Neonatal assessment team

USA987, MSN, RN, NP · May 20, 2015

One of my fellow L&D nurses tend to the baby after delivery. NICU team comes for high risk deliveries or if heart tones are crappy. When NICU comes...they just make sure baby is stable and then they go....leaving me to do the full baby assessment in addition to eyes and thighs etc. On super bad days it has just been the doctor and I in the room!

melmarie23, MSN, RN · May 20, 2015

We are a LDRP and special care nursery (level II) unit. Most RNs are labor & mom-baby trained. All NRP certified and can serve as second RN at deliveries. About a 3rd of the nurses are "core" and are also cross trained to the SCN, like myself (just coming off orientation). Any deliveries where there is fetal distress/crappy strips, mec, shoulders, vacs and urgent/stat cesareans we are to attend. Our Pedi hospitalists attended those deliveries as well.

Provided all is well with baby, the nursery nurse leaves and the labor nurse recovers mom and attends baby. After the first hour, usually the charge RN, or a RN with a mom-baby assignment will relieve that labor nurse so she can get caught up in charting. Our recoveries/turnovers usually take about 2 hours (more or less) before that couplet goes into a mom-baby assignment.

If a slow shift then the 2nd RN will usually stay after delivery and help with the recovery...and usually is responsible for "doing baby up" (measurements, meds, bath etc).

Elvish, BSN, DNP, RN, NP · May 20, 2015

Dedicated baby nurse (that's me!) at all deliveries to catch baby, initiate skin-to-skin, and do initial assessments/VS/eyes & thighs.

If preterm, crap strip, mec, suspected shoulders, or instruments/c-section, NICU team is also present just in case. If baby is term and stable, s/he stays with me and I recover in mom's room until turnover to postpartum.

Some things we automatically call peds for (mec, VE) and some things it's my discretion (shoulders, bad strip).

NurseNora, BSN, RN · May 21, 2015

All our labor nurses are NRP trained. Second nurse is one of these labor nurses unless high risk for some reason, then NICU nurse and NNP present for assessment and stabilization. If baby is stable I send second nurse out after second Apgar because I've got the baby skin to skin, and I'm not moving it until it's finished eating. I can recover Mom and a healthy babe together. If I gave any question about the babe, I'll keep the second nurse there.

NurseErin83 · May 22, 2015

I'm in a large metropolitan level III facility and nine times out of ten it's just the RN and Dr/midwife in the room. The RN tends to both mom and baby simultaneously. For high risk deliveries NICU will come to make sure baby is stable. Once delivered, the mother-baby RN will come to assess baby within 30 minutes or so. I wish we had two RN's at delivery!

Elvish, BSN, DNP, RN, NP · May 22, 2015

I wish we had two RN's at delivery!

It's an industry standard so you should. (That's not a criticism of you, but your facility maybe needs to be take this more seriously.) Sure, most of the time baby is going to be pink and fine apgars 8/9. But those few times you get a blue floppy kid who gave you no previous warning, having only one pair of hands is a bad bad place to be in.

NurseErin83 · May 22, 2015

It's an industry standard so you should. (That's not a criticism of you, but your facility maybe needs to be take this more seriously.) Sure, most of the time baby is going to be pink and fine apgars 8/9. But those few times you get a blue floppy kid who gave you no previous warning, having only one pair of hands is a bad bad place to be in.

No offense taken! I'm fairly new to this speciality and unfortunately was under the impression this was the norm. It worries me to see it's definitely not.