postpartum mother/baby unit staff ratio - page 2
Hi all, I have a question about patient ratios for postpartum mother/baby units that have one nurse for the mother and baby. I recently interviewed for a position that assigns 5 couplets to each... Read More
Jul 20, '02Thanks for everyone's thoughtful replies. I am sure I will be back to ask more questions when I accept the position and start work. Any suggestions for a smooth transition are appreciated. I have already committed to memory the info about the bg of 40.
Anyone care to give me a rundown on what it's like to receive a new mom and baby from L&D. I imagine baby doesn't come directly with mom. I imagine mom needs breast checks, fundal checks, lochia checks, perineal checks, vital signs, possible antibiotics, possible rhogam, pain meds. Baby: vs, bg, possible antibiotics, bili check, direct coombs? (don't get it),all those metabolic tests, I&O, and other stuff I am unaware of. How close to the mark am I?
Jul 20, '02Depends on your facility. We get mom with babe from L&D. Mom gets all the checks you mention, but baby doesn't. We used to do all those tests (bg and bili, etc), but are now only doing those tests if something is wrong (no testing for testing sake, there has to be a symptom to explain why you tested).
The reason is mainly that almost all babies get low bg after birth, but it will rarely cause a problem as long as they breastfeed within a reasonable amount of time (the previous poster already mentioned that they used to keep baby NPO for 24 hours and never killed any of them). Babes were getting supplemented if they were kept in the nursery and their bg was low, which made latching them on the breast a little more difficult, so now they come with mom and get a full physical assessment minus lab work. They get vs q1h for 3 consecutive normals and then you can also do their first bath, and we monitor the number and type of voids and stool as well as how breastfeeding is going. And don't forget PKUs which are done after 24 hours. Mom gets full checks every 4 hours for 24 hours, then every 12 hours.
Jul 20, '02Bessie, I'll give you a rundown of what we do at my facility...
Baby - received into the transition nursery usually at 1 hour of age. They typically stay with mom in Recovery for the first hour, nursing if mom is wanting to bf, cuddling if not. The first check is a full head to toe assessment including Dubowitz. We check BG and follow our protocol which is >50 no recheck, 40-50 recheck next hour, <40 call ped for further orders, lab stat glucose, and recheck in one hour, <30 call ped, lab stat, NICU consult. Some peds say feed for a <40, some say wait, just depends on who the ped is. When baby is 2 hours of age we do vital signs only and repeat BG if necessary. At 3 hours of age, we bathe and shampoo, check vitals and BG (if nec.) and start weaning from the warmer. At 4 hours of age, they go to mom. If they didn't get to bf in recovery and the baby is stable during transition we will wrap them and take them to nurse as soon as possible rather than waiting the full 4 hours.
For mom, we receive her from L&D, check vitals every 30 minutes x 3, also doing a full head to toe assessment upon arrival. This includes fundal height check, lochia, etc. We check fundus and lochia with each of the initial 3 sets of vitals. They are required to have one of the nurses with them the first 2 times they are out of the bed. We measure the first 2 voids to make sure they are emptying.
As far as day to day routine, for the babies we keep up with voids/stools, feeds, they are weighed each night and vitals are done q4h. For moms, we check vitals q4h until they are 24 hr post delivery then it is once a shift unless they are PIH or it's otherwise indicated. We monitor lochia, fundus, bowel sounds, flatus, etc.
We have a lactation consultant on the floor every day who goes around with all the info on the moms and visits every mother who is bfing. She watches the baby latch on, helps if needed, and gives all the info concerning our lactation center. Most of us all have had alot of experience helping babies get latched on and we have frequent inservices about bfing so we can give the same info to our patients instead of them being told 3 different things by 3 different nurses.
Ack, sorry I just realized how long this is.
Jul 20, '02Fergus51 and TennRN,
Thank you for all the detail you have given me. TennRN that was not too long. I soaked up that post like a sponge. I am an information fiend! I like to know what to expect. I now know how to direct my self study before I start work. Someone mentioned the Dubowitz. I only briefly remember that from school. Perhaps there is a website?! I am getting excited about this new adventure. At first I was just nervous. Now I am nervous and excited.