unit "culture"

Specialties Ob/Gyn

Published

What is birth usually like at your facility? How many births do you do and how many providers deliver at your unit? I'm especially interested in second stage management- do all your MDs break the bed? How about delayed cord clamping and skin to skin? Do you have CNMs? Do you do LDRP rooms or LDR and PP, and what do you like/dislike about your set up? Is your facility certified baby friendly, and if so what do you like/dislike about it?

I am just curious what other units look like!

Specializes in L&D.

We do ALOT Of deliveries(5500-7000/year). And we have a lot of providers. I haven't counted them, but I'd bet there's about 30 from several different clinics. When the patient is complete and it's time to push(I try to get them to labor down some first if possible), the nurse pushes and calls the OB when it's time for the actual delivery. When the OB gets there, we break the bed down for delivery. The MD places baby on mom's belly to cut the cord and we do delayed cord clamping if requested(although one of our new docs always does it which I think is great). Dad cuts cord and if baby is doing well we place baby skin to skin for several minutes(then we usually take to the warmer to do vitals, dry a bit better, trim the cord, and weigh), then back to skin to skin. We are just LD with separate post partum. One thing I really like about our setup is we have a nursery team who is nursery only(PP is couplet care) so the nursery comes 1 hour after delivery to do baby's first bath, eyes/thighs, and assessment in the patient's room.

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Specializes in L&D.

I spent a couple years refusing to take baby fron Mom to do measurments and weights. I really pushed for others to do skin to skin (just demonstrate a few times how much better the baby goes to breast) and complained to management about how wrong it was to interrupt STS before babe is finished nursing. We finally got permission to admit newborns without length and weight. Our department management is supportive, but it does help to be a squeaky wheel about best practices.

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Specializes in Community, OB, Nursery.
I spent a couple years refusing to take baby fron Mom to do measurments and weights. I really pushed for others to do skin to skin (just demonstrate a few times how much better the baby goes to breast) and complained to management about how wrong it was to interrupt STS before babe is finished nursing. We finally got permission to admit newborns without length and weight. Our department management is supportive, but it does help to be a squeaky wheel about best practices.

I think someone on our unit just figured out a few months ago that we can admit our babies without a weight (our admit forms don't ask for length). For a long time it was just assumed that because the form asked for it, we had to have it to admit. It has made that part of the process so much easier. Baby nurse stays in there to dry baby off & put him skin to skin, grab a set of vitals while he's there, fill out bands, and then go admit. All this can be done in 10ish minutes.

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Specializes in L&D/Maternity nursing.

I work on an 18 bed LDRP unit. We average 1200 births a year. We have 3 OB practices, one with one midwife. There are also 2 family practices that deliver with us, one of whom teaches and has residents.

Its not very often that we break down our beds for deliveries. I do it more often for tricky repairs than for actual deliveries. We lower the foot of the bed if needed, but usually we just raise the bed to the high the provider needs and/or the provider is gowned and is sitting on the end edge for delivery.

Delayed cord clamping is routinely done by some providers, and for others is done on request of the parents. If baby is stable, they go right to mom's chest for skin to skin for the first hour (we're a BFHI facility). We even do skin to skin in the OR for scheduled and non-emergent cesarean sections.

I like the variety that being a LDRP unit provides me. I can go between labor and postpartum/mom baby at will (we pick our own assignments provided acuity allows for it). Its nice to be able to labor and deliver a mom and then to take them post partum the next night.

What do I dislike? The no pacifier aspect of BFHI. I understand the rationale behind it, but when you are on nights and trying to deal with those 2nd night babes who just wont settle and mom (and support partner) are just plain EXHAUSTED, THAT is when I wish I could just give them a bink. It is a personal belief of mine that nipple confusion is not that much of an issue that BFHI makes it out to be.

Oh and I wish we had more midwives. And that we did water births.

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Specializes in Reproductive & Public Health.

What do I dislike? The no pacifier aspect of BFHI. I understand the rationale behind it, but when you are on nights and trying to deal with those 2nd night babes who just wont settle and mom (and support partner) are just plain EXHAUSTED, THAT is when I wish I could just give them a bink. It is a personal belief of mine that nipple confusion is not that much of an issue that BFHI makes it out to be.

Oh and I wish we had more midwives. And that we did water births.

I agree with this. Babies have a physiologic need to suck, and if they aren't with their mom, it can be realllly frustrating to not be able to use a sucky. I can only keep my gloved pinky in their mouth for so long!

But I'd much prefer that type of frustration to the frustration I feel when I see almost every single new mom walk out of my unit with a bag full of formula samples.

ETA- I used to do waterbirths all the time when I was a licensed midwife (CPM), doing home and birth center births. I am about to start clinical rotations at a hospital that does waterbirths, and I have to admit I have some trepidation, now that we have a bit of data on waterbirth outcomes. Gotta do some more research.

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Specializes in Nurse-Midwife.

>>What is birth usually like at your facility?

The best way to describe it? PROVIDER-CENTERED CARE.

>>How many births do you do and how many providers deliver at your unit?

300 births/month - many OB/GYNs, a few family practice MDs

>>I'm especially interested in second stage management- do all your MDs break the bed?

Well, the nurses do, because they're catering to the providers. Bed broken, legs hoisted in 'leg rests.'

>>How about delayed cord clamping and skin to skin?

No delayed cord clamping... and skin-to-skin depends on the nurse. Most nurses I work with do skin to skin for 15-20 seconds, then hand the baby off for measurements and vitals. ?????

>>Do you have CNMs?

Uh, no.

>>Do you do LDRP rooms or LDR and PP, and what do you like/dislike about your set up?

I do like separate LDR from PP rooms. The labor and delivery unit is much busier at all times of the day/night. I think it's nicer for the patients to get to a quieter/calmer unit after birth.

>> Is your facility certified baby friendly, and if so what do you like/dislike about it?

No. Well, being baby-friendly and more patient-centered would be great improvements, IMO. Not sure it's going to happen - with the culture being to bend over backward for the providers. You know, they want us to be able to manage a laboring patient so she delivers in the 15 minutes between scheduled c-sections. Sometimes that's just not feasible. Babies have a way of coming out on their own terms.... I guess that's what the hospitalists are for.

Culture is really the right word for it - no one really talks about the culture. They just live in it. I don't think most people I work with consider the culture - or how it is centered around the physicians and nurses - not the patient - they're just doing what they're doing because that's what they know. And for the nurses who have only worked at this hospital - I don't think they can even fathom of anything different.

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