Baby Nurse Responsibilities

  1. I work in a LDRP unit where we usually have 6 RNs staffed each shift and do about 80-100 deliveries a month. When a patient is about to deliver, a RN comes in and is the baby nurse. Right now we have it that the baby nurse is in charge of resuscitation as needed, the initial assessment, 2 sets of vitals 30 minutes apart, and notifying the resident of the newborn/putting in orders. Also the meds and measurements if baby isn't doing skin-to-skin. What is your baby nurse responsible for? Does it change for vaginal vs C-section deliveries? Also who assumes care for the baby if there is a maternal emergency?
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  3. by   LaborRN87
    Hi! I work in an LD unit, about 350 deliveries a month. We have both LPNs and RNs function as the baby nurse. They are responsible for initial apgars, assisting with skin to skin and breastfeeding for the first 30 minutes-1 hour, vitals q 30 minutes x 4-5 sets, shots and drops, and entering baby orders and the newborn admission profile. Additionally, for vaginal deliveries they generally assist with prepping and resetting the bed, clean up, handing off sutures, and putting away instruments. For c-sections, they function more or less as a second circulator, assisting with anesthesia/positioning, doing the foley and prep while the circulator charts, and giving report to NICU, then taking over baby once NICU leaves.
  4. by   AZBlueBell
    Quote from LaborRN87
    Hi! I work in an LD unit, about 350 deliveries a month. We have both LPNs and RNs function as the baby nurse. They are responsible for initial apgars, assisting with skin to skin and breastfeeding for the first 30 minutes-1 hour, vitals q 30 minutes x 4-5 sets, shots and drops, and entering baby orders and the newborn admission profile. Additionally, for vaginal deliveries they generally assist with prepping and resetting the bed, clean up, handing off sutures, and putting away instruments. For c-sections, they function more or less as a second circulator, assisting with anesthesia/positioning, doing the foley and prep while the circulator charts, and giving report to NICU, then taking over baby once NICU leaves.
    Ours is very similar to this. Our NICU RN's are typically assigned to be the baby nurse, but L&D nurses can if needed for staffing. So baby nurse is responsible for apgars, resuscitation if needed, breastfeeding assistance, vitals for the first 2 hours (or til transferred to PP), assessment, orders, footprints and measurements. If we are super busy with deliveries, sometimes they need to catch and release so the labor nurse takes over for the couplet as a whole if possible or someone else does baby vitals if couplet care isn't appropriate staffing wise at that time (issues with the Mom that the L&D Nurse needs to handle).

    Our baby nurses typically don't do anything with the delivery at all, only baby stuff. If there's a Mom emergency, other L&D nurses come to help and baby nurse keeps baby.

    C-sections they are responsible for the same things, except they typically get all the measurements and footprint stuff done in the OR versus having to wait for that stuff after a vagincal delivery.
  5. by   ashleyisawesome
    Our charge nurse is usually the designated baby nurse (though if multiple deliveries are going on at once or charge is busy, she can call another nurse to go be baby nurse).

    In a vaginal delivery we "catch" the baby, do initial resuscitation, assign apgars, trim the cord, put on diaper and hat, put baby skin to skin, fill out and apply ID bracelets, and do the first set of vital signs. If mom doesn't want to or can't do skin to skin, we also do foot prints and weight at that time. The rest of the vitals (q30 x4) are done by the labor nurse who is also recovering mom. After mom is done doing skin to skin/feeding, the nursery nurse comes to the room to do the admission assessment and give shots/erythromycin, put alarm bracelet on, and put shirt/socks on. The nursery nurse also enters all of the orders ahead of time once baby is born. If the baby needs an immediate bath (HIV or Hep C), the baby nurse will do it, otherwise it's done in postpartum 12+ hours later.

    In a C-section the baby nurse catches the baby, brings it to the warmer for NICU to check out, helps with resus if needed, gets foot prints, applies bracelets, then brings baby to mom for skin to skin if desired or just for a little snuggle if no skin to skin is wanted right away. If they are doing skin to skin we stay and do vitals q30 for as long as mom is holding baby. If they don't do skin to skin, we then take them to the nursery with dad following us, weigh them and hand them off to the nursery nurse who does the admission assessment and meds and monitors baby until mom is brought to PACU and then baby is brought in to be with mom. If vitals still need to be done at that time the labor nurse who is caring for mom in PACU finishes them.

    If it's twins we have two baby nurses and one will usually stay for the duration of recovery to help the labor nurse out with all the vitals and stuff.
  6. by   PeakRN
    We have a specifically trained transition nurse (typically from mom/baby but there are a few from our pediatric units) who care for the infant if they are full term and low risk. Premature or high risk infants are cared for by the level IV NICU team.

    Our staffing remains the same regardless of if baby is born vaginally in L&D or c-section in the L&D OR. If baby is born in the ED our peds ED staff is responsible for the infant's care. If the baby is born anywhere else (most often this is in the ICU) NICU will always assume care.

    If cared for the by transition nurse they are responsible for all of the infants care until transferred to mom/baby or grad NICU. If cared for by the NICU team they will be stabilized as needed an as soon as possible be taken from L&D to the NICU.

    Mom is cared for by labor nurses/midwives/OB attending so if either mom or baby (or often both) is critical it doesn't distract from the other's care.
  7. by   LLLovely
    Quote from LaborRN87
    Hi! I work in an LD unit, about 350 deliveries a month. We have both LPNs and RNs function as the baby nurse. They are responsible for initial apgars, assisting with skin to skin and breastfeeding for the first 30 minutes-1 hour, vitals q 30 minutes x 4-5 sets, shots and drops, and entering baby orders and the newborn admission profile. Additionally, for vaginal deliveries they generally assist with prepping and resetting the bed, clean up, handing off sutures, and putting away instruments. For c-sections, they function more or less as a second circulator, assisting with anesthesia/positioning, doing the foley and prep while the circulator charts, and giving report to NICU, then taking over baby once NICU leaves.
    This is what I have experienced, or this with minor variations, at most of the places I have worked. However, right now I work at a large teaching hospital and we do things a bit differently.

    Each day a mom-baby nurse is assigned to be the "baby nurse," however that nurse does not enter the room until an hour after delivery. When delivery is imminent, we call our charge nurse who acts as backup in the delivery. She will typically dry the baby, complete and apply ID bands to the family, put a hat on the baby, and hang pit. If need be, she will draw cord blood or package up a placenta to send to the lab. She also may fetch things like methergine or hemabate as needed.

    If there are known risk factors, we call the peds team to come down for delivery. If baby is good when they arrive, they often just leave baby on the chest. If baby needs a check, they do it at the warmer as quickly as possible and leave or take baby to the NICU if needed.

    Once the immediate stuff is over, the L&D nurse is responsible for the baby, but no documentation is required, no VS. We make sure baby's breathing is good by observing the couplet, ensure there is no central cyanosis, assist with initial breastfeeding, ward off pushy family members who want to hold the baby during that first hour, etc. Only if baby appears to be decompensating or in distress do we do anything other than protect mom and baby. If we get an unexpected problem at delivery, the charge nurse and L&D nurse do the initial resuscitation, just some stimulation and suction on mom's abdomen, or whatever is needed and call the peds team if a full resuscitation is started.

    At the one hour mark, the baby nurse comes in to do VS, measurements, eyes and thighs, head to toe assessment, suck reflex/latch assessment, and call to peds resident for newborn exam. They also take the tube of cord blood collected by the delivery provider and send to lab if needed. (The L&D nurse is responsible for ensuring that gases and placenta get sent as quickly after delivery as possible if they need to be sent.) The baby nurse also starts preparing the family for discharge by documenting information on who their pediatrician will be, whether they have a car seat and transportation, whether they plan to circumcise, whether they need any assistance at home, and so on.

    I have to be honest that this process made me nervous initially because I was accustomed to getting VS immediately and q15min for the first hour, then q30min, and so on, but it works really well. It ensures that mom and baby get as much bonding and breastfeeding time as possible in that first hour. Everything else can wait. Plus, it avoids a stranger coming into the room immediately after delivery. Our moms, with very few exceptions, have already met providers, students, attending, and charge nurse before delivery, so all the faces are familiar. By the time the baby nurse arrives, they are cleaned up, sitting up, covered, etc.

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