Is there a Dr present at c-sections just for baby where you work.

[crysobrn]

We are a smaller hospital. Approx 400 deliveries a year. We have always had a doctor present at c-section deliveries along with a nurse. Recently there has been a push by the family practice docs to NOT attend c-sections with us, citing that we do not have a baby doc with us for vag deliveries, it's cutting into office hours, and that other hospitals do not have docs present just for baby, etc.

Just curious what they do at your hospital (please tell me how big your facility is, how many nurses are present etc...). We do not have a NICU and our RT's are not nrp so we cannot call them in an emergency situation. We doubt that anesthesia will be able to help us since they are in charge of mom and worry that no one will break scrub to assist. Also if anyone knows of any standards of care regarding this it would be helpful. Thanks in advance.

[queenjean]

We don't usually have a ped/doc for the baby at the sections, unless we are doing the section for fetal distress.

[SmilingBluEyes]

Well see, your dr does NOT have to break scrub to care for baby. You have a couple alternatives.

FIRST: If this is a baby who "goes bad" unexpectedly, you CAN have anesthesia come over to help intubate as needed quickly---- while you call for backup/assistant MD to deal with this. You can always call ED if you need a dr to come up while you get a ped inhouse to help, also. We have done this, (had MDA intubate) and it does work. It's not optimal, but you have to act fast. And obviously, get as much qualified, experienced help at the warmer as you can. No one can resuscitate a baby alone, clearly.

And understand, as stated, you MUST MUST have an NRP certified individual present, who is soley dedicated to care of neonate at birth. Whether that is a nurse or cardiopulmonary person, it varies. But, Always, no exceptions, at every birth someone NRP certified must be there for baby alone. Read your NRP text put out by AAP; it discusses and holds us to this standard.

SECOND: If you anticipate a problem, e.g., bad strip, condition of mom, heavy mec staining, prematurity, etc, you are wise to advise the OB/Fam practice doc you are bringing in the high risk ped on-call to attend the delivery. They will thank you, believe me.

Good luck.

[Spidey's mom, ADN, BSN, RN]

Two docs and a scrub tech for the mom. Me, the NRP certified RN at the warmer for the baby. A circulating RN. A CRNA.

The assisting doc can come over and help with the baby if need be and has. So can the CRNA.

Our docs are Family Practice with OB certification.

No doc or pediatrician for the baby.

I had my last child in a big city - I was amazed at how many folks were attending my cesarean . .. the Neonatal doc looked in at my son and spent about 30 seconds in the room. Big charge for that 30 seconds. I'm grateful though.

lady partsl delivery - one doc, one RN. ER folks available.

We do not have respiratory personnel - RN's do that.

steph

[sweetie1215]

Well, I am at a teaching facility (large) so it is totally different b/c NICU is a phone call away. We have the circulator and a second nurse to help with the baby. If there is an indication to call the NICU (nonreassuring FHT's, preterm, chorio, mec) then we call them.

[Elvish, BSN, DNP, RN, NP]

Peds comes to all our c/s deliveries - not always a neonatologist, but a RRT, an RN from NICU, and a NNP. Every c/s.

[nurturing_angel]

We are a small community hospital. We have OB/GYN, entire surgical team, NRP trained Ob nurse to help circulate, NRP trained OB nurse just for baby, and pediatrician for each and every delivery.

[HelenofOz]

I am at a private hospital in NSW, probably up to about 800 births/year.

The team for LSCS is-surgeon, assistant (MD), scrub RN, scout nurse, anaesthetist and anaesthetic nurse for mum, and paediatrician and midwife for baby. Unless it is a dire emergency they don't start until the paediatrician has arrived.

And thank goodness for that last night. At the end of a long, extremely busy day we had an emergency LSCS, Mum had the potential to go very bad very fast, so assistant surgeon was another obstetrician from that particular practice and 2 other anaesthetists were available if required as their lists had finished and they "hung around" just in case. Mum was fine, but baby went flat-by all accounts the paediatrician did a fabulous job, and bub was much improved but spending the night in NICU. My heart ached for the Dad-not knowing if his wife would survive, and then finding out his baby nearly didn't.

Have also seen an orthopaedic surgeon assist at an LSCS-I wonder what the family thought of that bill. His list was interrupted for the emergency so he offered to assist, and I think he secretly enjoyed it.

[littlepeach]

We have guidelines set up by the peds for c-section attendance. All c/s must have a NICU nurse for baby. If nurse feels uncomfortable about delivery then ped will come. For anything considered high-risk ped will come. But, mostly it's just Nicu staff. The nurses are very competent with NRP and can handle their own. But can be dangerous, and has been sketchy in the past.

[pirap]

There is a neonatologist present AT EVERY BIRTH plus an RN from the NICU--plus of course moms people. There is a neonatologist on call 24 hours a day/7 days a week. We have approx 5000 births a year and the largest regional Neonatal ICU in our area. What you are describing is an accident waiting to happen.

[Jolie, BSN]

There is a neonatologist present AT EVERY BIRTH

OK, now that seems like overkill to me. With healthcare costs thru the roof, why have a highly-trained and expensive professional present at every birth, regardless of history and risk factors?

I am not questioning the presence of an NRP certified attendant for the baby, just the addition of an often unnecessary neonatologist to every delivery.

[Elvish, BSN, DNP, RN, NP]

Pirap, do you mean that there's a neo at every birth be it vag or c/s, or are you referring to c/s? I know that may sound like a dumb question, but since that's the topic of thread.....I'm confused.

If it's for every c/s, I can see the wisdom, though an NNP, RN and RRT would likely do just as well as a neo. If it's for every birth period, then that does sound like a bit much. JMO.