Newborn Transition Policy

Specialties Ob/Gyn

Published

We are needing to update our transition policy to make us more baby-friendly. We currently have our babies spend a couple of hours with mom and dad with no VS or real assessment other than initial apgars. Then they go to the nursery for 4 hours for hourly VS, bath, Vit K and eye ointment and HepB, weight, gest age exam, etc.

This 4 hour period is way too long and we know it needs to be adjusted. One of the problems is the requirement of VS q1hr for four hours and the unwillingness of the RNs on PP to do this. Also, the LD RNs are a bit resistant to starting VS during their watch.

Basically, we want to change the VS policy for transition and then restructure from there. What do you do?? What are the VS requirements for your newborns?

Thanks!!!

Specializes in nursery, L and D.

We only do sugars on LGA (over 9.5lbs),SGA (under 5 lbs) babies with DM moms, over 42 weekers, and under 36 weekers. I have heard of some places that get 1 baseline sugar on AGA babies, don't know if that is true or not.

This is our routine. Nursery nurse goes to delivery.....baby given to nursery nurse before it goes to mom. We do APGARS, dry, give vit k and eye gtts, get footprints and band. Wrap baby in blankets and put on hat. Give to mom, she gets to keep baby for an hour in delivery room. L and D nurse brings baby to us after an hour. Do weight and measurements, initial VS and assessment. Baby has to be two hours old and have 2 temps above 98 before bath. Bathe and do triple dye. After bath must have temp above 98.5 before coming out of warmer. Dress baby and wrap.........usually takes about 4 hours total before baby can go out to mom. If baby is ready to go close to time for docs to come or report (within an hour) we keep them until that is over. Not the best way. If I had a choice I would love never to separate mom and baby, do at least 1 hour skin to skin, bathe in room, etc.

Specializes in Family NP, OB Nursing.

We put babe to mom's chest, clamp/cut cord, and then dry and do initial VS with babe skin to skin. We keep baby there as long as mom wants. Usually, when the doc is done with exam/repair we put baby in warmer to do weight/length/vit K/e-mycin and we clean mom up during that same time.

We need babies weight to admit them to the hospital and we are supposed to do that within the hour. Mom usually wants to know what it is anyway (this separation lasts about 5-10 min).

Then baby is diapered and placed skin to skin with mom for as long as desired. We encourage at least an hour and also encourage breastfeeding initiation. We get intial VS then about 30minx2 then qhx4. We get these while babe is in with mom. The initial bath is done whenever mom is ready for us to do it...sometimes that is after 10 min, other times it's 5hrs or more after delivery.

Glucose checks only on LGA,SGA or symptomatic babes as well as those with diabetic moms, if less than 40 we have them nurse immediately or bottle feed then recheck 30 min later.

We do LDRP.

Specializes in Telemetry, Nursery, Post-Partum.

We still have separate nursery and postpartum for now...the plan is to go to mother baby by September, but who knows if that will happen (lots of staff moving this summer, having babies themselves, etc, lots of holes to fill!). Anyway...a nursery nurse goes to every delivery. If mom wants (some don't) baby goes immeadiately to mom's chest. How long baby stays there depends on the nurse and on the baby and mom. Some nurses will let mom and baby send more time together than others. Anyway, we get vitals pretty quickly after baby's born, then 15 mins later. L&D will usually get a set 30 mins & 60 mins after the nursery's last set. After mom and baby bond a little, nursery will try to quickly do the measurements (need those to offically admit baby), footprints, Vit k and eye ointment, and an assessment. I personally try to wrap all that up within 15 mins, or if they are still trying to get mom repaired/cleaned up I will slow down a little. I attempt to "time it" so baby gets back to mom as soon as possible after the L&D nurse(s) have her cleaned up. Assuming mom and baby are both healthy, baby will stay with mom on L&D until mom is transferred to postpartum. At the time usually baby (and frequently dad) come to the nursery for a bath. We don't do a bath till the baby is at least one hour old and over 98 degrees. After the bath the baby has to stay under the warmer until they are back to 98 degrees. We don't have a set amount of time the baby stays in the nursery, most of the time we try to get them back out to mom's room as quickly as possible. Unfortunately the babies that come over right around shift change just seem to get stuck on the warmers longer:(

We only do blood sugars on SGA, and LGA babies, or those less than 36 weeks (or maybe its 36 weeks and under) and those with diabetic moms. We do our accuchecks at 2 hrs, 4 hrs, 6 hrs and 12 hrs.

Specializes in OB, lactation.

Ours are probably about half and half going to moms chest/ going straight to the warmer. The ones that go to moms chest, it's usually just for a minute to say hello then do initial stuff (ht/wt, vit k, eryth, footprints, bands, initial v/s under warmer). After that, some give baby to mom, some leave baby to 'bake' under warmer for another set of vitals then bath.

I try to always get my couplets skin-to-skin... alot of times I'll kind of put it like their choice: they can 1) stay in warmer or 2) go skin-to-skin because they need one or the other to stay warm enough (which is very often true since alot of my patients don't listen about keeping baby warm and I walk back in room to find family passing baby around in a diaper!!!!!!!%#($*)#*$~!)

Whatever order the above routine happens in, it is ALL done in the room - our nursery if only for sick babies. I am sooo glad; I couldn't imagine separating healthy babies and moms!! Especially for hours at a time!

I am trying to transition to doing more skin-to-skin. I find that my breastfeeding moms do better than some of the other nurses kids who don't end up getting with mom for longer periods (after initial alert period).

For anyone interested, here's a conference presentatio video / power point on "Skin-to-skin Contact and Perinatal Neuroscience"

and that same guys page on Kangaroo Mother Care... the diferences in skin-to-skin vs. separation are amazing!

Specializes in nicu, transition.

well, after going back to work for a few days on, I tried very hard to promote the "skin to skin". I have found that mom usually for the most part, wants you to take the baby and get it cleaned up. So if that is the case, I do as much as I can in as little time possible and then give back to mom. I have been able to get the first set of vitals or at least see that baby is stable when mom is holding baby initially. Most of the moms (not all), are exhausted and start to doze off and would rather you care for their baby (all cares, even bath are done in the same room).

We do have a nursery open 24/7 and unfortunately the well ones come in to be babysat. For some reason, our postpartum nurses who do "couplet" care, offer the babies to go to the nursery at night so mom can get her rest. This means for the pp nurse that she is no longer responsible for the cares of that baby, nursery nurse is. I used to work in the nursery at night before I did transition.

Specializes in ob,gyn.

Rooming in is our policy also. We try to do procedures while baby is on mom's chest as long as baby is stable.

ALL hospitals need to stop doing this, "taking baby away for hours at a time, so stuff can be done to it" It's so NOT necessary.

Where I work, is the best method I've seen so far, and I've worked at 8 different facilities (I do some travel nursing)

We ALL promote baby first, the physicians tell the patients in the office, we tell them when they come in and we all do it.

Unless there are complications, babies go immediately skin-skin and STAY there for 1 HOUR, RARELY do any of us do it differently, if mom is breast-feeding they do , if not baby just hangs. We do a set of vitals on mom's chest, at 30 min. I will apply bracelets and do footprints, ON mom's chest.

At 1 hour of age, the nursery nurse comes to admit the baby and does all the weighing, meds, assessment.

Then baby stays with mom until they're taken to post-partum, then baby is off to the nursery for a bath and more vitals. (This I disagree with, baths should be done in the room)

I understand the rationale, PP nurses dont have time for that, (Ive worked pp too, I know how it is)

I Just wish it could all be done in the room, unless of course the parents dont care and do want to rest.

Every other place I've worked at, baby is whisked off and weighed and then of course, meds and assessment.

Here, our doctors are used to not knowing the baby's weight for an hour and patients enjoy being able to hold their baby.

We also encourage, the mom to do skin-skin for the entire hour, not pass the baby around, and such, we also don't allow visitors in the first hour, unless the mom really wants them, of course.

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