Recovery for vaginal delivery

  1. 0
    I am looking to see when the recovery from a vaginal delivery starts at other hospitals.

    Where I work we start it when the MD/midwife has completed all repairs, placenta is delivered and basically they are ready to walk out of the room.

    My mother has only work in facilities with this same policy.

    My aunt and my mom's friend have had the same experience until recently when they changed jobs (work at the same hospital). The policy there is to start recovery when the placenta is delivered. My aunt feels this isn't safe and refuses to do this and she's getting a lot of grief.

    I'm trying to see what other facilities do. Also, if you know of any standards of care regarding this I would appreciate seeing them.

    Thanks.
  2. 21 Comments so far...

  3. 0
    Generally, recovery starts at my place once placenta is out and lasts an hour before they get turned over to M/B. If there's a lengthy repair or Mom's bleeding is an issue, they'll push turnover back a little and call M/B to let them know.
  4. 0
    In my place, recovery starts within 15min of placenta delivery. If there's a long repair, we'll keep her a little longer afterwards if necessary, but that's rarely necessary. We usually keep our couplets for 2 hours before sending them to M/B.
  5. 0
    Our recovery also starts when the placenta is delivered. Usually it isn't an issue unless a resident is doing a repair that takes forever, lol. Our "goal" is for them to be transfered to MBU within two hours after placenta but that rarely ever happens. We recover mom and baby and the first hour of recovery the focus is on skin to skin care and breastfeeding (saying mom and baby are both doing well). We basically only do VS on mom/baby and fundal checks during that time (along with helping with breastfeeding). Second hour is full assessment, shots, bath, etc for baby. Feeding and showering mom. Our MBU will oftentimes refuse to take a patient that isn't basically able to be walked over and put into bed without needing anything else. Doesn't always happen in that two hours, lol. Actually, unless they are bottle feeding and didn't have an epidural (or not a heavy epidural) so you get baby sooner and mom gets out of bed sooner, two hours almost never happens, lol.
  6. 0
    2 hours?

    This hospital that my aunt works at wants the moms off the floor at end of recovery which is 1 hour long and starts at delivery of placenta. Maybe if they kept their moms for 2 hours we would feel different but not 1 hour.

    Where I'm at recovery starts when the doctor is finished with the pt...hence recovery because all procedures are complete. The recovery lasts 1 hour and then we work to get them to PP. We never plan to keep a standard vaginal delivery for 2 hours...we couldn't even consider it because of how busy we are. We have 13 delivery rooms and have been running at capacity just about every night. It's crazy.

    I just can't imagine 2 hours...that would seem like forever.
  7. 0
    Quote from SAHStudent
    2 hours?

    This hospital that my aunt works at wants the moms off the floor at end of recovery which is 1 hour long and starts at delivery of placenta. Maybe if they kept their moms for 2 hours we would feel different but not 1 hour.

    Where I'm at recovery starts when the doctor is finished with the pt...hence recovery because all procedures are complete. The recovery lasts 1 hour and then we work to get them to PP. We never plan to keep a standard vaginal delivery for 2 hours...we couldn't even consider it because of how busy we are. We have 13 delivery rooms and have been running at capacity just about every night. It's crazy.

    I just can't imagine 2 hours...that would seem like forever.
    I can see how, if you do 1 hr recovery it would be more important to start recovery after repairs are made rather then placenta. I personally can't imagine a 1 hr recovery b/c none of our patients meet our transfer criteria before then, in ANY situation. Our MBU nurses are rather spoiled and so the expectations they have before accepting a pt can't be met in 1 hr. I also work at a decent size hospital (10 LDR's, 2 OR's and 2 RR's, always full, sometimes doing vag deliveries in the RR's b/c we run out of rooms so we are expanding to 14 LDR's, 4 OR's and 4 RR's). We sometimes push our recoveries faster depending on census but generally MB won't budge without a power struggle. The expectation for transfer is that the mom is ambulatory and has pee'd, showered, and had something to eat before transfer. Usually, our epidurals haven't even wore off in 1 hr, lol so there is no way those things could be met. Pee'ing is the big thing for our MB nurses, they refuse to do a cath if necessary, so transfering before pt has legs back or before she has voided would send them on a rampage and they would flat out refuse. (fwiw, our traveler nurses are always floored by our recoveries) We also don't have a nursery nurse to do babies so that is all us as well. This is also another holding block at times. We are a "baby friendly" hospital so we encourage early skin to skin care and breastfeeding from the start. So, like I said before, the first hour is strictly skin to skin and bf'ing. This also allows time for the epi to wear off. 2nd hour is baby assessment, bath, shots, etc and getting mom up to shower/pee/eat. I guess if we had a nursery nurse to do baby (we DO often times have someone in MB that is the "nursery nurse" but depending on who it is, that can sometimes mean someone who does nothing, but without serious begging, 99 percent of the time they refuse to do anything with a vag baby) that would take a chunk of time off. And, if we could transfer before mom is totally ambulatory, etc we could easily do it in an hour. So, I am curious, what all is done in that hour and what are your expectations for transfer?
  8. 0
    Quote from bmcm2girls
    Our recovery also starts when the placenta is delivered. Usually it isn't an issue unless a resident is doing a repair that takes forever, lol. Our "goal" is for them to be transfered to MBU within two hours after placenta but that rarely ever happens. We recover mom and baby and the first hour of recovery the focus is on skin to skin care and breastfeeding (saying mom and baby are both doing well). We basically only do VS on mom/baby and fundal checks during that time (along with helping with breastfeeding). Second hour is full assessment, shots, bath, etc for baby. Feeding and showering mom. Our MBU will oftentimes refuse to take a patient that isn't basically able to be walked over and put into bed without needing anything else. Doesn't always happen in that two hours, lol. Actually, unless they are bottle feeding and didn't have an epidural (or not a heavy epidural) so you get baby sooner and mom gets out of bed sooner, two hours almost never happens, lol.
    I don't know how you'd ever get all of that done within 2 hours after placenta and you didn't even mention all of the charting and teaching involved!
  9. 0
    Our recovery starts at delivery of placenta and is 1 hour long in most cases. Baby stays with mom for up to 1 hour then goes to nursery. Our pts usually cannot get up yet due to epidural and are transferred on a stretcher. Most of the time our recovery last a little over an hour. If there is an extensive repair we may keep pt longer. Our Mag pt's stay with us as long as they are on mag. Our c-section recoveries are 1 hour from the time we get to Recovery as long as mom is stable and v/s are within guidelines. Sometimes recovery times can be related to the unit. A smaller unit may be able to do longer recoveries. We are a high risk unit with a level 3 NICU, 15 LDR's and 3 OR's. We do around 500 deliveries a month.
  10. 0
    I should also add that we have 2 nursery nurses to take baby, we do not do baby baths, meds, and only the initial and 30 minute assessment on baby. If there is a complication with baby they go straight to nursery or we call NICU for assessment. Our pts do not have to be able to walk, shower, or pee. They have to have stable v/s of course, and no post delivery complications. But an hout is possible with teaching included if you do not have to wait for epidural to wear off.
  11. 0
    Quote from L&Dnurse13
    Our recovery starts at delivery of placenta and is 1 hour long in most cases. Baby stays with mom for up to 1 hour then goes to nursery. Our pts usually cannot get up yet due to epidural and are transferred on a stretcher. Most of the time our recovery last a little over an hour. If there is an extensive repair we may keep pt longer. Our Mag pt's stay with us as long as they are on mag. Our c-section recoveries are 1 hour from the time we get to Recovery as long as mom is stable and v/s are within guidelines. Sometimes recovery times can be related to the unit. A smaller unit may be able to do longer recoveries. We are a high risk unit with a level 3 NICU, 15 LDR's and 3 OR's. We do around 500 deliveries a month.

    Your unit sounds only slightly larger then mine. We also have the only high risk unit and NICU in the state, and while we have less rooms, our NEED is probably to be the size of yours, lol. We do 400-450 deliveries a month...so not much less. How big is your MB unit? What is the staffing ratio for your MB nurses (and is it couplet care or not)? If we could do those type of recoveries (transfer in stretcher, baby to nursery for bath/shots/etc), I would probably think 2 hrs was long as well, lol. Our CS deliveries are a half hour from the time we enter the RR if mom is stable. Mostly b/c baby goes to nursery rather then being done by us and mom won't be getting out of bed. Basically, it is just to make sure vs are stable and fundus is firm. Our goal is to reunite mom with baby as soon as possible and to have breastfeeding within the first hour so that is why we only do a half hour recovery.


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