Admission of mother & baby after delivery outside of hospital

Published

Specializes in L0-high risk OB, PP/NBN, Med/Surg.

Thanks to all of you who have responded to earlier questions. This is a great format for sharing information. Am looking at two policies about women being admitted to the hospital. #1 is when a pregnant woman comes in for evaluation with a "problem " with the pregnancy. Moms less than 20 weeks gestation go to the ER for evaluation. Moms 20 weeks or greater gestation go to L&D for evaluation. Anyone in question I send to L&D because I'd rather have them there if it is PTL & we're off a week or so to give them a better chance than sending them to the ER where they have less chance of saving a pregnancy. If the woman is pregnant, but the problem is not pregnancy related, asthma for example, she is sent to the ER, but they could send her up for an OB evaluation later if a pregnancy related problem was noted, like an NST if she reports decreased fetal activity at 34 weeks. Is that how most of you are looking at admissions of pregnant women? Any other suggestions or supportive literature> #2 is a policy about handling moms & babes that deliver at home, in the car, in the hospital parking lot.... & how they are then brought into the hospital system for evaluation & admission. They can come through the ER or on their own. The L&D & NICU Charge Nurses evaluate them both & the mom goes to PP. If the baby is low risk & stable it goes to the Newborn Nursery. If high risk or unstable, it goes tto the NICU. They put ID tags & "halos" on the babies as soon as they are seen to identify & provide security for them. Again, just looking to see if anything different is being done out there. Not much in the way of literature on either of these situations. As you may guess, this hospital is facing a JCAHO survey soon & I was hired to bring it into the 21st century. Anyone out there heard the words RESISTANT TO CHANGE? Thanks to you all from this aging pioneer in OB.

Up Vote Up Vote ×

All our Moms come to OB, unless less than 20 weeks. They are rarely evaluated in the ER beyond "There is a pg woman at the triage desk having contractions, water broke, etc., come get her". In an ideal world, less than 20 weekers stay downstairs. However, the squad generally bypassess the ER altogether if they have a pregnancy complaint, which has resulted in 17 and 12 weekers being brought to L&D triage.

When a baby is birthed outside the hospital, they are still brought to L&D for evaluation and skip ER.

Up Vote Up Vote ×
Specializes in ER.
All our Moms come to OB, unless less than 20 weeks. They are rarely evaluated in the ER beyond "There is a pg woman at the triage desk having contractions, water broke, etc., come get her". In an ideal world, less than 20 weekers stay downstairs. However, the squad generally bypassess the ER altogether if they have a pregnancy complaint, which has resulted in 17 and 12 weekers being brought to L&D triage.

When a baby is birthed outside the hospital, they are still brought to L&D for evaluation and skip ER.

Same way with us on the policy number 1, though squads always come in through ED, and we make the decision (I work in ED) if they go upstairs or not, usually in consult w/ the L&D nurses.

Policy number 2 - these pts are usually coming in by squad for us, but either way, the triage nurse checks the baby quickly first, makes sure baby is stable. If baby is not stable, baby stays in ED b/c we have the most extensive training for code situations. Of course, L&D/nursery nurses come down to help out. Mom stays w/ baby, wherever baby goes (ED or L&D). Unless Mom is hemorrhaging, or in otherwise unstable condition. Again, potential code situation, ED is best place, b/c ED doc and staff goes to all code situations wherever they are in the hospital, and it is MUCH easier to deal with a code in our "home" place.

Up Vote Up Vote ×
If baby is not stable, baby stays in ED b/c we have the most extensive training for code situations.

See, this is different in our hospital. All women's services staff, L&D, NSY, and PP are certified in NRP. Our ER staff is not required to be, since we do not have pediatrics at our facility.While L&D staff does have ACLS, we would much rather leave it to the "experts" in ER or ICU for an adult code. But, we have the most extensive training on neonates. If baby is delivered outside the hospital, they are assessed by the EMT's. If stable, they are immediately brought to L&D. If unstable, we meet them in the ER.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
See, this is different in our hospital. All women's services staff, L&D, NSY, and PP are certified in NRP. Our ER staff is not required to be, since we do not have pediatrics at our facility.While L&D staff does have ACLS, we would much rather leave it to the "experts" in ER or ICU for an adult code. But, we have the most extensive training on neonates. If baby is delivered outside the hospital, they are assessed by the EMT's. If stable, they are immediately brought to L&D. If unstable, we meet them in the ER.

This is how it works where I am. ED wants NOTHING to do w/birthin'babies.

Up Vote Up Vote ×
Specializes in Cath Lab, OR, CPHN/SN, ER.
This is how it works where I am. ED wants NOTHING to do w/birthin'babies.

Exactly :)

I'm assuming all of the above info is if they present to L&D triage.

For us, if you come thru ED-

Less than 20wks- Depends on what's happening. OB complaint, ED sees you then will probably call an OB consult (so OB will come to ED to see you, may admit you or have you f/u with them later). We have sent 18wkrs to L&D is she was about to deliver. Much better for mom to at least be in a more comfortable environment for her loss than to have it be in a small ED room.

Greater than 20wks- OB complaint: Register then go as a direct admit to L&D, unless you're about to deliver now.

Non-ob complaint (MVC, asthma): Seen in ED. We do FHR, we have a FHR monitor for continuous monitoring. Depending on what's happened, OB may come down to see the patient (esp if an MVC and there is a risk for an abruption or somethign). If they need continuous monitoring, an OB nurse will come down and stay with patient.

Up Vote Up Vote ×
This is how it works where I am. ED wants NOTHING to do w/birthin'babies.

Same here! It's a big joke between the departments that the ED nurses (who tend to be the most assertive, kick butt, confident people) freak when they see a pregnant woman or a baby. We're happy to take those patients off their hands as long as they are always willing to help us with the sick adults (had a dad pass out in the unit not long ago and the ED girl came up!).

Up Vote Up Vote ×
This is how it works where I am. ED wants NOTHING to do w/birthin'babies.

Yep! We've had them deliver on a gurney with ER staff running them back to L&D and in the elevator on the way up because ER wanted no chance of delivering down there. Just this morning we got a call, "there's a woman down her ready to deliver, come get her." Luckily, she was only 6 cm but I'm sure you've all had similar experiences.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

WE get called down to ED for any immenent deliveries. We have to bring our own precip kit and warmer for baby. They do NOT do these if they can help it. We have delivered babies in ED on the gurney and in the Car in the parking lot. ONce they are on hospital grounds, over 20 weeks', they are OURS. NOT ED's!

Up Vote Up Vote ×
Specializes in NICU.

If they have a mom delivering in the ER, they call down our NICU high risk team for the baby and we bring our transport bag of tricks and heated incubator. If the baby is born at home, EMS brings both of them to the ER and they stay there until they are stable enough to go to L&D/NBN/NICU. Usually the mom is doing fine and goes up to OB pretty quickly. But if the baby is coding, we will stay down in the ER with the baby until it's stable to go to the NICU. We are supposed to take over the resussitation once we get there, though the ER staff (both nurses and docs) are always really helpful and don't just abandon us. In the rare instance that the baby is actually doing fine, we warm it up and then we'll personally take it to the NBN for admission.

Up Vote Up Vote ×
Specializes in Cath Lab, OR, CPHN/SN, ER.
WE get called down to ED for any immenent deliveries. We have to bring our own precip kit and warmer for baby. They do NOT do these if they can help it. We have delivered babies in ED on the gurney and in the Car in the parking lot. ONce they are on hospital grounds, over 20 weeks', they are OURS. NOT ED's!

How big is your ED? We're lucky enough to have equipment down there for a neonatal resus, although OB and NICU will still bring their own- we have what we can to get us by until they arrive. We have three shock trauma rooms, one that serves mostly peds. This room also has a neonate resus cart, warmer, and deliver kits- now if that bed only broke down. :)

Our ED is very big on getting anyone who needs to be in L&D outta the ED- most of the nurses/docs down there want nothing to do with it! I'm finding out I have a L&D nurse hidden somewhere in me. :p

I hope you don't think I was trying to turn this into a L&D vs ED type of thing- I like adding my input since we do get a lot of L&D pts. At least we do here- they don't follow the simple instructions of "Go to L&D and press button on wall to enter".:confused:

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Our ED is rather small actually Aneroo.

Up Vote Up Vote ×
+ Join the Discussion