high risk OB?

Elvish, BSN, DNP, RN, NP · Jul 29, 2008

Sounds as though your hospital's setup is a bit different than ours. Our high-risk OB/antepartum is a separate unit from L&D, though physically close. Our stable high-risk antepartums are mixed in with mother/baby couplets. Anyone unstable is in L&D already.

We see preterm labor (stabilized), placenta previa, partial abruptions, PROM, rule-out preeclampsia. That is the general mix. We also get, when they present in the community triplets/quads/quints once moms are on bedrest and/or close to expected delivery. In my 3 years I have seen 2 sets of quads and several sets of triplets. No quints that I have seen. Twins all the time, mostly in with PROM that I have seen. Sometimes you might get a pt in for obs after a MVA or something similar, but mostly those pts stay in L&D.

You are going to get really good at fetal monitoring working in an inpatient setting that is exclusively high-risk OB, which is obviously something that will come in handy if you go on to L&D. There is the occasional *oops* delivery in the bed/on the toilet in antepartum, in which case it's a good idea to have your ducks in a row beforehand. You'll learn what the usual sx are that an antepartum is about to break, and you'll learn that there's sometimes no warning at all.

I enjoy antepartums. Some of our patients are there for weeks/months at a time and we get really attached. We just had a lady delivery at 34 weeks that had PROMed at 25 and was with us the whole time until she delivered. We miss her now! That will probably be different from L&D where pt turnover rate is high r/t the nature of the job (though not to say you can't bond w/ your patients in L&D).

The pace can be steady, or it can be frenetic. All it takes is one pt to break and it can throw your whole shift into a tailspin!

I can't speak to ratios for an all-antepartum unit, since ours is a mixed unit. (We generally have 3-4 couplets and one antepartum.) But I know there are plenty of posters here who can. :)

IMO, if you want to do L&D, high-risk OB is a great place to start. You will be able to get some basic skills, you'll get to know the docs, and you'll get to know protocols/standing orders. All of which will come in very handy in L&D. Best of luck to you! :)

HappyNurse2005, RN · Jul 29, 2008

I just wanted to know a little about high risk OB. It seems that at my hospital the manager described it as the "feeder unit" to L&D. She said that once a position becomes available in L&D the High Risk OB RNs get first choice. I wondered what kind of things might be seen and what everyone thinks about going from High Risk OB to L&D? What is the usual patient ratio and pace? If this is the way into the unit do you all think I should go for it? Any advice would be appreciated

Your hospital set up is obviously different than ours, but no two hospitals are going to be the same.

We do have a "high riskOB" unit, but we call it antepartum. Our antepartum and l&d is the same large unit, but each has its own "half" of the unit (with the OR in the middle). Same nurses, though, you don't have some AP patients and some labor pt's. One night you might have labor, next it might be AP.

I wondered what kind of things might be seen and what everyone thinks about going from High Risk OB to L&D?

We have anything you could think of practically. From OB problems like PPROM, PIH, PTL, previa to non OB things like pneumonia, headaches, gastroenteritis, cholecystectomies, asthma, sickle cell crisis, suicide attempt, seizure disorders, once we had diabetes insipidus. All of the pts are over 20 weeks preg, though. Under that and they go to another floor. Plus, we keep our pt's on mag, so if they are post vag delivery or post c/s and on mag we keep them for the extra 12 or 24 hours.

Yes, it can help with l&d in some senses. you'll learn about complications of pregnancy, normal and abnormal lab values, about how to read a strip well which will all be useful. Plus, the high risk pt's do eventually have babies, so if you are there first you'll be more comfortable when they are in labor.

What is the usual patient ratio and pace?

The ratio depends on many things: the acuity of the patients, whether or not they are on continuous monitoring, how needy they are, etc. 2-4 moms per nurse though. Pace can be achingly slow, if they are very stable, or can be hectic. People who are in pain, going into labor, new admissions, babies having decels, etc. Its usually steady to busy.

If there is no way to get straight into labor and delivery, then this is definitely a way in, and a good learning experience as well. YOu might end up enjoying it and not just using it as a stepstone.