Babies After C-Section

Fiona59 · Jul 11, 2005

I've never heard that. But then I worked in a postpartum unit where 100 babies a month was considered a slow month.

Most section babies stayed in the nursery until Mum was alert and orientated but then they roomed in with her. Maybe this is where your facility has concerns? The time involved with the recovery checks on Mum and the assessment time needed for the infant.

Editorial Team / Admin · Jul 11, 2005

Is it generally accepted practice that babies are more "unstable" after a C-Section and therefore need more intensive nursing care for the first 24 hours? In our very small hospital (100 births a year) we are questioning the need to have 2 nurses present for 24 hours after a C-section when we have only one Mom and one baby.

Since your facility delivers at around 100/year, it could be viewed as a precautionary measure for your babies. High risk OB is not practiced there, I am sure. And I am sure you are below a Level III nursery. C-section babies are not considered "unstable" and unstable may not be the word you need to apply here...."at risk" seems to be a more appropriate term. Having two nurses in the nursery is probably a hospital policy for All neonates (and a good one at that).

So, your facility may be practicing global safety for all C-section babies.

Jolie, BSN · Jul 12, 2005

Are you working in a mother-baby unit, or a well-baby nursery? 2 RN's for each area (post-partum and nursery) might be excessive, but 2 RN's for a mother-baby unit, even with a low census is not over doing it!

C-section babies do have a higher rate of NICU admission, not only because of the method of birth, but also because of the conditions that lead to a C-section in the first place. C-sections done for CPD are likely to involve large babies, perhaps IDMs, who are at risk for blood sugar instability. Babies delivered by C-section following prolonged ROM are at risk for sepsis. Babies born by stat C-section for distress secondary to prolapsed cord, abruption, etc. are at risk for complications related to oxygen deprivation. Any infant delivered by C-section may be at risk for retaining fetal lung fluid, leading to TTN. Most of these newborns will "declare" themselves fairly soon after birth, within the first 4 hours or so, but it is possible for any infant to experience a sudden change in condition due to aspiration, sepsis, or undiagnosed cardiac defects. For this reason, staffing with 2 RN's is prudent, in my opinion.

Are there any other units in the hospital staffed by a single RN?

bfusco · Jul 12, 2005

This is a Level I OB unit, and I am asking about planned C-Section babies who have an apgar of 9/10 or 10/10. We have a policy that we have 2 nurses on the unit for 24 hours with C-Section babies and 8 hours with lady partsl deliveries. And, by the unit I mean the whole unit including postpartum and nursery (they are all part of the same area that is about 6 rooms large.) I just think that the policy is arbitrary and unnecessary, we should be staffing based on the condition of the infant, not how it was born.

SmilingBluEyes · Jul 12, 2005

I think staffing ANY hospital with ONLY ONE OB/NRP-qualified RN is crazy as well as dangerous, regardless of acuity of your patients. I have worked in rural hospital settings where we did only 20-30 del/month and yet, would never have dreamed of staffing with one RN ever.

You have NO idea what the ambulance will be wheeling thru your doors, small or not.

bfusco · Jul 12, 2005

I think staffing ANY hospital with ONLY ONE OB/NRP-qualified RN is crazy as well as dangerous, regardless of acuity of your patients. I have worked in rural hospital settings where we did only 20-30 del/month and yet, would never have dreamed of staffing with one RN ever.
You have NO idea what the ambulance will be wheeling thru your doors, small or not.

We do 10 deliveries a month, and our Nursing Supervisors are all trained to help on OB and help with deliveries.

SmilingBluEyes · Jul 12, 2005

that is good, but are they NRP qualified and immediately available? What if they are busy elsewhere?

SmilingBluEyes · Jul 12, 2005

Are you working in a mother-baby unit, or a well-baby nursery? 2 RN's for each area (post-partum and nursery) might be excessive, but 2 RN's for a mother-baby unit, even with a low census is not over doing it!
C-section babies do have a higher rate of NICU admission, not only because of the method of birth, but also because of the conditions that lead to a C-section in the first place. C-sections done for CPD are likely to involve large babies, perhaps IDMs, who are at risk for blood sugar instability. Babies delivered by C-section following prolonged ROM are at risk for sepsis. Babies born by stat C-section for distress secondary to prolapsed cord, abruption, etc. are at risk for complications related to oxygen deprivation. Any infant delivered by C-section may be at risk for retaining fetal lung fluid, leading to TTN. Most of these newborns will "declare" themselves fairly soon after birth, within the first 4 hours or so, but it is possible for any infant to experience a sudden change in condition due to aspiration, sepsis, or undiagnosed cardiac defects. For this reason, staffing with 2 RN's is prudent, in my opinion.
Are there any other units in the hospital staffed by a single RN?

this says it well.

MissJoRN, RN · Jul 12, 2005

C-section babies do have a higher rate of NICU admission, not only because of the method of birth, but also because of the conditions that lead to a C-section in the first place.

I agree with this statement...was thinking the same thing but didn't have the wording.

You did catch me off-guard by stating that your nursing supers are trained for your unit though...maybe you can be more subjective with your staffing plans. My thought was to have the highest staffing policy in place because in my experience (on a peds unit average census of 4 and an LDRP/N with fewer than 200 births a year) is that our supervisors were clueless to the needs of these units. They understood the nuances of acuity in the units and MS floors but couldn't grasp why sometimes a peds nurse can take 6 pts herself and other times 2 nurses are needed for 1 kid. So I liked having best staffing in place in the written policy to back up why a nurse can't be floated today.

bfusco · Jul 12, 2005

Actually our 3 bed ICU is staffed with one RN as is our 3 bed ER on the night shift. The nursing supers are Neonatal Resuscitation Certified, and OB is always the priority spot- even if there was a code going on. I'm not proposing a permanent cut in staffing, just some flexibility when there is no other option. But, never would I want to jeopardize the patients.

SmilingBluEyes · Jul 12, 2005

I know you would not want to jeopardize anyone; I hope you did not think I was accusing you of that.

You have given me a clearer picture of your staffing patterns and I thank you. I think for the most part, it sound great---a lot like the hospital where another member, Steph works.

Believe me: Some places, it's not this well worked-out. I have read and seen myself some horrible staffing situations in small hospitals in the past 8 years. Typically, we could NEVER count on the house super or ED staff to help us in an emergency; we were on our OWN. All they did was send an ER doc (useless to us----no offense but he/she typically did little to help and did not want to be there anyhow) -----and the supe would call peds and/or OB or a CRNA for us---all of whom were on beepers, not immediately available.

As you can see, We were left to deal with the rest in most emergencies. Not too ideal, as you can see.

I also don't think csection babies are higher-acuity based ONLY on the mode of delivery. Truly, the prenatal history, labor/delivery course and neonatal health after birth ARE the deciding factors.