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.