Initial assessment while in Kangaroo Care

Chanceygrl · Jan 25, 2016

Most issues we ran into were nurses just not wanting to do it. You can perform a head to toe on moms chest. At some point you have to weigh the baby so at that time you can do a more in depth assessment but honestly if the baby is healthy, pink, breathing and in no acute distress then it should be with mom. You can auscultate, palpate and assess the basics there and even more in depth if you want to. Once everyone finally got on board we have had no issues.

e8y82002 · Jan 25, 2016

The term kangaroo care was new to me. I don't think we do this at our hospital. How exactly does it work and when does this normally occur?

cayenne06, MSN, CNM · Jan 25, 2016

Are you talking about routine skin to skin for stable couplets? I usually hear the term kangaroo care reserved for babies in the NICU.

It is very easy to do an initial, comprehensive assessment on mom's chest. No need to worry about things like hip clicks, red reflex etc- those things are better done in a calm environment, not right after birth. The best thing we can do to help baby transition is to leave him/her the heck alone!

What exactly are the staff worried about missing? I think the best strategy would be to identify specific concerns and make sure they are allayed. Adopting changes like this is more a matter of shifting unit culture than anything else. Getting management to buy into the idea, providing inservices and education, and implementing protocols that support the policy change are all important. Sometimes the postpartum work flow is not conducive to maintaining skin to skin, so it is important to look at that carefully. No amount of educating is going to help if nurses are still under pressure to get weights and measures within minutes of birth to satisfy the admitting requirements, or if unit culture puts pressure on nurses to get the initial bath done stat.

Efelliot81, BSN · Feb 3, 2016

I work at a Baby-Friendly facility. It was a 2 year transition process for us to be certified and our lactation consultant that spearheaded the transition is now actually traveling and working for the Baby-Friendly initiative. We transitioned slowly making small changes and now babies stay with their mothers and transition and initial admission is actually quicker than when babies were brought to the nursery. Our biggest hurdle was getting the physicians to make rounds in the rooms and not bring all the babies into the nursery. It is an adjustment but almost everything can be done while baby is skin-to-skin.

babyNP., APRN · Feb 3, 2016

It's better for baby and mom to stay together immediately after birth, as long as the baby is stable. Why does the nurse need to do a full assessment immediately after birth? A quick once over for major defects and making sure that the baby is breathing and otherwise okay should be enough for the first hour.

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Elvish, BSN, DNP, RN, NP · Feb 3, 2016

I am the baby stabilization nurse at deliveries, have been doing it for about 2 years. The way it works is, I set up my warm blankets on the warmer that's turned on, more to keep my blankets and a hat warm than to have a place for baby. I don't usually use it for much else except to weigh/measure.

I go in for deliveries whenever the docs do, or because I'm in L&D already sometimes I'm there before the docs are. Especially when it's a G4 coming out of triage 8cm. May as well go on in, it won't be long.

Anyway, as the head and body deliver, I throw two warm blankets on mom's abdomen. Usually a baby blanket and a big thick bath blanket. Baby delivers, goes straight to mom's abdomen on top of one of my warm blankets. I have the bulb to suction if I need to (I only do it if I need to), otherwise I just dry/stim with that first warm blanket until they clamp/cut. By then the kid's usually about a minute or so old and I have a pretty good idea of whether they're going to need any more resuscitation once I assign their 1m apgar. If not, I pull the wet blanket out from beneath baby, open up Mom's gown, plop him down in the middle of her chest, and cover him up with her gown and then the warm blanket/hat.

I stay close by until my 5min apgar to make sure baby is ok. I've been burned by the occasional kid that decides to have 1m/5m apgars of 8/2. Wrong direction, buddy. So I stick around. Around 5min I'll grab a set of vitals while baby is skin to skin. If those vitals are ok, I leave baby alone until my next VS check in 30min. 3rd VS are 30min after the 2nd. Usually by the time 2nd or 3rd VS are due, Mom wants to know a weight so I do my weight and full head to toe then. Otherwise, assuming all is well, I leave baby alone. I usually do shots and drops while baby is on Mom.

It requires a bit of a shift in thinking but it can be done. The skill of knowing when a baby can stay on mom and when she needs a bit more resus is an acquired skill after weeks, months, years of doing it. You develop a sixth sense about it, almost. What I've found to be a bigger issue is when docs question me taking baby off of mom. Most of them know me and know I won't do that w/o good reason but there are a couple that seem to like to nitpick me.

Of course you will have times where immediate skin to skin is not possible or where Mom doesn't want it, which we respect. But most of the time it works pretty well.

RN-Doula · Feb 4, 2016

Skin to skin aka kangaroo care is done at all the teaching hospitals here in So Calif. One private hospital I know wanting to be certified Baby friendly, fired all the nurses who refused and hired and trained new grads for the Baby friendly care to be done right. It's not hard once you get used to it.

And my niece recently delivered, last Nov at 6 cms with her epidural they were plying her with apple and cranberry juice, telling her to drink to give the baby sugar.