Admitting newborn at the bedside

georgiaRN20 · May 9, 2014

I am a mother-baby nurse. For normal lady partsl deliveries, we assess the babies at the mother's bedside in L&D 1 hour after they are born, so they can do skin-to-skin during the "magic hour." (We are in the process of seeking the Baby Friendly designation). C-section babies come over the newborn nursery shortly after delivery and they are assessed there. Baths are delayed until babies are 6 hours old (baby friendly) unless mom requests that it be done sooner.

PinkNBlue, BSN, RN · May 9, 2014

I'm mother baby too... So do you have an assigned nurse from MBU that goes to do all babies in L&D? Like a baby nurse, who's responsible for vitals, bath, erythro and vit k, etc?

georgiaRN20 · May 9, 2014

We have a designated nursery nurse (we all take turns) who does the initial assessment and meds. Baby's first vitals are taken at 1 hour old by the nursery nurse if she can get there in time. If the nursery nurse can't get there right at one hour, then the L&D nurse is supposed to take them, but I don't think they ever do. We often get there and the baby's temp is low. I had one the other day at 95 degrees, but I've heard they've been as low as 91. After the admission assessment and meds, it's the L&D nurse's responsibility to get vitals on the baby every 30 minutes (not sure if that actually happens either). When it's time for the baby's bath, either the nursery nurse or the nurse caring for the couplet (whoever has more time) will do it in the mom's PP room. This really isn't a great system. I think it's a little dangerous because for the first hour, the baby really isn't getting any attention from anyone other than the mother and visitors.

Elvish, BSN, DNP, RN, NP · May 9, 2014

We have baby nurses who go to deliveries, do the initial resus/apgars and skin to skin. We do vitals on Mom's chest and then flip him over to his back so we can assess him while he's still on Mom. Some moms need a break if they've had a particularly stressful labor/delivery and ask us to take him to the Giraffe; in that case we do all the stuff under the warmer. The only thing we HAVE to take him off Mom for is to weigh. Unfortunately, mom's chest does not have a built in scale. :)

C/sections moms, we have a warmer in the OR and we do the inital resus/assessment/VS under there. Once that's done, we wrap baby up and hand him to support person. From the OR they go to recovery either on Mom's chest or support person pushes him there in the bassinet and we finish the newborn stuff in recovery.

Of course the caveat is that these are all term low-risk deliveries. VS are q30min x 3, then q4h x 24hr. We try to have everything, including first 3 sets of VS, done before we leave L&D.

NICU comes to all the sections, mec, and preterm deliveries. If they need accuchecks, we do those in L&D as well. If they do need venipuncture (CBC, cultures for chorio or +GBS untreated) they go to the nursery for that but we have a 4hr window for it, so it can happen after turnover to mother/baby.

georgiaRN20 · May 9, 2014

We don't go to deliveries. I think most of the time it's usually just one L&D nurse who is responsible for both mom and baby, even though NRP says there should be a designated baby nurse. When we do the assessments in L&D, they are under the warmer. NICU also goes to all c-setions, meconium, pre-term, etc. I think one of the problems we have is that we don't have written policies or protocols (to my knowledge) for a lot of the things we do. We are still trying to work through this baby friendly stuff, and we are usually notified of new changes via email or word of mouth. Definitely not ideal.

PinkNBlue, BSN, RN · May 9, 2014

This is great information. Thank you!!!

If babies are having respiratory issues (grunting etc) do they observe baby in mom's recovery room under the warmer or do they bring baby to the newborn nursery for further observation?

Elvish, BSN, DNP, RN, NP · May 9, 2014

Depends on how grunty they are. If they're a little pale and a little grunty, we usually just watch in L&D (the ones doing the watching are nursery nurses so we know our own threshold, know what I mean?). If they are working too hard, or if their color is off, we take them to the nursery. Fortunately the warmers have pulse ox capability so we can throw a probe on the baby if we need to. That helps. Most of the time, the slightly-grunty-slightly-pale ones will transition just fine on Mom's chest. I was a skeptic at first but having seen it a few times, am now a believer. :)

georgiaRN20 · May 9, 2014

if it's during the magic hour they will call stork squad (nicu) to come assess the baby.

PinkNBlue, BSN, RN · May 9, 2014

Our warmers have the same capability for a pulse ox, oxygen etc.

We're currently admitting the babies at the bedside in mother baby. L&D brings both mom and baby up, we put the baby in the warmer next to mom's bed, the nurse is responsible for mom's assessment, baby's assessment (finish the vs, give vit k, erythro, bathing, charting admission stuff). We're probably going to try having one of our nurses be a baby nurse in L&D but am just curious as to how other hospitals, that do something similar, run it.

Thanks so much for your input! So helpful!

**LibraSunCNM, BSN, MSN, CNM** · May 9, 2014

When I worked as a mother/baby nurse at a large teaching hospital we had one M/B nurse each shift assigned as "admit nurse." The L&D nurses did eye ointment, Vit K, weight, and the first set of vitals (I think technically they were supposed to be done in the first 30 min but it varied in reality). Baby was supposed to be skin to skin for at least an hour after that, and then we were allowed to admit them. Depending on how many babies were born each shift, we either admitted them bedside in L&D under the warmer, at the bedside in M/B in the bassinette, or in the nursery under the warmer, although we tried hard to avoid the nursery since it's a Baby Friendly institution. Common reasons for separating baby from mom and admitting in the nursery were if the admit nurse hadn't been able to get it done while the pt was in L&D, it was the middle of the night and the pt. had a roommate in their new M/B room. It was frowned upon to disturb the roommate with the admission process while they were (trying to!) sleep. Or occasionally by patient request.

The admit nurse did length, assessment, Ballard score, etc., bath, and then another weight. I wish we had had a policy to delay the baths longer, but that didn't happen while I was there. After bath the baby went right back to mom's chest to warm up. So there were not any hard and fast rules, admission happened in a variety of ways depending on the workflow of the shift. We could sometimes have 10-15 babies per shift, so it could really get crazy. But overall most babies were admitted at the bedside with no separation from the parents.

NurseNora, BSN, RN · May 13, 2014

We have two L&D nurses at each delivery. We only call a nursery nurse if problems are anticipated. Because I like keeping mom and babe skin to skin, I'll usually send the second nurse away once we have determined we won't be needing our NRP skills. VS are taken within the first 15 min and q30min thereafter. It's not hard to take baby's VS while sts, and taking them q30 is no great difficulty either. I've been doing it for at least the last 20 years. Just accept it as part of the delivery process and get used to it. I'm now trying to get people to start doing it more in the OR for section moms.

Sometimes the baby needs a little extra help and goes to the warmer and may even stay there a while. If it's just a little tachy or grunty, it can still go to mom. Often putting baby on her tummy helps clear the lungs and thats the position she'll be in on moms chest. Skin to skin helps regulate baby's respiration, heart rate, temp and blood sugar so it's an OK treatment for mild problems. If any question, we call a nursery nurse.