Newborn Transition Policy

  1. We are needing to update our transition policy to make us more baby-friendly. We currently have our babies spend a couple of hours with mom and dad with no VS or real assessment other than initial apgars. Then they go to the nursery for 4 hours for hourly VS, bath, Vit K and eye ointment and HepB, weight, gest age exam, etc.

    This 4 hour period is way too long and we know it needs to be adjusted. One of the problems is the requirement of VS q1hr for four hours and the unwillingness of the RNs on PP to do this. Also, the LD RNs are a bit resistant to starting VS during their watch.

    Basically, we want to change the VS policy for transition and then restructure from there. What do you do?? What are the VS requirements for your newborns?

    Thanks!!!
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  2. 18 Comments

  3. by   babydoll99_99
    I work in Mother Baby Care. We do VS Q shift, but baby doesn't come right to us. I think that when in Nursery it is q 30 min x2 and then q 1h x 2 at our hospital. Breastfeeding moms get to feed right after delivery and then baby goes to nursery. Bottle feeding moms get baby (barring anything unusual) for about 10-30 minutes (depending on mom) and then goes to nursery right after. Typical baby will be back out to mom 3-5 hours after going to nursery (depending on how fast it takes the baby to warm up).
  4. by   SmilingBluEyes
    Infant immediately to mother's chest, skin-to-skin, unless unstable. Baths and meds may be deferred, eye drops up to an hour. Vital signs can and are to be taken while infant is skin-to-skin with mother, if at all possible. If mother is adamant, bath is given first. But the preference is to allow skin-to-skin and breastfeed the first hour of life, if at all possible. In reality, many nurses still wisk baby away and weigh, bathe and give meds right away, after a few minutes on mom's chest. We are working to change this across the board among all the nurses, as evidence shows newborns and their moms make this initial transition better when allowed to bond this way, first.
  5. by   Amiejayrn
    This is a very interesting thread to me as I am a new grad and I am on orientation as a "transition nurse". Our hospital's policy is to do exactly what you were talking about Smilingblueyes, but NONE of the nurses follow that. And it is not just the transition nurses who do not follow it, it is the L&D nurses who are on them to "get things done". They (the L&D nurses) know that once they have mom and baby stablized, they can ship them to Postpartum and be done with them. We do have a nursery but it is small and not staffed unless needed, so baby stays with mom the whole stay, unless she requests the baby go to the nursery. Otherwise, we do vitals q 30 minutes X3, bath and eyes & thighs while mom is in her LDR room. I guess the rationale that I keep hearing from the ones who are supposed to be precepting me, is that they want baby dry and temp checked often before they walk away. For me being a newbie, I would feel comfortable to dry baby completely, get one set of vitals and do the eyes before mom does "skin to skin". I could do all that in 5-7 minutes tops. I do want to support our hospitals policy but I just want a little peice of mind knowing the vitals are WNL. Am I on the right page here? I would like to hear others opinions on this topic. Thanks
  6. by   NurseNora
    Quote from Amiejayrn
    For me being a newbie, I would feel comfortable to dry baby completely, get one set of vitals and do the eyes before mom does "skin to skin". I could do all that in 5-7 minutes tops. I do want to support our hospitals policy but I just want a little peice of mind knowing the vitals are WNL. Am I on the right page here? I would like to hear others opinions on this topic. Thanks
    I don't like to see people do the eyes before mom and baby have had a chance to look at each other for a while. The ointment probably blurrs the baby's vision even more than it is anyway (did you know that the focal length of a newborn is fixed to about the distance from Mom's breast to her face?) and many of us believe it is important for them to be able to look at each other right away.

    You can dry the baby on Mom's chest and do the temp there, pulse and respiration too. You do not have to take the baby away from the Mother to be sure the vitals are WNL.

    You will be amazed at how much better the newborn who has been allowed to remain skin to skin with Mom nurses in comparison to those who have all the other stuff done first.

    To answer the origional question, our routine is first set of vitals as soon as possible after delivery, then q30min X4, q1h X 4, then Q6h. Eyes and thighs to be done by one hour of age. Bath when temp is stable. I think it stabalizes more quickly on Mom's chest than in the warmer. We need the weight and length to admit the baby and get into the computer, so after 5-10 min on Mom's chest, I'll take baby just long enough to weigh and measure unless it's already nursing.
  7. by   ElvishDNP
    We do skin to skin or Mom holding, whichever mom prefers, for at least an hour unless mom or baby is unstable. We really encourage moms to breastfeed during this time also. It is possible to get some vitals & do a once-over to make sure baby is ok while s/he's with Mom. (All this is while couplet is still in L&D). L/D does weight and if one of the good nurses, will do the vitals they're supposed to do. In the nursery we do vitals q30minx3. Once baby has 2 warm temps we do bath, shots, & drops. If baby's cold, we wash the face & leg to do the Eryth & Vit K within 2 hours. After bath baby has to have one warm temp before we d/c the warmer. Then back out to mom. Depending on baby, it usually takes 1-2 hours to them back out to mom. This is for healthy babies, of course.
  8. by   CEG
    Quote from Amiejayrn
    . For me being a newbie, I would feel comfortable to dry baby completely, get one set of vitals and do the eyes before mom does "skin to skin". I could do all that in 5-7 minutes tops. I do want to support our hospitals policy but I just want a little peice of mind knowing the vitals are WNL. Am I on the right page here? I would like to hear others opinions on this topic. Thanks
    I am a new grad, so take it with that in mind. To me, getting a set of vitals is not more important than mom seeing her baby. You can very easily do vitals while mom holds baby. You can also dry the baby. Mom's chest is a very effective warmer and there is no reason for baby to sit alone under to the lights.

    If this were your baby would you want to wait 5-7 minutes for your baby to have eye gunk? Especially since now your baby can't even see you? Nine months is a long time to wait only to have the baby whisked away immediately for "procedures."
  9. by   midwifemamma
    unless there are problems, babies go right up to the mother's chest, skin to skin, and stay there for at least an hour. we encourage them to breastfeed during that time. vital signs are done on mom's chest (q30x4, qhourx2, then q4hours). eye ointment and vitamin k can be delayed up to an hour. baths should get done before transferring to postpartum (usually 2-3 hours or so).

    i feel it is very important that the babies go right up to their mothers who have waited their whole pregnancy to see them and worked hard to birth them. unless complications arise, i don't feel that babies should be taken to the warmer for drying, or vital signs, or meds. all that can be done on mom's chest, including the meds.

    our healthy term newborns do not go to a nursery for transition, they constantly room in with their parents.
  10. by   ElvishDNP
    Quote from midwifemamma

    our healthy term newborns do not go to a nursery for transition, they constantly room in with their parents.
    I wish that were how we did things; unfortunately, our facility (and some staff mindset) isn't set up to handle it.
  11. by   SmilingBluEyes
    Rooming-in is our policy, too. Thank goodness. Nursery is for sick babies, only.
  12. by   L&DRNJenn
    Quote from JaneyW
    We are needing to update our transition policy to make us more baby-friendly. We currently have our babies spend a couple of hours with mom and dad with no VS or real assessment other than initial apgars. Then they go to the nursery for 4 hours for hourly VS, bath, Vit K and eye ointment and HepB, weight, gest age exam, etc.

    This 4 hour period is way too long and we know it needs to be adjusted. One of the problems is the requirement of VS q1hr for four hours and the unwillingness of the RNs on PP to do this. Also, the LD RNs are a bit resistant to starting VS during their watch.

    Basically, we want to change the VS policy for transition and then restructure from there. What do you do?? What are the VS requirements for your newborns?

    Thanks!!!

    I am very new to L&D but I'll tell you how it is done where I work. Each shift we have a designated float nurse that will be present at deliveries and observe the initial transition of the baby. Either they or myself will assign the apgars. I try to let mom have baby on chest for a few minutes, because if everything is ok, no need to wisk them away. So the baby nurse will do initial assesment including maturity scoring. Listen to heart and lungs, suction if needed. Weight and measurements. Footprints and bands. They give the vitamin K and erythromycin. Then usually dad will put the first diaper on the baby. The baby is usually done around the time of repair of mom wrapping up. We do vital signs q 30x4 on baby. A blood sugar within the first hour for LGA and within 2 hours for AGA. As the primary nurse for the patient, I assist with all breastfeeding and depending on demand of the unit I will get the vital signs and DFS on baby. Mom and baby stay with us for 1-2 hours and then they both go to postpartum together. Even then I think they leave the baby in the room for awhile. Babies are bathed I think 4 hours after birth.
  13. by   CEG
    Quote from BSNgrad_6_13_03
    We do vital signs q 30x4 on baby. A blood sugar within the first hour for LGA and within 2 hours for AGA. .
    Just curious if most places do blood sugar on asymptomatic AGA babies? Seems a little excessive to me. Haven't seen that done.
  14. by   crissrn27
    We only do sugars on LGA (over 9.5lbs),SGA (under 5 lbs) babies with DM moms, over 42 weekers, and under 36 weekers. I have heard of some places that get 1 baseline sugar on AGA babies, don't know if that is true or not.

    This is our routine. Nursery nurse goes to delivery.....baby given to nursery nurse before it goes to mom. We do APGARS, dry, give vit k and eye gtts, get footprints and band. Wrap baby in blankets and put on hat. Give to mom, she gets to keep baby for an hour in delivery room. L and D nurse brings baby to us after an hour. Do weight and measurements, initial VS and assessment. Baby has to be two hours old and have 2 temps above 98 before bath. Bathe and do triple dye. After bath must have temp above 98.5 before coming out of warmer. Dress baby and wrap.........usually takes about 4 hours total before baby can go out to mom. If baby is ready to go close to time for docs to come or report (within an hour) we keep them until that is over. Not the best way. If I had a choice I would love never to separate mom and baby, do at least 1 hour skin to skin, bathe in room, etc.

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