Pediatricians attendance for scheduled c-section

[trish2307]

At my hospital the policy states that a physician needs to attend those scheduled/low risk/repeat c/sections in case the infant needs resusitiated. All of the staff are certified in NRP. Some of the drs are trying to change the policy and have dug up studies stating that infants born via a repeat c/section with an uncomplicated pregnancy are no more likely to run into trouble than with a vag delivery (where the pediatrician is not present).

Was wondering what other hospitals do? Personally I do not think they need to attend but to be forwarned and be available stat if needed. We are a community hospital that "births" about 650 babies a year and have a level 2 nursery.

[prmenrs, RN]

RCP=Respiratory Care Practitioner. aka, Respiratory Thearapist.

By the way, we have a home birthing-type place 2 floors above us; the nurse-midwives deliver babies up there. We got called "stat" for a baby up there today.

I know it's a normal process and all, but, boy--when things do go wrong, it's real scary!!

[mother/babyRN, RN]

Same as layna...With repeat c/s they are not required to be there, unless it is a multiple gestation or some other risk factor...We don't have a nicu but we are all NRP certified..Docs USED to attend but didn't think it was necessary and a waste of their valuable time......

[mother/babyRN, RN]

Belive me , WE want them there, but it really isn't us the big whigs listen to....

[mother/babyRN, RN]

At our facility it was of course mandatory for the OB people to be certified in neonatal resucitation...It was NOT mandatory for pediatricians or OB docs. THEY were invited to attend and participate in the course if they desired. And they were treated to a large dinner at a very nice restaurant. We got to stay up an extra four hours from the night shift and got sent home without any dinner....Sometimes ( I kid you not), we have had to wrestle the child from the OB or PEDI because they are not up to date in NRP and we are, and they know that.....Scary some times...For sure...

[layna]

Like mother/babyRN, it is not mandatory for our docs to be NRP certified either. Our situation is much like the one described by lindaisanurse, where the family doc assisting in the C-Section breaks scrub if we have a problem.

When I was a new nurse at another hospital, we always had docs attending with us (usually a pediatrician). I learned a lot from this and missed it when our hospital was "bought out" and this practice was ended. The bottom line is this: we have to work with what we have and work on continuing to establish better communications with our docs in terms of how we care for our patients- including encouraging them to make NRP mandatory for all involved in the first few moments of a baby's birth.

[Mofe'ny]

We have a pediatrician for all scheduled 'routine' c-sections.

Any STAT C-sections greater than 36 weeks gestation are attended by a pediatrician also. Any C-Section less than 36 weeks is attended by our neonatologist. The other pediatricians recently agreed to transfer care to him of any baby less than 36 weeks--- after 1 lawsuit and several potential bad outcomes by peds in other practices. We also have 2 NNP's that work for the neonatologist that can attend c-sections for the doctors in that practice. (Our neonatologist also practices as a pediatrician since we are a small Level 2 NICU.)

As far as STAT C-sections, Nursery RN's are required to go to the OR and the OB sometimes does cut before the Peds gets there. In those situations, anesthesia assists, and could intubate if necessary. If the baby does not require intubation, we take infant to the level 2 nursery and follow our standing orders until the peds gets there.

I don't think that we will be having to go to c-sections by ourselves anytime soon--- they just changed the policy so the NNP's could attend C-sections in February! :) Any RN that attends deliveries must be NRP certified.