Is this normal for most L&D/OB units?

JenTheRN · Nov 26, 2006

I don't think that 6 hours of monitoring is what most hospitals do. We tend to stablilize baby, then allow for bonding/breastfeeding, then we do vitals at one hour (baby usually goes to the ny for this). After vitals and bath, baby goes back to mom.

I know a lot of hospitals do all vitals and bath in the room. I think that 6 hours away from the baby right after birth would be really difficult, and it doesn't allow for any kind of early bonding or breastfeeding opportunities.

Jolie, BSN · Nov 26, 2006

Was the unit a L&D only with a separate newborn nursery and post-partum floor, or an LDRP?

I've worked in both and can attest that in the L&D/NN/PP set-up, many a baby was separated unnecessarily from mother in the hours after delivery. The L&D nurses were not expected to provide immediate care to the baby, so if anything was required other than a quick set of vitals, they would send the baby to the admission nursery immediately. Once there, the baby typically remained under the warmer for a few hours, having blood sugar checks, first bath, etc. Even babies who had no special needs at delivery were only allowed to stay with the mother in L&D for the first hour of life. (I have no idea why.) Most were returned to mom when she was transferred to the PP floor at about 4 hours of age.

In the LDRP set-up, the babies were assessed in a warmer at mother's bedside, and remained with mom during the recovery period, cared for by the same nurse. This was much more conducive to early breastfeeding, bonding, and provided better thermoregulation, as baby was almost always skin to skin with mom. Baths, vit K, and eye medication were typically delayed until after the recovery period. With the exception of hepatitis exposed newborns, this is preferable, as the babies are not cold-stressed by a bath at a time when they are transitioning in terms of respiratory status and glucose regulation.

I would recommend that you tour the unit prior to delivery and ask specific questions about the handling of the newborn in the immediate post-delivery period. I personally would not choose to deliver at a hospital that routinely separates mom and baby.

Good luck!

SmilingBluEyes · Nov 26, 2006

If mom and baby are healthy, both places where I work, baby goes on mom's chest right after delivery, and stays there for skin-to-skin contact and bonding/breastfeeding. The baby does not leave mom's breast until Mom is ready. Then we bathe and do the head-to-toe and gestational assessments. The only thing we do do, is make sure the eye meds are given within first hour after birth and serial vital signs during that first hour to two.

Now, we will bathe and weigh baby if Mom wants it done right away----some people simply can't handle post-birth immediate skin-to-skin for whatever reason. It's up to the family what we do, but I encourage skin-to-skin and tell them why.

So yea, I think skin-to-skin at least the first hour is BEST for the new couplet. Babies are shocked enough after birth, and their transition to extra-uterine life is dramatic and can be rough. It's much easier for the poor kid to learn to breathe and adapt to extra-uterine life if we don't rush the baths, meds and weights right away. There is evidence enough to support this; we are in the process of making it (immediate skin-to-skin contact after birth) a written policy in one hospital at which I work.

So, no, don't let them whisk your baby away from you unless there is a medical necessity, for either of you. It's not good or necessary to rush things that first hour. I recommend you make your preferences clear before the baby is born, so your caregivers know how you feel and respect it. The baths can wait and vital signs can be done while you are holding, bonding with, and breastfeeding your baby.

Oh and don't get me started on bottle-feeding breast babies. SURE your baby needed something to eat, 6 freaking hours after birth!!!! That was of their doing, to have this have to happen. That is one reason why taking newborns to the nursery is such a poor idea, right after birth. That first hour after birth is the best time to initiate breastfeeding, when the baby is awake yet quiet and taking it all in. You missed a golden opportunity to get breastfeeding off to the best start, just by their taking your baby away from you so early and for so long.

Just be sure to tell them, unless there is a strong medical need, bottlefeeding will not be done with your baby for any reason whatsoever. (I can't believe parents still have to say this). There is no need to give a baby formula, unless blood sugars are unstable, and then, we give by cup, not bottle. I think it's horrible to bottlefeed a breast baby without prior and informed consent from the parents! Sorry I guess I digressed on the breastfeeding issue. (like I said, I should not have gotten started)....

Best advice? Talk with your doctor, and the nurses about your preferences. They are not unreasonable. And HOPEFULLY, this hospital has since "seen the light" on some of their rather questionable practices and changed policies regarding early bonding and breastfeeding for new couplets.

Congratulations and best wishes for a safe, joyful birth experience for your family.

HappyNurse2005, RN · Nov 26, 2006

Was the unit a L&D only with a separate newborn nursery and post-partum floor, or an LDRP?
I've worked in both and can attest that in the L&D/NN/PP set-up, many a baby was separated unnecessarily from mother in the hours after delivery. The L&D nurses were not expected to provide immediate care to the baby, so if anything was required other than a quick set of vitals, they would send the baby to the admission nursery immediately. Once there, the baby typically remained under the warmer for a few hours, having blood sugar checks, first bath, etc. Even babies who had no special needs at delivery were only allowed to stay with the mother in L&D for the first hour of life. (I have no idea why.) Most were returned to mom when she was transferred to the PP floor at about 4 hours of age.
In the LDRP set-up, the babies were assessed in a warmer at mother's bedside, and remained with mom during the recovery period, cared for by the same nurse. This was much more conducive to early breastfeeding, bonding, and provided better thermoregulation, as baby was almost always skin to skin with mom. Baths, vit K, and eye medication were typically delayed until after the recovery period. With the exception of hepatitis exposed newborns, this is preferable, as the babies are not cold-stressed by a bath at a time when they are transitioning in terms of respiratory status and glucose regulation.
I would recommend that you tour the unit prior to delivery and ask specific questions about the handling of the newborn in the immediate post-delivery period. I personally would not choose to deliver at a hospital that routinely separates mom

I work in an LDR with a separate PP floor and nursery (for those moms who want it-rooming in is encouraged). We do not separate moms and babes at birth. the baby is on the moms chest/belly if she desires. baby then taken by nursery RN over to warmer bed (in room, visible from moms bed) to assess baby, give eye meds, vit k, give o2 if necessary, suction if necessary, weigh baby dress and wrap baby and back to mom until mom goes up stairs, which is 1-2 hours after birth. the nursery nurse leaves, then I am responsible for baby and mom until transfer. then baby is to nursery for MD assessment, bath, head/chest measurement, length, warmer bed, etc. this is about 2 hours i hear, then back to mom.

TrudyRN · Nov 26, 2006

I'm due to have a baby in June and so far have planned to have it where I had my last baby in 2001. The CRNA who gave the epidural was just magical. But one thing that kind of disappointed me was how as soon as the baby was born they whisked her away and I wasn't allowed contact with her for nearly 6 hours after she was born. Neither baby or me were traumatized or suffered permanent damage or anything, but it would have been nice to be able to hold the baby and feed it and cuddle (I breastfeed and they gave her a bottle they said just to put something in her stomach while she was being monitored).
I know the hospital isn't like Burger King but is this the way they do it in all hospitals now?

You're due in June but then you switched to past tense. I'm confused.

HappyNurse2005, RN · Nov 26, 2006

She's talking past tense about the baby she had in 2001. I think she's hoping NOT to repeat that same situation when she gives birth in June.

klone, MSN, RN · Nov 27, 2006

At our facility, healthy moms and babies spend at least 1-2 hours together in the delivery room before baby is brought to the nursery (if baby is LGA, SGA or GD we try to bring them to nursery in an hour). Then, mom is cleaned up and moved to her PP room, and baby is assessed, measured, bathed, and stabilized, and brought back out to mom. If it all goes well, that's about an hour. The mother can also come into the nursery to be there for all of that. IMO, if the baby and mom are both healthy, there's no excuse for a 6-hour separation. This is the time you should be bonding, breastfeeding, etc.

ETA: at our facility, we don't have official rooming in or couplet care.

mitchsmom · Nov 27, 2006

We do everything in the room if a baby is normal/healthy. The only exception is that sometimes the baby is taken into the nursery (where it's quiet) for the hearing test. That is usually the day after the birth.

When I'm going through our baby safety teaching (consent) I even tell my moms that she should check ID's and check with her nurse if anyone comes to take the baby because it is unusual for a baby to be taken anywhere.

:)

It varies... just check with the unit where you plan to deliver for their policies.

SmilingBluEyes · Nov 27, 2006

We do rooming- in where I work. Have for years. I am continually surprised when I hear units that do not. It's just so strange to me. Even if policy is to take a baby to the nursery for assessments and baths, make it clear you want continous and constant contact with your baby, as much as possible. Ask them if they can hold off on these things til you are on your feet and can accompany your baby to the nursery for these things. I always offer this to my parents. The only times our babies are in the nursery are if the parents need a break, or we are doing hearing/PKU screenings. And I invite parents to come in to observe, as much as possible.

You have the right to keep your baby with you at nearly all times. Don't be afraid to politely request this. Assessments and baths CAN be done in your room. Some just don't like to do it this way.

tinyscrafts · Nov 28, 2006

shop around for a more progressive hosptial...

CEG · Nov 28, 2006

I've heard of people getting a note from their md/midwife saying that the baby does not need to go to the nursery.

Personally I wouldn't deliver at that hospital. If they think mom and baby should be separated for 6 hours then imagine what other outdated procedures/policies they still have. Also, it sounds like they routinely feed breastfed babies formula and that is very poor practice.

Maybe you could take a tour of the unit? You don't have to mention that you have given birth there before, just ask all your questions and make your decision.