RNmomof4

I work on a mother baby unit in a hospital that is increasingly more baby friendly. We have a seperate L&D unit, but mother and baby are transferred together unless there is a NICU admission or a maternal special care admission (once mom is stablized, baby can stay with mom). I think becoming a baby friendly hospital is a slow process that involves changes over months, if not years. At delivery, babies are placed skin to skin and babies temp is taken while baby is on mom's abdomen. After roughly an hour of skin to skin and breastfeeding initiation, baby will be weighed, measured, given vit k (if mom desires) and any necessary labs done (at mom's bedside). After 2 - 3 hours, couplets are transferred to our unit. Until about a year ago, infants were whisked to the nursery for an assessment. Now, moms and babies go to their room together and initial assessments are bedside. On some occasions, a baby may need to go to the nursery for an O2 check. We are now in the process of starting to perform baths (which are done 6 hours post delivery) at the mom's bedside and then put in skin to skin for warming. I think these are wonderful things, but many mothers do not comply with kangaroo care, which makes me nervous. All in all I think it is a change in culture (nurses, patients, physicians, etc) that will take some time, but will reward us all with multiple benefits.

We have 8 hour OOB protocol on my unit and I find the patients do much better (moving around, c/o less pain) the earlier they are up. Sometimes patients request to get OOB at 4 - 6 hours and we will if the epidural has worn off completely. I think dangling at the side of the bed is even good. From experiences in which moms refused to get up at 8 hours, I feel that recovery is slower. Many times patients that dreaded getting up, have said, once back in bed, "Thanks! I feel so much better now."

I am on a unit with couplet care and one of my best friends on the unit did the switch you ar eaout to make a few years ago. I think you have to approach the sitatution just the way you would if you were switchin to peds nursing or home health, go in with a newbie-learn everything attitude. It will come much quicker and I think you may enjoy the continuity that couplet care provides for the patients. As far as organization, I don't find it any different than managing other patients! Best of Luck!

Generally, at my hospital, standing orders for lady partsl delivers include benzocaine spray (we provide ice packs as well) for peri pain, hemorroidal cream for hemorrhoids, 800 mg ibuprofen for cramping and pain r/t peri swelling, 1 percocet for PP cramping (especially for a 3rd, 4th, etc. baby). Most c/s orders include toradol for first 24 hours, a couple 2 mg morphine, once in awhile demerol. After that, 2 percocets and 800 mgibuprofen around the clock!

We don't have any standing order for the use of narcan to assist a patient with voiding after the foley is out, but we do have standing post op c/s orders for narcan if pt has decreased output, seems to work well.

Hi! I work at a hospital that delivers 5000+ babies a year and we take an average of 8 patients (any combination of moms and babies, some moms have babies in NICU, some babies have moms on the high risk unit). We encourage rooming-in, but don't require it. Physician assessments are done inthe nursery as are weightsduring night shift. Moms really don't send babies to nursery during the day. I currently work 12 hour day shifts, but worked nights for 15 months. I feel that nights are far busier than day shift. We don't have lactation nurses available to focus solely on breastfeeding, night nurses carrier a heavier patient load and moms tend to be exhausted and, often, so much more emotional at night, therefore needing more attention. Plus, babies that are in the nursey need to be bottle fed or taken back and forth to moms for feedings. The best thing that our hospital does to ease this load is to limit what patients we accept. We don't accept babies on O2 or that need anything but routine meds (no abx) and no moms on insulin, mag, or severe PPH (we do take moms on abx and check cbgs with no sliding scale). I know a lot of nurses don't think post partum, nursery nursing is really nursing, but it is! It's just very different and uses less skills and more teaching! Hope you enjoy your start in moms and babies!