Postpartum Nurses being the Baby Nurse?

Specialties Ob/Gyn

Published

Hi All!

My facility is in the process of changing the way babies are handled at delivery and I need your help to find other facilities that do it this way!

A little about my facility... We are a 775 bed hospital in NJ, right outside of NYC. We have about 6,500 deliveries a year, with 50 postpartum beds. The postpartum nurses do couplet care with typically 10-12 nurses for the unit on the floor. We also have two charge nurses and two nursery nurses in the main nurseries to admit babies, assist with circumcisions, handle lab orders and phototherapy babies, as well as feedings for any babies not in the rooms with the mothers and more.

Currently, the L&D nurses are the ones being the Baby Nurse at delivery and in charge of the initial resuscitation and assigning APGAR's. They assist with the skin-to-skin and breastfeeding immediately following. About one to two hours after birth, the L&D nurse will bring the newborn to the nursery for the postpartum nurse to officially admit the baby. We will do the weight, measurements, admission medications, vitals, head-to-toe assessment, bath, and any monitoring that needs to occur. Typically the mother comes up to the postpartum floor shortly after and as soon as the baby is done, we will send the baby out to the mom. Separation time is typically one to two hours.

Right now we are in the process of changing all of that! They would like for a postpartum nurse to attend the delivery and be the Baby Nurse. She would do the initial resuscitation, assign the APGAR's, and then do the whole admission process (except the bath, which will occur later during their stay), in the L&D recovery room. Babies that need closer observation, such as respiratory distress babies, as well as all c-section babies, will still go to the main nursery after delivery for admission. The "goal" or "purpose" of this new change is to keep the mother and baby together. However, there is a lot of push back from the postpartum nurses about not wanting to be the Baby Nurse.

We have been given the opportunity to find a hospital that does it the same way or similar as described above, so that we may do a site visit to better understand the process. I am looking for that hospital!

The key changes are:

-Postpartum nurses being the Baby Nurse and doing the initial resuscitation and APGAR's

-Admitting the baby in L&D

-Once mom is stable and ready for transfer to postpartum, mom and baby would travel together, never being separated

-Decreasing the staff in the main nursery (ours would go from four RN's to two RN's)

I'd like to hear how your hospital handles babies at delivery! I'd love to find a hospital that does it the same way as above so that we could possibly do a site visit!

Thanks for your help!!

Specializes in OB.

I'm pretty sure I know which hospital you're referring to, having recently moved from northern NJ :) I worked at an almost-as-large hospital in NYC on mother/baby, and when we became Baby Friendly we instituted all of the changes you've described EXCEPT having the postpartum nurse be the baby nurse at delivery. We weren't experienced with being present at delivery, assigning APGARs, or doing resuscitations, so it seemed like too much work to make that transition (although certainly we were capable of this!). Rather, the L&D staff still provided the baby nurse for delivery, but then we had assigned "admit" nurses from postpartum whose sole job all day was to go to L&D to admit, assess, weigh, and bathe babies, OR to do the admission in the postpartum room once the couplet arrived, whichever worked best depending on the flow of the day. We had one admit nurse per shift, which was often inadequate for the sometimes 10-15 babies per day to admit, but the actual process worked well. I've actually never encountered a facility where the baby nurse is from postpartum.

holmesln

9 Posts

We have suggested that same process many times and explained how it wouldn't even require an orientation, just a change in our workflow, but it has not been received well. So I am out to find some kind of similar process so we can better understand!

Nurseinprocess

194 Posts

Wow. Some other hospitals have way different processes than ours. Where I work the L & D nurses do the baby catching and apgars/initial assessments of the babies. They spend about two hours recovering the pts and assisting with breastfeeding. Then if mom and baby are stable they get moved to post partum and that nurse will admit the baby and the mom to that unit. The babies don't get bathed for 6-12 hrs now (which is awful, it was better when they got bathed right after coming over to PP because now it's just a big pass along job from one nurse to another). I think they should just be bathed under a warmer in L & D before they come to PP. We don't have a nursery anymore. Baby friendly is definitely not parent friendly. It is interesting how very different the hospitals handle their birth centers.

I don't think it makes sense for a PP nurse to be the baby catcher, she would have to have no other patients. On my unit we have 3 couplets per PP nurse.

Specializes in LDRP.

When I first started, we did it like you currently do it. Labor nurse (usually the charge nurse, the moms primary nurse concentrated on mom) did resus/apgars (always straight to the warmer after cord was cut), we grabbed a weight and foot prints in the room, then handed baby to mom for a bit to nurse/hold and then usually around the 2 hour mark when we were ready to move mom to PP, we dropped baby off in the nursery for admission/bath/meds. Baby was returned to mom once it was warmed up after the bath. A lot of our staff is trained in labor and postpartum and we float back and forth, but there are some that only do labor or only do PP/nursery. Our nursery trained nurses could be baby nurse if we were in a pinch and charge was in another delivery.

We went "baby friendly" a couple years ago. Now we still have the charge or another labor/nursery nurse catch baby and do resus. Baby goes straight to moms skin after delivery and Apgars/vitals/tactile stim/bulb suction are all done on moms chest. If they need more we whisk them over to the warmer. Weight/prints/meds/assessment are all done in the delivery room by the nursery nurse (we call her when we are ready) after mom has had at least 1 hour of skin to skin and attempted the first feed. Sometimes the labor nurse does the assessment, etc if it's an easy recovery and we have time. Baths are done 12 hours after birth in the PP room by either the PCA or the PP nurse. Baby and mom go to the PP room together and are never separated unless medically necessary or mom requests the baby go to the nursery for a bit so she can rest.

Lulu33

9 Posts

I'm curious to hear how different hospitals do this as well. I am a NICU nurse but we are cross trained to nursery and have a lot of stress and anxiety of how it is handled where I work. Labor nurses only cover the mother. Some labor nurses are nursery trained, but there is a lot of pushback from the nurses who do not wish to do nursery. There is one (!) or very rarely two nursery nurses on per shift. The physical nursery is not used except for circs/hearing/CCHD testing after baby has been moved to postpartum with mom. The nursery nurse is responsible for attending all deliveries, resuscitating baby, APGARs, assessment, q30min vitals, weight/length, meds, breastfeeding/skin to skin, any blood glucose's, etc. during the two hour stay with mom in labor and delivery. This is for every baby that delivers on your shift. So if three babies deliver within a two hour period you are responsible for this all in a timely manner before sending baby off with mom. If you are lucky, that labor nurse is trained with the babies and can take a set of vitals while you are running to the next delivery. There is a lot of pushback to make any changes to this as labor nurses do not want to take the responsibility of doing both mom and baby.

Specializes in OB.
The babies don't get bathed for 6-12 hrs now (which is awful, it was better when they got bathed right after coming over to PP because now it's just a big pass along job from one nurse to another). I think they should just be bathed under a warmer in L & D before they come to PP.

Are you unfamiliar with the research suggesting that delaying baths 12-24 hours has significant health benefits for babies and the promotion of breastfeeding?

Specializes in LDRP.
Are you unfamiliar with the research suggesting that delaying baths 12-24 hours has significant health benefits for babies and the promotion of breastfeeding?

Yeah, this is one of the changes I don't really mind at all. We get a lot less babies with low temps/sugars now that we do this, and breastfeeding retention is better (I am sure this also has to do with rooming in and better breastfeeding education for staff). Plus instead of taking the kid to the nursery to bathe, we do it right in the room and the parents can be involved and ask questions, which is a good learning experience for new parents.

BSNbeauty, BSN, RN

1,939 Posts

Our hospital has created the neonatel assessment nurse. They are typically NICU nurses who have been cross trained or direct hires. The NAN do all the initial and ongoing treatments for the baby while the baby is in L and D with the mom. The purpose is to decrease separation. The infant will only come to the nursery for monitoring or sepsis work ups.

BSNbeauty, BSN, RN

1,939 Posts

I will add that post partum nurses are cross trained at my job to be the NAN nurse if needed. However, it is rare since the NAN nurse is a staff role .

Skips, MSN, RN

517 Posts

Specializes in L&D.

We have two separate units: L&D and postpartum.

There are limited postpartum nurses that are trained to second in deliveries. Most of the nurses that are the "second" or "baby nurse" are L&D nurses. If we are busy, we pull from postpartum to do seconding. However, a lot of those nurses do not like to come down to L&D.

We do delayed bathing and skin to skin for 1 hour post delivery if baby and mom are doing well at delivery. We like as much bonding/transitioning on mom as we can. This means waiting an hour for weights/measurements. The first breastfeed is done within the first hour of skin to skin. We are going baby friendly here soon.

Mom and baby both recover in L&D for two hours post delivery. Then they go up to postpartum. Rooming-in is what we do with all couplets. We have a nursery, but it's used for procedures. We can take the baby in the nursery for a couple hours to let mom rest, though. But it's not standard practice.

holmesln

9 Posts

Thank for all the responses! Still having a hard time finding a postpartum nurse being the baby nurse most of the time though :(

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