timing of newborn bath

dawngloves, BSN, RN · Nov 21, 2003

Originally posted by susancox
I. The baby has to have a temp of at LEAST 36.4 C AND have eaten (which I haven't seen mentioned) before the bath.

Rational for the eating? :confused:

Mimi2RN, ASN, RN · Nov 21, 2003

All our normal newborn care is done in mom's room, vss q 30 mins x 2 hrs. Assessment, meds, footprints, initial blood sugars when necessary. Baths are usually done after mom and babe are transferred to pp, as long as the baby is warm and stable. We give sponge baths, not sink baths, washing the hair with running water. as the pp nurses have to use the little sink in mom's room.

The first sink bath I saw was after my granddaughter's birth. My son assisted the nursery nurse with her bath, but I wished that the green had been washed out of her hair. My new granddaughter (two weeks ago) stayed in the room for a couple of hours, after one set of vitals. While mom was being transferred to pp, she went to the nursery. This time my son gave the bath by himself. He's had lots of practice in the last 15 months!

I thought people would like to see a baby pic, hope it works.

Mimi2RN, ASN, RN · Nov 21, 2003

Don't attachments work any more?

Try again.

I guess they don't.........

OBNurseShelley · Nov 21, 2003

By far my favorite place did it this way: (although, not completely baby friendly, it worked well)

L&D nurse, receives baby, assigns apgars, as long as all is good, NO FURTHER INTERVETNIONS ARE DONE, except for keeping baby warm, and breast feeding, assuming baby is pink, breathing and/or crying.

at 1 hour, a nursery nurse comes to the room and admits the baby, giving meds, assesment, weight, measurements, foot prints, ballard, bath. ALL DONE AT THE BEDSIDE, again provided baby was stable, also if heel-sticks were needed the labor nurse would start that, ie, GDM, LGA, etc.

THen at about 1 1/2 -2 hours, mom and babe transferred PP, baby never went in the nursery unless parents request.

THis system was awesome, took the stress off of L&D nurse, allowed for bonding, and made for a smooth trasnsition to the MBU.

It's amazing just how many different ways there are to do this, and I agree, some of the "policy's" have to do with convenience, NOT evidence based.

Jolie, BSN · Nov 21, 2003

Dawngloves,

It's an attempt to prevent an asymptommatic hypoglycemic infant from bottoming out during a bath. Most units check blood sugars only on babies that fit their protocol or are symptommatic. But it is possible to have a hypoglycemic baby that neither fits the protocol nor is symptommatic. If such a baby is fed prior to bathing, chances are that he will tolerate the bath without dropping his sugar too badly.

L&D_RN_OH · Nov 21, 2003

Originally posted by SmilingBluEyes
NO none of this makes sense to me at all. It sounds inefficient and VERY un-patient-friendly (not to mention NOT baby-friendly). Sounds like a HUGE waste of resources to me on a well baby. We as LDRP nurses accomplish ALL the above, and RT never ever gets involved (nor does nursery) UNLESS a baby IS SICK. I am amazed any place works like this.

"Hospital routines" are a HUGE source/reason for dissatisfaction expressed by many patients....causing many to then elect to go to midwife-run birthing centers or simply birth at home in subsequent pregnancies. I can see why in some cases. Sorry.:kiss

There is an RT at every delivery here. For the majority of deliveries, there is only one nurse. It's actually a help to me that the RT is available to handle the baby, while I assist the doc with whatever; getting sutures, fundal massage, running for Methergine, KWIM? Granted, most of the time, babe is placed right up on Mom's baby and RT is really not needed. But when they are needed, they're needed fast. I actually thought it was a little strange when I started here too, but it seems to work for us. And I think NSY transition is common in this area, as most hosp around here do it. We have just transitioned back to LDRP's in the sense that Mom stays in the same room, but PP care is still done by the Mom/Baby nurse, and baby is taken care of by the NSY until transition is done.

Eventually, we are aiming for total LDRP care, but it's a slow transition, especially when you have L&D, M/B, and NSY RNs who are resistant to change. And with only 3-4 L&D RNs on to cover the floor, many times it would be darn near impossible for us to do bedside transition. :eek:

And what's wrong with midwife run birth centers or birthing at home? I opted to birth at home, then went to a midwife run birth center and I work in L&D. :chuckle

L&D_RN_OH · Nov 21, 2003

Originally posted by OBNurseShelley
L&D nurse, receives baby, assigns apgars, as long as all is good, NO FURTHER INTERVETNIONS ARE DONE, except for keeping baby warm, and breast feeding, assuming baby is pink, breathing and/or crying.

at 1 hour, a nursery nurse comes to the room and admits the baby, giving meds, assesment, weight, measurements, foot prints, ballard, bath. ALL DONE AT THE BEDSIDE, again provided baby was stable, also if heel-sticks were needed the labor nurse would start that, ie, GDM, LGA, etc.

THen at about 1 1/2 -2 hours, mom and babe transferred PP, baby never went in the nursery unless parents request.

This is the way we do it when we CAN do bedside transition. But not all L&D nurses have done a complete newborn assessment, given meds, or Ballard, etc. so if the NSY is busy and can't come out for transition, baby goes in. Our transition is done by the SCN. We don't really have a reg. NN. I would love to have an easier transition, like the one you mentioned above, and with the L&D nurses cross training to M/B right now, maybe it will happen in the not so distant future. :)

L&D_RN_OH · Nov 21, 2003

Originally posted by SmilingBluEyes
And yes,where I work ALL RN's having anything to do with babies (that is labor/delivery, postpartum and newborn nursing) MUST have NRP certs current at all times. That is mandatory and if it lapses, we are taken off the schedule until we GET current. It's that important.

Same here.

susancox · Nov 21, 2003

Okay stupid question but what is an "RT"? Is that what some of you call your techs?

L&D_RN_OH · Nov 21, 2003

Originally posted by susancox
Okay stupid question but what is an "RT"? Is that what some of you call your techs?

Resp. therapist

SmilingBluEyes · Nov 21, 2003

Originally posted by L&D_RN_OH
And what's wrong with midwife run birth centers or birthing at home? I opted to birth at home, then went to a midwife run birth center and I work in L&D. :chuckle

NOT A THING; ya missed my point, I guess. We should care somewhat about patient satisfaction. One way to help ensure it is to let MOM AND BABY bond first! Having 3 or 4 pairs of hands on the baby before Mom gets her chance IS NOT user-friendly.

Some people have NO choice BUT to birth in a hospital. Birthing centers are GREAT but not all of us are considered eligible to use them. What's wrong with ensuring moms and babys are allowed to bond in PEACE without a lot of fuss from staff around them in the hospital? I am sorry, I just think your system there sounds a bit wasteful and NON-baby friendly. Patients should be the FIRST Ones handling their babies, if they are healthy. NOT RT's and 2 or more nurses.

From a NURSING standpoint, When you get used to it, you CAN do the mom and baby recovery VERY efficiently.. (most places here, its a given).......it's prioritizing and familiarizing yourself with the s/s of any subtle changes. I have done this for YEARS. There is no need to take a baby to the nursery for any reason unless the baby is not transitioning well. And RT has much better things to do than catch healthy babies where I work, I guess! (just ask them).:roll

webbiedebbie · Nov 21, 2003

I recently attended a breastfeeding seminar where they stated that the hands should not be washed on the infant if they are going to breastfeed during the first hour. While I don't fully understand the rationale, they stated that the smell of the amniotic fluid on the hands had something to do with better breastfeeding. PLEASE DON'T TEAR ME APART ON THIS ONE. I am not trying to start something. Just curious if anyone else has heard this or understands the rationale.

When I worked M/B years ago, we did the bath under the warmer after bonding and encouraged the fathers to do the bath while mom watched.

Where I am working now, the infants are whisked off to the Nsy during the first hour! Nsy states all babies are cold stressed and most moms don't see their babies until 2-3 hours later!