OR -C/S QUESTIONS

Stacy in North Texas · Dec 2, 2009

The surgeon (OB) catches (or rather pulls out) the baby. Yes, he or she wears a sterile gown and gloves (it IS surgery). He or she places the baby on the warmer. If it is a high risk case, the NICU nurses attend the delivery and assess the baby and do apgars, but if it is a routine case (like a repeat), the L&D nurses attend to the baby and do apgars. Yes, a full count is done at uterine closure and again after skin closure.

ldcmw1 · Dec 2, 2009

So the OB brings baby over to the warmer? What about leaving the sterile field and yes I know the surgeon is doing surgery and must be gowned and gloved? Do you also do a full count at closure of the peritoneum? NICU doesn't come to every C/S? How many nurses do you have in OR if NICU doesn't come to delivery? In my opinion, it doesn't seem right to have the circulating nurse do all of that by herself.

retiredlady · Dec 2, 2009

Depends on the hospital. Our NICU always attended with the pediatrician.

JP2011 · Dec 2, 2009

At my hospital 4th year OB resident and Maternal Fetal Medicine Fellow over sees, 1st year OB resident does actual incisions if baby is stable, if it is stat 2nd year OB does surgery, attending and fellow over see. Surgical tech passes baby over to Peds residents who perform assessment and apgars. We have a L&D nurse to circulate and one L&D nurse to do surginet (record keeping/data keeping). counts before uterus is closed, and after stomach is closed.

CEG · Dec 2, 2009

At our facility there is a dedicated baby nurse who wears a sterile gown/gloves and holds a sterile blanket to receive the baby from the OB. The baby nurse goes into the sterile field to get the baby and returns to the warmer. The circulator does a count at uterine closure and again at the end of the surgery.The baby nurse takes care of the baby in the OR then returns to the patients room if the baby is stable. When surgery is finished the mom returns to her room to recover and baby is there. Baby nurse generally gets bath, eyes, thighs done and makes sure baby is stable then the mom's nurse (who was previously the circulator) takes over mom and baby.

I don't think the previous posters understood the point of your question- which I think was to figure out how to get the baby out of the sterile field without contaminating anybody.

ldcmw1 · Dec 2, 2009

Thanks, we are trying to change our policy at our hospital. The circulating nurse catches baby and then is responsible for doing all the computer charting, counts, running to get things if needed, calling for cord ph, collecting cord blood, etc. Many times when we have sterile gloves and blanket and are ready to pass baby to NICU team MD will ask for kiwi or delee and we have to drop blanket and take off gloves and grab what they need. We usually don't have time to put new gloves on before delivery and grab baby with no gloves and sterile blanket that is no longer sterile. Neo and NICU nurse come to room for all our C/S's and basically stand and wait for baby to be born. Now common sense would tell you that two of them are waiting to receive baby why not have one of them catch baby and bring to infant warmer. The argument is that they don't know about sterile technique.... hum they work in the NICU performing plenty of procedures that require sterile technique. Just can't figure out the resistance to change things.

Sometimes we have an extra nurse back there to help us but USUALLY we are too busy and are back there alone in the OR. As far as counting we do full count before surgery, we use to do just laps and sutures at uterus but now do four full counts: before, at uterus closure, peritoneum, and skin.

I just wanted to know what the procedure was at other hospitals. Also, do you give antibiotics before surgery or at cord clamping?

MS Kathy · Dec 3, 2009

The amount the circulator has to do in our c-sec is crazy- and you have to do more!

Our nursery does receive baby from surgeon, so that is at least one thing.

We do a base count (before entering or right after spinal- depends on exact circumstances).

Full count (count 1)

Count softs at closing of peritoneum/fascia (laps, atraumatic needles, hypodermic needles, cord clamps, specimen cups,bovie tip, blades) (count 2)

Full count at closing of skin (Count 3)

Along with cord blood, cord gas, gathering instuments, grabbing vac if needed, grabbing meds, making calls- charting is absolutely out of the question.

They are changing some of our stuff up, but just the counting is crazy (that isn't going away even though they are trying to reduce the number of instruments in the tray- we have 54 right now- and redo our count sheet so we don't have to name each instrument but they will be grouped into scissors, retractors, etc.)

We've decided informally among the L/D nurses to try to take 2 nurses in to get spinal in (or have a tech hold pt for spinal if we have 2 techs) and get base count done, and prep. But that is only possible if there is someone free to come help.

Our director of surgery has been observing us to help with the count thing and showing us how to put the laps into the count bag, and even she said the amount of stuff we have to do is crazy and even worse if there is only one nurse and one tech.

HeartsOpenWide, RN · Dec 3, 2009

In my unit we do it all. We do not have designated PP nurses, L&D nurses, nursery nurses. We wear the white "one size fits all" gown with gloves, hat, mask, googles, shoe covers. If your patient goes for the section you go down with her, receive the baby, do APGARS, admit baby; then care for mom and baby post c/s. The assisting physician hands the baby off, then baby comes to warmer which is covered with sterile blanket and cord clap.The circulating nurse does counts; there is a hanging thing that has pockets for each sponge.

RNBelle · Dec 3, 2009

We do not do our own c/s. The OR crew is called in for all c/s. The L&D nurse will be the one to catch the baby. The OR crew does their own circulating and recovery of the mom. We do not have the staff to do our own c/s at any time of the day.

LDRNMOMMY, BSN, RN · Dec 8, 2009

We have a med tech don a sterile gown and gloves who "catches the baby" with a sterile towel and brings the baby to the warmer. There is a dedicated L&D nurse for the baby or a NICU RN or provider if we anticipate that we will need one. We do a full count at the closing of the uterus and again as the fascia is closed a soft count is done when closing skin.

sahm02 · Dec 9, 2009

We have an surg asst (which may or may not be an RN), one circulator(RN) and we call our NRT team which is a resp therapist and a NICU nurse at each section. The asst takes the baby from the OB and then transfers to the sterile warmer at that point it is no longer sterile after we place the baby in b/c the NRT team is just wearing regular gloves, they are in charge of the infant now. the cirulator will recover mom in our recovery room until she is transferred out to PP.. we do three counts after initial also..