for unnecessary (and potentially harmful) interventions. I'm glad I didn't start out in a unit with this culture, and as an experienced nurse, I wouldn't put up with it. Kudos to the nurses who buck the trend and allow their newly delivered moms and babies sufficient recovery time.

pirap · Jul 25, 2008

our policy is a minimum of 1 hour in recovery following a lady partsl delivery. some nurses hang onto their patients forever and the faster ones drop off and get a new one-totally not fair. some nurses hang onto their patients as long as they can only to dump on the post partum floor right before shift change.

i really wouldn't worry about that hour except if you are one of the ones who like make your pt hang around for as long as you can.