Mother/Baby nursing?

htrn · Jan 19, 2007

We are trying to do the same thing on our unit and it has been very, well, let's say trying. We are taking a step back and looking at the bugs we need to work out but will be going back to it.

We have decided that due to staffing on nocs, we can't really do mom/baby nursing on noc shift. We have one nurse for the nursery and one nurse for PP and Labor/AP with a CNA between us. If we even have one mom that want's to keep her baby in the nursery over night, then we have one person tied to the nursery - so it is just not feasable. BUT, often if the Labor nurse is tied up, the 'nursery' nurse will do mom assessments/meds/etc in addition to the nursery with the aid or a bored lab tech/RT/x-ray tech to baby sit while she is out of the nursery.

One thing I have learned, if we are going to move to rooming in and mom/baby nursing, we are going to have to change how we do alot of other things as well. We, too, do our weights and baths on the night shift. But there is nothing to say that it MUST be done on nocs. Why can't these things be done on PMs, do it in the parents rooms and get teaching done at the same time. Can supplies to stock the cribs be kept in a more central location closer to the post-partum area to make stocking cribs easier?

Another area we are struggling with is when the baby is actually turned back over to the labor/PP nurse after birth. We were having a nurse come to the deliver to stabilize the baby, do the 5 minute apgar and then just leave the mom and baby back to the labor nurse. I think we are learning that the baby needs to be completely admitted by one nurse while the mom is being stablized after delivery. After mom is transferred to her postpartum room and baby has had all initial vitals, eyes and thighs, bath, dubowitz, footprints, etc... then the baby can be turned back over to the postpartum nurse.

Good luck in the transition. It has been somewhat painful for us, but from what I understand, it has been somewhat painful for everyone that has converted to this type of care. In the end, I think it will be a good thing.

HappyNurse2005, RN · Jan 19, 2007

I am labor and delivery, but our mother/baby unit just changed to all day rooming in and couplet care. the nursery is available for those who request it, but it is expected that the baby stays with mom. the same nurse now cares for mom and baby where it used to be that the nursery nurse took care of the baby.

its just started in the last 2 weeks and yeah, its been trying for them.

MIA-RN1, RN · Jan 20, 2007

QUOTE: BUT, often if the Labor nurse is tied up, the 'nursery' nurse will do mom assessments/meds/etc in addition to the nursery with the aid or a bored lab tech/RT/x-ray tech to baby sit while she is out of the nursery. END QUOTE

This is terrible practice. Leaving someone who is not up on newborn care, not NRP cert, and not aware of the warning/danger signs of a newborn in trouble is bad nursing practice. That bored x-ray tech is not going to notice if there is a problem. What if the newborn starts choking/gagging and the nb nurse is away? Who will have the skill set to care for the problem???

MIA-RN1, RN · Jan 20, 2007

We do mother/baby nursing:

Each nurse is assigned four (sometimes five) mother/baby couplets. Plus often we have gyn patients on overflow on our unit as well as antepartums. They try for only three couplets if one has an antepartum or surgical patient but it doesn't always work that way. There is a nurse assigned to the nursery, but when there are no babies she is 'helping hands' and helps us out with vitals, baths etc.

The couplet-care involves all care of the mother/baby. The nursery nurse cares for babies that are in the nursery for whatever reason, but it is the assigned nurse who is essentially responsible to ensure the baby's vitals and checks are done. The nursery nurse also assists with circs, does baths and puts baby charts together.

Night shift is also couplet-care, but many more babies are in the nursery. I don't work overnights but I think that the nurses tend to get their babies vitals themselves because there can be 20 babies in there and only one nurse (I don't think this is safe care but there is little to be done right now). but the nursery nurse (and maybe a tech) feed and care for the ones staying overnight, for the most part.

The assigned nurses weigh their own babies and do their PKU's around midnight. Usually with the 11pm checks after shift-change.

Couplet care actually seems to work very well because the nurse is aware of the entire couplet and it seems to be more holistic because you can care for both more easier. At least in my opinion.

The biggest challenge is that it doesn't feel like couplets are seen as individuals. My patient load is four couplets, which means EIGHT patients. And if one has twins and then I get an antepartum as well, then it gets harder.

If a mother has a baby in the special care nursery, then the special care nursery nurses care for the baby, and are in charge of it even when its out visiting in mom's room. I would be in charge of caring for the mom though.

NurseNora, BSN, RN · Jan 24, 2007

When I worked in the big city medical center, the L&D nurse was expected to recover mom and babe together. Then both went together to PP where couplet care was the norm.

Now I work in a small, rural hospital with LDR's where everyone is expected to be able to work all 3 areas. Often (depending on staffing and patient load) the laboring nurse keeps the couplet after delivery. We encourage patients to keep their babies with them, but lots of moms want to send the baby to the nursery for the night. So we usually have some nurses with couplets and some with PP so that one nurse can stay in the nursery with the babes of the tired moms.

When I have a delivery, I send the "baby nurse" (the second NRP person present for the delivery) out as soon as possible because I want to put the baby skin to skin as soon as possible. We now are required to weight and length to admit the baby, so I take it long enough to do that and then give it back. I do eyes and thighs after baby has nursed. There's no hurry. No problem taking VS, or doing heel sticks for glucose while mom is holding baby. They really nurse so much better if they're allowed to stay with mom as much as possible right after delivery.

NurseNora, BSN, RN · Jan 24, 2007

And yes, night shift does the weights, stocking, etc. AWHONN guidelines suggest 3-4 couplets maximum or 6-8 normal PP or newborns per nurse. Eight healthy patients isn't too much.

nurseynightnight · Jan 24, 2007

Our RN's do labor/delivery,postpartum and nursery. We also have 1 LPN on every shift that can do postpartum and well babies. We are not separated since we are a small hospital and only do around 700+ deliveries per year.

Usually we have 1-3 labors per day and around 5-6 pp patients. Of course there are always times when we end up with 6 labors and 12 pp patients but that is not the norm. We have usually 3 RN's, 1 LPN and 1 secretary on staff for nights. And one of the RN's is the charge nurse.

Now we try to keep the same patients. So if I come in one night and have a labor/delivery. I will keep her that night and take her and babe back the next night. I guess we are kind of spoiled and rarely have more than one labor per night and around 2 moms/babes. I have only had 1 night in the past 5 years when I had 4 moms/babes.

We only have 1 assessment to do on mom/babe at 11 pm. So I try to do my babies assessment at bath time around 9pm when I also weigh baby. Mom's I do before she goes to bed. We only do vitals once if they are over 24 hours old so that is at the same time. Then we have to do baby checks every 2 hours.

We do not have a nurse in our nursery unless we have a sick baby. Then we tend to push all of the babies in there. Otherwise they hang out at the nurses desk. This leaves us free to tend to our mom's or other labors that may have come in. Our unit secretary is able to watch the babies if we all have to leave the desk at once. Although usually 1 nurse is available at the desk area.

It definitely takes some organization when you do end up with 3 or 4 mom's/babes and trying to keep it all straight. When did so and so eat, did he have a bowel movement, who had the swollen perineum,etc...

We also try to complete a lot of the teaching stuff on nights. We tend to do the bath demonstrations and pictures. We also have to complete the infant hearing test and make sure mom has watched her films.

Most of our nurses also draw their own PKU's and some other lab work like bilirubins in the am.

Good luck with this! I think it makes for happier patient's when the same nurse is taking care of mom and baby and their isn't that division. If mom has a question about her baby you don't say "call the nursery and they will tell you."

SmilingBluEyes · Jan 24, 2007

We do LDRP care. This means, most of our nurses are cross-trained and do

it all.....labor/delivery as well as postpartum and well baby care. It can be hard at first to get organized but with practice, you get good at it. It becomes preferable (at least in my mind) do couplet care anyhow. It makes no sense to me whatever to have a separate nurse care for a baby and mom each......I like to see how the couplet are doing together, bonding, breastfeeding, etc. This is best done when you have both in your care.

I just do my assessments on both mom and baby when I come on shift. I look mom over first, as her how it's going, pain, breastfeeding etc, and then I look baby over. I also observe them breastfeeding, diapering, doing infant care and how the family dynamic is working. This becomea second-nature with experience, and rarely do you assess or visit with mom without checking on her baby and vice-versa.

Give it time. As you do it more, you will become so adept and comfortable, you will wonder why you did the other way before. I know because I have done it both ways (I used to work in a hospital where an RN took care of moms and an LPN did newborn care). And IMO 3 couplets is ideal, albeit 4 the AWHONN standard. The reason is, while most are healthy, you will always have one or two couplets that have breastfeeding issues or other things going on that may make them "needier" and it can be tough. Don't be afraid to balance the load, and spread out the "problem" couplets among nurses. ONE nurse should not, for example, be expected to care for all the newly delivered c-section moms, or the moms needing extensive breastfeeding help. Sharing the "wealth" ensures the couplets get the best care possible, by not spreading any one nurse too thinly.

HTH!!!!!!

shortstuff31117 · Jan 25, 2007

My unit does LDRP so we are all cross trained. Well except me I start my L&D training next month LOL. We are a small unit, about 800 deliveries a year. But anyway, this is how it is on our night shift. There are 3 nurses, and on secretary/OR tech. Usually we will each have 2 couplets, or someone might have 1 couplet and do rule outs. It's rare for us to have 3 couplets and really rare to have 4. I do vitals and assessments every 4 hours on mom and baby. Sometime between 12 and 4am I take the babies to the nursery and weigh them, do a hearing test, PKU, and footprints. If we have a sick nursery baby then one nurse is tied up in the nursery taking care of the baby. We usually dont keep healthy babies in the nursery, but sometimes we're nice and let a baby hang out with us so mom can sleep. But if we get busy the baby goes back to mom, and they understand that. We also do stocking, etc. on night shift.

When we have a delivery the baby nurse comes in, stabilizes the baby, does the weight, length, shots, bath, etc. Usually it takes long enough that they do two sets of vitals on baby and mom is stabilized and cleaned up before the baby nurse leaves. It seems unsafe to leave one nurse to recover both mom and baby, even if help would be available.

Carrie

SmilingBluEyes · Jan 25, 2007

With experience, you will become more comfortable with this, Carrie. It's not unsafe, really, as you can watch both mom and baby well in the recovery phase. You develop instincts with time and experience, and know who needs very close watching---at least more than the usual. That is where experience is the advantage and the best teacher.

Never be afraid to ask for help if you feel any situation they leave you in where you work, is unsafe!

jannrn · Jan 25, 2007

I have done mother/baby nursing for 7 years, but the last year or so have done med/surg because of a move. I have done mostly couplet care with some variations. One hospital had separate L&D from the PP/GYN/NSY. L&D nurses ONLY did L&D with very few exceptions (a clique-ie situation, but the L&D nurses were very skilled because it was very high-risk facility) the postpartum nurses could become certified for antepartums and care for those ladies who needed to be stable, and not needing continuous fetal monitoring over 2 hours in length or they had to be transferred to the "other side" (L/D).

Postpartum nurses could be assigned a combination of stable mom/baby, gyn or antepartum pt.

we had a nursery that always had a lead nursery nurse. this person cared for a pt load of babies and they would assign themselves the ones who first needed constant nursery care (we also had an NICU that was separate) had lab work (besides PKU) etc. sometimes if none of those babies were on the unit they just picked 4 or 5. the babies still were enc. to room in with mom, but moms had the choice at night or any time to have baby watched in the nursery. the nursery rn could call the babies rn if it was in the nursery and was fussy, or needed to eat.

we also had a Transition nurse, who would help out in the nursery (no baby assinment) if no delivery emminent, asses the risk factors for a baby whose mom is in labor and if needed let the NICU team know if they needed to be at the delivery. otherwise the baby was a 'nursery baby' the first 4 hours, the transition nurse was the babies nurse for that time and gave it the meds, bath, vitals, paperwork, breastfeeding help etc. during that time. after that (or at the next shift) the stable baby went to couplet care and moms nurse was also the babies nurse.

we also had nurses aids that could weigh the babies -but not assess - help with breastfeeding, even pku's but I don't think any of them did that, mom vitals, restocking/cleaning of baby cribs, baby holding, feeding, changing, answer phones, restock charts. we also had a unit secretary during the day but at night the charge nurse did that along with usually a smaller assignment.

other places I have worked did it differently but this is quite long.