Do you or your team members attend deliveries?

Mimi2RN, ASN, RN · Jul 29, 2003

We attend high risk deliveries and all c/s. We have a hospitalist with us, used to be an RT, but now that's only when the doc is tied up with something else. Most babies do fine, occasionally they need to have PPV, once in a while chest compressions. We rarely use meds. Babies are amazing little creatures, get them out and they're much happier. If a baby is being throttled by the cord, having decels, they usually transition without problems....but we do attend the delivery.

Our role is defined by the doc...one loves catching babies, I can barely get my hands on them. With mec, we hand the ob the delee and assist with suctioning....after transfer to the warmer, we assist with cord visualization and suctioning, if necessary. If it's crying, often I'll delee. Make sure your equipment is ready, ours is supposed to be checked by the labor nurse, sometimes I'll get there and the anesthesia bag hasn't been put together. Go through your NRP book, and the CDrom is very good.

Considering our numbers, we do very well with the babies. If it's a micropremie, and we know it's going to happen, we like to have the transport team from the level III available, I'm quite happy to grab the baby and take it to the next room where the team is waiting (that takes maybe 10 secs). Childrens Hosp is an hour away.

You will be nervous, but you will do fine.......we can do so much these days. A little fear is healthy! In the NICU you see the worst babies, but to see a baby that is expected to have problems come out of it looking good, is wonderful. Most of the deliveries that we are required to attend have a good outcome. We also get calls to come "stat". Sometimes the baby is already out but in trouble.....those can be bad. If they are bagging, I want to know...it will come to us, anyway. And I'd rather have the labor nurse call us, instead of giving the kid O2 blowby for 20 minutes, "he won't pink up"!

One look you will remember.....fish eyes....you'll know what I mean when you see it. Stressed out baby! And the family are saying "Isn't he cute, such big eyes".

Good luck in your new nursery!

:)

dawngloves, BSN, RN · Jul 29, 2003

If you worked with me you would have to fight for space since the fellow, the resident and a student all want in! I kinda stand back and watch, throw in a suggestion now and again and then ask if they still need me. If the baby is admitted I'm the glorified baby pusher as then they all hang back as I push a 100 lb isolette!

Don't mind me, just a little fatigued with the new residents. Hey! Check your PM!

babyrn67 · Jul 30, 2003

One good way to become more comfortable with attending deliveries is to attend as many as you can. (good and bad). You will get in the routine and be a pro before you know it.

Mimi2RN, ASN, RN · Jul 30, 2003

Originally posted by dawngloves
If you worked with me you would have to fight for space since the fellow, the resident and a student all want in! I kinda stand back and watch, throw in a suggestion now and again and then ask if they still need me. If the baby is admitted I'm the glorified baby pusher as then they all hang back as I push a 100 lb isolette!

I think I'm glad I'm not dealing with that many docs and baby docs!.

Kristi, will you be in a teaching hospital?

pengland1965 · Jul 30, 2003

We are a level lll nursery with direct access to L&D/OR. We attend all c-sect. and high risk deliveries. The code team consists of the admitting RN, an RT, and the NNP. If the EGA is below 35 weeks or there is a known defect, the Neo also responds.

We follow NRP guidelines.

Immediately after delivery, we begin drying and stimulating the infant.

The RT is directly in charge of delivering O2 via blow by or bagging. Occasionally, he will intubate if the NNP is having difficulty. He is in charge of the transport isolette to and from the nursery.

The RN does suctioning, counts heart rate and if needed, chest compressions. If medications are needed, sometimes the RN will draw and give meds while the NNP performs compressions.

The NNP is in charge and sets the stage for the recesitation. He usually intubates.

If the Neo responds, he will usually stand on the sidelines watching, unless the recesitation requires chest compressions or meds. Then the Neo will take charge and the NNP will intubate and give meds.

NICU_Nurse, BSN, RN · Jul 30, 2003

Oh, thank you all SO much!

Dawn, I PM'd you last night before work.

Okay, first of all, what exactly is a hospitalist? I've heard the term but never worked with one.

Secondly, Mimi, yes this is a teaching hospital. I also work at a teaching hospital right now (I start my new job next week), but I've heard that the way that they are run is completely different, so I'm very excited to see how their whole system is set up. The teaching hospital I'm at now doesn't allow NICU RN's to attend deliveries; only RT's and Interns/Residents attend, so this will be a first for me. I was told that admitting nurses always attend the C-Sections, whether they're supposed to be precipitous or not, so I hope to have ample opportunity to learn more and get my hands in there.

Of course, I'm a bit anxious, but I know once I get the chance to do it I'll feel more comfortable. I'm a builder-upper. Anticipate the worst and that kind of thing.

So, pengland, when you say the RN is in charge of suctioning, do you mean via the ETT that's just been inserted?

Thanks, again, all of you, for answering my questions! You're making me feel better already. I'm definitely going to keep studying my NRP and I'll let all of you know how it goes. :)

nurseiam · Jul 30, 2003

Going to deliverys has to be one of the highlights of my job! We go to all c/s to assign APGARS. We also attend all high-risk and anything that L&D feels uncomfortable with. We keep the drawers on the beds locked. We usually know ahead of time so we set up the bed ourselves. We never send someone that is not ready and nobody ever has to attend alone. I used to want to work in L&D but now I just get to help with the baby and never have to check a cervix!!!!

Mimi2RN, ASN, RN · Jul 30, 2003

Kristi, a hospitalist is an in-house doc as attending. We have them in adult ICU and peds for MCH. Our peds work 24 hour shifts, rotating so they'll work every other day for several shifts. They work 4-10 shifts a month, it varies. They cover any unassigned babies (those without a ped), also any county clinic babies. Also the family peds often request Hosp. coverage, so they won't get called in the middle of the night. This is for normal newborn, our nursery, peds and any ped codes in ER. Also they get admits through ER.

They started working at our hosp at the end of last year. All good peds, one is a neonatologist, and all originally from out of town. They have made a big difference to our hospital, we are keeping much sicker babies....it has (and is) been a learning experience for all of us. We are so busy lately that there are times another one has to come in for a few hours to help out. They don't often get much sleep, although we do try to limit calls during the night. I know it has made a difference in the lives of some of our babies, as we don't have to wait for a doc to show up.

mimi

CatRN · Jul 31, 2003

Hi Kristi,

Most NICU's I've worked in (all level III's), we attended the deliveries (all c/s, mec's, fetal distress, preterm, etc). We are also required to go through an ALS program because we, the nurses, do our own intubations, umbilical lines, PAL's, and PICC's. Usually, if you are on first admission you wear the beeper and go to all the deliveries until you get a baby. Other places, you are just the delivery nurse and have no assignment other than to attend the deliveries and help out your fellow nurses. Sometimes, you have one baby that's on NCPAP or a stable vent and go to deliveries as well. Most of the time, if you are tied up with a parent or a baby, then another nurse will go for you. Depends on the place....I've seen a lot of different ways of working it. East coast is usually more difficult assignments as far as nurse to patient ratio than the west coast, in my experience. :)

NICU_Nurse, BSN, RN · Jul 31, 2003

Cat,

Wow! So if you're first admission (not just the delivery nurse, as in your second example), you go to every delivery just in case of an admit? I'm wondering how you get work done on those nights with multiple deliveries!

As far as I've been told (and keep in mind that orientation starts next week, so this info could change), it doesn't sound like we'll be intubating or doing the UL's, PAL's, or PICC's. The new place has an NNP present (24 hrs, I believe) as well as having interns/residents, and possibly an attending neo available. I'm interested to see what my role will be!

CatRN · Jul 31, 2003

Dear Kristi,

We usually have an NNP and always a Neo in house, but they don't go to the deliveries unless requested or if the kid is really, really sick. At other places, usually just a pedi resident. Not sure how your facility will be, but first admission is like being in charge....you can't give it away.....or bribe your way out of it. Everyone must do it.....it makes the night fly!!